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CITY OF CUPERTINO
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BUILDING DIVISION PEAK
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BUILDING ADDRESS:
PERMIT NO.05040070
ER'S NAME:
MTrT-TARL PQ
FERMIT ISSUE DATE
n 26054rROL
ONE:
SANITARY NO.
ARCHIIECnENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
D LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am Itenecd under pmvlaiom of Chapter 9 (commencing
with Section 70M) of Division 3 of he Business am! Professions Code. and my license is
infuseClercea R 4°162
REMODEL BATH/KITCHEN/PLUMB/HEATER
Licence Cles, Llc.g
[ ass
3 D,eeontmemr��_
ADD A/C & LIGHTING/ENLARGE SHOWER
d A CNITECCo DECLARATION
5 Iundemmnd;myplans &hillhe used Aspublic records
CONTRACTOR: IPEK CONSTRUCTION
Licensed Pmreasional
3 OWNER.BUILDER DECLARATION
F I hereby affrm that I am exempt from the Contractor's License Law far the
] following moron. (SCCtiup 7(131. 3, Business and Professions Cade: Any city or county
i which requires a Permit m ennawct, alter. improve, demolish, or mpair any suucom
i prior at is Issuance, also mqulms the applicant ror such permit o file a signed statement
Contrectur's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he Is licensed pursuant to the provisions of the
G
$ (commencing with Section 7000) of Division 3 of the Business and Prefecsians Coda)or
.. Nat he Is exempt therefrom and the basis for Ne alleged exemption. My violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
Am more than fmw hundred dollars ($500),
❑ 1. as owner of the pmpcny, or my employees with wages As their sole eompenmdon.
3 6 6 10113.00 Required Inspections
will d0 the work, and the swctume is not intended or offered for sale(Sce. 7004, Bodnex,
end Professions Code: The C mommes License Law does not apply m an owns of
9 P
bulMsoimprove Nemprove wW sire nsochwmkM1immlrod through his
ampenywW
own employees, provided that such Improvements are not aroetred fm We. If.
rofintended
WildingorImpmwmmtlahathwithin oroyeaormprovefrthe owner-
Wilier.
11
Wlo.). wiB have sire burden of proving diet he did not Wild m improve for purpose of
sate.).
❑ 1, a aver of the pmpcn, am canuasaing with
and :) )bund uraaclort U.
project (Sec. 7044. Businessand Code:) The Cs
ry who Wiuns
had
serene Law dos oat apply m m awns or pmpcny who build, or improves therson. rad
of
caT%construct d
owner
Conorm
whe LaNfar each pmJLaa WINamnlNLtar(a)IIRn,Yd Panamint to NCCeaVletOfa
f1
License Law.
se
S
❑lam esemDt under Sea .B kPCfar Nis reason
mer Data
' WORKER'S COMPENSATION DECLARATION
I hereby Arm under penally of perjury one of the following decimations:
❑ I haw and will mainloin eCenif¢me a(Comm�uo self -insure fa WarkefaCanpen-
eation, M provided for by Section 3700 of the Inbar Code, for Ne performance of the
work for which this permit is issued.
❑ 1 have and will maintain Warku's Compensation Insurance, as required by Section
5700 of the Labor Code, for Ne performance of Ore work for which this permit is Issued.
My Workers Compensation Insurance carrier and Polity number am:
Carrier: . Polity No.: _
CERTIFICATE OF EKEMFnON FROM WORKERS'
'
COMPENSATION INSURANCE
(This section need oat he completed If the Permit is rarer hundred dollars ($IM)
or kaL)
I unify that in Ne perforrnmee of the work for which this permit ts Wood. I shall not
employ any parson in any man rout emmcsubjecua tit Workons Compensation
U. of California Dat
Applicant
NOTICE TO APPLICANT: IL after making thisCenifc'te o Eacmpiion, you should
become subject to IM Wokcr i ComPcnation provision of the Ida, Cade, you muss
fowl..,iy with such provision or Nis permit shall W doomed rtwkm.
0Mth
CONSTRUCTION LENDING AGENCY
1 hereby aMrm Nat Nero Is conamminn lending agency for the performance of
>
the wish fm which this permit is Wood (Sec. 3097. Civ. C.)
QUndeh
Name
Lcnder's Addreu'
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I certify Nat I have mad Nis application and slot that Ne aWw infor miun is
Hcorrect.
