05030010CITY OF CUPERTINO I
" �'" ° ' "�
N
BUILDING DIVISION PE
.CONT�CT�ORI-,NF'OI
EAGLE CONSTRUCTION
BUILDING ADDRESS:
PERMff N b 5 0 3 0 010
OWNER'S NAME:
PERMIT ISSUE DATE
CHR
ONE:
SANITARY NO. CONTROL NO.
ARCHIECV GINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Descri Lon
1 hemby affirm mal I am licensed under provisions of Chapter 9 (commcncinp
P
with Section 7") of Division 3 of fie Business and Professions Code. aM my license is
in me force am err L%05)
KITCHEN REMODEL/UPGRDE SUBPANEL
Liumus, Class Is.0
Dam 'A M C COOtra,m
ARCHUECTS DECLARATION
1 mukrsund my plans shall W used as public n,mds
Licensed Pro(ermomnl
OWNER-BUILDER DECLARATION
I herehy •Irnm mot 1 •m exempt from ile Conmactors License Law for the
following m•."n. (Section 70313, Business sed Pmfcstiom Co id: My city m county
which nequima a permit m cnnsuuc4 eller. improve. demolish, or repair any structure
prior m its is mmee. also rryuircs tk applicant for such permit in 0m a signed atammerml
that h< i[ licensed pussumum the provisinn[ of the conuacmr: Liecnsc law(Chaplm 9
Sq. Ft. Floor Area
Valuation
Dimon 3 e Business and Professions CMe) or
(emmiomencing wish Section 7000) of DimW N
.
that he is exempt therefrom and um basis for the alleged exemption My victual lon of
Semon 7031.5 by any applicants fora permit subjects the applicant in a ciQ Mosby of
3 ?�t�PJ9ngi1fl3et0 0
OGGnarse Type
Occupancy YP
ore mom men fixe hundred dollars (5500).
1, as owns of the property, Or my employees with wag, as their sole eompemadon,
wil.it Prclis otection his Cru morns LimedaLnerdosmwapply to 7W. Business
code: The ensewho Law dors nm apply m an
and Prty
Required Inspections
q P
tt emors ual hionfutedduough Eu
w1r bas rough is
employ uilNnimpmtsuchirmn.aMwha
f
/
aru[uchwoh
own employ=. provided that such improvements are nolimmnded rrortered (maale.11.
own
, the building m improvement u sold within one Sear of completion, rue owner-
(,/I✓
a7
Wilderwill haw the Wrdco of proving Out he did not Wild or improve f, purpose W
samJ.
� V
1, a owner of the progeny, am eacluaiwly contracting with licensed contrasrors us
eonslnuel the project (Sec. 7006, Business and Professions Cade:) The Contsacmrs Li.
cense law tines not apply m an owom of pnopmy who builds or improves dmrern, and
who contracts for such pmjecU with a commissariat licensed postai on die Gnnmetor[
LCGM1Q Law.
❑ l am e�leeejmpt umnd, .B@PCfor this reason
�s"' ,�,
n, Y�s��s1 Date / ^rt ��
WORKER COMP CATION DECLARATION
1 hemby &from under penalty of perjury one of the following dec uations:
❑ 1 "...it will maintain a CeNfam of Comment mself-insure for Wa&dsCompen-
souon, as provided for by Section 37M of the Latter, Code, for the perfonmmmm of me
work for which mix permit is issued.
❑ i have and will maintain Workrls Compensation Insurance, as required by Section
37(10 of me labor Code. for me performance of dm work for which this Permit or no.
My Worker Compensation Imes.,rrimand Polity number=:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(ihbsemion=it Out W eomplemd if th permit is fmomm hundred dollars (SIOD)
or less)
I cm ify that in me perfommanco of dm work for which this permit is issued. I shall nm
employ any person in any manner so as in lsrcmne subject in the Werkeri Compeltsadon
Laws of California. Dau
Appli,m
!NOTICE TO APPLICANT: IL after mating this Cenifi,u of Exemption, you mould
become subject in the Workers Compensation pmvuimm of Nn Labor Cade. you mine
,
foMwith comply with such provisions or this permit Nall W deemed rooked
CONSTRUCTION LENDING AGENCY
I hereby aRrm mat therein. construction mndingapenry for me performs e,of
the wash for which this permit b issued (San. 3097, Civ. C.)
Landers Name
Lenders Address
1 comfy mu 1 haw =it oris applicuion and sum mu IW above infoematlrn b
were, 1 agree m comply with all city and county dminumes and sum laws refining he
Wilding construction, and Immby anmorin mpl,errmtiw[ Of this city m corer upon One
abnw-m,tinKd propeny(an Its radiatiwhich
(We) agree In Lw, indemnify and keep hNnless me City of (aMni o againff
grim and Capes
s,cost Menses which may In my way a[[Ne agal,l,ld City
may
inbllld,,j usee Or he
in eonsequenee o! me grousing of Nb permit.
pe
APPLICANT UNDEESTMDS AND WILL COMPLY WITH ALL NOWPOINT
SOUR/CB.gEGULATI(hNc \
_ OS
1 �/'••seri
Issued by: Date
1
A J 1
$Ignature —
Appli,nUConuacl
.
Re-roofs
of
eOr Dam
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or forum Wilding ommpanl atom in handle hnardous material
as defined by do Cupertino Municipal Code. Chapter 9.12. and the H,Im and safety
Code. Ohony� 25532(,)7
All roofs shall be inspected prior to any roofing material being installed. .
