04050074 CITY OF CUPERTINO °r'„f??AY�y��s�w�y�r�'m+zitizl-y�nrT7x7LLTT��'P<a4--���+��
BUILDING DIVISION PEB eCVI�l(1�4�,d 1tAt,l'VR �' N
BUILDING ADDRESS: SARATOGA KITCHEN & BATH PERM..No04050074
mgER'S NAME: PERMIT ISUB DATE
GEORGE
PHONE: SANITARY NO. CONTROL NO.
(408) 281-9250
ARCHITECUENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p
i10a2 LICENSED CONTRACTOR'S DECLARATION lbDescri [ion
1 hereby affirm than 1 am op
licensed under provisions of Chapter 9(commencing
8 with Section 7000).f Division Sof Ne Buainm and Prefessluns Code,andmyliceve is
888y m mu farm and cruet "18$3Vp BATHROOM REMODEL
Gp? Lkam.Cl, Uc.a
F Dam Contractor
9 ARC CTS DECLARATION
I urbcmund my plans ho anis panAJlc rtcrNs ,.
il:8V; LkcnudPru— fcss� u '
OWNER-BUILDER DECLARATION
E I hereby affirm that I am exempt from the Como ctofs License Lew for tic
S a o (.[Irwin&moron.(Sudan 703 t'5,Busims and Pmfes,lons Code:Any city or county
n$9 which requires a permit to construct,slot,improve,demolish.m unfair my structure
f2� poor b iU Issuance,also require{the applicant for such pmnllt b rile a signed conformal
Elm that he is licensedpursuanitotheprevision of theConuacoriliaenuLaw(Chapter9 Sq.Ft. Floor Area 9 J Valuation
l$ (mmmoneing wlN Section 7000)of Division 3rf the Budneaend Professions Cade)ur /
.- Jun he Is exempt Motorman and the barb for the alleged exemption.Any violadon of
Semlon 7031.5 by any applicant for•permit subjects the applicant to a civil Penalty of 3 WNQm"erO 0 �Pceupancy Type
not ream Nun five hundred dollars($500}
0I.aowneroftiepropany,mmyemp[oymwithwagsudnbso)ec mmdon,
will do do wmk and NesWnure Is notlnunded.r offered(orsnle(Sec.70th,Business
and Professions;Calc:The Contrmors Llan taw dons net apply to in owner of Required Inspections
pmpeny who bui Ids or impoves thereon,and who does such work himself or through his
awn emp[oycs,provided Nn such Impovemena art am intended reoffered(msale IL _
however,Ne building m Improvement is mid within am:year ofc mpledon.the owner.
Wilder will have me bund.of proving WI he did.m Mid or improve for purpou of
sale.).
0 1,a owner of do reopen,am exclusively contracting with[lamed contr sem 0
construct tha project(Sec.7044,Business and Protection Code:)The Comeuter's LI-
cans taw dean not apply to an owner of property who builds or improve Merton.red,
who contracts for such pmjecu with a c.ntncor(s)Rcemed pursuant he the Contruorl
I=
Law.
am exempt under See ,B&P C far this moon
War Dao
WORKER'S COMPENSATION DECLARATION
1 hereby affhm under penury of perjury one of the following declarations:
0 1 have and will mdnuin aCeNTimm ofConunt(o self-insure for WoraersCompen-
natlon,as provided(or by Section 3700 of the labor Code,(m the Performance of Ne
work for which this pnmit is issued.
1J 1 bans{and will maintain Worker&Compemdon Imran.,as required by Sedan
3700 ofd.labor Code.for Ne Performance afore wag rmwhich NU Permit is Wood.
