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03010091CITY OF CUPEWrINO�y, ;'Z>uz:-;.taus BUILDING DIVISION PERMIT CONTRA, CTOR-IN, FORMATION BE I EDI NO ADDRESS: CRAFTSMENS GUILD INC PERM I NO. 809 ROSE BLOSSOM DR 03010091 NER'S NAME: 10566 S DE ANZA BLV APPLICATION SIMS DATE JEAN AW 01/15 2003 PHONE: (408)366-1000 SANITARY NO. CONTROL NO. ARCHI9EC RIWGINEER: BUILDING PERMIT INTO BLOC ELECT PLUMB MECII LICENSED CONTRd under S DECLARATION LI. hot 1 hereby affvm that I am licensed under provisions ofacodChapter 9 (commencing p e Job Descri tt�f � �LE® wiNSection 1XXpnfDlvlsinn3of Nm Busine. and Pnfcssions Codo,nndmyliccnseis in fulls nd effe G License Class Li .# Dare Con REMODEL KITCHEN/BATHRM & WINDOW UPGNff MAR 1 ZLUUU ��a=� CHITIiCTS IARAT w 1 on rod n my plans shall M used as public records I V/ �`— Licensed Professional ill BUILDING OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am1. exempt from the Contractor's Law for the C's e: Any c reason. Professions Any city or county 7o3L5. Businessandmpr followwhich erdon demolish. Or: re Permit ns construe!, alrec improve, repair structure which requires improve, f Int signed stammcm n b Permittfile ed trior to its issuance, also requites the applicant Iia such Permit a License tSection7 the the (comm ening Sq. Ft. Floor Area $60>�A tgltion Codter9 wit ofprovisions sion 3 eBusinessanProfessions Cnde) or (commencing with Sections of Division 3 of the Business and Profes, add sit (cel he is exempt Nercfrom end Ne basis for Ne alleged cacmption. Any violation Of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant a civil penally of not more than five hundred della. ($50% ❑ 1, as owner of the properly. or my employees with wages as their sole compensation, equired Inspections will do the work, and the structure is not intended or offered for aele(See 71144, Business Law does and Professions Code: The Contractors License not apply m an owner or 10 2 - PIERS propcny who builds orimproves Hereon, end who does such work himulfonhmugh his own employees.provided that such improvemmnu are notimendedoroffered formic. If. 103 - UFER however, the building or improvement issnld within one year ofcompletion, thenwner. 104 - REBAR builder will have the burden of proving Nat he did not Wild or improve for purpose of 105 - ANCHOR BOLTS E] 1, as owner of the property, am exclusively contracting with licensed contractors to 106 - SEWER & WATER construe the project (Sec. 7044, Business and Professions Code:) The Contractor's Li. cense Law does not apply to an owner of property who Wilds or improve thereon,and 202 - UNDERFLOOR PLUMBING who contracts for such pmjeee with a conlracter(s) licensed pursuant to the Convector's 203 — UNDERFLOOR MECHANICAL License Law. ❑ l am exempt under Sec. ,B&PC for this mason 204 - UNDERFLOOR FRAME Date 205 301 - UNDERFLOOR INSULATION - ROUGH PLUMBING One, WORKER'S COMPENSATION DECLARATION I hereby affvm under penalty of perjury one of the following declarations: 302 - TUB & OR SHOWER 0 I have and will maintain a CeniGcare of Consent to self -inside for Workefe ComKn. cation, m provided for by Section 3710 of to Labor Code, for the performance of the 303 - ROUGH MECHANICAL .,itfor which this peemitisissued. 304 - ROUGH ELECTRICAL ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3 05 - FRAME 3700 of Or Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation lnsu.nce ca ,, and Po�licyp/itmberam: 306 - HOLDOWNS cerci: Policy NR-�� 26- 307 - INSULATION C� ERTIFIC E OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 308 - SHEETROCK This aceienneed not he completed ifthe permit is formic hundred dollars ($100) 309 - EXTERIOR LATH or'caz) 310 - INTERIOR LATH I cenify Out in the performance of the work for which this permit is issued, l shall net 311 - SCRATCH COAT employ any permn in any manner so no to necomc subject to the Worked Compensation Laws of California. Date 313 501 - ROOF NAIL - FINAL ELECTRICAL ENERGY Appllcam NOTICE TO APPLICANT: If, after making this Ce oificate of Exemption, y ouahnulJ become subject to the Worker's Compewtion provisions of the Lahor Code. you must 502 - FINAL PLUMBING ENERGY fnMwith comply with such provisions or this permit shall M deemed revoked. 