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04070091zaa,C �Zu << Z� ,�,Y of CC ham i.�• 0 z a a U 0 U CITY OFC JPERTINO a�4+sA `(' BUILDING DIVISION PER BUILDING ADDRESS: LEPETICH JAMES A ET AL PERMIT"D04070091 20570 PERMIT ISSUE DAM OWNER'S NAME: - LEPETICH JAMES A ET A SANITARY NO. CONTROL NO. NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: - BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing 'i with ScOion 7IXlo)of Division3of the Business end Prefceions Cedc,and mylicense is in Wu fame and affect. DEMO EXISTING BBQ/BUILD NEW ONE License Class Conti attar DBN Contractor - ARCHITECTS DECLARATION ARCHITECTS ! 1 understand my plans shall W used as public records - Licensed Professional ON i OWNER -BUILDER DECLARATION Conti License Law ror the I hereby .(Sero that 11. exempt from the Cantons Coo i following tosser. (Section ](131.5, Business and Professions Code: Any city nr county 1 which acquires a permit o construct. Slot, improve, demolish, ..pair any svuetuo S prior to its issuance. also requircume applicant ror such permit to Glc a signed statement Law 9 Sq. Ft. Floor Area Valna[10❑ i that he is licensed purauan to the provisions Of the Canuxor''sLicense (Chapter (commencing with Section 7")of Division 3 of the Busineeund Professions Code)., 3 thea he is exempt themfram and the basis for me alleged uemptiom. Any violation Or IX er0 0 Occupancy Type Section 7031.5 by any applicant for a permit subjects the appiicanno a civil penalty of not... man five hundred della. (5500). r ' 01, as no, of the property. -1myemployees with wages as Well sale compenatlon, Required Inspections 9 p willdotheenork,anathe swctoreitnotinondedorofferedforsale(See.70 .Business e Conuors License Law does not apply to ea owner of aaI Professions Cmc: Thu propeny who builds orimproves thereon, and who doessuch work himselforthrough his Own employees, provided tat such improvements sre nOinonded orolfered foreale. If, however, the building or improvement is Sala within one year of completion, the owner builder will have me burden of proving that be did not Wild or improve for purpose of , sale.). ❑ 1, as Owner of the property. am exclusively convecting with licensed contracoss In ' construct ite project (Sec. 7W. Business and Professions Co he) The Canmcor's Li. cense law dose not apply to an owner of property who Wilda or improves memon, and, who contacts for such projects with a contractor(s) licensed pursuant In the Convector's License Law. Ism emptunder Sec. 8&PC or this moon ,-- 0 er `� Dale 7 I L Q ENSATION DECLARATION A O WORKER'S CO I hese y affhm under Penalty of perjury one of me fallOWPOLIsations: I have and will maintain a Certificate of Consent to adf-houre for Worker's Compen- ration, as provided for by Section 3700 of the labor Code, far me Performance of the work permit Car which this peit is issued. 1 have and will maintain Worker's Compensation Insurance, as refined! by Section 37W of the labor Code. for me is rfamence of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEM MON FROM WORKERS' COMPENSATION INSURANCE (This Sectio need not he completed if the Permit is foram hundmddoila. ($100) ror less.) 1 certify th t in me perfmtmence of the work for which Nis Permit is heard, l shall not employ rson in any manner pal Lc me Subjedmme Workcrs'CompensaGon Law of a forme. Date A Y N 1 E 0 PPLICANT: If, eftd making this Certificate of Exemption, you should Lehnr Cnde, moa became SUM1 d o the Worker's Compensation provisions of me you Z forthwith comply with such provisions or this permit shall W deemed raveled. yCONSTRUCTION LENDING AGENCY 1horw affirm therein iso lending agency for the performance of issued > me work for which this permit is issued (Sec. 309], Civ, C.) ? Lcnucr's Name � Lrwrrs aaamaa I cvnify mat I have read this application end sante met We above ofommium is cortin. 