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05040118a E 0C a� M G a2 UC OF C CITY OF CUPERTINO?y��q�,�aiap BUILDING DIVISION PFaff C"V L]�lltl.VTQ!<1�L ,k1� Q BUILDING ADDRESS: DALE E HAMILTON 1ERMITNCb5040118 OWNER'S NAME: PERMITISSUEDATB DWA D ENG 371 NECTAR rT PHONE: SANITARY NO. CONTROL NO. (408)842-7972 ARCHITECrIENGINEER: BUILDING PERMIT INFO BLDGO ELECT PLUMB MECH O O O LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby Arm Nal I am licensed under provisions Of Chapter 9 (commencing with Section 7000) of Division 3 ofBm Busied., and Profusions Code, and my license is infill rorro And ertot. REMODEL KITCHEN & BATH (2) License Clue Lic. g DateContractor , ARCHITECTS DECLARATION ernd my plashall he used As public ...mat 1 undmna Licensed Professional OWNER -BUILDER DECLARATION I herehy affirm that 1 am exempt from the Contractors License Law for the following mason. (SCedun 7031.S, Business and Prorusin s Code: My city or county which requires a permit to construct, alter. improve, demolish, in repair any structure 40000 pd., in is isuance, also requires Ne applicant fursuch permit in rile a signed statement that he is licensed pursuam to the provisions aftho Common' Lkcnse Lear (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Sctfo07000) of Division 30fthe Bulinessand Profusions Cade) Or Net he Is exempt therefrom and the bol, for the alleged exemption. Any violation of 3 6yUWl911k0cj0 0 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not marc than Eve hundred dollars ($500). E_] -I, As owner of the property. or my employ. with wages As their tole mmpc madmi Required Inspections er will do the work, and the suucmm is not intended or offered for age (Sec. Business and Prefaced.. Code: The Contractors Liome law d= not appy m An owneof q P property who buildsm).prows moron, andwhodoesuch work himselforthroesgb his own employ., provided that such improvements Am not intended oroRered forule. If, hpwever, the building or improvement Is sold within one yeu ormmple ton. the owner. builder will haw die burden of peering that he Old seasdW purposear improve for purpose but/ilde Irp 1, as owner of Ne property. am exclusively contracting with licensed convectors to construct the project (See. 7014, Business and Profession Code:) The Conuamara U. ' eerie Law it. bol apply m an owner of proper who builds or improves thereon, and, - who contras for such projects with a comractods) licensed punuml in the Contractors License law. ❑lare exempt und�o�Sec . B & PC/for /\ ♦ 'Nl/e tenon � { qq Owner L I- MAA ..— Date u / 1� r' J / WORKER'S COMP N DECLARATION V 1 hereby Allison under penalty of perjury am of the following dmlantions: ❑ ]him And will maintain a Certificate of Convent to self -Insure fm Workers Compere udon. As provided for by Section 3700 of the labor Code, for W performance of the work for which this permil is issued. ❑ 1 haw and will maintain Workers Compensation Inaurinex, as expired by Section 3700.17 the Labor Code, far du perfmmano of Ne work far which this permit is Issued. My Workers Compensation Insuranu earner and Policy number see: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' ' COMPENSATION INSURANCE (This section read not b. completed lithe permit sforonc hundred dollen (3100) or Ires.) 1 certify that in the performance of the work for which this permit Is issued,) shall not employ any PC.. in myon n r u beeynerIt' I ds Workeri Compemation ' Laws of Califorgig qm Applicant l • NC410E TO AP LI ANP. IL after making this Cenif te of Exemption. you should become subject in the Worker's Compensation provisions of the labor Code, you most foMwith comply