503 - FINAL MECHANICAL ENERGY CONSTRUCTION LENDING AGENCY I hereby affirm Nat there is a constmetion lending agency for the perfumince of 504 - FINAL BUILDING ENERGY the work for which Nis permit is issued (See. 309], Co, C.) Lender's Name 505 506 - FINAL ELECTRICAL - GAS TEST Lender's Address 1 certify Nat 1 have mad Nis application and state Nat the above information is 507 - FINAL PLUMBING emmecL lagree to comply with all city and county ordinances and sole laws relating to building conswnion, and hominy authona rep rsenlalives of Nis city to enter upon the 5 FINAL MECHANICAL above mentioned Progeny for inspection purposes. OA ADF FINts(We) agree to save, indemnify andkeep harmlessthe City of eugenic. against liabilities,judgmen, costs and expenses which may in any way accrue against said City 5N G in consequence of the granting of Nis perms. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by5 1 WORKS Date SOtuREL Re -roofs Type of Roof �///S/6O3 fAlm HAZARDOUS MATERIALS DISCLOSURE a� Will the applicant or future building Occupant store or handle hamodous material az defined by the Cupertino Manic ideate Chapter 9.12, and the Health and Safety 2ss32DO' /Jp - All roofs shall be inspected to any roofing material being installed. �de.Section 0Y.0No prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicam or future building occupmt use cyvipmesn or devices which emit haardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Distna] ❑Yes o I have read he haurdnus materialsmyviremen. under Chapterfi95nfNC Califon No building iia Health&ncil, Codc,Se.,. h. iti myrandishilk1 to nisvmtde occ Jres not v'urtcntly have a meant, thm it is my rtspomibility to notify the nroupanl of Nc scyuimmems which must M met prior in issuance ora Ceniicatc ofacuR�ncyt S ignature of Applicant Date it All roof coverings to be Class "B" or better ow rmalorindagent DDa/ta DMZ WOO F_L� ¢ZU zonKz OZ -0 ~d s�fa aOaU w3LL� F O W a0 0 as Xm —ZQ iRo 0Z Z2 CITY OF CUPERTINO BUILDING DIVISION PERMI _ BUILDING ADDRESS: 809 ROSE BLOSSOM DR OWNER'S NAME: JEAN AW PHONE: ARCHITECT/ENGINEER: LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section]JJJ000) of Division 3 of the Busine .and Professions Code, and my license is in full Nugond cff e License{',(ass Li M 7 15 0 ;11 Con CHr1Ecrs LARAT un crst n my plans shall be used as public records I L'.0 { Licensed Professional pv— OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5. Business and Professions Code: Any city or county which requires a Permit to construct, alter, improve, demolish, or repair any structure prior to ins issuance. also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the 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 not more than five hundred dollars ($500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself 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 purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to consuuct the project (Sec. 7044, Business and "rofessions Code:) The Contractor's Li- cense Law does not apply to an owner of proper y w.lo builds or improves thereon. and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law. ❑ I am exempt under Sec. , B & P C for this reason Owner Date _ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a Certificate of Consent to self -insure 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 Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance ca 'cr and Policy tuber are: / — arri Policy CERTInCXFE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Otis section need not be completed i f the permit is for one hundred dollars(S 100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become su hjcct to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Set:. 