06050060 CITY OF CUPERTINO z°sem ,
BUILDING DrVISION PERMIT CONTRAGTQI2INFQRMr�.TION a:
BUILDING ADDRESS: ` KITCHENS BY MEYER PERMIT 110.06050060
10017 SPANISH QAK CT
OWNER'S NAME: PERMIT ISSUE DATE
PALMER 278 CASTRO ST OS/08/2006
ONE: SANITARY NO. CONTROL NO.
(415) 968-8318
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
iO0 LICENSED CONTRACTOR'S DECLARATION
a 1 hereby affirm load 1 unlicensed under provisions of Chapter 9(commencing Job Description
i<o, with Section 7p00)of Division 3 ofthc Busincssa.d Professions COde.sed my Beane is
in full force mdeffect. 32 pelf DECORATIVE GAS APPLIANCE INCLUDES ELECTRICAL
•.�z Licenq Class Lic.g
;F Dae(/}I� n�—comracmrl �-�,e r' SWITCH. ORIGINAL PERMIT# 06020040
ECrSDEcuanTION THIS IS A REVISION ISSUING PERMIT CARD ONLY
lee I understand my plans shall W used as public records r
IyV
0 Licensed Nofassional
OWNER-BUILDER DECLARATION
CamusON
C I hereby alRnn that 1 1. exempt from the CantranCo License Law for my
<p O Whichfollowing reason. nun,ar,Ano Buainm and Profesduns Cade:Any city or county
m which or in its issaapermit reetres thLmmr.im for
Nmiitt me a sig any SVYnure
INSWitsiensedp rpount also uims pro provisions of
for Contractor's
filcaeLaw(Chned mmcm
-�< lo,atleincingwJpurstionUS 70 of
uo oline f
li¢mclxiw(Chepter9 Sq.F[. Floor Area Valuation
u $ (commencing With Section 7000)of Division]of the Business and Profeuiam Code)or $500
y Nat he u exempt therefmm and the basis for the alleged exemption.Any violation
of
Section 7031.5 by any applicant for a permit objects the applicant to a civil penalty of APN Number Occupancy Type
net more than five hundred dollars(MS
0 1,as owner of the property,or my employees with wages u their Sale compensation,
Will dodo,work,.ndmeswcmrtnnot intended oroffered for sale IS".70".Basilnes - Required actions
red Professes ions Code:The Comactor,License Law docot apply m e an owner of 9 p
property who milds orimproves dmmon,said who doessuch work himselfor Waugh his
awn employees,provided 0.1 it+mpmvements arcnot inmtdedroRered firsale.IL
however,the building or improvement is to within ane year of completion,Ne unne,
builder will have Ne burden of proving that In,did not Mild or improve for purpose of
.I,.I.
0 1,as Owner of She:property,am exClasively Can=ing wit IiceruW conuanom m
Conswcl to project(SO..7()44.Business and Professions Cade:)The Contracto/a Li-
continue Law does not apply In an owner of pro,ovy who milds or improwea thereon,ad.
who conm is for such projects with.eomractar(s)Iicemand punuam w the C...torS
Lk-.La W.
❑lam exempt under See Data for Nu rtawn
Owns Data
WORKER'S COMPENSATION DECLARATION
41 1 hereby&ifuns under penalty of perjury am of the fallowing declarations: \
❑1 have and will maintain a Cnofiam of Carsem m silt-invert far Warkefs Compcn-
aadm,as provided fair by Section 3100 of on,Labor Code,for the perfofmana of to
Woh for Which this permit is issued.
0 1 have and will mainuin Workoes Compensation Insurmce,as required by Semon
3100 ofthe Labo Code.for the pedo mce ofte Wok for which this permit is issued
My WmMes Coompentation fromr.ce canner and Policy mortoorr art:
Cartier. �/Jf YV1 P.VS IVIS. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE v
(ITU section need aotbeeonpkmd if to permit is foram hundred do0us(SI00)
or less_)
1 urn fy that I.We perfomtuec of the Work for which this penal,is limed.I shall not
employ anyperun in any manner in as b became subject in the Workers Compensation
Laws of Cah omia.Data
Applicant
NOTICE TO APPLICANT.If.after making this Cuf ificam of Exemption,you Should
become subject m the Wert Compassion.provisions of sic Ionor Cade you muss
.J O faMwith comply wit such provisions ch mu abe permit shad) deemed muted.
