04050084 CITY OF CUPERTINO -' -�3en .a» ' .
BUILDING DIVISION PERMITkC01vT1tACTOR INF'URMATQN
BUILDING ADDRESS: HEMANTHARAJU T SUBBANNA PERMITND04'050084
749S PRORPR("T RM
OWNER'S NAME: PHRMIT LSSl1E DATE
Adkhk HE
E; SANITARY NO. CONTROL NO.
ARCHnECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
+�o o LICENSED CONTRACTORS DECLARATION
1 tummy affirm this 1 am licensed under provisions of Chapter 9(commencing Job Description
wide Sccaon 7")or Division 3 of the Business and Profeulou Codo.and my license is
bfail
secioand ercem TERMITE REPAIR/REPIPE
]�? Dwi-hense Clan Conn
B U Dau Connector
ARCHITECTS DECLARATION
I I uadcraund my plans Mail he moa u public meards
U
`sed LiceMed Professional
OatNEon exa.DER DECLARATION
+� 1 hcrthy affirm Net 1 1. exempt from dee Covens Co License c Law for the
LL o o following mason.(Sudan
7031.5.Business and Profcanne Code:Any city or county
$ which requires a permit to construct,altar.Improve,demolish,or repair my mucwro
FZ� prim to its issuance,aha requires auapplimnt rnrauch permit in file a signed statement
< deuheislicensedresonantintheprovisioeofIMConuecuesImmucLaw(chapter9 Sq.Ft. Floor Area V aeon
FCO (eommendngwi thcmf mond of basisfrof alleged exe radon.Myavi Cade)of
3$ Natio u as1.5 b Nemfrom and Ne Pao far be ct,the exemption.Any violation of nom,,
our nu ?than by airy applicant rs(a permit wbjttu the aDPlicant w•anti penalty of 3 6dffT0Qlfaet0 0 yvyupancy Type'
not mart than Oro hundred dollars(5300).
0 1,u owner of the property,a my employee wide wge u Ihh wle compemden.
and do orison K and Ne he C.munotl Limmus aro din roc sa apply M an owner•• Required Inspections
and Prowho lou Cade:The improves
trubrk Licence Law data not apply lo rt owner of q P
Own
who builos i improves thereon,and who doseouch work houseIf edfewsak his
ownver,thce,Dwvidr i prove improromenuartnot ear deamoaered for owner.
bawrer,Meow building Impwrowst Isheldwithin nneyeas of mmove far don owe or
builder will face ate Wrdrn of proving Out las did rot build m improve(or purpose of
tale).
0 1,as Owner of the property,am exclusively connecting with licensed wntruwn to
construct the project(Sec.7044.Enormous and Profesnoe Cade)not Conuactmal U.
awe Law doe not apply in an Owner of proputy who braid,Or Impmros Nemec.and.
who contracts for such projects with a combomer(U licensed pursuant w the Con ro mora
ruse Law.
tel
am aaempt under Sea. .B&P C far deo ream
Ow / sic A9rf1.U.k,f�lg Data 5��/a4 .
T WORKERSCOMP SATION DEC ON
1 hereby affirm under Knotty of perjury am of Ne following dwlantbns:
fl
ow
and will maintain a Cerafiaub orconsemm self-insure fm Wminces Compon.
n,u provides for by Saaan 3700 of ata Isbor Code,for she performance of the
for which this permit is issued.
hero and will mdmism Workers Compensation Insurance,u required by Section
of the Labor Code,for Ne perfamemm,of the work far which this permit is issued.
Workers Compenuam Inwm em carrier and Polity number art:
er. Policy Na.:
CERTIFICATE OF EXEMP 10N FROM WORKERS'
COMPENSATION INSURANCE
(Thu senior need notbecompletea Hdee permit is fmonehundmddollan(5100)
or lass)
i certify that in Ne performance of ft work for which this permit u leaned.I MVI am
rmPloyanypuemin en ncrw ,u�em p subject b the Worlons Com=m
padon
Laweafcellfomj.D t s c'�flu,�4
Applice G
NOTIC PPPLICANr:If.after m ng Nu Certificate of Exemption,yes maul;
become w jot w au Workefs Campemtion provisions of the Isles Cede,you most
0z fomhwide comply with such pmvisiau or Nis permit shall M deemed toward.
zO CONSrRUC ION LENDING AGENCY
(•. 1 hereby affirm than Vert is a wutwctim leading agency for the performance of
C, ate work for which this permit Is ounce(Sm.3097.Civ,C.)
W Q Leaders Name
z IsndehAddross
LIC I ceNfy,that I haw mad this applicaaon and mu that Nc shove information is
B.! wmtt I Mom to comply with all city sod county oNirutwes and sum laws uWing w
C)rV' building conswction,and kreby wNodrs mprnenutiws of Niaaity w tela up"Nc
W ehovc(W)wat!ogre property for impeeaon team,los ^
(We)agree b sero.Indemnify and hm0 hay In
dee City of Cupertino Against
id City
y�j in consequence
or
carding of peso which may In anyvny weme against said City
()a APPLIC NT of UNDERSTANDS
of this Permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINT Issued by: Date
SOURCE REGULATIONS. 5'/�(p/fH,
�'I Re-roofs
on of App <H oAZARDOUS MATERIALS DISCLO RE Oau Type of Roof
WIII the applicant or future building owupant nom m handle husNaus material
u dcBmd by the Cupertino Municipal Cade.Chapter 9.11.and the Health and Safety
C.do.Section 15531(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yos PN.