1 agree to comply with all city and county oblinanm and state laws relating to
U
building conswnion, and hereby authorlm mpeamtKiwa of Nis city in enter upon the
above-mentioned for Inspection pugmmL
14
property
(We) ,gree be save, indemnify and keep harmless the City Of Caroni no against
raj)
IlablRtles,judgments. coats and expenses which may In any way accrue agalnataald f.'lly
In consequence of the gmnting of Nis permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REG' LAT��pgNS. II
Re -roofs
Type of Roof
d6LJ 9 /13/0`1
Si naturco(A iwn onlracmr Da
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MATERIALS DISCLOSURE
HAZARDOUS
Will the applicant or forum building occupant store or handle hazardous material
as donned by the Cupertino Municipal Code, Chapter 9.11. and the Health and Safmy
We. Section 25532(4)7 �
All roofs shall be inspected prior to any roofing material being installed.
❑Yrs 16N.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Wilding occupant use equipment or devices which
emit haaarhous air contaminants ss dcOncd by she Bay Area Air Quality Management
all new materials for inspection.
Disuia7
❑ Yes Rfk.
I ban mad the hmardnwsm,trials requirements under Chap er6.95 order C,lirm.
nia Hui" SafetyCade, scedons 25505.25533 and MN. 1 unJentand NairNe Wilding
dors not currently how a moans that It u my maponihility t notify sit occupant nfshc
regairemena<whigh must he prior m lasaamee of a certirat of Oc- ey.
Signature of Applicant Date
4.met
All roof coverings to be Class "B" or better
Owner or authonz epc I Dal
d I n N iS1Ilk '5i +IL a� iV J�Fu�Y_a�ll k7 t 19 ,i 5P� 1 k+, k F r
j "k<<MiRES'TDNTT.T�'ryER«O��CT`COrL SHEE,T,ry ' F
a i�Ik� s
tb
CUPER�TINO
Assessor's Parcel Number: -344 ) O f 13
Name of owner. W, r, n ar I Ai o
Project address.
Contact person. Ni;cla- U Phone. Ao8 309 -163
Fax.
Net square footage of lot.
Existin Proposed
Square footage: First floor: `,Sammi �3arre_
Second floor: CSOML "5a mo
Garage:
TOTAL:
Are thereat least two 10 foot by 20 foot clear spaces inside the garage? N
Is privacy protection planting required for the project? Y
On what floor(s) is work being done? is� Rnd 2.,J
Code editions: 2001 CBC
2001 CPC
Effective 11/1/02
(Y - N)2001 CFC (Y - N)2001 CMC
(Y - N)2001 NEC (Y - N)
No, Sit�ccai
APR 13 2005 ;
Plan Review Process Work Book Page -B-Revised 4/28/04
1 HrrKU V CU
%t-AW6RDANCE WITH THE CITY OR
CUPERTINO CODES AND ORDINANCES
')ATE---�f— —,1---3 ^oJ—
SIGNEU_G/^
This set of plans and speciticat1 i— ons MUSS77
oe kept en the job at a:! times and it is un
lawful to make any changes or alteration,
%n sdI wiiheul w.tten permission fron.
the bw,d,ng Dept., City of Cupertino.
Thm damping of this pian and specifications
MAL111 NOT be herd to permit or to be ar
approval of the violation of any provisions
40'My City Ordinance or )rate Law
OFFICE COPY
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CITY OF CUPERTINO^'1:,aam
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�COIYTRefCT.ORIINF.URMATIQN�=
BUILDING DIVISION PERMIT
'3+s 'w%'h+ - 9ks.-tom. ' �s".uyYS'S�wYSa•��'
BUILDING ADDRESS:
PERMIT NO'0 5 0 4 0 0 7 0
W NER'S NAME:
MTrWAT7.T WC)
PERMIT ISSUE DA'Z'E
E;
SANITARY OL NO.
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BIDO ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
reby affirm 1 am licensed under provisimu of Chapter 9 (commencing
1 Mm w
with Section 7000) of Division 3 of the Business and profminn Code, and my license it
