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02050019QCC zro� 1n6o �y-LL ,YE :zaz�a .060 .LLC. IOC t?> cd o..3= OZ z C eJ BUILDIING UPERNOPERMIT CONTRACTOR INFORMATION: ON BUILDING ADDRESS: PERMIT NO, 22999 VOSS AV 02050019 NAME: APPLICATION SUB DATE IOWNER'S IGOR KHURGIN 05/03/2002 PHONE: SANITARY NO. CONTROL NO. ARCHITECTMNGIN'F.ER: BUILDING PERMIT INFO BLDG ELECT PLUMR MECH LICENSED CONTRACTOR'S DECLARATION Job Descnp tion I hereby aRrm that I am licensed under provisions of Chapter 9lcommencing wnoSection 7000)efD,visien3oftheBu,inessand Professions Code. and myI'eme Lin full force and effect. KITCHEN WINDOW UPGRAllE �® NBk icense Class Lie. Is FI Date Co maL TI ARCHITECT'S DECLARATION Cased TNs ' U 1 2002 1 understand my hoes shall public AUG Licensed Professional _ OWNER -BUILDER DECLARATION 1 hereby affirm that 1 an exempt from the Contractor's License Law for the ��/+ Q following reason. ection 7031.5. Business and Proressionc Code Any city or county (S ✓y BU'L� 1 V V O which requires a permit to construct. alcom improve. demolish, or repair any structure priorm its iswance, also mmoresthe applicant for such permit to file a signed statement. ---- - - -- j " °4 j 113.;§"2 �V,G`lY' .'{V, .a' 4'� ii jt ay` - Valuation that he is licensed pursuant to the provisions of the Contractors License law (Chapter 9 (commencing is ith Section 7000) of Division 3 of the Business and Professions Code) m that fie is exempt therefrom find the basis for the all<gca ezemptiod. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty .Tee in.. the. five hundred dollars (1500). 101%PL; tivOURIDAT I ON Occupancy Type ❑ 1, as own« of the pmp=ny, in my employees with wages as their sole comp=neaion,PIERS will do the work; and the almClu a is not intended or offered for sale (Sec. Todd, Business and Professions Code: The Contractm Contractor's License law docs not apply an 10 3 - UFER Required Inspections owner of property Who builds or improves thereon, and who does such work himself 104 - REBAR or through his own employees. provided that such improvements men¢ a not intended or _ ..., _ _ ... - i salevehowever. within not year or -..105 - _ _ _ ___ _ . .: ... ANCHOR BOLTS' ... 7 . completer completion, -baddethebiWdingerhnen of provngdus o....e for the ox'nee-Wilder will have the burden or proving that he aid not build or mpro.•e for pmmos=er.al<.). 106 - SEWER & WATER _ 1, ru owner nl she property am contracting rim licensed a to 202 - UNDERFLOOR PLUMBING - Codudmm Business a cattle:) The contractors Licenser the present Tapp. 7t14a, Business and ,my who License law dime not apply man owner of property who builds or improves thereon, 2 03 - UNDERFLOOR MECHANICAL' arta who fee such pros«' x'ith . enntmemgs) been w pnrla.nt to me 2 04 - UNDERFLOOR FRAME is License Contractor's License Lax•.. ❑lam exempt under «. B&P C for this mason 205 - UNDERFLOOR INSULATION Date �� tee/%3/ WORKE OMPENSn'}7iON DECLARATION 301 - ROUGH PLUMBING 302 - TUB & OR SHOWER (hereby effort order preally of p=dory enc nIhe following declarations: 303 - ROUGH MECHANICAL 01 have and all ma ,lain a Cenincme of Consent to self-insum fee Workers 3 04 - ROUGH ELECTRICAL Compensation, es provided for by Section 3700 of the Labor Code, for the 3 05 FRAME perrermanee m the work for which this permit is isaued, - 01 have and will maintain Worker's Compensation Insurance, as required by Section 3 06 - HOLDOWNS 3700 or the Labor Code, for the performance of ate work' ter which this pcettdt is 3 07 - INSULATION issue) My Worker s Compensation Insurance carrier and Policy number are i 1 . ;�-, SHEETROCK. :_:. .. .. .. . carie.' I policy Nn•- rCERTIRCATION OF UEMPION FROM WORKERS'( EXTERIOR 1308 s` `3109?' �r LTH A COMPENSATION INSURANCE r ' ' -_3-10-.