Wills applicant or rulom building oceupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I
huardous air cwuminemu as dcnmd by thc Bay Arta Air Quality Management all new materials for inspection.
District?
O Yen KN.
1 hoes mad the huanlous materials mquirtmenu under Chapter 695 of the Califor.
nu Health&SafctyCade.Sectimu 25505.25533 mal 155th.l understand Ne if the Wilding
does not camently haw a i mant.that it it my responsibility b anti l'y the occupant of the
wquimmcnu which must be met pnorwiuuanm alfa Certificate of Occas
14/0
mmw nal r=aa am Date All roof coverings to be Class"B"or better
CITY OF CUPERTINO -' -�3en .a» ' .
BUILDING DIVISION PERMITkC01vT1tACTOR INF'URMATQN
BUILDING ADDRESS: HEMANTHARAJU T SUBBANNA PERMITND04'050084
749S PRORPR("T RM
OWNER'S NAME: PHRMIT LSSl1E DATE
Adkhk HE
E; SANITARY NO. CONTROL NO.
ARCHnECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
+�o o LICENSED CONTRACTORS DECLARATION
1 tummy affirm this 1 am licensed under provisions of Chapter 9(commencing Job Description
wide Sccaon 7")or Division 3 of the Business and Profeulou Codo.and my license is
bfail
secioand ercem TERMITE REPAIR/REPIPE
]�? Dwi-hense Clan Conn
B U Dau Connector
ARCHITECTS DECLARATION
I I uadcraund my plans Mail he moa u public meards
U
`sed LiceMed Professional
OatNEon exa.DER DECLARATION
+� 1 hcrthy affirm Net 1 1. exempt from dee Covens Co License c Law for the
LL o o following mason.(Sudan
7031.5.Business and Profcanne Code:Any city or county
$ which requires a permit to construct,altar.Improve,demolish,or repair my mucwro
FZ� prim to its issuance,aha requires auapplimnt rnrauch permit in file a signed statement
< deuheislicensedresonantintheprovisioeofIMConuecuesImmucLaw(chapter9 Sq.Ft. Floor Area V aeon
FCO (eommendngwi thcmf mond of basisfrof alleged exe radon.Myavi Cade)of
3$ Natio u as1.5 b Nemfrom and Ne Pao far be ct,the exemption.Any violation of nom,,
our nu ?than by airy applicant rs(a permit wbjttu the aDPlicant w•anti penalty of 3 6dffT0Qlfaet0 0 yvyupancy Type'
not mart than Oro hundred dollars(5300).
0 1,u owner of the property,a my employee wide wge u Ihh wle compemden.
and do orison K and Ne he C.munotl Limmus aro din roc sa apply M an owner•• Required Inspections
and Prowho lou Cade:The improves
trubrk Licence Law data not apply lo rt owner of q P
Own
who builos i improves thereon,and who doseouch work houseIf edfewsak his
ownver,thce,Dwvidr i prove improromenuartnot ear deamoaered for owner.
bawrer,Meow building Impwrowst Isheldwithin nneyeas of mmove far don owe or
builder will face ate Wrdrn of proving Out las did rot build m improve(or purpose of
tale).
0 1,as Owner of the property,am exclusively connecting with licensed wntruwn to
construct the project(Sec.7044.Enormous and Profesnoe Cade)not Conuactmal U.
awe Law doe not apply in an Owner of proputy who braid,Or Impmros Nemec.and.
who contracts for such projects with a combomer(U licensed pursuant w the Con ro mora
ruse Law.
tel
am aaempt under Sea. .B&P C far deo ream
Ow / sic A9rf1.U.k,f�lg Data 5��/a4 .
T WORKERSCOMP SATION DEC ON
1 hereby affirm under Knotty of perjury am of Ne following dwlantbns:
fl
ow
and will maintain a Cerafiaub orconsemm self-insure fm Wminces Compon.
n,u provides for by Saaan 3700 of ata Isbor Code,for she performance of the
for which this permit is issued.
hero and will mdmism Workers Compensation Insurance,u required by Section
of the Labor Code,for Ne perfamemm,of the work far which this permit is issued.
Workers Compenuam Inwm em carrier and Polity number art:
er. Policy Na.:
CERTIFICATE OF EXEMP 10N FROM WORKERS'
COMPENSATION INSURANCE
(Thu senior need notbecompletea Hdee permit is fmonehundmddollan(5100)
or lass)
i certify that in Ne performance of ft work for which this permit u leaned.I MVI am
rmPloyanypuemin en ncrw ,u�em p subject b the Worlons Com=m
padon
Laweafcellfomj.D t s c'�flu,�4
Applice G
NOTIC PPPLICANr:If.after m ng Nu Certificate of Exemption,yes maul;
become w jot w au Workefs Campemtion provisions of the Isles Cede,you most
0z fomhwide comply with such pmvisiau or Nis permit shall M deemed toward.
zO CONSrRUC ION LENDING AGENCY
(•. 1 hereby affirm than Vert is a wutwctim leading agency for the performance of
C, ate work for which this permit Is ounce(Sm.3097.Civ,C.)
