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03070148
CITY OF CUPERTINO x�*':`�7w.€ks -x .:r� BUILDING DIVISION PERMIT CONTRACq TOR INFORMATION 40VI i ;n BUILDINGADDRESS: CUPERTINO PLUMBING PERMITN'03070148 OWNER'S NAME: 10297 S DE ANZA BLV PERMITISSUE DAT, ONE: SANITARY NO. CONTROL NO. (408) 253-0618 ARCHITECfIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 AAe00 LICENSED CONDUCTOR'S DECLARATION Job Description U I hereby affirm that I am licensed under provisions or Chapter 9(commercing P with Seek..? ))of Division 3 or Ne B rind Pmressians CSMe.And my license is in murq = u5 m P7 Fl tc 3 BATHRM REMODEL pp2 LlccnnC a sc a � .S Dam curer for arc ¢. n ARCHITECTS D ATION �i neerstanJ my plena(hall W uac public rcrnrda s+ Y�da+a, Dy 3 G Licensed Professional OWNER-BUILDER DECLARATION Contr ON AUG 1 9 2003 3 00 1 tarsoereby.ffirmSas that 1 I.S.exempt from IW Cmm�ts Co :License law for sbe E00 o follwhich Lincs. (SecGun ID3 LBusiness and improve, de oli Code:Any city or aunty .,$'n which)its issuance,v permit re caress the elm,,improv,h Permit t car repair any[.nature -- b,iy pdonnitsensedpursuant it)thetWvpplimm for ouchmo is LfienseLaw(ummenl < (comae(commencing pSection7 h)provisions of the CnntncmYsndPrrclaw(Chapmr9 Sq. F[. Floor Area de V01118(IOn $ (est he is xempth omforen and 0 Divisinn 3(a,of WtheegedC.C.Pl ft.Any Code)or Nat he is exempt Ibemfmm and Ne buts for me alleged exemption.Any viaHJon.f 35905044 . 00 Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred doll..(SSW). ❑h As owner of the propcny,or my employers with wages As Heir sole compensation, will do the work end in, net..isoat intended or offered bank,(Sec.7061,Business _ ane Professions Code:The C.nvacmh License Law dots not apply m vn owner of 2 O 2 — UNDERFLOOR pL ectiions property who builds or improve,thenen,And who doea tach work himself.,through his own employees,provided that such improvements are not boarded or offered far Sale.If, 301 — ROUGH PLUMBING however,the building or improvement is Sold within rete year of completion,the owner N builder will hawe burden of proving that he did not Wilder improve fo,purpose or 302 — TUB & OR SHOWER Sale.). 502 - FINAL PLUMBING ENERGY 1,a owner of the Sec.pro,cit,,,Business sines and contesting with:)no Cmnvacros to cortswathe es no.(Sec.oan Businessrope Pro fusions Code:)no Conuaera, Li- 506 — GAS TENT come Law doesr suchot plre man ith awner ofproperty actor4 who sed pubrimprow BactCommeand, 507 — FINAL. PLUMBING• who contracts for such projects with v eamncmr(q licensed pormem to she CamnnoYs Lkcue law. C]I am exempt under Sec. ,B&P C for this Lesion OwDECLARner Data , WORKER'S COMPENSATION ATION I hemby&Mror under penalty of perjury on of Ne following ducluations: 1 haw and will maintain a Cenificaa of Consent to self-Insure far Worker's Compen- ution,u provided for by Section 37110 of the Labor Code,for the performance of the work for which this Permit is issued.C)I have and will maintain Worker's Compenantinn unnce,u required by Section 3700 or the labor Codc.ror Ne performance of the for which this permit is issued. My Worker's Cnmpenutinn ttuyr.na ca1picr v y numb, n: I Trier.f"TE br Policy No.:-1tY—OOO-7Pb CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This acctinn need not be completed If the permll is far arc hundred solum($1 W) car leas.) I comfy Net in the performance of the work ran which Nis permit is issued.I shsll not employ any person in any mannerist AS to berome subject o be Workeri Compcnsatlon Laws of California.Data APplicluo - NOTICE TO APPLICANT:If.after making this Cenificsm of Exemption,you should ` become subject to the Workch Compensation previsions of the Labor Code,you must O forthwith comply with such provisions or Ibis permit shall W deemed revoked. r CONSTRUCTION LENDING AGENCY ';4 k farwych thi thatthemi issued(S.C.Construction7.Clending agency for performance of C � me work for whicM1 this Permit Is issued(See.31197,Civ.C.) a7 ACantle,.Name aZ Leads'a Atli.. U Q 1 ceniry that I Mw read this application and sum that the above information is " Pcorrect.I agree to comply with all city and county ordinances and sum laws rotating to C)U building construction,and hereby authorim minesenmtives of this ci ty to enter upon the G above mentioned property for inspection purposes. (We)agree In sive,indemnify and keep harmlcu the City of Cupertino againsl Hh Ilabil ities,judgments,costs and expenses which may In any way accmc against mid City / UZ in consequence of the granting or this permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ;Cwc, REL'(1E LATION (g'-- Re-roofs uro.(Applican Contractor m. HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF -will the applicant or forum building sxcupam store or handle heuNuus mvmrisl ASfined by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safety Schon 15532(.)