3097, Civ. C.) Lender's Name Lender's Address 1 certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURC REGULATION Sifnaturi of Applicam/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Munrc al Code. Chapter 9.12, and the Health and Safety Code. Section 25532(a)? ❑ Yes No Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management District? ❑ Yes o I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code. Sections 25505,25533 and 25534. 1 undcrsmnd (hat ifthe building docs not currently have a tenant, that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Certificate of Ocevgpncti, 11 OwW,�6r authorized agent //'y�� _ Date CONTRACTOR INFORMAL _-RAFTSMENS GUILD INC 10566 S DE ANZA BLV 366-1000 v: PERMIT NO. APPLICATION SUB DATE 01/15/2003 SANITARY NO. CONTROL NO. Job Description BUILDING PERMIT INFO BLDG ELECT PLUMB REMODEL KITCHEN/BATHRM & WINDOW UPGRADE Sq. Ft. Floor Area $ 6 0 WCation Occupancy Type 102 - PIERS equ►red Inspections 103 - UFER 104 - REBAR 105 - ANCHOR BOLTS 106 - SEWER & WATER 202 - UNDERFLOOR PLUMBING 203 - UNDERFLOOR MECHANICAL 204 - UNDERFLOOR FRAME 205 - UNDERFLOOR INSULATION 301 - ROUGH PLUMBING 302 - TUB & OR SHOWER 303 - ROUGH MECHANICAL 304 - ROUGH ELECTRICAL 305 - FRAME 306 - HOLDOWNS 307 - INSULATION 308 - SHEETROCK 309 - EXTERIOR LATH 310 - INTERIOR LATH 311 - SCRATCH COAT 313 - ROOF NAIL 501 - FINAL ELECTRICAL ENERGY 502 - FINAL PLUMBING ENERGY 503 - FINAL MECHANICAL ENERGY 504 - FINAL BUILDING ENERGY 505 - FINAL ELECTRICAL 506 - GAS TEST 507 - FINAL PLUMBING Y 5 FINAL MECHANICAL 0 9 � F I NA1L� GRADE /i Re -roofs Type of • • All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better CITY OF CUPEI�TINO CITY OF CUPERTINO PERMIT APPLICATION FORM r APN # < r O Fee Description Date: c� Building Address: MECHANICAL BCONSTAX Owner's Name: / f BUILDING : PhV: Ind/Off/Comm/Quasi Contractor;G f j4fT5A . � NIS GV f L I� G License # �O Contact:/I( Hotel and Motel Phone #: ;111� 40 A licant/Contractor: Applicant/Contractor: Constax - Resi/Mobile #: Fax ��� — is Qo Buil ng Permit Info: B Elec Plu ec Job Description: Residential: Co e i BELEC200 Sq.Ft. Floor Area: t ELECTRICAL $/Sq.Ft.: Enerey Architect/Engineer: fl f 44_E�-47r 6 I L NC Valuation: / Type of Construction: BINVESTIGA Occupancy Gr up: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances 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 BELEC 1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Enerey BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWlvIULTI New Multi -Family Res MECHANICAL BNEWMULTI New Multi -family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBIN 1 of 3 I� c� /lbs<3Z CITY OF CUPEIkTiNO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BNUMULTI New Multi -family Res PLUMBING BOVER T IME Overtime BUILDING BPBACKFLOW -Inspection 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 97) BPREPIPE Re i e 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 cfm MECHANICAL BREMAM AN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFITRNOV Relo Furnace > 10K 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 BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL 2 of 3 CITY OF CUPERTINO PERMIT APPLICATION FORM QuanpiU Fee ID Fee Description Fee Group BREMVENFAN Vent. Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING -� BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSF&2FAM Single & 2 Family BUILDING BSFNA Single Family New Add BUILDING BSPECIAL Special Insection 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 Chane 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 > 1.75 M Btu MECHANICAL 3 of 3