W Q Leaders Name
z IsndehAddross
LIC I ceNfy,that I haw mad this applicaaon and mu that Nc shove information is
B.! wmtt I Mom to comply with all city sod county oNirutwes and sum laws uWing w
C)rV' building conswction,and kreby wNodrs mprnenutiws of Niaaity w tela up"Nc
W ehovc(W)wat!ogre property for impeeaon team,los ^
(We)agree b sero.Indemnify and hm0 hay In
dee City of Cupertino Against
id City
y�j in consequence
or
carding of peso which may In anyvny weme against said City
()a APPLIC NT of UNDERSTANDS
of this Permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINT Issued by: Date
SOURCE REGULATIONS. 5'/�(p/fH,
�'I Re-roofs
on of App <H oAZARDOUS MATERIALS DISCLO RE Oau Type of Roof
WIII the applicant or future building owupant nom m handle husNaus material
u dcBmd by the Cupertino Municipal Cade.Chapter 9.11.and the Health and Safety
C.do.Section 15531(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yos PN.
Wills applicant or rulom building oceupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I
huardous air cwuminemu as dcnmd by thc Bay Arta Air Quality Management all new materials for inspection.
District?
O Yen KN.
1 hoes mad the huanlous materials mquirtmenu under Chapter 695 of the Califor.
nu Health&SafctyCade.Sectimu 25505.25533 mal 155th.l understand Ne if the Wilding
does not camently haw a i mant.that it it my responsibility b anti l'y the occupant of the
wquimmcnu which must be met pnorwiuuanm alfa Certificate of Occas
14/0
mmw nal r=aa am Date All roof coverings to be Class"B"or better
CITY OF CUPERTINO
BUILDING DIVISION PERM tC� T�iGT +r INFQRMAT•N
..1 DING ADDRESS: HEMANTHARAJU T SUBBANNA PERMIT"904'050084
9S PRORPECIT PT)
NER'S NAME: PERMIT ISSUE DATE
HEMANT
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGMEER: BUILDING PERMIT INFO
IDG. R! PLUMB MECH
(� 0
tion LICENSED CONTRACTOR'S DECLARATION
1 hereby,affirm that 1 am Ecomad under provisions Of Chance 9(commencing lob Des1riA16309
with Section 7")of Division 3 of thc Business and Professions Code,and my license is
'4 mo imm�rnaonderea. TERMITE REPAIR/REPIPE FEBLi,mac Chaos Lie. 1005
n�p DamC.nnamer
_Ctl ARCHITECTS DECLARATION
�a a I understand my plans shell he uscJ as public records ��1
JyU L
o� Licensed Pmfessionel
g OWNER-BUILDER DECLARATION
i7 I Coach,affirm Oat 1 am armorial farm the Conf aaore Lieenm law far Rom
00 rollawing mason.(Section 703 1.5,Business and Pmfcssiures Cadc:Any city at county
$ which requires Is permit in construct,alter,improve.demolish,Or ispair any structure
poor m in issuance,also myuiru the applicant for such PCrmil m f Ic a signed sutemcm
Chat he is licensed pursoanua the provisions of the Conuecter's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
yl=-0 (Commencing with Section 7010)of Division 3 of the Business and Professions Conde)Or
wNg Nal he is exempt therefrom and thc baso for be alicged crampoon.Any violation of
Section TW 1.5 by any applicant for a permit subjeca the applicant to a civil penalty of ane 3 6 'Q�mbet0 0 Occupancy
not more Nan five hundred dollxn(S500). P Y Type
El I,u owner of the property,or my employees with wages az their sale compensation,
will do the wank,and be structure is not intended or offend for age(Sec.7044,Rusiuea
and Profession,Code:The Conmaara Liana law docs not apply an an owner of Required Inspections
progeny who builds or improves thcaan,and who docs such work himself or through his
own employers,provided Nal such improvements art not intended orofferad for We.If.
however,the building or improvement is sold within one year of completion,the awnce-
builder will have the burden of pouring Nat he did not build or improve fur purpose of
sale.).
❑1,as Owner of On propeny.am exclusively convening with liansed con8acmts to
cons ner the project(Sec.]Ofd.Business and Professions Code:)The Convacmr's Li.
cense law dors not apply in an owner of property who Wilds or improves thereon,and
who contracls for such pmjecm with a contractor(s)licensed pursuant to the Conuacmrs
Ima Law
m .
I aeaemptuadp.See� �� �(t����� ,9&P C far this reason
J WORKER'SCOMPE SATIONDECL R ION
L hereby af8nn under psoas,of perjury one of the following declarations:
❑[haw and will maintain a certificate ofconeart of wlf--insure for Workers camp.d-
salion.ss provided for by Second 3100 of Bre Labor Coda,for thc performance of the
work for which Nis Permit is issued.
❑T have and will maintain Workers Compensation Inmramm,ss required by Section
3100 of the Labor Code,far the performance of to work for which this permit is issued.
