03020068 (3) CITY OF CUPERTINO ma,�t
BUILDING DIVISION PERMIT k"yCONTRACTOR°TN�'ORM CT..
A�iwt.m�ft Yha u 3 ,lyrVhx .
BUILDING ADDRESS: MATZ CONSTRUCTION PERMIT NO.
OWNER'S NAME: 10574 ORANGETREE LN APPLICATI A
ONE: (408) 257-6376 TRSANITARY NO. CONOL NO.
ARCHI7EC RINOINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
20o LICENSEDCONTRACTOR'Srd,pDECLARATION Job Description
' 1 ion tly70 0)of that I em fOut Bu under provisions of Chapter 9(Commencing p
with Sutton 7IXq)of Division Sof Ne Buainf[�and Pmfcuions Code,and my license u
5 ucmlfoc KITCHEN REMODEL/WINDOW UPGRADE
PINALem
,0 ARCHIIECI'SD RATION
y 1 unacntanJ my plies shall he uuJg(puhlic¢turas
7U
3 w LucnuJ Pmfueional (� f�J
9a OWNER-BUILDER DECLARATION - OCT 2 02003
0 1 hereby maso.(Ofm Thal 11. exempt from the Contractor.License Any C law for the
0 o following union.(Sutton 71131.5,Bueincsund Pmlusiuu Cale:Any city or County ,
$ which requires A pclmh to conYNct,al@q Improve,demollah,M repair any stNCtum
Fiy prior to its issuance,also esquires the applicant forsuch Permit to file a signed statement
c that he is licensed Puuvanuo the provisions ofthecontncmra License LAW(Chapter 9 Sq. Ft.Floor Area 25V��I�100
$ (commencing with Section 7000)of Divislon 3 of the Business and Prolessions Code)or '
.. Nat he Is exempt dominoes tad the basis for the alleged exemption.Any violation of
Station 7031.5 by any applicant for a Permit subjects the applicant w a civil penally of Type
not mom than Rw hundred dollars(SM. � 3 Me t1_1'I98fbeF 0 0 � OccupancyJ e
❑I,uownuefthaproperty,army employees with"gun
thev role cmnpenssdan, -
wllldothework,and ultimatum,inot intended eroffefedfmule(Sec.70",Butrras 101 - FOUNDP. j� dInspections
' and Profession Cade:The Contractors License,Law ow'Imr law docs t apply as an of
property who bullelsorimprows thereon,and whedoessuch wark himselfer through his 102. — PIERS
ownempmyees,provided m4tsuch improvements aro not Intended moBered rnrsale.R. 103 — UFER
however,the building or improvement is veld within otte year of completion,the owner-
builder .will haw the burden or proving that he did scot Wild or Improve for purpose of 104 — REBAR
Axis.).
❑1,as owner of the property.Am exclusively cmtruti.1 with licensed ronuacmn w 105 - ANCHOR BOLTS '
ceutruct the project(Se"
mru
7044,Business and Ps7me,Cede:)71m Contractors U. 106 — SEWER & WATER .
untie u law sonot apply As an owner of properly who bunds or improves Income.and 202 — UNDERFLOOR PLUMBING
who cont
us
uep under Sec. B&PCf�r Nb moon
us for such pmjecu with a conuactor(t)Reinstall pursuant to the Contractors
Lw`q" 203 - UNDERFLOOR MECHANICAL
m - ,
/ 204 - UNDERFLOOR FRAME
owner GWa ER'SC MPENSATION DEC DION 205 - UNDERFLOOR INSULATION
Ihereby aformunder penalty ofperjnryant ofthe following declantions: 301 - ROUGH PLUMBING
have and will maintain a Certillmic of Co-Asian to salf-finsum for Worter's Compen. 302 TUB & OR SHOWER
Adult.As provided for by Section 3700 of the Iabm Code.for the performantt of the 303 - ROUGH MECHANICAL
work for which this permit is issued. ,.
❑1 nave and will maintain Workers Compensation Insurance,As required by Section 304 — ROUGH ELECTRICAL
3700 of the Labor Code,fm the Performance of ate wark ler which this pconit is lasund. 305 — FRAME
My Worken.Compensation lnannnu esnlcr and Policy number am: 306 ''— HOEDOWNS
Canter. CERTIFICATE OF EXEMPTION FROM WORKERS 307 - INSULATION.COMPENSATION INSURANCE 308 - SHEETROCK
or leas.)rrnsAmdonneed not becompleted ifdue month Isfor onehundred dnnan(giro) 309 - EXTERIOR LATH
I anify that In the pe mmmu of the work for which this permit B Issued.I Hull not 310 - INTERIOR LATH -
employanype nl caymanne,.Uwbecomeubjectwfwofken,c.,fwton311 - SCRATCH COAT
laws of Califom ave
ApPli n f r r-ice 313 - ROOF NAIL
�TO APFUCAN71rZf.,making vets Cemnuww ELmNmn,ynusbnuk 501 - FINAL ELECTRICAL ENERGY
anbjut m the Wofkeh Cempcwuon pmvisiou of tui IaNn Cade,you muss
7 forthwith Comply with such provisions ofthis Knout shall Wdeemed mokcd. 502 — FINAL PLUMBING ENERGY
? - CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
lmmhy AM.wtdttm o a umtrunma lending agency ler the Nrrmmanuor
the 504 - FINAL BUILDING ENERGY
11S work fur which this Pcrmh is issued(Sec.3097,Civ.C.)
