04020094 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMNif`
BVIIDING ADDRESS: CRAIG CUMMINGS PERMITNcb4020094
OWNER'S NAME: PERMITISSUEDATE
E:
SANTTARY NO. CONIAOL N0.
ARCH=1ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Op LICENSED CONTRA=R'S DECLARATION JobDescri tion
F 1 Wreby Minn than 1 sero li¢need under provisions of Chapter 9(commencing P
with Seeton7")of Division 3 of the Business srW Professions Code.and my license
? in full fores end effect.
9'n I msclata Um.M MS BATHROOM REMODEL
N� Dam Contractor
4< ARCHITECT'S DECLARATION
2 1 understand my plans shall be used as public rttmda
aU
G
t; Licensed Professional
g OWNER-BUIIAER DECLARATION
f 1 hereby affirm that 1 am exempt from Ute Cmwctofs License law for the
00 following mount.(Seetion 7W 1.5,Baines and Prefersiou Code:Any city of county
m which require a Permit to consuucL elms.improve,demolisA or repair any structure
thetdo Pdormslimuwenitcep.aNlsanLm mr.M w0liNeOntffomrsuchpierW..mla4aiganwed(Cnl•m^pmmor9n
Sq.Ft. Floor Area Valuao
(*mmcncingth Suellen 7000) Division 3of Bunessand ni Cocke)of
Nat heis excerpt Mnfrom and she basis for 0n,alleged exemption.Any viobYm
of
section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of 3 5 ib��0 Occupancy Type
not mom Nan Eve hundred dollars(SSW).
O 1.u owner of Die pfopmy m my employ=with wage u thch slc emnpeuadm.
will do the wwLaed Ne snuctumunmintended uraRehedforsale(Sec.]Ose,Business Required Inspections
bu
and Professions Code:The Conuacta't Liceme Law dom eqcs not apply an owner or `Z
property who ilds or improves therern,andwho doessuchwmY himselfortiuott nhis
own employees.provided that such impronormnu sm nm inaendcd moRe s!for ale H.
however.Ne Wilding or improvement issold within one year of mmpletim.the owner.
Wilder will ban the Wrden of proving that he did not build or improve for purpose of
cote.).
❑L as awmr of the pm.7 am exclusivelyand cmuacUng with licensed monYacmrs on
i.
construct d project(Sec,to C4,Business and property
who ns Code:)The Cmuacmfs Lid /
wtae law dors nm apply m an owner of property who milds of improves Hereon.and /
who mnuaeu for such mojeeu with a emvacmrts)licensed pursum on the Conuum/s !SL
se Law.
)Ln �t— WORKER'S OM�SATION UECLARA—XJPCfw(is main
Ow
1 hereby affirm under penalty of perjury orte of the f ng declar bore:
1 have and will maintain a Certiheam of Convent to self-mme forwohsYscompen
cation.u provided for by Section 3700 of the Labor Code.for the Performance of the
wort for which this permit is issued.
❑I have and will maintain Worker's Compcncotim Inmmnce,m hequimd by Section
3700 of He Labor Code,for the pertomance of the wort for which this Permit is issued
My workch Commutation Incurso e eanim and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EKEMPDON FROM WORKERS'
COMPENSATION INSURANCE
(This auction need not beeompkmd lithe Permit is for one hunched dollars(SIM)
re,loss.)
I eerdfy that In the perfomame of the wort for which this Permit u issued.I shall not
employ any person in any manners at at Income abject to the Workers Compensation
Laws of California.Dam
jtppli.,
NOTICE TO APPLICANT:If.afar making this Certificate of Eaemption,yon shmld
become subject to the Worker's Compensation provision,of the labor Code,you most
O forthwith comply with such provisions or this permit aball W deemed mNd
rvm
:y CONSTRUCTION LENDING AGENCY
I hereby of am Nat Hem is a mn,trucetion lending agency for the Performance of
me work for which this Permit is issued(Sum.3097.Civ.C.)
ALeneces Name
z Lcmm,'a Add.
C 1 codify that I lave and We application aed sum WI the above information is
roma.I agree in comply with all city and county ordinances and sum laws elating in
building censwction.and hereby southern mi mususam of this city to corm upon the
a�7 abo n-mentioned property for inspection purposes
a fY (we)agms in cove,indemnify and tech harmiran the City of against s against
y inconstswe ceofth,core and eapcmewhich mryin any way accrue against said City /
z in conscgucnec of the granting of this permit
.•w APPLIC U ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR R G ONS. I
SiindinderdrApplstaill0icanessum-14� TIp�DG-2 Re-roofs
HAZARDOUS MATERIALS DISCLOSURE " Type of Roof
Will the applicant or future building occupant nom or handle hazardous material
at deflned by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safety
Core,section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
E]Ye *5o
Will the, rear or future Wilding tan If a roof is installed without first obtainingan inspection,I agree to remove
OP d Wnr use equipment of devices whiten P gre
It ick? us sir conuminanu u defined by Nc Bay Arta Air Qualify Management all new materials for inspection.