? All roofs shall be inspected prior to any roofing material being installed. ❑Yu Will the applicant car future Wildingoccupanl site cyuipmcnl or devices which If a roof is installed without first obtaining an inspection,I agree to remove hazardous nir cnmaminans u defined by the Bay Area Air Quality Management all new materials for Inspection. ct7 ❑Yes >N. I have mai the amandmis mearialsmyvirtmcnts under Chapmrfi YS of Ne cable, Ti-Drum&SafmyCWe.Secdmu 25305.15533 and 25536.1 unJersmne Nm HOW building acanot Cutrtntly haws anon],mat it is my respouin iry m n Ibe rcC.Pul of Ja men whiehmnlLeemm o.toamIameanardoe.a.r ea Signature of Applicant Date ({ Owner or authurireJ.gem D Ic ° All roof coverings to be Class "B"or better CGS CITY OF CUPERTINO ` a -OF PERMIT APPLICATION FORM 19 CUPERTINO APN# Building Address- 121//5 cdk, .Owner's Name: / Phone#: M Ich4eL t :r p t'an 00.;W5.- 0 413(o ComActor: License #: z cv te�i'N0 ?l u w.t N6.. y94s Contact: yy � Phone#: R �`-1 RAJ,-,f,4 YoB 3019 y28 Applicant/Contra tor: (� uildi Permit Info: Bldg Elect Mech eson: Residential: / al: Sq.Ft. Floor Area: Architect/Engineer: Valua ' n: oar Type of Construction: �� Occupa sit e d L ! X — uJ iTH i /k ve,it o P- P*AJ 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 I Investigation fee BUILDING BMITIGATC I Comm. Housin Mit. Fee BUILDING tof3 zS� � j( • CITY OF CUPERTINO CITY of PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description_ Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMUET-I 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 PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmos heric 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 cfrn MECHANICAL BREMAIRHAN 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> lOK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Mise X22aratus ELECTRICAL BREMNRAPP Rem Non-Res A liance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM r CUPEkTINO Quantity 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 RmdLSigns Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL .BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL 8REMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING . BSF&2FAM Single & 2 FamilyBUILDING BSFNA Single Family New Add BUILDING BSPECIAL Special Insection 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 ZADDCHG I Address Chane BUILDING 3 of 3 CUPERTINO '$ at rj + DIVISION PERMIT tCONTRACTOR INFORMATION `y BUIL INC ADDRESS: DAVE SMITH ROOFING PERMIT NO.03090048 R'S NAME: 1052 KELLY DR PERMIT ISSUE DATE NE: (408) 973-9427 O.SANITARY NCONTROL NO. ARCHITTiCT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH +Op LICENSEDCONTRd under previsions lob Description Fu I hereby affirm slim 1 am Ilancd under provision of Chapter Y(commencing � p W with 5c tian7IXkpo(Dindon 3 of NC Business and Profession Com,and my license is ±�h Lin runr . (in I. S- ?e 1 JINSTALL 1/2 OSB INSTALL 50 YEAR SHINGLES (GAT) 25 DaenL as �—Lt I f Date I d Oaiu l my plea shall hARCH e u 5 D c RATION s puhlici mrd+ s FINALE® C l;; Licensed Professional 3 OWNER-BUILDER DECLARATION <l I hereby affirm that I am exempt from the COYraclor License Law far the O O following reason.(Section 7031.5,Business and Prnrcssions Code:Any city or county SEP 1 5 2003 5$� which.quires a permit to ennatruet,not,improve,demolish,nr repair any+tructum jey prior to its issuance.alsuoquirenhc applicant forauch permit to file a signed staument 2�0 that he is licensed pursuanuo the provisions of the Commumr's License Law(Chapter 9 Sq. Ft. Floor Area Valuation pa (commencing with Section TBW)Or Division 3 of the Bmincseand Profession+Chaki or `R E that he is.emit therefrom and the bssu for the alleged exemption.Any violation of 5 �11 ING Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Type not mom than five hundred dolhn($5WppN Number Occuane). "' Occupancy -- ❑I,as Owner of the popery,or my employees with wages as their sole compensation. will do the woh.and the structure is not intended or offered for sale(Sec.7W,Business 3 05 and Pofession Code:The Contractors Liane Law don net apply to an owner or - E Required Inspections properly who builds or improves thereon,and who does such work himal(or though his 307 - INSULATION own employees,provided that such Improvements arc not intended or offered our sale.If. 6O1 — " ROOF TEAR OFF however.me building or improvement is old within one year of completion,the owner. builder will have the burden of pving mat he did not build or impmw for purpose of 602 ROOF PLYWOOD NAIL ale.). 