03110090 CITY OF CUPERTINOd � CTOR YN.FdRMA.
BUILDING DIVISION - PERM.
BUILDING ADDRESS: I KB INC PERMIT NOO 3 110 0 9 0
22415 RANCHO DEEP C1.1 DIR
OWNER'S NAME: PERMIT ISSUE DATE
IRLEY POITRAS 346 MAIN ST 11/18/2003
;E: SANITARY NO. CONTROL NO.
(650) 941-4384
ARCHITEC tENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
loo LICENSED CONTRACTOR'S DECLARATION - I Job Description
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing P
With Section? )uf Division Sof the cosine..ann�rofessinns Codc,and ylicensc is
„ in mu rata a.Hf C- r b� 77,7 N KITCHEN REMODEL
y Z Liccnsc a Lic.g
s, t t. Comment'
etQa ARCHITECTS DECLARATION
E 2< 1 understand my Ed....hall be used as public records
)au
yoy Licensed Professona
il
7 g OWNER-BU ELDER DECLARATION
2<E I hereby upror that 1 am exempt from Ne Contractor's License Law for the
00 fallowing reason,(section 7031.5,Business and Professions Code:Any city or county
<m which requires a permit to construct,alter,improve,demolish,or repair any strucmm S7000
°Zapriarto its issuance,also requiresthe applicant rorsuch permit to File a aignedstamment
that he is licensed pursuant to the pmvisi..a nRhc Cmured.,'s License Law(Chapter 9 Sq. Ft.Floor Area Valuation
2�ct (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i
at he is exempt dasmfmm and Ne basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of N�i}15er00 Occupancy Type
not mom than live hundred dollars(5500).
1,a owner of the property,or my employees with wages a their sole compensation,
will do the work,and the Stmewm is not intended oroffered forsals(Sec.7044,Business Required Inspections
and Professions Code:The Contractors Licteue Law does e not apply to an owner of
property who builds or improves thereon,andwho dmhim
esuch workselfor through his F' q
Own HALED
employees,provided that such improvements are not intended oroffered for sale.If.
bowevea Ne building or improvement is sold within one year ofcompletion.Ne owner. ., (s
builder'will have the burden of proving that he did not build or improve for purpose or JAN 6
sale.). 2004
❑1,as owner of the property,am exclusively contracting wit licensed contractors to
constmct the project(Sec.7044.Business and Professions Code)The Contractor's Li.
cense law does not apply to an owner of property who builds or improves thereon,and BUILDING
who contracts far such projects with a contracmr(s)licensed pursuant to the Contractor.
Licenm Law.
0 1 am exempt under Sec. B&P C for this reach
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of pe jury one of the following declarations:
I have and will maintain a Certificate of Consent o sel Pinsum for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance,as required by Section
37M of Ne labor Code,for to performance of the work for which Nis permit is issued.
My Worker's nmpensatio�TlsumncSeRricrand Palieynumbe'aram�a: t
✓ Poliry No.:r 7/3 LIC 67 :yo ,
,7 CERTIFICATEOFEXEMPTION WORKERS'
COMPENSATION INSURANCE
(Thissection need notbecomph and if the Exbroh is future hundred dollars(2100)
or less.)
I certify Out in the performance of the work for which this permit is issued,1 shall nut
employ any person in any manner so as to become subject o the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,alter making this Certificate of Exemption,you should
become subject to he Worker's Com pcnsation provisions of the Labor Cute,you must
J ,x forthwi IS comply with such provisions or this Permit shall be deemed revoked.
ti 0 CONSTRUCTION LENDING AGENCY
I hereby affirm that there is aconsractinn lending agency lot the Porfarmancenf
5 Ne work fur which this permit is iseucd(Sec.3(97,Civ.C.)
W� A Lender's Name
M z Landers Address
U C 1 certify that I have mad this application and sum that the shove information is
On F cortect.l agree to comply with all city and county ordinances and state laws relating to
0 building construction,and hereby authorim representatives of Nis city to enter upon the s
r G
(we)shove- property for inspection purposes. /
(we)agree
e m save.indemnify and keep harmless the City of Cupertino against
o-Fi Vl liabilities.judgments,costa and expenses which may to any way aremc ageinn said City
V 7 in cnnuyucnec of the ton' gr6fthispermit.
tom- APPLICANT-N WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU A'I'IONS.
h,-i r-4 Re roofs
Si tumiof AppmanVCmtmcror Dam
HAZARDOUS MATERIALS DISCLOSir,41 Type of Roof
Will the applicant ser future building occupant store of handle harartlous material
at darned by the Cupertino Municipal,Cade,Chapter 9.12,and the Health and Safety
Code, 25532(a)?