I. full forte and effeL.
Lk.N854�1'1
REMODEL BATH/KITCHEN/PLUMB/HEATER
License Class,
Da¢c°mnuo"
ADD A/C & LIGHTING/ENLARGE SHOWER
A CHrIECTSDECLARATION
I understand my plans shall he used u public mcnrds
CONTRACTOR: IPEK CONSFRAUD E®
Licensed Professional
OWNER -BUILDER DECLARATION
• 1 hcrehy (siect that 11. exempt n w Canbacnrs Law for w
e: My c county
lesson. (Section 71131.5, s ons Code: My city
. Business and Proimprove,
whichfollow
atmnuro
t. atne, improve, de ler mash s
requires peUnit re rnre,
whichasissuance,
ed
for Coit permits Oic a mse, La (Chopmem
r p the h Permit
is lensedpalso the lhovisio the Canusenr'aLcemlaw(CMpnr9
Sq. Ft. Floor Area
Valuation
LMnt
ocatin s of
i wtboislkcnsedPunuantnNepmvialonso(
I (commenting with Section 70M) of Division 3 of the Busimanamd Prorm(ons Code) or
. that he Is eumpt wrefrom and Use bash fir, the alleged eumption. My violation of
Section 7031.5 by any applicant fm a permit subjects the applicant in a civil penny of
APN Number
ancy Type
not mm Nan Bw handled dollars (5300).
01,uownerofwpmpmy,mmyemployeewithcagesuwirmkm pcmdm,
0113.00Re Required Inspections
will dove work and wswcturcI, not intended m offered fmsale(See. 7044. Business
and Profession Cade: The Controcmr's Licenselaw data nal apply to an owner of
propeny who builds or im proves, wleon, and who dos such work Mmulf or through his
ownemploym, provided that uch improvements tie not Intended or offered forsale. If.
however, the building or improvement is sold within am year of compledon. The owner.
builder will have w Wrdm of proving that k did not build or Improve fm purpose of
sake.).
❑ 1, u owner of the property am exclusively contracting with llcemd sun== in
'
construct w pmjm (Sec. 7044. Buiness and Pmf ssions Code:) M Contractor's U.
cense law data not apply to an owner of property who builds or impmws careen. and,
who contracts for such projects with a eonaaelar(s) licensed pursuant to the Contractors
License law.
❑ I am exempt under Sec. . B Is P C for this rcamn
Data
WORKERS COMPENSATION DECLARATION
1 hereby eairm Under penalty of perjury am of w following dmiantions:
Mve and will mainWn.CWficate of Contin n selfdnsore fm Worke/s Compm-
. as Provided fm by section 37M of w labor Cade. ren w performance of w
11wner
for which this permit is int a t.
haw and will maintain Worker's Compensation Inuranm, u required by Section
of the Inbar Cade, for the performance afw work fm which this permit h Issued.Workers
Cnmpenutlon Inaunme caMcr and Polity number w:
er: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
'
COMPENSATION INSURANCE
trials secdar reed mtbocompimul lithe permit isfmanc hundrW dollars (SIM)
m lass)
I artily that in the per(mnence of w work fm which this permit is issued. I shall not
employanypermninanyman r ours O1m: jeettow Workets'Compemdan
laws of Califomia. Dec
Applicant
NOTICE TO APPLICANT: If. after making thisCcniTt a Eumpthm. you should
become mbimt m Ne Worter's Compemtloa pmvisim. of w Labor Code, you must
' forthwith comply with such provisions or this Permit dull k deemed mwkcd.
CONSTRUCTION LENDING AGENCY
1 kr thi cal can la agency for w performance or
mmmrc. 3
which s . Cil.
' the wort fur which this permit h issued (Sm. 309'1. Civ. C.)
Lenders Nam.
v Lender's Add.
I Certify that I have read this application and can that the above information Is
+ cmroct. I agree to comply with all city and county ordinance mesons laws relating n
building crostruction. and hereby aulhorles reprmnutiws of this city to enter upon the
7 abate -mentioned property for Inspection purposes
(We) agree to sew, indemnify and keep harmlm w City of Cupertino against
7 lobilldes. judgments, cases and expenses which may In my way accrue against said City
In consequence of the granting Of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REG LA NS.
Re -roofs
Type Of Roof
c dNti �113�0S
Signature of Ap icon I Da
N MATERIALS DISCLOSURE
ABOGUS
Will the applicant or future building Occupanutoro or handle hvardom material
as darned by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
.ale. Section 255320)7
All roofs shall be inspected prior to any roofing material being installed.
0Ye 060
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipment or devices which
..It haaardou air cenuminants u dcOmd by the Bay Am Air Quality Management
all new materials for inspection.
Diwict7
❑Ye ['jfNu
I have mad the heardnusmasedals requiromenu under Chapter 6.95 of the Califor.
nia Hcalth,S Safety Code. stations 25505.25533 and 25534.1 understand that irthc building
data nm cureolly hew a small. that 114 my roapanihiiity in amity the ..P., of the
requirommuwhi hmuubcmetpriorniuvarec.f.asureanorocc
Signature of Applicant Date
te�
All roof coverings to be Class "B" or better
Owner or aumod see I Da