My Workers Compensation Insurance career and Policy number art:
Carver. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
1 (This union decd not hceamplcted ifthe permit I,Mean.hundred dollars(SIM)
or less)
1 unify Out in the Korea ...of the work for which this pamit u issued,l shall not
employanyperaminayY in Permss he oarF ubjecuothe Workcri Compensation
a Laws of Californi. S/��yfTtys
ApPlia��tttt
NOITCa'UA 4P ICANT:If,after roaring Nis Cenifcave of Exemption,you should
bceame w deet an the Worker's Compensation provisions of be Labor Code,you raw
.J O foMwids comply with such provisions of this Permit shall be doomed mwked.
Z'M CONSTRUCTION LENDING AGENCY
F+� l hereby affirm Oat Nem is a construction lending agency for be Performance of
!Ythe work for which this permit is issued(Sec.3097,Co,C.)
Uj 0 Lrndcea Name -
z Lenders Address
U C) 1 certify that I have mad Oil...lemimi and sale that the shout information is
LL P coned.1 agree to comply with all city and county ordinances and state laws radiating to
O U building COnmruell.n,and hereby authorim representaovu artists city to cover upon the
W abovcmemioneml property for impation purposes. (////�
H 0. (We)agree he save,indemnify and kap harmiss the City of Cupertino against I
rq liabilities,judgments,costa and expenses which may in any way accrue against said City J
(„)z A APPLICANT
of the grooming of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. VOL/
J
Re-roofs
mac of ApP canVCOmm�oa Data
HAZARDOUS MATERIALS DISCLO RE Type of Roof
Will the applicant.,fuwm building nccupam sou.c.,handle harardous mamrlal
az defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Calc,Section 25532(a)?
❑YeUN. All roofs shall be inspected prior to any roofing material being
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harardous air contaminants az defined by the Bay Area Air Quality Management
District1 all new materials for inspection.
❑Yes IgNu
Is ave read the M=M;)us mamrials mquimmenu under Chapvef 6.95 of Ne Califon
nice Health&Sgf 1,C.dc,Sections 25505.25533 and 25534.1 undersand that if thc building
Jots not currently haw a¢war,,hat it is my responsibility to notiry Or occupant Of be
feyuifamena which muss lr met priormiuu"no'or.Cenlfieamaf Oceu'� gna
ey.
Va A �fi. �• i4/Orr- Signature of Applicant Dale
hcr tar awhDateorircJ agent All roof coverings to be Class"B"or better
OWER-BUILDER VERIFICATI04
. 1. (Check one) I or my immediate family (parent, spouse or child) will perform
4
A. All the work authorized by this permit
B. _ A portion of the work
C. None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer(see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
erformed
j
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side).' 1'
Property Owner's Signature✓ ad 5//4_/ °100 tY
Job Add rs . 710 5 PRDS PECT fbPa), CUPek ANO, CAWit# 0(to Soo$y
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
City of Cupertino Building Department
I CITY OF 10300 Torre Avenue
L U P E(2 I N O Phone: (408)777-3228
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself,you .
may protect vourself from vossible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work
(including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and 41
you are subject to several obligations including state and federal income tax withholding,federal social
security taxes,workers' compensation insurance,disability insurance costs,and unemployment compensation
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
if the structure is intended for sale,property owners who are not licensed.contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit, erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department,
City of Cupertino
Printed on Recycled Peper
aem. ° VITY OF CUPERTINO 0
O
CUP TYOF O PERMIT APPLICATION FORM 0
APN # Q Date:S/1/f/�DD�-
Building Address: 7¢q5 PRDSP�c Mailing Address (if different from building address):
-T R.D., cupeR7iN0 , CA -9qS&>-7
Owner's Name: Phone #:
Hemt N-n4po 3U T SuBew-,NA GorALRN 5to- 574-Q68$
Contractor: License#:
lckmwe t - gut Q)L-2
Contact: SzW iDHyA &C)PNLA-w Phone: Cupertino Business License#:
510'579-4688 408-774-8175 Fax:
Building Permit Info:
Bldg t& Elect ® Plumb N Mech ❑
Job Description:
Residential f T 7 'C= o r 1 r /
Sq.Ft. Floor Area: $/S .Ft.
Cost of Project: Occupancy Group:
�'.�o- $3000• �
e of Construction: Please check this bo ' ct is a
second-story addition: ❑
[;Pro'ect Size: Standard ❑ Large ❑ Mair ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
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
�S�
OITY OF CUPERTINO •
CITY OF PERMIT APPLICATION FORM
' WUPEkTINO
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
WaL BPSPRINK Lawn S rinklerBackflo PLUMBING
IMF BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Instatl/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
A 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 Li ahtina Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> 1 OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc A aratus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE . Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/A aratus ELECTRICAL
BREMRECEPT Re ti, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Re air/Alter Heating MECHANICAL
2 of 3
OCITY OF CUPERTIN(#
CITY OF PERMIT APPLICATION FORM
CUPEI�TINO •
Quantity Fee ID Fee Description Fee Group
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems D'IEC .:LAICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swinuning 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 Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Change BUILDING
•
3 of 3
02/11/2004 16:26 6503251531 XCLENT REAL ESTATE PAGE 13
FRW : wwtaS FM N0. = 031 457 "fit Nov. 24 2W3 LOS 34M P1
IS
•. APDFIM
r.—...•_ .. ..