with such provisions or this .It shall M domed mewomd. AGENCY CONSTRUCTIONMOM Is acnstrun miLENDING 1beauty ich thi Net dartssro ageoy for the pedurmmce of (Sec.3alending the work for which Ns permit Is issued (Sec. ]097, Civ. C.) Lenders Name i Lenders Address i I certify that I haw read this application and Aum that the show information is ' wrest I Agree to comply with all city and county ordinances and state law relating m building com Arietion, and hereby audu rib repruentatiwa of this city to cuter upon tis Alsom-mentioned property for inspection purposes. (Wei agree to save, indemnify and keep harmless the City of Cupertino against I IlabiliOes.Judgments, cots and expenses which may in my way acaon, against said Cit in conuence Of the ScentiOf s mail. a I APPLLICANT UNDERSTANDS AIND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. Re -roofs L24 1411110- Signature of ApplicmVCmtnclor t DBm HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant nom orhandle hnutlous mated. As defined by the Cupertino Municipal Code. Chapter 9.13, and the Health and Safely c.Jc. see den 25533(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑ Yes ®ia 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 emit havardous air coninminanu u def ied by the Bay Area Air Quality Management all new materials for inspection. Dimict7 FK ❑Yea Ides I have mad the lumamnus materials requirements underchap erd.95 of the Califon - me HulM& SeeyCode, Souorts25505, 25533 and 35534.1 undemund thm if do Wilding dows not currently haw A umm, Net It is my responsibility w notify the recupanl of Ne requirements which mutt be met pdor aanm ar, CenIII eer/ap Signature of Applicant Date �aart. 44!e All roof coverings to be Class "B" or better own. ` ar� mo ap em 1 of 1 0 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36615010.00 DATE ISSUED.......: 04/19/2005 RECEIPT #.........: 29369 REFERENCE ID # ...: 05040118 SITE ADDRESS .....: 1588 PRIMROSE WY SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... io OPERATOR: conniew COPY # : 3 OWNER ............: DWARD ENG ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5230 RECEIVED FROM ....: EDWARD ENG CONTRACTOR .......: HAMILTON, DALE E LIC # 21932 COMPANY ..........: DALE E HAMILTON ADDRESS ..........: 371 NECTAR CT CITY/STATE/ZIP ...: GILROY, CA 95020 TELEPHONE ........: (408)842-7972 40 FEE ID UNIT BPERMFEE VALUATION BPLANCHK PERMIT FEE BSEISMICRE VALUATION BENERGY PERMIT FEE ELECTRIC SQUARE FEET PPLBG SQUARE FEET EPERMITFEE FLAT RATE MPERMFEE SQUARE FEET MPERMITFEE FLAT RATE PPERMITFEE FLAT RATE TOTAL PERMIT : METHOD OF PAYMENT ----------------- OTHER TOTAL RECEIPT : QUANTITY 40,000.00 453.60 40,000.00 453.60 200.00 200.00 1.00 200.00 1.00 1.00 AMOUNT ------------ 1443.77 1443.77 AMOUNT PD -TO -DT THIS REC 453.60 0.00 453.60 605.33 0.00 605.33 4.00 0.00 4.00 217.73 0.00 217.73 16.00 0.00 16.00 16.00 0.00 16.00 38.37 0.00 38.37 16.00 0.00 16.00 38.37 0.00 38.37 38.37 0.00 38.37 ---------- ---------- 1443.77 ---------- 0.00 1443.77 NUMBER ------------------ M/C I 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 [lEeIe in "k9A • CUPEIIiTINO CITY OF CUPERTINO• PERMIT APPLICATION FORM S API 36 -1 -d O Fee Description Date:kPRIL fq, 2u05 Building Address: Mailing Address (if different from building address): Iii$$ IMROS� (n�A ZTINU CA - Owner's Name: BBOILER2 Phone #: aJZV Ell G BBOILER3 -6040 Contractor: -9,%_6 4A -H 1 L-1 oA1 C0N.5` ?WC-T1CW 1 NC License #: V $ 6 0 z ci Contact: Phone: 2,53-G 040 Cupertino Business License#: A-P_CC.AFax: Boiler > 1.75M Btu MECHANICAL Building Permit Info: Construction Tax BUILDING Bldg ❑ Elect Plumb Mech ❑ Job