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05040101 CITY OF CUPERTINO '� '£'"''^'n xtivK `nr ta&""" BUILDING DIVISION PERMIT CON'C Q—T, OR,INFU�RMAT.IQN.� BUILDING V ADDRESS: PERMIT NO.504 0101 19382 PRICE ER'S NAME: PERMIT ISSUE DATE STEVE FARBER NE: SANITARY NO. CONTROL NO. ARCHIIEC IENOINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH �0o LICENSED CONTRACTORS DECLARATION Job Description I ly 1 hereby affirm Net 1 un licensed under provisions of Chapter 9(Commencing P wish Secdon 7(03)of Division 3 of the Business arM Profession Code,and my license is s ,e.11foatanderc BATHRM REMODEL (UPSTAIRS) - SICZ Llcenu Cl Lto.g SIC Dem CCnmulor CONTRACTOR: JOSEPH M. DAGUE CONST. O ARCHITECTS DECLARATION � F I IV�LE I uedeatsnd my plea CHI E TS 3 KKK«CC1lll 50 lic resecods Licensed Pmfeanional OWNER-BUILDER DECLARATION r0t) 1 hereby.(arm that 1 1. exempt from the Commerce,License Lew for the >.O O following reuoa(Section IIn Id,Eushw.sluer..and ",deruna Cade:Ani m or county _�2 $ which iSs isha•permitmuinalk4pplin I prose,demo)W,rirepair anytaterrut f. n_ v.� priormitsiensedpSurrquithe tM epions at theSochpcnat's filase signed g athathe mencinwit pSesuanUothe)of Divisio of the ComranuYa Wase Law(Chade)or Sq.Ft. Floor Area Value (](](] $ $ that M is exempt pt thction erefrom n d but,f r the the Business edmcam a ProfessimtCade)or SLI dant lu le sumps Nem(mm and Ne bu4 for nu Jleged eumpBon.My violetim of Section 7031.5 by Sy applicant for a permit subjects the applicant to a civil penalty of APN Number rant mom than five hundred dollars 003). 36904034 . 00 P C]1,as owner of the property,ar my cmploycet with wages as their sok compensation, will do the work and the a.umum Is not intended oro@CoA fewtato(Sec.7044,Business and ProfeWon Cade:The Conaamnfs Dame LAW chat Out apply W an owner Cr Required Inspections property who b W Ids m tmprovea Kerma and who dun suc h work himself or through his own cmployma,provided that such Improvements are natimended arartared fa tele.If, however,Ne building or Improvement is Sold within am yeti of eampletion.the owner. builder will have the burden of proving slut he did not build or Improve for purpose of sato.). ❑1,as Counter of the property,era exclusively Contacting wish Ilcerued Conaanmn to eo..wm Ne project(See.7044,Business and Protest...Cade:)The Conuumfa U. cane taw don not apply in an owner of proper who builds or Improver daemon.and who contmcu for such pmjccu with a contractor(s)licensed pursuant u the Contracufs Licmue L.W. ❑Imexcmptunder See .BBPCfnshuusson or Data WORKERS COMPENSA71ON DECLARATION I hereby.Man under peeally of perjury,cove of site following decimations: 1 ham and will maintain aCvtifiesaaf tem se Consent self-imam for W.rkefaCompen- and.n,ss provided tar by Section 3700 of she labor Code,for the performance of the work for which this permit Is issued. ❑1 have and will maintain Warlces Compensation Inunax,u required by Section 3100 of Ne Labor Code,for the performance of she wark("which this permit is land. My Workela Compe..ad.n Iruurance Cartier and Policy number tie: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE MIS semian need not M completed if she permit It f.ronc hundrud Eollaa($1M) or less.) I unify that In the performance of the work for which this permit is issued.I Mall not emplayanylemaninmeymanre ataahmme subiecl so the Workue'C'a n�.N�on Laws Cf California.Dam —�—�i L'—'1 Applicant / ��yW— NOfICETOAPPUCCIAv1J'T:IfyMte eking this Certificate of Exemption,you should become Subject in NENbherY CompensmWa pm loon of site labor Code,you mull .J forthwith Comply wish such provision or this Permit"I be deemed mooted. O Z tiCONSTRUCTION LENDING AGENCY [—r I hereby affirm that them It a eonwcdon Lending agent for Ne performance of the S arls far Which this permit is lased(Sao.3097.Civ.C.) WM 0 Landefe Name 7 z Lender's Address UQ 1 certify that I blue mad this pplication and Shia that the above Information I$ k.E Comm l ora to comply with SI city she county ordinances Of end Cute dews r upon ac p Dove-mcnnmuctioaandher inspection ns suthonpreonams. ive of Nu City uenter upon the W thou-IW.)a ed property(in in pity an keep es IW.)agree to cove,indemnify and kap hamin m 003 City of Cupertino s id City r.yy incosequeneOf thetetsing expenses Watch may In my way acne against City V APPLICANTCUNDERSTIAND$ANof this D WILL COMPLY WISH ALL NON-POINT Issued by: Date S REGU ONS. �r Re-roofs H DOUS MATERIALS DISCLOSURE Dau Type of Roof Will the applicant or(mute building acupmt uoro or Mnek hanrdom materisi e dcOned by tie Cupertino Municipal Code,Chapter 