03040053 (3) CITY OF CUPERTINO
BUILDING DIVISION PERMIT ;.,, M §;Its - O _ fA
BUILDING ADDRESS: PERMIT NO.
10630 CASTINE AV JEFF/MARY' HULTQUIST 03040053
OWNER'S NAME: PERMIT ISSUE DATE
JEFF/MARY HULTQUIST 04/09/2003
SANITARY NO. CONTROL NO.
ARCHITECT/lINGINEER: BUILDING PERMIT INFO
BlDO strep PLUMB MECH
30o4
LICENSED CONIRACIORSDECLARATION JobDescri uonO 1 hereby rdE m Nu 1 am Reamed under provWam of Chapter 9(commencing p
with secM
d70'10)MO)Ivlslao 3.1'the EutiaAs and Profesdalu Code.sed my licaoc is
n in full tome and erten
Us.d�a
License Case cel„'ramro KITCHEN REMODEL/UPGRADE
oil
ARCHITECTS DECLARATION
1 undersand mY Danshall be used as public records 17 ))
Licenced Professional 17
OWNER-BUILDER DECLARATION U J
<f I hereby aRrm that 1 em esempl from the Convector's License Law for the /
a O following mama(Scedan 703 IJ.Business and Professions Cade:Any city w county
$fi which requires a permit to consumL slur.Improve,demolish,on,repair any vrucwm
Sn prim to its issuance.also requires dnapplicam ferment permit ve 51,atigmdmtemem
< that rte is licenaw mauve to provisions of the Contruwrs License law(Chapter9 S Ft.Floor Area
g P q. Valuation
$ (commencing with Section 7000)ofDivision 7oftheButnwaudProlaawnsCode)ler $255000
tat he is eanmpt therefrom and the hues for the staged eaemp0oa Any violation of
ion 7031.5 by any appliunlfor•March subjects the applicant In a clMI penalty of D8Tt 3ApN p. 00 Occupancy Type
notmom than fire Watched dollsm(5500). �4 3 r
❑I,as amount of Oce property,a my employees with were,u theirsele compenudon,
will do the work,and the structure anatinunded wofferad retain(Sec.7044.Busimu
and Profeatiom Code:The Comuurs Uawe IAw dee,me apply se an owner,of 101 - FOUNDI$F94*Inspections
Property who bulldswimpeavestheroan.and whodasamh wakhimMilfwthrough his 102 - PIERS
own employees,provided Lim such Impravemm etee not Imeded aoacted fault.if,
however,the building or improvement taaeld within Mm year of completion,the answer. 103 — UFER
builder will have the burden of proving Ow he did ret build m Improv fa purpose a 104 — REBAR
Mile.).
❑1,ns owner of the property,m eulwively com'aing with licensed ccomaom to 105 - ANCHOR BOLTS
MHUMM the project(Sec.7044.Business and Production Cade:)The Cco9anmes U.
name Law door.01apply wan Manor of property was builds or nnprowe demur,and, 106 - SEWER & WATER
who contracts For such pmjem with,emumortJ licensed personal be the Conmcwra
LAW.. 202 - UNDERFLOOR PLUMBING
V"—.
lame=emP}undersee BAPCf chances"
203 - UNDERFLOOR MECHANICAL
0S 4I D. 03 204 - UNDERFLOOR FRAME
��J .�I]n ORRER•s MPENSATLON DECLARATIO 205 - UNDERFLOOR INSULATION
l leemby tm under peuRy of perm m of the following d mgco r 301 - ROUGH PLUMBING
vemd will msinwnaCenlfie,mof Camnlwelf-Insurofa Worke sC mpcn- 302 — TUB & OR SHOWER
n,u provided fa by Emma 5700 of the IAba Cade,fa the perfamsna of this
workforwhichthtapermitlsIz-r 303 - ROUGH MECHANICAL
0 I have and will maintain Worka's Campenallm Imuran,u required by Seam 304 - ROUGH ELECTRICAL
5700 of de labor Code,for the performance of the vert forwmch this permit is bound. 305 — FRAME .
MY WarkC
ers mPmfttian wmann curia mod POLICY number m:
Carrier, Policy No.: 306 - HOLDOWNS
CERTIpICC MPENSATION INSURANCETE OF EXEMPTION FROM 307
307 - INSULATION
tThtasalmmnd ret berm PImd1 Hth,lermh aforamhullthadonm(SI00) 308 - SHEETROCK
was`) 309 - EXTERIOR LATH
I only, it inJ a pvfarmana of the work for which this pumh a Leaned,l shall nest 310 - INTERIOR LATH
employ arnMu niay maw u w lemma subject ce the Workea•Canpesmaon 311 - SCRATCH COAT
Laws of, u
Ap, ant
N CAM:It.'fly mating this Ccnifiuu of 6s d 1
p ,you should 313 - ROOF NAIL
I Ile WatarncanrcnUWPM =Cf'he'AbwCa -YOMmaa 501 - FINAL ELECTRICAL ENERGY
,z, fore ithcomply with such provisions a this parmitsiwl bcdeened rtwted.