1 agree to comply with all city and county ordinances and area laws heisting W building construction, and hereby authorise representatives of dens city to enter uPor me ..ewe- (we)a ad gree to surerty far imap ify a purposes. y (we) agree o ave, indemnify and keep harmless the City o Cupertino against in any way accrue againslsaid City A IiabiliGu,judgmcnv,eosan and expenses which they in consequence of the granting of this permit. APPI.ICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT T/V Issued by: Date SOI�CE REGULATIONS. S2 r - u��Cr n0 7I[6104 <Z Re -roofs Type of Roof SA 'cOfAPPlicamuCcuma� r Dao k/ HAZARDOUS MATERIALS DISCLOSURE Will thc applicsm or future building Occupant stare or handle Waxi ous material as dc0ned by the Cupenino Municipal Code, Chapter 9.12. and the Health and Safety Cade, Saner 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑ You gNu If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment Or devices which call W.Rous air contaminants as dcGncd by the Bay Area Air Quality Management all new materials for Inspection. DisricR ❑Yes [�Nu I have read the WasNeusmatcrials requirements under Chapmrb.95 aide, Califon nia Health & Safety Cook, Sections 25505.25533 an125534.I understand thatif the building Ja�s,snot cromed have a tenant, mat it is my responsibility o notify me occupant Or me regdirements hichanan t<ptiorte;aasncearac,rd0aamora<pancy. Signature of Applicant Dale �-dee—�nyv��Cr n, lU 11+6'I All roof coverings to be Class "B" or better Uwnmr auNarnrcd recent Data ac Assessor's Parcel Nu4er: 3 5`i - is - Oil Name of owner., u L Project address Contact person. Phope.- 1 4-mak i Z b' Fax. Net square footage of Existine Proposed Square footage: First floor: I z'- fL Second floor: — Garage: A OP C? F TOTAL: 2I VL rCGC tern E {t'�.pEVi'I r c D Are there at least two 10 foot by 20 foot clear spaces inside the garage. `�USS b9 Is privacy protection planting required for the project?YD N 1 P�Ai �d unlavrh� $'.a set of P 1 emea n same On what floors) is work being done?� r ; �j Vol on 0% b an9es of alter ntha SUOM9 tc, make doyen Pann�ston no. tlons Brief description of world% C6- s Q -V ; 5, 4! it- c oti t IJ IG Ja Ir k Kti aNn°' d j7e ,ca OTbs —V aY"any 9wv n 01 Code editions: 2001 CBC (Y - N)2001 CFC (Y - N)200 C9Col th " �jStoL&*- 08 2001 CPC (Y - N)2001 NEC (Y - N) w„y cm 040 Effective 11/1/02 Plan Review Process Work Book Page -8-Revised 4/28/04 n F— L L T oo . CUPEkTINO *CITY OF CUPERTINO• PERMIT APPLICATION FORM o�/o�a0/1 APN # O l Fee Description Fee Group BAPPLOTHER Date: Building ress: -Zos;;W S C-09 w �rp �u Mailing Address if fferent from ilding address): Own Name: BBOILER2 Boiler > 100K to 500K Btu MECHANICAL Phone #: Contra m u nnY MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu License #: Co �cauao.s /� • l_nP.uSi`e�, Ph e: 4o�/2s2 i�Lg F yn MECHANICAL Cupertino Business License#: Building Permit Info: Bld ❑ Elect ❑ BUILDING Plumb ❑ Mech ❑ •JobDescn tion: cSosn,,UA, .� ;_s,v0 3iB Q 3 Residential W rek - JC 15a Commercial ❑ Sq.Ft. Floor Area: BCONSTAXH Hotel and Motel BUILDING $/Sq.Ft.: Cost of Project: BUILDING BELEC1000 Elec 600V <= 1000A Occupancy Grou Type of Constructi n: Elec 600V > 1000A ELECTRICAL BELEC200 Please check the s the project is a second -story addition: El Project Size: Standard ❑ Laze ❑ Major ❑ Energy BUILDING Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL 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/OfFComm/ uasi 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 L WITY OF CUPERTINOO PERMIT APPLICATION FORM 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 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 BREMAIRHAN A/C Units <= 10,000 din MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace > 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 BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT I Repair/ her Heating MECHANICAL BREMRESAPP I Remodel Res App liance ELECTRICAL 2 of 3 i OCITY OF CUPERTINO* cuPEZ0 PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs 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 Inspection 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 Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 • LJ BUILDING DIVISION PERMIT BUILDING ADDRESS: Ytnml a IVU ^ ---- _ __ LEPETICH JAMES A ET AL 04070091 NAME: L0G LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm That 1 and licensed under provisions of Chapter 9 (commencing with Section 