E7) CONSTRUCTION LENDING AGENCY
F 1 herby affirm that them is a construction lending agency for the performance of
Clthe Work for which tis permit u issmd(Sec.3097,Civ.C.)
Uj Q Leader's Namc
z Lenders Address
f)Q 1 anify that 1 have read Nis application and sou Out the above information is
l+. F Cartmel.I agree to comply With all city and county ordinances and sum laws relating to
OV building construction,and hereby autarire representatives of this city to enter upon the
ahovc-mc judgm pmpc costs
for a pcNOn purposes.
a (We)agree to Save,indemnify and keep hennkas the City of Cupcnino against
h Iia consequence cnu,costsmd expenses which may in any way accmc against Said City
V,'� APLICANec of thegrantingof this permit.
r. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
s0 RCE ^VIATONS�j
/fir—, /�-
610106 Re-roofs Z��
Signdium of ApplicanUCoutrantar Data
HAZARDOU MATERIALS DISCLOSURE Type of Roof
Will the applicant Or future Wilding occupant store Or Walk haaardous maw"
as defined by the Cupenina Municipal Code.Chapur 9.11,and the Health and SafnY
Cat.Basion 15531(3)7
E:]Yen �Nu All roofs shall be inspected prior to any roofing material being installed.
Will to a Ihxnt Or future building aea nth ai If a roof is installed without first obtaining an inspection,I agree to remove
pp e e Wal it Qu or dewire a men g P g
emit hvaMus air conuminrnu as de0md by the Bay Arta Air Quality Management all new materials for inspection.
Distrix?
CYes Nu
I ham sad the hvudoutmadmials requiem ntsunderCMpmr6.95ofthe Califm.
nu Hahn&Safety Code,Savms15505.15533 md25534.1 umknund lowifde building
does Out cumnly have a,nam,dust it u my responsibility m ratify loe Occupant of the
rt iq,Lm�1�nae " `e' rgn/i� Signature of Applicant Date
Owner o mtoomd agent /25�DU,c All roof coverings to be Class •'B•'or better
Community Development
10300 Torre Avenue
420
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
SCUPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
OWNER'S NAME: `y PHONE #
GENERAL CONTRALTOf vk, FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
• Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contras r Signature Date
CITY OF CUPERTINO
sm 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 34232082 . 00
DATE ISSUED. . . . . . . : 05/08/2006
RECEIPT # . . . . . . . . . : 34295
REFERENCE ID # . . . : 06050060
SITE ADDRESS . . . . . : 10017 SPANISH OAK CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PALMER
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5623
RECEIVED FROM . . . . : KITCHENS BY MEYER
CONTRACTOR . . . . . . . : MEYER, ROMOND P LIC # 19637
COMPANY . . . . . . . . . . : KITCHENS BY MEYER
ADDRESS . . . . . . . . . . : 278 CASTRO ST
CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94040
TELEPHONE . . . . . . . . : (415) 968-8318
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPLANCKREP HOURS 3 . 00 261 . 42 0 . 00 261 . 42 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 261 . 42 0 . 00 261 . 42 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 261 .42 9384
TOTAL RECEIPT 261 . 42
•
mmw
CITY OF CUPERTINO NDN
Or PERMIT APPLICATION FORM 01JO WOO
CUPEkTINO
R-Sav tS ,-6e 0(4qjneLt W�IJd�V ILJ
4VPN # 342- 3a- 00 2 Date: S �;2 _ o
Building Address: �M • i g Address (if different from building address):
Owner's NamePa Phone # f / %
-, p O/C?(1O
Contractor: License#: I�,� O
-3o i
Contact: Phone: `)(,g r196L Cupertino Business License#:
Fax: (yxok 4�1
Building Permit Info: 1�COrCrh Gcu-, oo0u,&- ftit"CI") e&JHCCe
Bldg ❑ Elect Plumb Mech
Job Descrip 'on:
Residential X Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: Occupancy Group:
,J �3
Type of Construction: Please check this box if the project is a
Usecond-story addition: ❑
ro•ect Size: Standard CY Large ❑ Major ❑
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/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
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CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
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 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 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
13 EMWURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Fumace> 10K btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Mise 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 Ak2pliance ELECTRICAL •
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CITY OF CUPERTINO
• CITVOF PERMIT APPLICATION FORM
CUPEkTINO
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 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 Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
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