-..-INTERIOR.-LATH...- -- - 'i• mlii section nced not he completed if the permit is for one hundred dollars 311 - ' SCRATCH COAT (slum ortess.) 313 - ROOF 'NAIL I tanfy th-t in h pert Tge�t,f the - k for which this permit s issued, I :non t plv rr. )ernes. `rbeenme5b) ttoI woekees" 501 - FINAL ELECTRICAL ENERGY Comp, a n La sof Carforei e q(¢ Oil/ac? 3/ o Apph I iii502. - 503 - . FINAL PLUMBING ENERGY FINAL MECHANICAL 'ENERGY NOTICE LCANTilf.aftermekingthisCcnificamofExcmption,yousM1oulO becomesuomply,le. In the tion t you Colons emmentmbor .yon mail or Permitshall he domed rtvit forthwith comply with such provisions or this permit shall such Pr 504 - FINAL BUILDING ENERGY CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL 1 hereby affirm that there i.s a cnnstrucilnn lending agency rte the performance 506 .. GAS TEST ofthe work for which this Permit it fame. flee 3097, ci.'. c.) - n Lenders Name .... ... 507 - FINAL PLUMBING.. _ Lender's Address 508 - FINAL MECHANICAL I teddy that I have Bead this arthinu on and state mat the .hove inrom,aion is somal. I agree In comply with all city and county ordinances and 11.11 laws relating 509 - FINAL GRADE m building eonatruction. and hereby initial representatives ofthis city to enter upon 510 - FINAL PLANNING the above-mentioned pmpmy for inspection purpose.,. (We) agrce i. save• indemnify and keep harmless the City of Caperton against 514 - FINAL PUB I C WORKS liabilities, judgments, costs and expenses %Lich may in any way accrue against said D 'APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT' APPLICANTUNDERSTANDS 50 'RCE ,'.A ION r9 < Issued Y Date VSO o Applica enmeacme erre Re -roofs HAZARDOUS MATERIALS DISCLOSURE ' - •W ll the apldcom «power building exxop er state w handle hnadoas material Type of Roof .. .. ...r... ,........ . _. as defined by me Cupntino Municipal Code, Chapter 9.12. and the Health and Safety cnde;s«sen 2ss3z(a) :. J . , • ; OYcs Nni'- ( s All roofs shall_be Inspected poor to.,any roofing material being installed,,.__,_ _. Will the applicant orfaure building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, l agree to remove emit be nd., air canmimr ms es d III all by the Bay A. Air Quality Management Di,,men all new materials for'inspection. Applicant understands and will comply with Eyes. ,, No :. all non -point source regulations., ,. 'I have read the hazardous materials rtquirtttmnts under Chapter 695 of the Califomia Health & Safety Code. Sections 25505: 25533 tmd 8534.1 undersmad that if the building does not solvently ban a mount, that it is my responsibility to notify the - - occupant of the requiremems which must be met prior to its of It Cenificam or Signature of Applicant Date / / All roof coverings to be Class "B" or better 0,011m�thimued - Data '. ... .. _ OFFICE BUILDING DIVISION BUILDINGADDRESS. 