79H fe OF
HT1
IDOfrrt e�00a W
7409 M�}'AMWT ISO {Wkt 1"1MD 91011
KCS TWWITE PLACE INC •••,••"•'and
.. 32�ifO LD006 RE1 �pb$ � r
JTOUJKMMCAUM
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by ' E WT H.. E CRY
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SIGNF9 J
This se plans specifications MU'-W:
be k e6 mob at all times and 'R is ga
lav u hake any'chenges or aiterati ns a
PA same Without writlan permission frrm
the building Dept., Gky of Cupertino. "s ,a ■ e, P.
The stamping of this plan and specifications ----- r
3HAEi- W.OT be held to permit or to be or.
3{jprF:�b,csfa,:he rvnn'I,aa &. B.iv.a+w� ue.arc vwr 1049!
,l any '.�' • r. M ar.ww+...M�s��.p ��...w«w. .rr�aaee.wa'
02/11/2004 16:26 6503251531 XCLENT REAL ESTATE PAGE 14
... Ftart K+R1d-e FiK N]. G31 457 73M- Na+. as 20M MMAM
' Woe2Msgatlontaeet
•�93 9Posrwr Ra ._ Wrpl4'iN0 ----- 930 L4
ada.eselAoyeyF+�pamd av So
22/4/02
12/4/02 16595 ...-_
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WHAT Z A WOOD PISMUNC,MT OBGAf �8P8C1sOP YT2 R1tAD TDYS
DOCb)14 M.. FT EEPLAM T$B SWU AIM i.1MlT,&TOM Of A 916oC1'ORAL PIST
CONTROL INSPECT= AND A WDOD DR$TRQVM VMLdt Od't6AM"' II'OIDC`IM
REPORT,
A Wold DaaMft Pea A:Otgatasm tmp didri Ropwt - ss to the Prsswm or dosnce of
oddana of egad deetto)hae vgm sad a 1s 1 VNWD tad aotiaeftla arms ead 00441M
roamuatet�flonatocao�Tuda$snYa •9nmd."'fllG4obfb�OfWood7keno3ia8?� .
&OMMMM U$pe&MftMamwagovomedby(M3tmandPatCaW&A1*WAmPbPJIOM .
swao srrowm do Pot-empty wbh baltdby soda ngntrsJle¢bm•ealY b6Ve'sm10ia7tal.D ei.tdaetliesl. '. .
a cd,hwUhir,dr 000dWmh*to olbar defata Oat do not pwam'to wood deatpOyfag oegaalNt m A
. Wood Deaeoyls$Pest dt Ori Repos doe,�'Rol ooaatLk, oa.�iuc�4 E�et4 mP.
a d1e7 eta not warty!dte scope of the Wmeae3 otdthet tbti 1c,0 6r jta employee►•
• Tlk$tmdntal4a9c Camtd As!
rogyirea�CCloa of sdY lease arses which ars v+d¢leavd.cwa«ble at the .
ome ofaospeedua• Same masa dfdle Wucbae sad trot atxesdbteto Nttdt�tiffs iNrfrot pfbo9o+r
rrellq 4usordtbnweee 400rA efaee conaeeFed,by aup�iad,6PP11s� a et tabineta• ►a
iafect(on%-ataY:M.habve fo titws a[ess wttb'got.iatbte,maYaooasi6P�e� if.yeu delta iaWa'omdm '.
abAetl w>u,thu'teua cot inspat�sd.a gttt6a ad en atlt5fimd OoA.'[7gtpat0.
NirninneorappiiencetarcnamwadWad °1natenutopeaeddutin8arau8naiapaatiott. ' ..
TM csrerbr 5orfare ad do t�sef w8+sot iap�ataA, Tf Sas want the v!!C Mesa at the roa�.,.
• de}asefped.Ysa abedd ceneM.f a reslmg contraetor who is iksalcd by tlta CmtriNar'a 9tn8taoadR' .
• -t•" 'r tomb s3 (bot Rot.Hmiw ft)pitm6iaS
trTbhE.calapaw does sot Mary or ovaateo %wz*say kdmp �dae W
app'Lapop{,wags desif;
hot
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M awW4hY
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t�.ateea m mty become vesitrh'tridam in snap etas 3f6et tbk dna Upon>equw,. .
Wn o1 '
. 1l1°°r areas wpa4d 6apar�raiad at n addbioaat obarga
•'ta jiteewift dant avor ttercr*.a bwdn is lata fawd to ewod fattbw Was amidpako,cot bbd
wilt.iot Sapp euoVrr= SMULd1 BE AWARE OF T®9 CLOSID.RM VM
' C(}AYfRACT(MiWrM OVMS oKVM=TAVXOTIMWORKFUMIB:AV&.T+ltMLF—
tf ra"aalad by la pftwn o*ft tbk' �
a minRisa of d+e umgrae will be performed• Swh .
twAuspaatot.WwW�lnfbw'phmosthsofdrdueof-bit y¢o", �''r7r'e"°"P a&aemoumsktl
trot eragee6,rbe wt;� � •� -
Wafi papa,tuw4 of lalw r palodeg am=04W Oom omoeatttwc Naw wood eapotmd m Wr waadFw
.' wtll ba p3ims paismd,osiy qoh mptatt at so additbad 60002.