gyp ' 502 - FINAL PLUMBING ENERGY
up
CONSTRUCTION
rp UCDONLEd
senndwatembsmmumtlmiaminate pu
503 - FINAL MECHANICAL ENERGY
the k for which the permuBIssued(sec.30",Civ.c.) 7
Louses 504 - FINAL BUILDING ENERGY
j
Leeder's Addma 505 - FINAL ELECTRICAL`
�O I certify ocoI banmply a this wvHewan and sato thrt us,above information,a 506 - GAS TEST
gr concct.l agree to comply with Yl city and county adinams and mu lawn totaling w 7 - FINAL PLUMBING
building construction,and hereby au,hodre rtprcuuudves of this city to Motor upon the
w alto e-men0onnd property fur Inspection pro pores 0 - F I L MEC I CAL
<4
(We)aju agree w cows Indemnifyexica and heapmay
Inlocations he City of CupaOl ld City 9 F I
rA IIeconacgance of nu,remand a this PC hick mryin anYnyattroc gtlmluid City
7
APPLICANT
T of the grandUNDERSTANDS
of w4 D WILL
5 NG
Fi APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RE U ON
9 c3 Re-roofs
+celUCanmcwr Dab
HAZARDOUIS MATERIALS DISCLOSURE Type of Roof
Will the applicant as
(Whom building resonant Marc or haMle hundow m,tetisi
as defined by the Cupenlm ManicJJj pal Cade.Chapter 9.13,ad the Halth and Safely
cavi.sucuan us5:t.)
Ove, All roofs shall be inspected prior to any roofing material being installed.
/ No
If a roof is installed without first obtainin an ins ection,I a ree to remove
Will the applies r(rete building aauPam tee eyuipmem or kvlcA whloh g P g
Mzerhms air ren minae u defined by the Bay Arca Air Quality MMsgemant all new materials for inspection.
❑Yp '�O
I haw rand Oce round; msmauvieh mquw haPte
immcundaCr6.95ofLite Cdifor-
nitHMilth&SafaYCode.Se,dm 25505.25533 and 75534.1 uMemmw the if de building
do.;not comedy have a M-4 Nal 111-my notentibillly w fiat fy the Moran,of Oce
requirement c motbometpdorwiuusnceofaCcNncauyof a anry. Signature of Applicant Date
ow fizcd agenl / to All roof coverings to be Class IB"or better
OAR-BUILDER VERIFICATIA
1. (Check one) I or my immediate family(parent,spouse or child)will perform:
• A. X All the work authorized by this permit
B. _ A portion of the work
C. None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. _ A portion of the work(complete section below)
Conti for Address/City Phone# State License # Type of work to
be performed
• 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer(see reverse site). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Perso irm Address/City Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information(reverse side).
Property Ownefs Signature te: �/�21�0 3
Job Addres 1 ob Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
•
s •
CITY OF City of Cupertino Building Departm�
C U PE INTI NO Phone:
Torre Aver
11W
one: (aoa)777-3228
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified. \
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself,you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection:
ff you employ or otherwise engage any persons other than your immediate family,and the work
(including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding, federal social
security taxes, workers' compensation insurance,disability insurance costs, and unemployment compensatic•
contributions.
There may be financial risks for you if you do not carry out these obligations,and these risks are
especially serious with respect to workers' compensation insurance.
For more specific information about your obligations under federal law,contact the hitemal Revenue
Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor,only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit, erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department,
City of Cupertino •
Printed on Recycled Paper
ammar CITY OF CUPERTINO O /
CUPEf�TINO PERMIT APPLICATION FORM
Alk
APN# 7, J Date: y 9 /a 3
Building Address:
1o63a Costine Ave .
Owner's Name:Je,-C� /r r by fi vISt P
CeatFhone#: 732 - 932-7
actn , / �_en. TI O �;
J
Buildin Permit Info:
B dg El ct Plum M h
J ription:
Residential JZ k;-k-Gk 2 n rio—ai o cL I cial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: _ dZSk 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. Housing Mit. Fee I BUILDING
1of3 � � ( V , 5�
ATY OF CUPERTIN0
CUPEIo 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
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamil Res PLUMBING
BNUSFD New Single Family Res BUILDING
BOVERTHVIE Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pbl Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Pian Check Fee .BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Repipe Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
lop BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM StomVRain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT. Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pipe PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units<= 10,000 cfin 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 MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
2of3
s �►
CITY OF CUPERTIl*
cuPER,TiNo PERMIT APPLICATION FORM
uan ' Fee ID Fee Description Fee Group
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, 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
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 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 Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
3 of 3
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