District?
❑Ye Ee.
I ban reed the baaNms materials hequisemenu under Chapterri.95 of IW Califor.
nu Health&SatmyCede.Section,35505.25533 and 29534.1 understand thatifthe Wilding
does not s.Tqtll a unarm Hat if u my miponnhility m notify the,aceupmt of the
reyuihe nuw roc f Wmerpridr Hissuanaofa Certificate or 0"y. Signature of Applicant Date
z
ter or authorivcd agent Dam All roof coverings to be Class "B"or better
• hPPROVED
TR ACCORDANCE WITH THE CITY Ofl
CllPERTINO C DES D NANCEB
111 L�T
;FEIB
C.1 i
4
�I�
— SIGNED
This se};j —,,,,,aps and specifications MUST
PA Ot hP un
lawful� make any changes or alteration
on sera without written ermission frorr
__ the burning Dept., City of Cupertino.
o y The r=ping of this plan and specifi ations
C N SHALCSOT be held to permit or to be or.
s �j approvaof the violation of any provision, ro
4 ww-Ov Ordinance or State Law. N
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aq�n *ITY OF CUPERTINO * o 0,-2-o
CITY of PERMIT APPLICATION FORM
•CUPEkTINO
APN # ?;%-J � Date: /
Building Addres : Mailin ss (i differen from building address):
Z203y 13gkt tcV
I
Owner's Nam Phon #:
l�'�!Ci (!S J,�t M 1,U C, S
Contractor: License #:
Contact: Phone: 2,5-2_7gyg� Cupertino Business License#:
62AI G Cc-,.�.t,u w G 1 Fax: 7 -&$;V 7
$uilding Permit Info:
Bl Elect � Plumb ( Mech
Job Descripti
Residentia Co erci
Sq.Ft. Flo Area: $/Sq.Ft.:
Cost Of Pro.) . Occupancy Gro
(G�
; Type of Cons ction: t Please check thF ox if the project is a
11second-stor addition:
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 1 M 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/ uasi 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
BINVESTIGAInvesti ation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee F BUILDING
1 of3
�s 3 . 73
SAM fITY OF CUPERTINO
UP OF TYO PERMIT APPLICATION FORM
'QuantityFee ID Fee Description Fee Group
BNUCOMME New Comm Electric ELECTRICAL
BNUC0NIIv1IN4 New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTWE 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
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 Stonn/Raln 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
BREM13USWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BRENSFURN Relocation of Fumace MECHANICAL
BREMFURNOV Relo Fumace > l OK btu MECHANICAL
BREMBEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rept], 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
2 of 3
`.0 PTY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM J
CUPERTINO .
Quantity Fee ID Fee Description Fee Group
BREMTHEATR Theatrical Ligbting 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
BSPECLU Special Insection BUILDING
BSWIM Swimming Poo] BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Tem Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electricals 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
ZADDCHG Address Chane BUILDING
•
3 of 3
ITY OF CUPERTINO "W�-'V
BUILDING DIVISION PERMIT ;'T�C--O"N'TRAI�CToI,R-�INFOiiM,&,TION"",'
ILDINGADDRESS' CRAIG CUMMINGS PERMIT 14020094
kk,o
21AM Ry Gip
R*S NAME: FERMn ISSUE DATE
rp�nkTr, rTTMMTNrq Q�11 2,12
ONE: SANITARYNO. `��L NO.
ARCHITECT(ENGTNEER: BUILDINGPERMITINFO
BLDG MECH
tf pn
LICENSED CONTRACTOR'S DECLARATION
I WrOhy affirm that I am located under pocrisions of Chapter 9(commencing Job Description
;N wi��Uon7�)nrDivi�on3of�B��wW�f��C�.�mylicenwis
in full force and effect.