All pepeo and fx*ddea =M be 4000d by a Rtm ae.t
ididift
as ot�aless4l. �•li.. '.°m''iOd.
wndea
Profoeriooe Code Division 9)and is ao tm wiW iha manufsctwaf9( [ �-..
NOT"; Tu $truahrat !rear Cenftoi 1108x4 mcom*Vo anmpdk%V bwrinidY,
cvgk wmd eo.pmoica, amp"on this WRCUae prc wo by vaAsos t�►Aued so�dss kfawo.:n
the wo tidotegs (ie. tanks Mh"foes, terom 4auabe, aa9gtu 4a11i
mtowtseadatiooa b tw"o tksw Aedup afaY TOY faomt compass to oompanY- You bwea rt.hm id..
amk a a lomd apletaa rr M eaatbar rrompeeY. ,
02/11/2004 16:26 6503251531 XCLENT REAL ESTATE PAGE 15
PREM : KWIE D PWM N0. : B31 437 ZV24- Hop. 24 WX if:Wm 10
• C'$ A$ 11T$PLACE WC
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11/1/03 8awlly.
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Mm
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movies B8 WCAMID. Pt BAva AOT IWBrPx AMB WNDER RWAPISEIEDs, APPLTAWOEO, iNOT OR
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ALL OF TRt 08120MCM TENS MILL DS WOWELTMb BY T" rtAamMOE 0� R aw m
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$48ffOOA TO "a AI) 10I9T. TRE CARrat MILD as to DOW BDT NOT Rf."M u.
...•rl'IUa IO A fBCT$DN =8 ITN
02/11/2004 16:26 6503251531 XCLENT REAL ESTATE PAGE 16
FF40M : 4"FIOLD M MD. = Bn 457 2.5074+ tb./. 24 203 10:38x+ P3
• ' WS T$Ral1 M PLACE DVC
PlV44(e0famdKdfi i P d TAR4rt
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TBA Now=6000 traftm AA NCAD4Rt.
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9. 0=9 - PATIOS.
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02/11/2004 16:26 6503251531 XCLENT REAL ESTATE PAGE 17
FM MATFI9 FMK N0. t 871 457 23W" NGV. 86 20@3 12:37M F4
• _ Kcs Tmmm FX ACI INC
P.asselDofPu.DaDOsp.atlosBSQAL 950L4
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*µ+NHLs Is A 09QIIOR TND ITRN
10B R.- +T MM p9 W. twm jumm TM SItloLTI6t IIP 7IL6 LAUILM PAOIL• a0TRs70
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.
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BRL}BRTxwjm DINR A99LAYfOO, LLowwo, TM WNW" LEW" OM32 ES msCTiD.
Rr.CMtVj TL(BI TTS OD16R IO ADVIePD TO CONTACT A LUMSM) MMM TO INPPBCT AND AWAIR
TNIs PILDLEme AS NBC=.
•r+•.SgILB ID A SECTION TRO ITPM
1OD - n"Wo. TE6 PAL m IN TEE otaTAM YALL6ATMWM ANNA IS Lmm1 -
• RDCODMq'=jW. A6PI.ACa TDs LSAASR.e PNIDET NITS A XW a'a.NI6AL.WIr1s P1DNCaT OP LI.m Tape.
�•�*�CILP Is A OWTIM WO IRBN
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AD AOM TNS WE, Za La PDVow DAIO= 6yIDSNT.
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mm6aticla DPT IS Racm, It mum mw=TO TNR EUEI'3a6R'ISf IM OR
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P4=4ffi•DATLCN. OMLPA TO REr1NLS6 OR SEPLACE SEN PIAORIEO DURING R 'MWAR MMITlRiU M
L A BPOTrO9 no rm
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•••••TRIO IDA "=ON ONE ITRX
NOTE: TILT$ PROP2RTY RAS PDCPNT'LY ARAN PAINTLO, AC-5 TIDDr,M PLAGE ASDOD48 NO LIAs1LLTi
TOR ANT DAi4M.ay Olt OTEBA ADVWJN Cmmmoo NRICR Moi aB r,.aNGPALBO BY TEE PAINT OR
OTRER ff"IAMS. SWULD A" COIDL•.TON5 BE DNCOVDOW AT A LATER INCE, R
sUPPLEIGMAL REPORT
NOOLO BE Imm WML ANY ADDITIIXNAL rIRDzms. ASOaNINBATT01M. ANo ffi.D9-
11. DIRNSA - "TLAIOA.
•lA • .'OTD. 6OC6.>n STOAT itWr IIX L0. /At,OMM NODO m ms" PEits WMED WSWIS-LT F"TEs
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02/11/2004 16:26 6503251531 XCLENT REAL ESTATE PAGE 16
FROM ! WtPl" FRX N1. a 831 459 2309" Nov. 24 iWJ 30�40F I r1
• KC TRRMITE PLACE INC
pg6KEddma/NdhagvamB�aa ,.s goal&
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THLS C mapxr WILL m. arm moat rwaos"D ay a"amb VOR A nmRmmaRFMICH PEN rAA? May eat
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tun==, WE WOULD Soaus A 6 2r=a w"I. REPORT*ill 117OTRaa.