My Worker Came Nan I nm carne ad Poliry�;�m: PP 39
Carrier. icy N..: , 3y
CL FICATE OFEKEMM NFROM WORKERS
COMPENSATION INSURANCE
(TidameOo need not becompkmd lithe permit isformen hundred dollen($100)
or lea)
1 comfy Nat in the performance of the work fm which this permit is issued,I shall am
employ any person In my mmneran as to become subject b Ne Workers'Compenndon
laws.(Califorme.Dao
Applicant
NOTICE TO APPLICANT:If.after making this Ccr iflcam of Exemption,you should
became subjm an the Worker's conformation Previsions of Ne Labor Code,you must
,J O (orNwith comply with such provisions or this permit shall be d.em.d mmlmd.
z� CONSTRUCTION LENDING AGENCY
,4 I hereby affirm that there is a constru than lending agency for the Performance of
Llai�,t
the work for which this permit Is Issued(See.3097,Civ.C.)
W�Q Lender's Name
Lender's Addrea
C,)Q I unify that I have mad this application and sem that the above Information is
IT,;'! corm.I agree to comply with all city and county on inances and sur Im totaling to
Q SV' building convection,and hereby smhodu repmsenudm of this city to color upon Me
I&l ahovo-mendmdmpeny fopeN
r inson PurPDWL
&L (Wu)-.j;;.'t.ave,indemnify ad soap harmless de Cry of Cupertino &,last
mu
In Iiabilk"Judimenu,candexpcus which may in anyway emus against aid City
V r77 in eomquenee.l Ne grenting.f Nu permit
APPLICANT UN ANDS D .COMP WITF�ALL NON-POINT Issued by: Date/-,
APPLIC REGU ONSy 5/4'
/N- OI N
//`� Re-roofs
Signature ol'APPIXIMUCOnflum3m
HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof
Will dor applicant or future building occupant port orbandle h eco dour material
Oncd by the Cupertino Municipal Code.Chapter 9.12,and Ne Health and Safety
we,Section25532(O? All roofs shall be inspected prior to any roofing material being installed.
❑YeIff e'
Will the applicant or rumre building occupant m equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
out mock o air comuninam as defined by the Bay Area Air Quality Management all new materials for inspection.
District? 1 /
OYcs aJTfi
I have mad the hmameun materials requirements under Chapter6.95 of the Califor-
nia Heal"SadmtyCodc,Secdom 25505,25533 and 25534.1 undersand NmlfNo building
doe not cwmndy ho a mount'that It M/eponeibil tonod(y 1m ocup.t o(Nc
requirement,which I:2r
c man r aGtec.ra gamer rap/Vf Signature of Applicant Date
Owner or ant orixcd agent Dem All roof coverings to be Class uBo or better
05i10/2004 07:44 7075297663 PERMIT SERVICS IMC, PAGE 02
05/10/2004 07:57 4000993 EARA70GA (ITC PAGE 02
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Sm �ITY OF CUPERTINO
CM OF PERMIT APPLICATION FORM 6
CUPEkTINO
APN# 0Date: y
Building Address:
.27-oSo 5-e.
Owner's Name: Phone #:
(!5 ecz .e_ X52 -/ go3
Con actor: License #:
2
Contact: >,_ , n Phone 2��_ Z S
,/"r-c,,�e., 8onfta J. Jenklns 0
Applicant/Contractor: North ayyPe nn"32 Fax #:
B ing Permit Info:
Bldg E ec lumb Mech
Pscri tion:
ntial: Commercial:Floor Area: $/Sq.Ft
chitect/Engineer: Valuat n:
Type of Construction: Occupancy Gr i
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> l OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to IM Btu MECHANICAL
BBOILER4 Boiler> IM 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 <= 1O00A ELECTRICAL
BELEC1001 Elec 600V > IOOOA ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
.BINVESTIGA I Investigation fee BUILDING
BMITIGATC I Comm. Housing Mit. Fee BUILDING
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i
CITY OF CUPERTINO
"TM°F PERMIT APPLICATION FORM
CUPERTINO
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 PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE PbIg 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 HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfrn 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> IOK 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
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D" m CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Fee ID Fee Description Fee Group
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Re air/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Ligting 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
BSF&2FAM Single& 2 Family BUILDING
BSFNA Single Family New Add 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 I PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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