9.11.and the them and Safety sad...Isssl(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes iNo W)II the applicant or fumm building aceupem use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit lammon air contaminants u dcftncd by Use Bay Am,Air Qu]toy Management all new materials for inspection. District? ❑Yes NO I have read the hear Wfleb requirements under Chlpteri95ofdm Califor. nu Hall"SafmyCCde.Stt7imw25595.25533 and 25334.1 undco mrd than ifthe Wilding cat .at cmuntiy haw h my uapomiNltsy m notify theoceupanI idea c`nty7 met priorm uanee.r a Cenificam of am �r. Signature of Applicant Date S All roof coverings to be Class"B"or better CITY OF CUPERTINO BUILDING DIVISION PERM( ,dITRA.CT.QRT,N�,OR A' N BUILDING ADDRESS: PERMIT 11%5 04 0 10 1 9382 PRICE lipBR'S NAME: PERMIT ISSUE DATE STEVE FARBER PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECTPLUMB MECH 0 0 0 0 Lopz LICENSED CONTRACTOR'S DECLARATION MJob Description li 1 bemby affirm that 1 am Hamed under provisions of Chapter 9(commencing wot Section 7W0)of Division 3.1'th=Best.,Lord Pwfmaiona Code.and my license is �'� InbsurarcewEaBeq BATHRM REMODEL (UPSTAIRS) z Llcenw ClooLic.X G Dam CastNr ' i5L CONTRACTOR: JOSEPH M. DAGUE CONST. ,eARCHITECTS DECLARATION y I understand my Plans shall he used u public records; o Liansod POfeasionel 3 OWNER-BUILDER DECLARATION +� I hereby affirmNn I am exempt from No Contractor's Licene Law for the i a o following mason.(Seed on 703 Lan 5,Business d Professions Cade:Any city or county a�$9 which requires a permit to Commit,alter Improve,demolish.or mpok any stmcmm Fair prior to its issuance,also required the applicant forsuch Permit m rile.signed statement that be is licensed purmanitO the previsions Of the Contractarl Llane Law(Chapter 9 Sq.Ft. Floor Area Valua"000 B (commencing with Section Nilo)of Division 3 oflW Businmand Professions Code)or .. that he Is c ompt Ncmfrom and the baso for to alleged exunp ion.Any violation of Section 7031.5 by any applicant Im a permit Objects Nc applicant to a civil penalty of APN Number Occupancy Type not more Nan five hundred dollars($500). 36904034 . 00 ❑1,a owns of the property,or my employees with wager as their Ole compenadon, will do the work,and the aBaciure is not intended or offered for sale(Sec.7D14,Business and profession Code:The Coneracars U.law dons oat apply to an owner of Required Inspections properly who buildsor improves thereon.and whodoessuch workhimself oruuough his own employcn,provided thatsuch Improvementsare not intended or oaemd for ale.If, however,the building or Improvement is Old within one year of Completion,the owner. Wilder will have the burden of proving Nu he did not Wild or improve for purpose of alesu 1,an owner of the property,am uclusively contracting with licensed contmmoo to veer La Um ms not (Sec.in X4,owner of and Professions Cade:)Thows themon,and.cense law dos not loan owner of progeny who sedWilds purr ant Rem theeon,and, who Contracts for such projects with acontrawr(s)(lamed pursuant w the ConuOrora / Lkonss law. ❑lam mcmpt undo Scc .B&PCfor this mown mer Dale t7� WORKERS COMPENSATION DECLARATION 1 thereby affirm under penalty of perjury one of the following declwdons: ❑1 ham and will maintain a Ccnifiicate or Conant to ml6lnsum for WorkcrsCompen- sation,as provided for by Section 37W of the Labor Cod=,for the pmformwa of the work for which this Permit is issued. ❑I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Coda,for Ne performance of the work for which this permit Is Issued. My Workers Compensation InOrance artier and Policy number am: Carrier. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE CIM,sectionneed nwIme mplewd ifthe permit In foronebundmd dollars($IW) Or Ws) 1 certify that in the performance of the work for which this permit Is Leaved.l shall our employLaw.of California. anymwncyta+sNMOme Ohj Warkcss'C van Law,of Califoson Dam ApPllunt / �'��^ NOTICE TO APPLIC .Ifs aftera'aking this Comilcate of Exemption,you should becnma,ubject m NE Water's compensation previsions of the Labor coub.you most .J Q forthwith Comply with such provisions or this permitshall be darned reveled. ti51 CONSTRUCTION LENDING AGENCY [•.r I hereby affirm that Nem is a construction lending agency for Ne Performance of �i the work for which this permit B issued(Sec.3097.Civ.C.) W Q Lendoes Name 7 2a Landers Address V I certify that I haw read this application and state Na the above information Is W conett 1 agree m comply with all city and County oNlnmas and soon laws Calving to / 0 building construction,and hereby authorise mPmmnulivc,of this city to order upon 1W abovoComiso ed Property for inspecu0n purposes . (Wo)agree to save,indemnify and keep harmless the City of Cupenima against rA liabilities judgments.costs and expenses which may in any way same against aid City V7 ineonsequmm of the gaming of this permit. 