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omnia STWAM T1nOWmE swear, mm mm Ba A auram AND Lsmam WtHr WE I:WSillm vmrm as
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• 'omn 31D re Y" 1WITALI•IUO 52APAh" OAAmE IgtP70 . ANY To A08 Nayt, jmbD BE AT
AWRTXM%;, CGLAOO. LIODLEDE GW BE CHCdEm At C4a 1 aam8 To jAp= , AD. VA
(sgala33-ISaa. TILE asimnovs WtY BE WX At DAL SISS: 861V 2APmn D9E0• AAE +TUBE
OCCOPAIITA Pu pdamom MOT=
vaetaRaTrmta aAtVLtA OR OCCUVAt"s Peat HM PAIOR TO rMILORTiDe
1. Tho 6a11a Lag its must be raneved Yate the prAWrtT bAme AmALgatXPA mars begin. All
fond that is not Metayy sealed in plena Or petal. 00WAL"irw meat be Pe4svad. ALL £e°a 1O
toe X"tl1e40900F Odd lteaaara that is not in teatocy fiMl� pl9 e1 metal COPtai.7tte
toot also M laamma frau the buiad.lata]. ALL. 110lud.Lyn� � 1
ingest mist sse; mast be tWantoa. All pain SRelediAg & bi
1. The Wetrceaec, . bo also Wil be V fr71
1. TOO or; A Set to ba used no be be to< Wa (Vol } W
d. Oishea and utanai3s Tad not to W mowed net
washed ffec after' f1ia&abas Pr £ebAm. tc
all not leave araalda oft surtawa and rail nib af7act peiOte,
a. VLaes ow shrWe Oaanacted to the building mot be £tae& or tam"IMI by the oaaee
lwving at leapt 6 to 12 iXtbat of apace to 011W the lvadgatloa terga to ge bat-ass the
shrubs sed thebt&M"' Oe the day bafore the fwdgation the axil around the etLA"t rm
Amuat be eoakad With*aatat the depot Of at lomat 6 1Ach X to at laeob 1 toot oLLtaazt( Ptam
the structure. 741, aill'raguira L to a hours Of waking, depamdimq mthe soil ooadlt&on-
S. We are required to Abut 0E2 the nct l yy" (or Vropm.a) =PLY Oct.* Into rue 99"a to
dag9Lmita !up with bOt.
We
'111tum the gaa back taand r -ILt oo olloLitho. TH& ELEcrAlcm MoT VTAY OK
a. You J.0 Awad m be eat Pt the hdeae fez twit rsigata.
7. 17H law fagu Lra9 that the £uedgetor has at aopplats eat o1 kala to the ptam&eeo dasLng
the doutea of Oar Evmrgatlon.
e. All automatic tLain deviW (apanklera, lights, olamal vast be terPae oft prior to
the rumlgation,
9. All anbanae, wattler vanes, Ohimoy etecae, at.. moat be removed by the oWnar.
lm. Cox* WLII be toast SP Ovald aan`aga W the --Of, gutt,r•r and dhieenaya hnuevar., Out to
the edxmgo e. ace. or tf�d•bld. Tof oth Isfoceaf, wad the undersigned "Iesm01:40ko. of e theOf "eure of kumigato . any&the damage .ro be uu,li
IL. E ddetracttr Exam liability fat daaags owbitfturiV ndghC aaaat.
ll- Pwtia•Stea epetatlPns my .wk aocssaaw dorLhO 1Aaiartnt*eatbai or hLQA m1ddN and a.y
nave to be :"chadulVd.
17- TO avoid poealbl.e #dauadd+etnnding, aur OOtpaAV reauaeta that all valuables, suds as
v
02/11/2004 16:26 6503251531 XCLENT REAL ESTATE PAGE 19
. FROM N MI8.OVW W. : 831 M 01 10:
230911 Nous 2{ 28diM M
•' _ Wo$TgaMrM kLACE AVC
rle7araaearWnatm. Yspat OVPEPt u- o41*,_—
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}�jY wl�' �' DobatbiO�eAq cPgpdft
jtaalry. large eraanta at ""I,, out. at.. be ra., ved OKI" to tm tmd.Watim.
11. It t2' "a", to the Attie and 0104 apace is lA a aloDet, aha Claret cost be -apt"d.
IF tll'A'RiR 14 MOVES FD7U+0WIY9 ApYLR71RIm1 YOU a11e11YtIum 8SMY70a8 SZK UR m MOW
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COO8lliea, Yosm OR TZMW IRN1TATio11. 011 gEV6fAY DBOR4RA8 eKl1Ti1, aNtwx C VISION, 9N1 MO
DRp8N2N{D9wRn�DD1.pMI�E4Nf6Sa, OR TE4"aA. DCNV%m YOUR to%*Ml 000" 7 CdllER OE paYD2c3AN AVO
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aaosRfam•� cA 9]as1 18901737-902 _
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en On
"TAsnk you tas ASI&OL{A% ear 0M*aoS to wM9meheC ivP•rtY l�adis� � the
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aafa Dppt.loat'Im of a ct"0a1 tMNaonLp -W fes p.r l.aaraA pw. mvide YOU
with the I'm *D0 s 94,tJLWA Of the stote of 4 oa Ctata any=
n� ftddeealtion as Chemicals to
and pout oecapmta With tba f011oMiD8 olstpr mlth ttaa Odntmt.
ooeq prnporty Phase take A f4W aaattatr to goad and becoaa
. stat. La. datplirsa oust Yea be yiwn cue Lollwfiap lafetwstioAs
—4QhW2fal - pF.DTiOIDED APa Toxic IsOY4cALS, atractoral Ywt **at%" 0pesatexa aro
Is...* and reMa4ted by tha 4t 0rrVX" Peat deatr.i 4aeRQ, aaa ePp1Y ppptlrSdWNlOYra
aro raaiaterad tad approved for Asa by the ealltox is Doparta"t of fdod and A0ri
'end the UnirM goat" gR.irpDRaniwl pzoteatioR iKmoY•. Roplaer tim 1a %+anted when the
ttaabemeL�its Tho d&gMa of Hak dOPtUdD W-tn's UOP"S of ��e Masywaro pEaaidsks Imeloted�M
Winiadaed."