22999 VOSS AV OWNER'S NAME: IGOR KHURGIN Music APCHITEC (ENGINEER: az y<a S N _ LICENSED CONTRACfOR'S DECLARATION i Z v, 1 hereby all= that 1 am licensed under provisions of Chapter 9 (commencing r3 h with Section 7000 of Division 3 of the Business and Professions Code, and my license is in full forte and effect. O w U License Class Lm # Dam Comoro, u. fi ARCHITECT'S DECLARATION vt aj 1 understand my plans shall housed as public records p o Licensed Prafessionel ' °' •o•� OWNER -exempt r DECLARATION — m 1 hereby affirm that 11. exempt from the ContnctCo License Lew for the C Z < following reason. (Section 7 construct, then, and Professions Codes Any city or county ca F O which inquires a permit re construct, applicant improve, demolish, ore a sig any swment i3$ poormtlissuance ,also requires Neapplicant foe such pumnit ctors file asignedchaptent Nat he id licensed puhuanno 00 provisions n 3 o Contractors License Law (Chapter ) (commencingwishSection ]m0) of Division 3 of the Business and Processions Code) or Nat he is exempt therefrom and the basis los the alleged plit.o o My l violation not Section a703 1 than by any Watched denbfm a pemilt subjects th appliranuo a civil prnelry or not more then five hundred dollbre (g5m). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do Ne work, and the aweture is not ;mended or offered for sale (Sec. 70a4, Business and Professions Code: The Contractor's License Lew does not apply to an owner of property Who builds or improves thereon, and who does such work himself or through his own employes. provided that such improvements we not intended or offered for sale. IL however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving thin he did not build or Improve for purpose of sale.). CL,u owner of the property, am exclusively contracting with licensed contractors to wmlhe project ISm. 7014, Busineu end Pinfasions Code:) The Courtroom's License Law does not apply to an owner of property who builds or impmves thereon, .it who curter. for such projects with a common(s) licensed pursuant to the Contractor's License Los, ❑ 1 in exempt under ec. B & P C for this reason XI WORKE' OMPENSANON DECLARATION I hereby affirm under penalty of perjury one of the following declarations: • � 1 have and will maintain a Comficem of Consent to self insure for Worker's W-- Compensation, at provided for by Section 37M of the Labor Code. for this T Performance of the work for which this permit is issued. 0 have and will maintain Worker's Compensation Insurance, as inquired by Section 3700 of the Lothar Code, for the Performance of the work for which this permit is issued. My Workers Compensation Insurance wrier and Policy number we: Ganite Policy No.: CERTIFICATION OF EXEMPnON FROM WORKERS', COMPENSATION INSURANCE (This section need not be completed if the Permit is for one hundred dollars (S Ins) or less.) I eenify that is the perform f the work for which this perMt is issuetl, l shell'noI employ any penin in any r rse.q m become bjen m Ne Workeei Campo qs t L.yyy(((aaa of California e rte CvY/D 3�0� APPIICE 'I If NOTICE CANE: If after melting this CW Brea of Eumptiov, you shouts Qy 0become so Ile. to Ne Woheh Campensvuon provisions of Ne Labor Cade, you must fonhwith comply with such provisions or Nis pemilt Nell he dttmed revoked. F rA CONSTRUCTION LENDING AGENCY a ' 1 hereby M. Nat there is a mnswction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. c) Lender's Name Vz Lender's Address 1 certify that 1 have rem this application end state that Ne above information is ww Ey correct. 