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03030086 (4) 117-1-7-7—777 11 CITY OF CUPERTINO '. i4''s' a ° A `,' =��`"'= BUILDING DIVISION PERMIT fdCd1V ) OROMA CIO„ BUILDING ADDRESS: PERMIT NO. OWNER'S NAME: PERMIT ISS KAISA HOLLM FIN SANITARY NO. L NO. ARCHffECfIPNOINEER: BUILDING PERMIT INFO ' BLOO EIF.LT PLUMB MECH . Hpp LICENSED CONIACTOWSDECLARATION JobDescri tion 1 hereby am.Nat I an Re mcd under pmvixom of Chapter 9(mmmuncint PMN Section 7000)of Division 3 or Ne Business and Pmfest...Cnde,andmyllecomisr�-�t�il nn �® U... .deflect Lie. KITCHEN REMODEL It IIV�IWC DamaContractor ARCHITECTS DECLARATIONAPR JU 2003I underund my plans"IW used as public records a Licensed Professional OWNER-BUILDER exempt DER DE Ce ContrON BUILDING 1 busby.(firm that 1 am exempts re the Caroms Co License Law for the L. g`11 Vl p O which nt el.rm. Pani.I ]1D I5,e. Ica . and Pmfuuorti Code:My city s county $ which�its issuance. also requires me.aWr,Wrmve,h mmiN.ore a sig any structure I tr^ thatprimW i its mused e,also requires Ne anions o roe sucCon"clue Um a,Law Catement < hayWisllmnxd pmeumtmNc rrovloloes of the Conln<tur'oUmnx hew(Chapter 9 Sq.Ft.Floor Area Valuation (cmnmeMnj with SeNon 7000)o(DivWdn3of Ne Butncn.nd Poreulou Code)w $25000 t $ Net W m exempt thuefmm and dte half for Ne allegnd cumpdon.Any violation of Section 70315 by any applicant for a permit subjects the applicant to a civil penally of 3 ��r. 0 0 Occupancy Type not more then flus hundred dollen($50)). 01.as.wner of the PmPesty.or my employees with wages u thebsole cmnpertsatlon, will do the work and the sousme is net Intended oroffered forsak(Sm.7044.Business 101 - FOUNDRgInspections ' and profession Codc:The Consumer,License Law does ort apply m an owner of "'Y'].'�id&iD P Property who Wilds or improves Newn.and who doessuch workhimselforthmugh his 102 — PIERS own employees,provided th.uech improvements art not intended m.Rered foruk.If. poweusr.Ne Wilding or lmpmvement is sold withNom year af.omplimon.the owns. 103 — UFER Wilder will baro she burden of proving that W did not build or improve for purpose of 104 — REBAR eek.). 1.as owner of the property,am exclusively connecting with licensed mnuanus us - 105 — ANCHOR BOLTS comb.ct the pmJect(Ste 70th.Business and Professions Cnde:)The Contractors U. 106 — SEWER & WATER cense taw does not apply t.an owner of property who bell&or improv thereon,and, who contracts for auto projects who a contracmr(a)licensed resonant mthe Contractor. 202 — UNDERFLOOR PLUMBING License Law 203 - UNDERFLOOR MECHANICAL Clam come .der Sm. B&PCfor Nla won yA�gf� G/ 3 tl p 204 - UNDERFLOOR FRAME WORKER'S MP SATIONDECL3 N 205 - UNDERFLOOR INSULATION I hereby affirm under penalty of perjury one of the following declarWom: 301 — ROUGH PLUMBING WWI.. -and will mabmmh.cweesx orcmsem to aHr-Iroum RawmWr.cempen. 302 — TUB Sc OR SHOWER which provided for by Secure 3700 of the LaWr Code,for the performance of On rorwhich thk Permit m issued 303 - ROUGH MECHANICAL 0 1 have and will maintain worker'.Compensation I...eco required by Section 304 4 — ROUGH ELECTRICAL 3700.17 the L.Wr Cede.forth.performance.(We work for which this pemth ts issued. 30 Mywonera coreprnuln den ttar 5 — FRAME acarrier and Policy number am: 305 — FRAMEHOLDONS Carrhen Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 307 — INSULATION . COMPENSATION INSURANCE 308 — SHEETROCK nrkse(TusxNm rend retbemmpktetl tribe permit 4f.rmte hundred d.0m(5100) 309 - EXTERIOR LATH I capiy Net In the Performs o Ne work for which this rmfmit ts issued,I"I not 310 — INTERIOR LATH employ any person in my ecu m beomesebject to the Wmiume CompemN.n ,311 — SCRATCH COAT taws of C.lifomia.Dem Applisuu 313 - ROOF NAIL NOTICE nth. :e.cone'mng Nbwt.lnsarw erne Codet. o 501 - FINAL ELECTRICAL ENERGY become oub m IC Woncf.C after meld tion pmvrlmc to of mor Cnde, u mutt zO foMwith reply wIN cosh pmvisiou or Nio permit Mall be domed mooted 502 - FINAL PLUMBING ENERGY y CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY [—� l hereby affirm that them I..commuclien lending.gency for the im(mmanceof x> the workfor which WsPermit 1.issued(Sce.3097.Civ.C.) 504 - FINAL BUILDING ENERGY LSEq LenderaName 505 - FINAL ELECTRICAL z Lenders Address J O 1 sonify that I have read duo application and we Nat the abets Information is 506 - GAS TEST context I agree to comply with all city and county ordinances and sum laws mating in 507 - FINAL PLUMBING building construction,and bereby.uNmlm representatives of this city in now upon the 0 "FINMECHAWCAL aWus-mentioned he nY forimnif ianpurposes.fY (We)egtce m sero•indemnity and keep haemlees the City of Cupenin.against O 9 In liabilities,judipoc amurs,and expevu which may he any way smuc.gainstWd City5L)z in wnsq enm of Ne genting of this Permit.SAPPLICANT O RCEE UNATIONS.ND ND WILL COMFY WTfTh(.LL NON-POINr