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
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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
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