1 agree to comply with all city and county ordinances and state laws miming C U to building constriction. and hereby auNadu teprtsinnndva of this city to enter upon y rte]Nc above-mentioned Property for inspection purposes, f,+ M. (We)aVa. to save, indemnify and keep humless the City of Cupertino against Vi liabilities, judgments, costs and expenses which may in any way mcme against said U z City in consequence of the granting of this permit, �APPLICA.NT UNDEj1R�STNA$NTDS AND WILL COMPLY WITH ALL NON-PDBNT Will the appheant or future building occuperat store m handle husNous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 255320)? ❑Yes la N. Will the applicant or is hum building occupant use equipment or devices which emit hazardous air mtna2-twid, fined by the Bay Area Air Quality Management Districts ❑Yes 1 have mad the h requirement; under Chapter 6.95 of Ne California Health & Safety Code, Sections 25505, 25533 and 25534, 1 understand that if the building does not uurtenily have a tensor, that it is my responsibility to notify the occupant of the requirements which must be met prior in issuance of a Cenificete of Occupancy. 02050019 PPLICATION S B DATE 05/03/2002 W ITARY NO. CONTROL NO. BUILDING PERMIT INTO BLDG ELECT PLUMB MECH Job Descripption KITCHEN WINDOW UPGRAIJE `� ■ WALE® AUG 0 12002 BUILDING $1000 3 4el3 b 6b)4,;.P951 10 103 104 105 106 202 203 - 204 205 301 302 303 304 305 306 307 308,_ X309' 3fi0- 311 313 501 502 503 504 505 506 507 508 509 510 514 Issued by: Re -roofs y�L Type of Roof - UFER Required Inspections - REBAR - ANCHOR BOLTS - SEWER & WATER - UNDERFLOOR PLUMBING - UNDERFLOOR MECHANICAL - UNDERFLOOR FRAME - UNDERFLOOR INSULATION - ROUGH PLUMBING - TUB & OR SHOWER - ROUGH MECHANICAL - ROUGH ELECTRICAL - FRAME - HOLDOWNS - INSULATION SHEETROCK -'EXTERIOR LATH' - INTERIOR LATH - SCRATCH COAT ROOF NAIL FINAL ELECTRICAL ENERGY - FINAL PLUMBING ENERGY FINAL MECHANICAL ENERGY FINAL BUILDING ENERGY FINAL ELECTRICAL - GAS TEST n - FINAL PLUMBING - FINAL MECHANICAL ` - FINAL GRADE - FINAL PLANNING AL_ PC WORKS //Tt�f//JJ .L•—_ Date 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. Applicant understands and will comply with all non -point source regulations. Signature of Applicant OFFICE Date All roof coverings to be Class 'V' or better 0 • quo w v 1 (i U r I MAY 0 3 2002 D e�C? H APPROVED IN ACCORDANCE WITH THE CITY 08 CUPERTINO CODL QND ORDINANCES DATE �_ SIGNED This sat of p!or, rnt, spec:fica6ons MUST be kept on ft c7 ct _:t times ad it is un lawful to n-!.: c a_> cr pns on some c:a`:2t '.-'7:_.l �sson from the Fu..da;. -. Cupe,ft. The s!ah:.. .... .a nd specifications sHRLI la; . t. cs mit or to be an mn:ova, ul ttc +.� Vita J any provision- r ^ d r. date ! am SUBMITTAL #1 0 i Sn CITY OF CUPERTINO fVITY OF CUPERTINO *'- 0 Z o S �' q PERMIT APPLICATION FORINT 1 . APN # �j —�d d /2 Date: OZ APTFEE Building Address: Z g�✓9 la d,4 r� vx- Owner's Name: Phone #: Contractor: License #: Contact: Phone #: MECHANICAL Applicant/Contraptor: Fax #: ' BCONSTAX Ind/Off/Comm/Quasi BUILDING Buil in Permit Info: Con. Tax for BQ Zone Bldg Elect Plumb Mech BCONSTAXH Job D cription: /1f..,]^), /�{�� -RLsidential: `1 ` '%fU`V BUILDING �I �/�-- Co65c al. Constax - Resi/Mobile Sq.Ft. Floor Area: $/Sq.Ft.: Elec 600V <= 1000A Architect/Engineer: Valuation: Elec 600V > 1000A Type of Construction: Occupancy Group: Quantity Fee ID Fee Description Fee Group APTFEE EACH STORY OVER 3 HOTELFEE EACH STORY OVER 3 OFFICEFEE EACH STORY OVER 3 BAPPLOTHER Other Appliances 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 Elec Svcs 600V <= 200A ELECTRICAL FEEBELEC200 1 13ENERGY Ener BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR I Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BNEWMULTI New Multi -family Res ELECTRICAL (��3 ° 1 of 3��—