Description: Con. Tax for BQ Zone BUILDING Residential 14 4- T14 7440 EL Commercial ❑ Sq.Ft. Floor Area: .K /R Constax - Resi/Mobile $/Sq.Ft.: Cost of Project: Wor000 Elec 600V <= 1000A Occupancy Group: Type of Construction: Elec 600V > 1000A Please check this box if the project is a KITCf+CN *- Zh7fi F-hMODE-L second -story addition: ❑ Project Size: Standard % Laze ❑ Major ❑ BUILDING 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 CUPEkTINO 0 OCITY OF CUPERTIN# PERMIT APPLICATION FORM uanti 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 rinklerBackflo PLUMBING BPSTORM Storm/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 BREAUMAN A/C Units <= 10,000 c&n MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > I 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 CUPERTINOO 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 Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ZOO ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL 00 MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING L®O PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING • 3of3 • 0 0 CUPEkTINO Assessor's Parcel Number: 3 fe (- - k 5 - d-1 0 Name of owner. 1F12u> p -RD E t-1 G Project address.. 1 `� $2s l-' 22-1 M (Z-0 Contact person. t7 wA-tz-D 1;N Phone. 2,53 - C D"4O Fax. Net square footage of lot, Existing gn1mre fnntaue. First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? Is privacy protection planting required for the project? Y N On what floor(s) is work being done? Proposed Y N Brief description of work. 17-E-My 9 E-1- V 15 -k -1=^J P% -T++ CZL-) 0 K S , Code editions: 2001 CBC (Y - N)2001 CFC 2001 CPC (Y - N)2001 NEC Effective 11/1/02 tJ u S -c civ -c i J tizA l (Y - N)2001 CMC (Y- N) (Y - N) . • _ APR 19 2005 1 Plan Review Process Work Book Page -8 -Revised 4/28/04 0 0 s SE � o � y pp O O W m Q ME W m 0 0 f) m v v y �a g 0'. o z � m 0 APR 19 2005 Z W ME Y 0 0 f) m o �a o z � 0 APR 19 2005 �09F�F0 A CITY OF CUPERTINO BUILDING DIVISION PERMIT,ICON —kAoTORANFORMATION BUILDING ADDRESS: RR PRTMRC)qR. WY DALE E HAMILTON Pr"""05040118 OWNER'S NAME: PERMIT ISSUE DATE DWA D 9 NE: SANITARY CONTROL NO. (408)842-7972 ARCHI7EC (ENGINEER: BUILDING PERMIT INFO BO PLUMB MOECH O LICENSED CONTRACTOR'S DECLARATION Description 1 Wrcby affirm the I Am licensed under previuoa of Chapter 9 (...In, .lob with Sceda. 7") of Division Sof Ne Business and Professions Code, and my license Is License eran eRem REMODEL KITCHEN & BATH 2 License Class ISc. A Da Contractor ARCHITECTS DECLARATION I undcnunJ my plain Mail an used a public records records FINALE® Licensed Pmfeaaional OWNER -BUILDER DECLARATION r 1 hereby African that 1 am exempt from Me Contractors License Law for the following mason. (Sudan 713 1.5, Business and Professions Code: Any city or county /sf. J� 2005 C which requires a permit to ennsuuct. Alter, impmve, demolish. or repair my structure Prior te its issuance, aim requires the applicant for such permit to file a signed statement that he is licensed pursuant m do previsions of Ne Conuacmfs License Law (Chapter 9 Sq. Ft. Floor Area u (commencing with Section 7000) of Division 3 of the Business And Profcai.na Code) or Jut W h ea oru Munfron and Um bash for do alleged exemption. Any violation of el0 0 Occupancy Type Sectionsubjects Ne Applicant to a civil penalty of myhunaandldolWa e mart Nan five (550011 ❑ 1, a owner of dte property, m my employcea with seta W IW it mm eompensadon, Required Inspections willdo Jnwork.andthemuseumisnoti.wded..ff.m4forsde(See.7044,Bu . and Professions Code: The Communes License Law does Out apply u an owner of property who buildsorimpretwa demon, and who