Issued by:5 Date VJI Re-roofs �gnuure of Applucsw,rector Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will dte applicant or future Wilding.ccop.nt store.rhandle hacamom masers] as defined by the Cupertino Municipal Code,Chapter 9.13.and the Health and Safety Code,Sutton 35535(.)7 %On All roofs shall be inspected prior to an roofing material bei. ❑Yu P P Y 8 g installed. Will IW applicant m future Wilding arupant sex equipment or dcviw which If a roof is installed without first obtaining an inspection,I agree to remove �n7 mum air eonumlmen s u retired by the Bay Area Air Quality Management all new materials for inspection. "hatmmu }Q No dm herudem materials requimmentsunderclupterG95ofdmcolirot Cok.S<u..MM5.75533end7S53d.lu, Nu l(dm alibiing hate a tenant.that Ir u my rox omibinty m d(y arurant of Nc mustbe pbe Issuwme.�eufluteof�e Signature of Applicant Date cedagent I D� All roof coverings to be Class"B"or better rni0z V— refr, d'qq-e - rrn Y" -e < (f Q O 0 o � ({'�13 "'f , t �Ir' / O U J u �' / APPROVED IN ACMTZANC�;,jrm THE CI Y OF I CLIPER LINO CODESANDgPUANCES 3/ 7 � DATE SIGNErC'r This set of plans and spedtiCations MUST b3 K^pl r ,a1B Pu a, au unity o, ,.........,.. any charves or alterations on eam. 'Athout wrm � kmen permort hW aA:&V Iept., Ciry a Cupemra. „. rho clamping of this plan end WedlICA D SHALL NOT be held to permit of to pe 0 •]pr)mval of the violation of my pMvb= all any City Ordinance or State testy • Client: KAISA HOLLMEN Planner's Name:STEPHANI Store Name: IKEA This drawing is an artistic impression Home Phone:408565135 Door Style:Abstrakt Grey Store Address:4400 Shellmound Street and should not be used as a blue print. Design: HollmenK.ROM Pull:Adverb 128 C hor Emeryville,California 9460 All dimensions and designations are subject to verificatio Createtl: Countertop:Custom DR Store Phone:510.420.4532 x1925 on job site and adjustment to fit jot)conditions. Last Saved: 1/24/03 View: Perspective Store Fax: 510.420.8662 Scale: Scale-to-fit an, CITY OF CUPERTINO • "rPERMIT APPLICATION FORM CUPEIkT�TINO O 2b3PO* ' N# Date: ;. ��1, zoos Building Address: 10553 :Faro I l o n-e_ Dr Owner's Name: Phone #: KUISq f ��Imen AGI Ir^kc� csl - NQ )q09 865 1355 Contractor: EUroS+ 1E I uU [AdCt-5 License#: _ C B . H I C 5y b� J y Contact: Phone #: Omo Nw6iamen 6�0 -365 15�/ 650- 7878365 Amp lic t/Contractor: Fax #: Buil ' g Permit Info: g �� Plumb) Mech Job Description: Residential: Commercial: Sq.Ft.-Floor Area: $/Sq.Ft.: ZO s �e Architect/Engineer: Valuation: �r Type of Construction: Occupancy roup:: i+ V)-e4-W, rcynocle- LIn Quantity Fee ID Fee Description Fee Grou BAPPLOTHER Other A liances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/ uas' BUILDING BCONSTAXB Con. Tax for Tln Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mob'le BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1Ani Elec 600V> I OOOA ELECTRICAL BELEC200 Elec Svcs 600V<=200A BENERGY ELECTRICAL Ener BUILDING BENERGYADD Ener Add Multi BUILDING BINVESTIGA Invest' ation fee BUILDING BMITIGATC Comm. Housin Mit. Fee BUILDING BMITIGATR Res. Housin Mit Fee BUILDING BMNEWMULTI New Multi-Famil Res MECHANICAL BNEWMULTI New Multi-fam'1 Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING 1 of3 �j JAR, :,1 CITY OF CUPERTINO / CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BNUMULTI New Multi-family Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING 13PCESSPOOL 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 /41 BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING 13PTRAP 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 clip MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM 3USWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc A azatus ELECTRICAL 13REMNRAPP Rem Non-Res Appliance ELECTRICAL BREN20LE Pole/Platform Fixture ELECTRICAL BREN20WER Power Device/Apparatus ELECTRICAL BRENRECEPT 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 I Theatrical Lighting Fix ELECTRICAL 2 of 3 aqIYOCIT OF CUPERTIN.O PERMIT APPLICATION FORM F �UPEkTINO Quantity Fee ID Fee Descri tion Fee Group BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation S stems MECHANICAL BSCBLVD Scb S ecific Plan BUILDING BSEISNIICOM Seismic Commercial BUILDING BSEISIVIICRE Seismic Fee Res BUILDING BSF&2FAM in le&2 Tamil BUILDING BSFNA in le Tamil New AddBUILDING BSpEC1AL S ecialI------:-- BUILDING BS W1M Swimming Pool BUILDING BTEMp Tem or 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 Mechanicalsq. foot MECHANICAL MpERMITFEE Mech Permit Issuance MECHANICAL ppERMITFEE Plumbing Permit Issue PLUMBING ppLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING BBOILER1 Boiler<= 100,000 Btu MECHANICAL 3BOILER2 Boiler> 100Kto500KBtu MECHANICAL BB0ILER3 Boiler> 500K to 1M Btu MECHANICAL 13BOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75 M Btu MECHANICAL • 3 of 3