Will me appfaol or future Wilding occupaln som, equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit ha,rdnns air comasomms as defoed by she Bay Arta Air Quality Management
all new materials for inspection.
Dumicl?
❑Yes Wo
I haw reed the hipu d oommerialsnquimments under Chepmr6.95 rf dtc call(on
nu Health &Safuy Cedc.Sestimmn%5.25533 tad 25531. Imulemund rhulfdc Wilding
does m ul Currently hale a mmol. that it 6 my ms,ema hlllly in nrdly me n[Lupanl Of die
myuirtments whkh mu ipnm.a i,umuce of Certificate, or Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or auhmi ed agent I Dam
CITY OF
•CUPEkTINO
%TY OF CUPERTINO 9
PERMIT APPLICATION FORM
APN #
32-6 f3o3G
Fee Description
Date:
Building Address:
+-A tck
Mailing Address (if different from building address):
\O U!i 011 ;�)R,
BBOILERI
Boiler <= 100,000 Btu
Owner's Name-
etr'�-�' i /)'1 cL 9/ �w
BBOILER2
Phone #:
Contractor:
(o-
BBOILER3
License #:
ye/o00 G
MECHANICAL
BBOILER4
Boiler> 1M to 1.75 M Btu
Contact: r Phone:
Cupertino Business License#:
Fax:
MECHANICAL
BCONSTAX
Building Permit Info:
BUILDING
BCONSTAX
Bldg Elect Q.
Plumb
Mech
Job Description:
BUILDING
BCONSTAXH
Residential S. Kkua k VzCt .0V&1-!zP11z",c
9dxkrw
Commercial ❑
Sq.Ft. Floor Area:
BUILDING
$/Sq.Ft.:
1Q6
ELECTRICAL
BELEC1001
Cost of Project:
V8
ELECTRICAL
Occupancy Group:
� 75
ype of Construction: /�
J 'FCU"
ELECTRICAL
Please check this box if the project is a
I� I ��4'�A l� i
BUILDING
second -story addition: ❑
Project Size: Standard Ja Large ❑
Major ❑
BINVESTIGA
Quantity Fee ID
Fee Description
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
BBOILERI
Boiler <= 100,000 Btu
MECHANICAL
BBOILER2
Boiler > I OOK 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
1 of3
4n..
o
CUPEkTINO
*.ITY OF CUPERTINO 0
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
Pb1g 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
BREMFURN
Relocation of Furnace
MECHANICAL
BREMFURNOV
Relo Furnace > l OK btu
MECHANICAL
BREMHEAT
Heater Installation
MECHANICAL
BREMINHOOD
Installation of Hood I
MECHANICAL
BREMMISC
Misc Apparatus
ELECTRICAL
BREMNRAPP
Rem Non -Res Appliance
ELECTRICAL
BREMPOLE
Pole/Platform Fixture
ELECTRICAL
BREMPOWER
Power Device/Apparatus aratus
ELECTRICAL
BREMRECEPT
Rc tl, Switch &Outlets
ELECTRICAL
BREMRELOCA
Relocation of Hood
MECHANICAL
BREMREPALT
Re air/Alter He
MECHANICAL
BREMRESAPP
Remodel Res A liance
ELECTRICAL
2 of 3
Son
CITY of
CUPEkTINO
0 CITY OF CUPERTIN®
PERMIT APPLICATION FORM
Quantity Fee ID
Fee Description
Fee Gron
BREMSIGNAD
Rmdl Signs Add Branch
CAL
ELECTRICAL
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
Swinuning Pool
BUILDING
BTEMP
Temporary Power
ELECTRICAL
BTEMPPERM
Temporary Bldg Permit
BUILDING
BTEMPSVCS
Temp Dist Svcs
ELECTRICAL
BUSLIC
Business License
BUILDING
ELECTRIC
Electical 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
•
3 of 3
6
an os
CUPERTINO
Assessor's Parcel Number:
Name of owner. C W' S
3zG 13036
Project address. 1 O S"( tq 1<k, o rL
Contact person. S �� ���` Phone. b — 3 % 2.3 5 5 -
Fax.
Net square footage of lot.
Square footage: First floor:
Second floor:
Garage:
TOTAL:
Existine
;oo
Proposed
• Are there at least two 10 foot by 20 foot clear spaces inside the garage? N
Is privacy protection planting required for the project? Y (N�
On what floors) is work beutg done.
Brief description of work.
Code editions: 2001 CBC (Y - N)2001 CFC
2001 CPC (Y - N)2001 NEC
Effective 11/1/02
MCEYV -1
MAR 12005
Ve
(Y - N)2001 CMC
(Y - N)
Plan Review Process Work Book Page -8-Revised 4/28/04
nr-W SV3 (',9•,C, I
(1'- N)
0
0
0
laznw]
24'7
16'
Florscent lights Existing Kitchen
Mr. & Mrs. McLaughton
10397 Vista Knoll Dr.
Cupertino, Ca.
24'7
0
Garage
8'7
6'2 - 1
Family Room
H
0
0
16'
24'7
Garage
HVJ
F;'9
New gas cooktop
Mr. & Mrs. McLaughton
10397 Vista Knoll Dr.
Cupertino, Ca.
is
24'7
Family Room
Remove old cabinets, install
new electrical circuits up to
current city codes, insulate and
resheetrock ceiling,add gas line
back to main,add recessed
lighting and new florscent lighting
to room.All plugs to be G.F.I.C.
protected.
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