w� Lenders Name 505 - FINAL ELECTRICAL
jz anaer.Addm 506 - GAS TEST
U 0 I unify that 1 haw and this application and rote Nat the above Information Is '
u.Fcorrect,I gee w rcomply with all city And county ordinances and sum laws misting to 507 - FINAL PLUMBING
0U building consumcdon,And hereby authorine,representatives of this city to Inner upon the FI&&NG CAL
y Ahovomentinned PmPeny for iupecdon Purposes
(Wo)agme M taw,indemnify,and kup harmless the City of Cupeniw agAimn 0 9 F I
G f/1 Iiab11111n,judgmen0.costs and expenses which may In any way accrue gainstuidCity rJ7 in consequence of the granting of this permit, S
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 WORKS Dat
SQJJ CEREGU TIIGNSS..
ze, - 1—f -- : -r - �' Re-roofs
Alam of Appllcalmontncmr - Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the Applicant orfuwm building uccuptnsmre or hon' Aimeen oro mAtenal
u deOned by the Cupertino Municipal Code,Chapter 9.13,and IM Health and Safety
Cad`,Oyo,255]g(e)7 All roofs shall be inspected prior to any roofing material being installed,
Willthe Applicant or future building occupant on equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
hanwous air contaminanm u de acd by the Bay Ama Air Quality Management all new materials for inspection.
uim7
❑Yes u '
T haw real anc huafdous noded-bmquiromcnu ander Clupmr6.95e17the G1hrm.
ilia H.Iih&Safety Coo,Sudou25%5.25533And255M.1undcntatdthuifth WIding
250
tolipantofNeSignatureofApplicantDate
G mm All roof coverings to be Class"B"or better
BACK YARD
1961
12 / 70 1141
W27366 W3018 W27368 DWAG24
54-R
24"L-BAR. S642 DISH. 24" SOSB30B SOSB30B LD 6-R cEIV�iD
F EB 1 9 2003
W12
36-L
X
APPROVED OCC -IN ACCOf2DA`!CE ITH THE CITY OF 3390
COMM() C0� - AN IINANCES B
1231
DATE=
SIgN�1� 3DB(30W 26 3DB(3OW 26 BWD30
This s@t of plea and ll tint ,tions MU i
la ful can the job at all Um and it is u -
I@W(yi to make any changes r alterations SUB-r I
09 s@Me Withatlt written pet nission from , 1 t,\�
the byilding Dept., City at Cu srGno. 1�
the stampifig of this plan and 1pWAF16H1.A6 BFH36 BFH36 v
SHALL NOT be held tai pwmJ „
approval of the viotatimn of ay ��s P3
of any, City Ordinance cr !ate
36 ]T6B
B( 114
L 25 J
44
L 1Z USE PANEL TO FLUSH SIDES OF ISLAND,TOP R/F
USE 1/4"PANELS TO FLUSH BOTH SIDES OF ISLAND
X — 32 USE PSSF3.96 TO CONSTRUCT REMOVEABLE FACE FRAME FOR WM
00809673
Design: 11/17/02 gr
An dimensions&size designations This is an original design and must Scale:maximum Date 12/16102
given are subject to verification on THE not be released or copied unless Schuler/chapelca
job site and adjustment to fit job HOME DEPOT applicable fee has been paid or job Garrett Wade
20085 Cedar Tree Lane Designer
conditions. order placed. Cupertino,CA Linda McDermott
a.
TITY OF CUPERTINO /
ciry°F PERMIT APPLICATION FORM 03
� �UPEf�TINO
APN# 09?
Date:
Building Address: /
?Oct leW zl
Owner's Name: Phone#: C
7` C/ OO Z
Contractor: License#-
7-
Contact:
:Contact: Cupertino Business License#:
Y
Building Permit Info:
Bld
El.eqy< Plumb Mech
Job escription:
Residential ❑ 'Ll r n V�IC �i i2 —� --
Sq.Ft. Floor Area: $/Sq.Ft.: '
i
Cost of Project: . Occupancy Group:
Type of Construction:
Quantity Fee ID Fee Description . Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits : foot BUILDING
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
BMITIGATC Comm. HousingMit. Fee BUILDING
� z1r � l
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`"T
TITY OF CUPERTINO
cuPEr�Tuvo PERMIT APPLICATION FORM
QuantityFee 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
BNUCOM M 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 ---.----
13PGAS 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
13PREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Stom]/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
E
COVER A/C Unit> 10,000 cfm MECHANICAL
IRHAN A/C Units r- 10,000 cfm MECHANICAL
APPLI A liance Install MECHANICAL
SWAY RemodelBuswa s ELECTRICAL
FIXT Li tin Fixtures ELECTRICAL
URN Relocation of Fumace MECHANICAL
RNOV Relo Fumace> 10K btu MECHANICAL
HEAT Heater Installation MECHANICAL
HOOD Installation of Hood MECHANICAL
MISC Misc A aratus ELECTRICAL
RAPP Rem Non-Res A liance ELECTRICAL
OLE Pole/Platform Fixture ELECTRICAL
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CITY OF CUPERTINO .
CUPERTINO PERMIT APPLICATION FORM
a ti Fee ID Fee Description Fee Grou
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl Switch&Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heatin MECHANICAL
BRENMSApp Remodel Res A liance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Si s,Mar uee ELECTRICAL
BREMTHEATR Theatrical Li tin Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREEMVENSYS Ventilation Svstems MECHANICAL
BSCBLVD Scb Specific Plan. BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
- - = - - BSPECIAL - - S ecial Ins ection - - - —_BUII DING------ --
- BSWIM Swimming Pool BUILDING
BTENT Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temn Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
• ELECTRIC Electricals foot ELECTRICAL
EPERNIITFEE Elec Permit Issuance ELECTRICAL
MpERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERNIITFEE Plumbin2 Permit Issuance PLUMBING
PPLBG Plumbin Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
•
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