47 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -0i SQURCEREGULATIONS, [l Re-roofs n-tuye pplTc Dam iC H OUS MATERIALS DISCLOS RE Type of Roof Will the applicant or future Wilding occupant store er handle hanrdous manorial as defined by the Cupertino Municipal Code.Chapter 9.12,rod the Heald,and Safety Cod=,Section 255320)? '1 All roofs shall be inspected prior to any roofing material being installed. ❑Yus SN0 Will the applicant or fuluro Wading aaapwt tae egolrm=fit or devious wm<g If a roof is installed without first obtaining an inspection,I agree to remove emit harm ou,air Contaminants an de0ned by Ne Bay Area Air Quality Management all new materials for inspection. DlalriCO ❑Yes No Ihaveread Nehaard us materials mquimments under Charter 6.95ofthe Cali For, niaHealth&Safety Code,Soc6au25505.25533m 25534.Iun&n=dmmifNo Wilding door not currently haw a knan"atmy responsibility in nodl'y the occupant f the /�..mquimmeoi,juh�{Lc mctpriorut, anceafacenificat,of Occv / y. Signature of Applicant Date —' ownceara nada cnt p All roof coverings to be Class"B"or better CITY OF CUPERTINO I�m 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36904034 . 00 DATE ISSUED. . . . . . . : 04/18/2005 RECEIPT # • . . . . . . . . : 29348 REFERENCE ID # . . . : 05040101 SITE ADDRESS . . . . . : 19382 PRICE AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : STEVE FARBER ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014 RECEIVED FROM . . . . : JOSEPH D. DAGUE III CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , • TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ------ - --- ---------- ---------- ---------- BPERMFEE VALUATION 7, 000 . 00 137 . 16 0 . 00 137 . 16 0 . 00 BPLANCHK PERMIT FEE 137 . 16 183 . 04 0 . 00 183 . 04 0 . 00 BENERGY PERMIT FEE 137 . 16 65 . 84 0 . 00 65 . 84 0 . 00 BSEISMICRE VALUATION 7, 000 . 00 0 . 70 0 . 00 0 . 70 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BUSLIC FLAT RATE 1 . 00 102 . 00 0 . 00 102 . 00 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ------- --- ---------- ---------- -- -------- TOTAL PERMIT 603 . 85 0 . 00 603 . 85 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 603 . 85 1193 TOTAL RECEIPT 603 . 85 • JIVEw r w x y nu•ms"'-YarsY- 5 r x avct�}wv-cnYA3ys xrsFp ni*, r u a< ' �l y f r��' 1r " {'�` r' ltc Aly 1 r� 1 d "✓{ a z"psa n *z.B 'fix ° b t= I2ESID . wt > so 3— ` • -„p,. ��'3 ,�3 'u Pzw ,..� CU PERTINO Assessor's Parcel Number: Name of owner. fSE�L/� Project address.. Contact person. � �O' �Phone. 3�3— qZ� Fax. Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: TOTAL: ® Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y N Ts privacy protection planting required for the project? Y N On what floor(s) is work being done? r Brief description of work. - Code editions: 2001 CBC (Y -N)2001 CFC (Y -N)2001 CMC (Y-N) 2001 CPC (Y - N)2001 NEC (Y - N) Effective 11/1/02 rrr~ APR h 2005 .6J I l Plan Review Process Work Book Page -8-Revised 4/28/04 Z s v 0 o 00 � .o OITY OF CUPERTINO 40 ��Z, �� o . CUPE(�TINO PERMIT APPLICATION FORM APN# Date: Building Address: Mailing Address if different from building address): Owner's Name: Phone#: Contractor: License#: C tact: Phone: Z?to3 pertino Business License#: Fax: Building Permit Info: Bldg,d Elect Plumb Mech Job escription: O / i'L'J Residential �( Q Commercial ❑ Sq.Ft. Flod Area: $/Sq.Ft.: Cost of Prolect, r oo Occupancy Group: c��ti6G�- c Type of Construction: Plea&6 check this pox ,jMe project is a -T/ 6-9E / / &f second-story addition: ❑ Project Size: Standazd Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax-Resi/Mobile BUILDING BELEC1000 Elec 600V<= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 2?3 KoO G ° 31 eS.' OITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Stonn/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO CUPEkTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct —MECHANICAL . BREMVENSYS_ . Ventilation Systems MECHANICAL - BSCBLVD - Scb Specific-Plan - - - BUILDING - BSEISMICOM Seismic Commercial . BUILDING BSEISMICRE Seismic Fee-Res 'BUILDING BSPECIAL r S 'ecial Inspection BUILDING BSWIM Swimming Pool -` BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC -Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mecb Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING • 3 of 3