dOMach work himanlforthrough his own employees, provided that such imprommenuae not Intended moffertA for sale If. however, We building or bnprovereem h sold within one year of campledon. the Owner. builder will haw; the burden of proving Jut he did not Wild or improve for purpose of eaten ). tr 1. as awur of Me put Party, am exclusively contracting with licensed eonlnemn to construct the pmjcct (See. 70/4. Business and Profeuians Cade:) M ConuAemea Li. mean taw docs not Apply In an owner of property who Wilds or improv Muton. and, who cu mels for such projects with a contractor(s) licemcd purtwm m the Conserves License law. ❑ 1 am exempt under C/for thason B k PPDate rSSm�.. �iss M Owner [ �,v R C K SA NDECLARATION / WORKER'S I hereby aft ml under penally of perjury are of the following declarations: I have and will maintain a COr ifian o'c' nsem roself-Iaum fm Worker's Compen. nation, As provided for by Sudan 3700 of the labor Code, for the performance Of the work for which this permit is lased. ❑ 1 have and will maintain Worker's Compensation Insurance, As required by Schon 3700 of the labor Cade, for the performance of the work fer which this permit is leased My Workees Compensation Inmrmee carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF MEMPTION FROM WORKERS' COMPENSATION INSURANCE (This soman need trot W complted If IW permit is fecone hundred dollars ($1410) or lea) 1 certify the, in the perfotmanco of the work for which this permit is Issued. I shall not employanymrmnlnmy ma. pat r/q aye t�A 1pma abject m Jn Workers' Computation Laws of Catifama.D��IV Applicant ]] mow' NOTICE TO APPLICANT-. If, ater making this Coni te of Samaritan. you should become abject W the Worker" Compmundon provisions of the IaWr Code, you most forthwith comply with such provisions ar this Permit shall W doomed neveked. CONSTRUCTION LENDING AGENCY 1 hereby affirm Met them Is awns rwilon lending Agency for tie performance of don work for which this permit It ivied (Sec. 3097, Civ, C.) Landers Name Lenders Address I cenlfy that I haw mad this Application and sum that the sbon Inform Wan is ' comm 1 agree to comply with all city and county ordinances And sante lam mladnl to Wilding conmuction, and hereby authorise repraanmiv of this city M enter upon the above-mendaned property for Inspection purpose& (We) agree to saw, indemnify ad kap harmless the City of Cupe.im against IIab111Ua,judgmenu.eatu and expenses which may in any my acme aguat said Chy in consequence orthe gaming of this permit. k APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. Re -roofs Type Of Roof `L.4 411M).5 Sllnanurc ofApplic HAZARDOUS MATERIALS DISCLOSURE Data Will the Applicant or future Wilding cat orhandin lrdous material cupstam ura as de0ad by the Cupertino Municipal Code. Chapter 9.17, and the Health and Safety Cmile. 75532f.)? All roofs shall be inspected to any roofing material being installed. ®1q. prior lWill If a roof is installed without first obtaining an inspection, I agree to remove the applicant or future Wilding Occupant Mae equipment or devices which ihirk haatd.us air contaminants a dcli ed by the Bay AMA Air Quality Management all new materials for inspection. isuict7 —/ ❑Yes 1JrrO I haw mW the hazardous materials requirements under Chapter 6.95 of the Califor. nia Hal"Safety Code, Smears 15505,25533 and 25534.1 walo sand Jut ifde Wilding does trot curcmly ban a tenant that it h my responsibility as wary the occupant or the mqulremenu which must Wmet priorsvence ofACenilkam ofa pan Signature of Applicant Date P rx L L r/19 DS All roof coverings to be Class "B" or better Owner r (Date or Authorized agent