603 - ROOF BATTENS ❑1,as Owner of the property,am exclusively contracting wish licensed contractors to — - construct%epmjcct(See.7044,Business and Prefossiooe Code:)The Conmctar's Li. 604. — ROOF IN-PROGRESS ane Law docs not apply to an owner of property who builds or improves themon,and, who contracts for uch proXcka with a commicor(s)licensed pursuant to On,Contractor License Law. 0 I am exempt under See. B h P C for thi+rtaon r Data WORKERS COMPBNSATIONDECLARATION - - 1 hereby aim under pemlty of perjury oro or the following declarations: I have and will maintain a CcrtiOam of Conant o Ulf-inum for Workers Compcn. _.. - "Ohni,as provided for by Section 37W of the Labor Code,(or,the per(orwMe Of the .. work for which mi+permit is issued. — ❑1 haw and will maintain Worker's Compensation Insurance,as required by Section ' 37W of the labor Code,for the performance of the work for which this permit is issued. My Worker Cionix, , lnLunt'ta��a`mer/ef/�d POlicy n be am: Cam 1 w`�VCP611cy No.: �I CERTIFICATE OF EKFIPIDON FROM WORKERS' COMPENSATION INSURANCE (Thu action need not hecomplcled if the permit a fm ane hunJmd MJlm(SI W) lest.) 1 certify mut in the peifnrmanec Of he work for which this permit is issued.I shall not employ any person in any manncr+o as m become subject n he Workers'Compensation Law,of California.Dao Applicant NOTICE TO APPLICANT:lE after making Nis Certificate of Exemption.you should hccome subjat tr the Worker Ci mpenation provisions of the Labor Code, no..at O forthwith comply with such provision or this permit shall he deemed revoked. ti N CONSTRUCTION LENDING AGENCY I hereby affirm met mere Is a convection lending agency for the performance of 3i Ne work for which this permit is issued(See.3097,Civ.C.) YLendch Name z Lender's Address J C) I certify mat I Noe read this application and+tate iN,the sinew information is y , COMCL,I agree to comply with all city and county ordinances and alae,laws relating to JO building conuuction,and hereby authorre representatives of this city to enter upon the C show-menllnned property for lnpommi pOW.,. y (We)agree to saw.indemnify and keep harmless the City of Cupertino againt rA liabilities.judgments,eon and expenses which may in any way accrue agalnt said City 2 ;)7 in consequence of the granting of this permit. /7 r7 LICANT UNDERSTANDS AND WILL COMPLY WITH ALL GNON-POINT Issued by: Date s0 EX GULA NS. Re-roofs inure of ApplicanVCromacmr Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant SOOM or handle havallous material as defined by the Cupertino Municipal Code.Chapter 9.12 aM the Health and safety e'SecDYu'15 No All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment Ordevims which If a roof is installed without first obtaining an inspection,I agree to remove it hamodmis air contaminns ss defined by the Bay Area Air Quality Management all ew materials for inspection. ' srict? /- ❑Yes �No . I have read the turandousmaudau requirements untkr Chapter 6.95 ofthe Califor. .in Health.&Safety Code,Sation 25505,35533 wW 25534.1 understand Out if she building /) of cuncn0y haw a urians,mat it is my r.ponibility m not the occupant of Oe, reyui nu which s be mtopriortuisongd tufa Ccnifuae,of Occupancy. Signature of Applicant Date 0 r or to m m ed agcm Pae, All roof coverings to be Class"B"or better Community Development Department • / Building Division City of Cupertino Rj 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408)777-3333 IU'PEIQJ IN 0 Building Department Subject: Re-roofing policy for the City of Cupertino 1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards and manufacturers specifications on re-roofing. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the building inspector when the re-roofing is completed. 3. All roofs shall be inspected prior to any roofing installation. 4. To receive a final sign off from the City, the following steps are required: 1) Pre-inspection and/or tear off approval. 2) In-progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. 5. If plywood is installed, a plywood nail inspection is required. 6. Any roofing which is applied without first obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be performed. IMPORTANT: 1. Flat roofs must have a minimum of 1/4" per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: �7 /� r job Site Address: 2- 3 -S 'rX or) �F c7 Roofing Company Na I O o A plicanYs Signature: / Date: \�1Jr61i�1DlJ� Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper 030°100 (`5 CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION FORM APN# 3�5rCal Date: 0-3 Building Address: I Z 3 P c!1 6 0© G 1� Owner's Name: K C C/ Phone#: ._O-2 Contractor: Phone#: "� 3 —9 Z� License#: �GS . G�`7 2jn& 7 Conta Phone#: Cupertino Business License#: "� 7- 8199 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Asphalt Shingles Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job Description: 3+3 1 ( Y-L 6_5 & ' l -,% S4-1l1 SD yQ4� 5 is G'R Residentia Commercial ❑ Fire Zone: Yes ❑ Ne-2] Confirmed with Plannin t. if there are an restric Cost of Project: // 000 O0 Type s ctio Occupancy group r Qty. if , A li b e Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING