03050070CITY OF CUPERTINO
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CoTllii CTOR INFO;RMII,TION
BUILDING DIVISION PERMIT
,
BUILDING AJDRESS:
r
VANNI BROTHERS CONSTRUCTIO
ERMITN0.03050070
OWNER'S NAME:
914 HYDE AVE
PERMIT ISSUE DAM
PHONE:
(408)253-7028
SANITARY NO. CONTROL NO.
HITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB
0 0 0
MECH
0
LICENSED CONTRACTOR'S DECLARATION
I herchy affirm that 1 em licensed under provisions ofChapterCoder 9 (commencing
Job Des t
with $Cor,.n
Business and Professions Cotler and mylicense isI.
fall an affect.
cffeo Lic.It
Licarom Class
ADD 437 SQ.FT./REMODEL
!�y
Dam ContractorAPR
ARCHITECTS DECLARATION
2 2004
I understand my plans shall he used a public records
B'YICL)ING
Licensed Professional
OatNER BUILDER DECLARATION
�/
1 herchy. License Law for the
that I am exempt tram he Colons
followingacus.. Sect 7031.5, Business and o
emoli Code: Any city or county
improve,
which reyuiru a porton to cnntlrvcL elle. improve, any swcmre
Permit
h permit t fie a sig
prior a, its issuance, also pursuantIn the the applicant for such permit m Glc a signed statement
he previsions of the
wit pSectio
License Lew (ChapterCode)
Sq. Ft. Floor Area
Va uauon
(that
(commencing with Section 7(and of Division 3 of the Guineas and Professions GMs) or
commencing 7") the
but he is
Net he is exempt therefrom end the basis for he alleged exemption. Any violation of
Section 7031.5 by any Applicant for aPermit subjects due applicant toacivil Penalty of
APN Number
Occupancy
P 1YPe
not more Nen five hundred dollars (55110).
Y
❑ I, as owner ofthe prepeny, or my employees with wages as their sale compensation,
will do the work, and the structure is not intended or offered forsalc(Sec. 7044, Business
101 -
FOUND� d Inspections
and Professions Codc: The Contractor's License law does not apply to an owner of
property who builds or improves thereon, and who doasuch work himselfor through his
102 —
PIERS
own employees, provided that such improvements are not intended or offered foredo. If.
103
UFER
however, the building or improvement I. sold within one year areompletion. the owner
-
builder will have the burden of proving that he did not build or improve for purpose of
104 —
REBAR
ale.).
105 —
ANCHOR BOLTS
. owner properly, exclusively contessions with licensedonnmaors to
ru
construct raj ct . Business
notapply.oanOwneandrtywh WidsorOThoesthemor'aLi
106 —
SEWER & WATER
does
wholawdeernotapplytoanownerofpmpcnywhobuildsoranttothedtereon,and
who contracts for such projects with a can,anor(q licensed pursuant m the Comncmr's
202 —
UNDERFLOOR PLUMBING
License Law.
❑lam exam o. ,
der SecB&PCfsr this moon
203 —
UNDERFLOOR MECHANICAL
�(
204 —
UNDERFLOOR FRAME
Owner AAI f'SCOMPENSATION LARAT�
205 —
UNDERFLOOR INSULATION
I hereby affirm ocular Penalty of perjury one of $a fallowing declarations:
301 —
ROUGH PLUMBING
have and will maintain a Cardigan of Consent self -insure for worker's Camino.
302 —
TUB & OR SHOWER
as provided for by Section 3700 of the Labor Code. for the performance of the
303 -
ROUGH MECHANICAL
for which this permit is issued.
❑ I have and will maintain Workers Compensation Insurance, as retained by Section
304 —
ROUGH ELECTRICAL
3700 of the Labor Code, for the performance of the work forwhich Ibis permit is Issued.
305 -
FRAME
My Workers Compensation Insurance carrier and Policy number am:
306 -,
HOEDOWNS
Policy No.:
Cosier. CERTIFICATE OF EXEMPTION FROM WORKERS'
307 -
INSULATION
COMPENSATION INSURANCE
308 —
SHEETROCK
scainn need not be completed If the permit is for one hundred dollars IS 110)
309 —
EXTERIOR LATH
or lless)(This '
I acetify that in the performance of the work for which this permit is imu.d.I shalt not
310 -
INTERIOR LATH
employ any person in any manncrsn in to become subject to the Worko'Cnmpensation
311 —
SCRATCH COAT
Lim of Calirornfin Data
Applicant
313 —
501 —
ROOF NAIL
FINAL ELECTRICAL ENERGY
NOTICE TO APPLICANT: If. flat making this Ccnifiasm of Exemption, you should
become subject to the Worker's Com genualprovisions of the Labor Code, you muss
fonhwitoComply with such prnismasorthis permit shall hedeemed revoked.
502 —
FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY
503 —
FINAL MECHANICAL ENERGY
I herchy affirm that here is a consmeinn lending agency for the performance of
the work for which Nis permit is issued (Sec. 3(197, Co, C.)
Lenders Name
504 -
505 —
506 —
FINAL BUILDING ENERGY
FINAL ELECTRICAL
GAS TEST
Lenders Address
I cenify bat) have read this application and ata, that the above informatiun is
cancel. I agree to comply with all city and county ordinances and state laws mlating t.
507 —
FINAL PLUMBING
building construction, and hereby auhorim representatives of his city to enter upon the
FINONG ICAL
above-mentioned property forinspeelion purposes.
(We) agree to leve, indemnify and keep harralss the City of Cupertino against
O 9
F I
liabilities, judgments, costs and expenses which may in any way accrue against said City
in
5
conscqucncc of @c groming of this Pcrmil.APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: 5
WORKS Date
EREGU1'ONS,/�
Re -roofs
Type of Roof
��.s / b
r 7
�SOU
� /� �or
gnamrc of ApphceHAZ racmr Data
HAZARDOUS MATERIALS DIS SURE
Will the applicant or future building Occupant,Chparose or hazardous materiel
i. f
u d, Sec by the nn Municipal Coda Chapter 9.12, utl the Health and Safely
and the
32(.)?
Codc, Section 25532(e)?
❑Yea Nu
All roofs shall be inspected
prior to any roofing material being installed.
Will the applicant s future building occupant useegmpmcm ordemas which
If a roof is installed without first obtaining an inspection, I agree to remove
iI hazardous air contaminants as defined by the Bay Arca Air Quality Management
all new materials for Inspection.
ell
l
❑YesNo
-.
- I have rand the havardous materials requirements under Chapter 6.95 ofthe Califor-
nia Health C Safoy Cud., Sections 25505,25533 and 25534.1 understand deaifhe building
'
does nr, currently how a tenant, hoe it is my responsibility to notify the Occupant of he
mtuircmc whiahma Hamer rtoi uanceoraccoiricateorOccupancy.
Signature of Applicant Date -
All roof coverings to be Class "B" or better
/�
or aunh rizcd agent Data
Cin OF
CUPERTINO
&Y OF CUPERTINO 0
PERMIT APPLICATION FORM
P_PN #
Date: 5'/)(0163
Building Ad ss:
Fee Description
Fee Group
s Name:
Owner=10.,
ar
�%��5ti
P ne
o� Z5S-icl
Contracto:
Q�
UA VI VI'l VAnnt br�Fhe✓s
icense #:
Contact:
ar_hm',�
Cupertino Business License#:
Building ermit Info:
1
-Bldg'
ect Q' Pl b
/ech rJ
Job cription:
BBOILER4
Boiler> 1M to 1.75 M Btu
'Rigidential �R
ICommercial
❑
Sq.Ft. Floor Area:
BCONSTAX
$/Sq.Ft.:
Cost of Project:
116oI
C)
Occupancy Group:
v��l
Type of Construction:
BCONSTAXBQ
I of
Quantity Fee ID
Fee Description
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
BBLDGFEE
Bldg Permits . foot
BUILDING
BBOILERI
Boiler <=100,000 Btu
MECHANICAL
BBOILER2
Boiler > IOOK 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 <= IOOOA
ELECTRICAL
BELEC1001
Elec 600V > IOOOA
ELECTRICAL
BELEC200
Elec Svcs 600V <= 200A
ELECTRICAL
BENERGY
Energy
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
BINVESTIGA
Investigation fee
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
BUILDING
I of
ano
CUPERTINO
PITY OF CUPERTINO
PERMIT APPLICATION FORM
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
BNEWMULTI
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
BUILDING
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
BPINI'ERCEP
Ind Waste Interceptor
PLUMBING
f BPLANCHK
Plan Check Fee
BUILDING
BPLANCKADD I
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/Ram Water
PLUMBING
BPTRAP
I 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
BREMFURN
Relocation of Furnace
MECHANICAL
BREMFURNOV
Relo Furnace > l OK btu
MECHANICAL
BREMHEAT
9
Heater Installation
MECHANICAL
BREMINHOOD
Installation of Hood I
MECHANICAL
BREMMISC
Misc Apparatus
ELECTRICAL
BREMNRAPP
Rem Non -Res Appliance
ELECTRICAL
BREMPOLE
Pole/Platform Fixture
ELECTRICAL
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2 of 3
CITY OF
CUPEkTINO
9 CITY OF CUPERTIN#
PERMIT APPLICATION FORM
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
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
PPERNUTFEE
Plumbing Permit Issuance
PLUMBING
PPLBG
Plumbing Fee sq foot
PLUMBING
ZADDCHG
Address Chane
BUILDING
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