+'2f .ALmft 24 a.nro rouav3n0 applta•tiam. Yea experiancaWm.s p9Aaa�eslamW coomomtas
seasonal illpeadotap cpar*Wx iaWulito too atel�tset yauc Phys
avd Yanr wet eeaa�l y..•
roc fa=me[ intonation Contact a0F of the f011ovi"I
Owaty Nealtb Oepsr6.aRtAar•.I..Iv1+I•p.R(6001 S 22,
Cakoty Apric9AtUML CWALLaetonen•1if*'*.....1308129 11 7 1
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8ltaabasal Peat CasorD1. mead I 1jyRJ7p
TEA7ONa fti}R MDAIYA TO OR RLCHM ODeDSMDWe. OR
cTomowx nw a JRIATIVE TO 'I9I8 C kvrm. M CIMM't. 4E001A cPNTFRI
O�On�M�OE1fw�I.2.No 0CfI77WMCY OtIRSNW AWO AYTT.R SRE ci®I1CAL TRRU'AmeT YRYOft 19 SlOWiWa YN6
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Na W W" naps= mer *NMINCs PA WL DO NOf ImSL COALIFtEo Tv twlm aUGW MmMm"AN riam' tY
WTEREOTep T,M M AM AWT380 TO CONTACT A LSCIIISM ROOFIIN COYfRI.'tOR 79 IA1C6
msfzcTION or THE Door covmmoi
TY ODNtr;,ZW UMM"TAY 8YI3T AT THD ?WjWTX OR TI16 VOM ORI01NMX UTATM 19 'SS far"T
CAN ROY m ramlow pun mm ocksoM A &OpftmcgYNPA REPORT MIL SL ISmm EY mra ow"y
Wt,% IORtRtR WCOmUND&%IOM5 AAD COMM
owomsix CARE WILL OF imxlw IN trucao ucs 0r MORY, DLT nA X$&VMI NO LTAprl— eon
nNowas 70 mum ngum OR 214"IN0. Erm" PIPES, OR OWER TACIId'M, OA To 5MM",
pump oA WALL ehm.
TEIs COHNARY 6M NOT aAIIIT. STAP. OR TtXTURE.
TRI;
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02/11/2004 16:26 6503251531 XCLENT REAL ESTATE PAGE 20
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sWaosa !�-.�-..---^�.ThklMl noaRiMel�Oil�
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7l pannOse d la !° M�' 1 YA m!ra�+a30 p01MPg7 N 1u a M 0!
Plte0�t0 wR 01!peBn W�oEsO b am aaol akerin fK! ���Q Mr Mdbtlr tOx mry Wnum,
psmfAtiNDe d u0&bM1L aWMb 04 M Vataollb fi daota0t m ai9
aeeBesnot.
T81600MM6A tMB OMBNLRB ROHR t0 P4'sMnbl ob�eWanaMa *gI"
• i9 W9Mfn'/bW�m.Ow�tlbanyYddVW1.IMM1aMda.MNM�Ines• "at1Ml►°"aa°°a"pR�'R"°NrOd"°m"
wagnaH tQ%)bawatOSTtesOA.aoe 'o/srti loeiRe !lrxdy sm,naeM Aaamm�HmIMINO.fM
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_ H.2y 4Daxmed woRcb 4aelieO n00uale'!lP �tlbwtgtYawM M4teV0 at M91+�P0°°^�Y°R�. Cirh as
ywewiraeor ken oweW m baaab BOaf. ewt.1Oa..muw atoemi shwa:
1ben Sea oy0 permnnadb9�!ce��ly.
1100a tlr oMNM.MadubM flea laa,taa liuceeM las m!a vko ooh r 4a n.A r r lata•y sanlsdh
wbOeeYVo�.>�oter,mpMuter oO PRsaO Mkl ABNlLD iroptweYe�P�OsM'�bi4b rely Oe fOtl OY ao0t7�
m opt. atlaeel�Md7'� 78eenmidaatt Berl ep�baa G Pel.! 1cAN1Ml�°�°m4
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oralpWan nmdtraPlM _
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ptoNOa YOa nofw. ARaBtsbwlY Bs�mynarweDsSwtYsm't!^e*M krp4loµiab raferYN 011MsaM w11!lP981N!l a0a
tofu ltelo�9aMHN+r'•+Psm'7NlTln twt9dd
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TOtblt 6,900+00
5.100.00 500.00
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02/11/2004 16:26 6503251531 XCLENT REAL ESTATE PAGE 21
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