7000) o'Division 3 ofthe Busidessand Professions Code,and my license is P w in full footstool effect. jLicense Class Let. g gi Dam Contractor ARCHITECTS DECLARATION �i I understand my plans'hall he used as public records U ? e t; Licensed Professional 3OWNER-BUIIAER DECLARATION <� 1 Wmhy effum that 1 am exempt from the Contractor's License Law for the 0 O following mason. (Sccfi 7031.5, Business and professions Cade: Any city tar coumy y 3 2 which requires a permit to construct, ager, improve, demolish, or repair any nmclum HZi prior In its issuance, also requires the applicant forsuch Permit to file a signed statement xx that he is licensed pursuant to de, previsions of the Commoner Licence Law (Chapter 9 yF$ (commencing with Section 7")of Division 3 of the Business and Professions Code) or that he is exempt Ihem(mm and lase basis for the alleged exemption. Any violation of Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of not mom than five hundred dollars (5500). O 1. m owner of Ne potty, or my employecs with wages o theirsole compensation, will do the work, and theatructum is not intended proffered footle (Sec. 7064, Business and Professions Code: The Conhacures License Law doe' not apply to an owner of the owner. hive the burden of proving that he did not build or ] I. as owner of the property, am exclusively contracting with licensed mustaches to convect the, project (Sec. 7846, Business and Professions Cade:) The Conmcmr's LI - cense Law docs not apply in an owner of property who Wilds or improv daemon, and who contracts for such pmjeets with a comma or(s)licensed pursuant to the Convectors Lt.. Law. 41 em emptunderSec B&PC pr this moon Da//m 7 f 4 Q WORKER'S COh ENSATION DECLARATION 11 Ila y affirm under penalty of perjury one of the followwjp declamdons: ❑ I have and will maintain aCenifiews in Cunsent to self-irrum far Wori efsCorepen- .k., as phvided for by Section 3780 of the Labor Code. for Ne performance of the ❑ 1 haw and will maintain Workers Compensation Insurance, as required by Section 37W of the Labor Code, for the performance of the work for which this permit is issued. My Workers Compensation I.e... carrier and Policy number am: COMPENSATION in the performanec of the work for which this permit is issued. l shall PERMIT ISSUE DATE �,gI LJob SII ascription DEMO E S D NEW ONE NOV *q 2004 BUI Area NO ICE. hPPLICANT: IL a idt making this CertiRcasa of Exemption, you should become sub cl he the Workar's Compensation previsions of the labor Code, you mug ,J 2 foMwido comply with such provisions or this permil shall W deemed revoked. z OCONSTRUCTION LENDING AGENCY [-�� I hereby affirm that them is construction lending agency for the performance of the work for which this Intent, is issued (Sec. 3097, Ci, C.) Q Lenders Name Z) z Lenders Address U Q 1 certify that I haw mad this application and sum that the above information is H correct. I agree to comply with all city and county oNinances and state laws mlaling to DU building consudetion, and hereby authorive representatives of this city to enter open the Cn alcove-menfuoad property for inspection Purpmea Qy (We) agree to save, indemnify and keep harolen the City of Cupertino against rq liabilities,judgments, costs and expenses which may in anyway some against said City U Z in consequence of the grafting of this Permit APPkICANT UNDERSTANDSS AND WILL COMPLY WITH ALL NON -POINT Issued by: HAZARDOUS MATERIALS DISCLOSURE Will the applicant or forum building Imcup rt slam or handle hazardous mandai as doffed by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety Code, Section 25532(a)? ❑Yes pino Will the applicant or future building occupant use equipment or devices which Omit hamardoes air contaminants as defined by the Bay Area Air Quality Management Dishier? ❑Yes ((No 1 have mad the hmallous materials oxluimmenb under Chapter 6.95 of the Cilifor. nia Health A, SafetyCode, Sections 25505.25533 and 25536. I understand Nat ifthe Wilding tlagp not emmody hew is utown, Nat it is my reaponslhillly, to nod I the acupem of rhe T Re -roofs Type of Roof Required Inspections type i10 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