Liecose Class-Us.0 MS BATHROOM REMODEL L E L13
Dow Cost.,
ARCHlTEC`rS DECLARATION
I understand my plains mail he mind as public records JUN 2 4 2004
is Q
�t; Licensed Professional
�0� OWNER-BUILDER DECLARATION
�z I hereby amorn des,I an,exempt from ft coneachoes License Law por the BUILDING
ii:a following reasion.(Section 7031.5,Business and Profossions Cods:Any city or county
which requires a Permit to construct,almr.impom,e.demolish.or repair any structure
l-,c. prior an,its issuance.also requires On applicant for such Permit to filh,a signed somentent
mat M is licensed pursuant to the prowisions or 0.Cmunclor's Let.LOw(Chapter 9 Sq.Ft. Floor Area VaIA�90 0 0
a (conomensing wiffiSOction 70)))of Division 3 of the Business morl Profissamis Conic)in
hot he is exempt thernefrom and the bases for don alleged caternpim..Any mlml im of
Sccoon 7031.5 by my applicant For.permit suilijects the applicant 1..chdi rearair,of
no,ourre than fl.hundred dicillass(M). 3 5AEFMunb9ID 0 Occupancy Type
0 I.uow=offtpmpmy.wmy=pjoymwi�MrAu��wlemmpe=don,
willdo On we&-end the structure ism,intended orufficind forage(Sec.70,14,Business
and Proofesions Codc:The Contractor'.Lt.Law does.1.11,W an manc,of Required Inspections
property who Wilds or fimpoorest themon.and w1boducesuch workhorculf in throngs his
own employ=,proo,idcd that such impornments runnot intended croffered for sals.If.
how,..Obc Wilding or mpno�cmmr I.sold withi.m.year.1'completion.On
build,,will he.On bod.of pomvi.,tho,he did tron Wild or i.p.for purpose Of
satc.).
0 1.as owner of the pmperty�am exclusively contracting with focused comment.to
construct On,parefca(Sec.7044.Business and Profiessions C:!.)The cromencones u.
cemse Law dons not apply to an Owner of property whit Wilds or improwes thencon.and,
who contracts for such pirjects with a commumr(s)licensed pursuant to On Connsaactoes
L ace L, .
ans node, B&P C fee Or, on
r A Date
WORKER-SCOMITNSATIONDECLARATIO
:50jdectarathirs.
�ution.as providcd for by Section 37W of the Labor Code.for due Performance of the
11
weak fee which this Permit is issund.
I in
0 1 w and will maintain Worloor's compensation Insurance,as required by Section
"',On LasWr Code.for On peffincroure.1'On.&to,which this .i,is named.
My ii Compensation Insuranco carricr and Policy number mc:
center. -Policy No.:
CERTIFICATE OF UEMPTION MOM WORKERS'
COMPENSATION INSURANCE
Cods flim ndmo hic completed ifthe ptnerift is rmmic hundred d.tl.($IW)
Or Wat)
I Certify that in me perforrarce of the work for which this Permit is isound.I chair not
employ any person in my mother so,as or become subject to On Worlers'Compensation
Laws of California,Date
Applicant
NOTICE TO APPLICANT.If.after making this Ccrificam of Exemption.you should
become subject so the Worker's Compensation Provisions of on,Labour Coun.you most
0z forthwith comply wife such porivisions,Or this Permit shall lic denoted oc�nkcd.
z C
CONSTRUCTION LENDING AGENCY
I hereby airtnot that them is a construction lending agency for the performance of
the work for which this Permit is Wood(Sce.3M,Cv,C.)
Undoes Name
Lender'sAddroust
z
U C) I corlify that I hove ad this application oil show in.,On mu�information is
L� come,.I alptic to comply with 01 city and county ordinances and seem laws relaung to
0 Wilding constriction.and hereby summon opresentati,nes of this city to cnanr upon the
b.,n-monnioned propeny for in,cedon purposes.
(We)agree W sa..bull and keep haroulcer the City of Cconninit a I.'
get
i,, liabilities,judgments.costs and expenses which may in my way see=against=it City
U Z in consequence of the granfing o(this Permit.
A 'CA UEP�ERSTANDS AND WILL COMPLY WITTI ALL NOWPOINT Issued by:
PPLnR G ;DNS. Dat
OUR
A I Re-roofs (�7
SiteratibriffA,plitantrCconerictm% �)"`Dnac
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Allmilks will or future building occupartslon,or handle hamodon;material
Round by -I--Municipal Code.Chapter 9.12.andi On,Health and Safety
cienimic"'F
C n Y. AIT. All roofs shall be inspected prior to any roofing material being installed.
'Y
Will the applicant or future building Occupant use,equipment or&vi=which If a roof is installed without first obtaining an inspection,I agree to remove
' 0
mjE hazardous air contaminants as difined by me Bay Area Air Quality Management all new materials for inspection.
"a L
District?
Let
C3
CY.
I ban noted the require==under Chipter6,95 often Carron-
0,
_ re
not fic.111,&SalllyCedc,Scetion,25M5.25533 and 25534.Itoolcomand thatifft Wilding
wo
is r
it. 4 Oat it is my nexperoothly no nodry On ex,upor,of On
no,- fly h a hoom
on mar me Oro, ey
I. me in torecirmwouisman"Ofaccrofficase Signature of Applicant Date
ermi.tWo'c age..
70 net or authod7zd agent All roof coverings to be Class "B"or better