[3y., NO All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building a .pant n eq proem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Dmit harartlous air contaminants a defined by the Bay Arca Air Quality Management all new materials for inspection.
istrict?
[3 yes ;�No
1 have read Ne hasardousmemrials requirements under Chapwr6.95 of the Califor.
ria Health&Sad m 235M25533 and 25534.1 understand thatifthe holding a
does not corm 1't h my resroambirty to notify the mcup u,of the
mqui ens
whichno 'asuancccfe certificate of Occupancy. Signature of Applicant Date
ow;ncrr autharved agent Date t� All roof coverings to be Class"B" or better
W 38'
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MICAY
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OVEN
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24" 14" 24" °
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NpCTCP - - ---' - W -
DW I '
OPP0� PASS THFU
IN ADCMANCE WRB THE to �?�+ Com' IVF
&.y'OT""COD PANTRY 8 ?003
DNovA
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SIONED_�. 70 �.r• _ ��-"
This set of PI s specifications MOST
wD°m
be kept on O. rob at all times and itis «sem„
lavdul to make any changes or alte NOOK
ermission fro
on same without wr'dten P
a¢Qna
the building Dept., City of Cupertino.
The stamping of this plan and specificIl s
SHALL NOT be held to permit or to be r —————
-----------
approval of the violation of any provraic "
,r anv Citv ordinance of State Law,
PFgP0.S®
PLAN
ALE:
DATE:11/1=3
DRAWN BY:HH
PAGE NO:
PROPOSED CONSTRUCTION PLAN REVISION:
DAT ITEM
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RESIDENCE22415 Rancho Reap Clifl Ddva aCFIlfNCE IN DESIGN,CONSTRUCTION&INIIXIORS
CUPEHTINO,CA 94022408-255-5398
346 MAIN ST. IDS ALTOS,CA 94022 OFFICIS PHONE:650.9414384
r FAX 650.949.1228 www.ikbinc.com GFN IJC:0667735
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� F D mz O m o a C RESIDENCE
22415� ERTI O Deep 940 liff Drive CUPERTINO,CN 94022 IXfL'[.LIT'fl: IN LfSIG t'. f'Un9'BUC9/O,A'.f Ia II HIOHI
W _ b ^ 408255 5998
LY 346 NIAI,N 51If')S AI:I OS,('n 940_'2` OI'J I(-b:PITO, AI-. M1�I) 441 41,'4
I'A ,C 650 049 123] uxu ikt,,, ow (;J, I1' p,,, J
November 13, 2003
To Whom It May Concern,
With regard to the homeowner's plans for kitchen renovations at 22415 Rancho Deep
Cliff, this letter is to confirm that interior remodel does not need Board approval.
Sincerely,,, ��
/Stephen F
• Rancho Deep Cliff Board President
P�CFY'UIE:D
NOV 8.2003
r
OFFICE COPY
�• ' WITY OF CUPERTINOO C�3 o 70
C ERTiNo IT APPLICATION FORM
N# Date: d
ilding Address:
I't
Ow ne 's Name: Phone #:Yo
_ _
S IrI-, o ��� `l0 �— S� ' 539 k
Contractor: License#: / / 7
1Jj
Contact: Cupertino Business License#:
l L0:tiro.- 4,j�,�c�. t.
Builddii Permit Info:
Bd'd ALJ Ele Pl b Mech ❑
Job Description: / '
Residential D--- U, 4 r,'dde-� Commercial ElSq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Occupancy G up:
Type of Construction:
Quanti Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK 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
BMITIGATC Comm. Housing Mit. Fee BUILDING
I of 3
Q0 WITY OF CUPERTINO*
n F PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Fan-ffly Multi-Fan-yRes MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamily Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BNUSFD New Single Family Res BUILDING
BOVERTEVIE Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pb1g Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPIN'TERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
All BPREPIPE Repipe Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo 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 cfin MECHANICAL
BREMAMIAN A/C Units <= 10,000 cfm 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
•
2 of 3
I'sI' OfITY OF CUPERTINO*
CUP TYOF O PERMIT APPLICATION FORM
ua Fee ID Fee Description Fee Group
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
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 MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Insection BUILDING
BSWIM Swimming Pool BUILDING
BTENIP 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 MECHP NICAL
1% ERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
3 of 3
[CITY OF CUPERTINO -777-777-77
BUILDING DIVISION PERMIT CONTORMATIONS'ILDING ADDRESS: IKB INC PERMIT NOO 3110090
2415 RANCHO
NEWS NAME: PERMIT ISSUE DATE
{IRLEY POITRAS 346 MAIN ST 11/18/2003
ONE: SANITARY NO. CONTROL NO.
(650) 941-4384
ARCHITECflENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
3 0 p LICENSED CONTRACTOR'S DECLARATION G� O O O
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
with Section]B0}a)nfDivision]of the Businusa°9ofessinnsCd aid nylicenscis
j�Zin ren roma��m' t. /"66�e73? KITCHEN REMODEL
LicenseC asd c HIC Lk.k
' AS DEC�RA I - FII\ A L6
E� 1 understand my planss suall ECTshall be used as public records �
JyU
Licensed Professional JAN 62004
OW NERBUILDER DECLARATION
<E I hereby,from that I am exempt from the Contractor's License Lew for he
C20 following reason.(Section 7031.5,Business and Prnfessiom Code:Any it,or county -
which requires a permit to consumer,alter,improve,demolish,or repair any structure IMI III 7 O 0 0
-Zaprions its issuanre,alsn requircuhc applicant for such permiuuacElcasipncJ xtammcm
that he is licensed pursuant to the previsions of the Contractor's Liecam Law(Chapter 9 Sq.Ft. Floor Area Valuation
a (commencing with Section 71)(M)of Division 3 or the Business and Profession,Cmlc)ur
y $ that he is exempt therefrom and the basis for the alleged exemption.Any violation o[
Section 7031.5 by any applicant for a permit subject the applicant to acivil penalty of 3 5&N2,Uii15er0 0 Occupancy Type
not more than live hundred dollars(5500). P Y YP
❑ I,ea owner of the preperty,or my employees with wages as their sale compensation.
will du the work,and the structure is not intended or offered for sale(See.704,4,Business
and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections
property who builds or improve thereon,and who does such work himaclf or through his
Own employees,provided that such improvements are not intended or offered for sale.If,
however.the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for premium of
mki.).
1,as owner of the property,am exclusively contracting with licensed contractors to
cons Wet the project(Sec.7044,Business and Professions Cade)The Contractor's Li-
can=taw does not apply to an owner of property who builds or improves themon,and
who continuo for such project with a comeacwr(s)licensed pursuant an the Contractors
License Law.
❑ I ame exempt under Sec. ,B A,P C far this remora '
mer Data
WORKER'S COMPENSATION DECLARATION '
1 hereby affirm under penalty of perjury one of the fallowing declarations: -
1 have and will maintain a CeriOcmc of Camcnun self-lamon for Worker's Comped- _
satien,as provided for by Section 3]00 of the labor Code,for the perfarm.ncc of the
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance,n required by Section
3700 mi
of the Labor Code,for Ne performance of the work for which this pert is issued.
My WorkerC. mpenaom l sunnD carrier and Policy number art:
"" Policy Na.: "Z2300('; `OU
LS .
CERTIFICATEOFEXEMPTIONRR WORKERS'
COMPENSATION INSURANCE
(This section decd not be completed true,permit is for enc hundred dollars(g1 W)
or less.)
1 certify Nat in the perf imsence of the work for which this permit is ismed,I shall not
employ any person in any manner sou to become subject to the Wormes'Corpcnsatlon
Laws of Califefnia.Date
Apprcant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to Lou Worker's Compensmion provision,of Ne Labor Code,you most
`/.. forthwith comply with such provisions or this permd shall he deemed mvoked.
Z O CONSTRUCTION LENDING AGENCY
Cr I hereby affirm that there is a construction lending agency for the performance of
> the work fur which Ibis permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
= z Lender's Add..
J I certify that 1 have read this application and stake that the above infommadon is
W F cored.I agree to comply with all city and county ordinances and same laws muting to
0building constipation,and hereby authorise representatives of this city to enter upon me
,r a ,hove-mentioned property far inspection ion purposes.
(We)agree m save,indcmm'fyyM keep harmless the City im Cupertino against
ti N liebllitics,judgmenu,cost and,x rases which may in any way accme against said City
r) in in consequcnec of the r (this Permit.
APPLICANT WILL COMPLY WITH ALL NO Issued by: Date
SOURCEREGU IONS.
o(-fK 0 Re-roofs
Bi tore o App mantlCantnctor Date
HAZARDOUS MATERIALS DISCLOS E Type of Roof
Will the applicant or future building Occupant store aro handle hanNuus matenal
m defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
fide.seolmn zss3z(a)?
es All roofs shall be inspected prior to any roofing material being installed.
.1'21 No❑Y
Win 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
it
h'."..'
azardous air contaminant as defined by the Bay Arca Air Quality Management all new materials for inspection.
fl?
E]Yea AI/Nti -
I have most the he ardous materials requirement under Chapter 6.95 of the Cali foo-
ataticalth KSair c 15533 and25534.1 understand but ifthc building _
does not curtcn at itis my respomiludity to dory(be occupanl of thc
requirement wIt hoe 'ssumet of a Certlfleam of OOccCaderay. Signature of Applicant Date
'16'L,0 6`1 All roof coverings to be Class "B".or better
0 ver ser amhorteed agent Dam