05120019 (3) CITY OF CUPERTINO '4KIN
tsOBUILDING DIVISION P fi� -
M . � Q
BUILDING ADDRESS: PERMIT N0.0 512 0 0 19
.1.658 JAMES TOWN DR
PERMITLSSUE DATR
JULIE & MIKE ST. CLAIR 12/05/2005
PHONE: SANITARY NO. CONTROL N0,
ARCHITECr7ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
X00 LICENSED CONTRACTORS DECLARATION Job Description
I hereby afr.Nat 1 am licensed under provision of Chopmr 9(commencing
with Sermon 70110)ofDivlaion J of the Busirua&Od Profession Cade and roy license u
mfull mmeand.Dem /1yp 373 KITCHEN REMODEL (NO. STRUCTURE CHANGES)
bZ License Class I> LinN
� p Dau_JJ_^ Cunuxtor 4V1F4 7`RNf7AI
- �ARCHITECrS DECLARATION
I undem,and my plans shall M used a public records
g u.
Licensed Professional
50 OWNER-BUILDER DECLARATION
I hereby.firm Net 1 1 exempt from tM Contractors Licence Law for tM
O O following mason.(Section 7(13 L4 Business and PmRvium Code:Any city m county $45000
5$Iii which rtyulrm a permit b emuwe4 alar,improve,demolish,ar mPWr ay awnum '
NO
prior to its issuance.also requires On applicant for Such Permit to file a signed moment Valuation
G
that M is licensed punuam t.Na proviaiom.f the Contractor',U.S.law(Chapter Y SQ. Ft.Floor Area
$ (commencing with Section 7000).1'Division 3 or the Business and Professions Cme)or
that M is exempt therefrom and the basis for due alleged eampdon.Any violatfon of
Section 7031.5 by any applicant for a permit subjects the applicant b a civil Penalty of r Occupancy Type
not more Nan Rw hundred dollars($500).
❑Lo he wCak the pro perty,mmyomployea withwages r Weir Sul.7044.Rathon,
,will do the work,C d e s o Como mosot Li caromded Law
ed s an,apply 7044,Bulinus Required Inspections
pmNand ny who
obu Code:The Convertor'+Liana Law dace ret apply lf an owner is Q p
mancinwyces.provided
that sathumomand ements oenot ch tom icark himadfor through his
.Sun ver,m Wilding
War such Improvements mid wit in ne you off mploutueorcd for onmar-
builder,me Wilding brimprow...injhat he withinoneWildorImproedogtheowwr-
builder will haw the burden of proving that he did not Wild car Improve for purpose of
co 1,u owner of Uro pmpcny,704,Business mand cofessi ng with licensed cnnlnnosa i. 3I
eoawm rhe project(sec.n an werofand profession Wild.
Code:)TheContractorstho ton.LI-
ceme law dont not apply to in owner of property wise Wilda rsSmpmws tMmon.and /
who contracts for such Or.jeeu with a contractor(s)licenced punuem m tM Contnnoh 0�
Lice.Law.
lam ucmptunder See.
i; b / 130 �B&PCfor cele moon
Dau
or WORKERS COMPENSATION DECLARATION
1 Mreby arum under penalty of perjury one of On fallowing dalaatiom:
❑l haw and will maintain a Cerdli ate of Consent maelf-imum for Worked'sCompen-
union,u provided for by Section 3700 of the labor Code.for We Performance of this
work for which this Permit is issued.
❑1 ban and will maintain Workers Compensation Insurance,as mquired by Section
3700.1 the labor Code,for the perf.....of On work for which this permit is Wood.
My Worke s Con IearW and Policy number am:
Carle Poliry No.:
CERTIFICATE OF EXEMPTION FROM WO RICE S
COMPENSATION INSURANCE
(Thin section need not be complcted if the Permit lsror.nc hundred dollarst$100)
.r less.)
I csrvfy that in the performance of the work for which this Permit Is Issued,l WII not
employ any person in any manner nab coma uh2 to OkWorkerif Compensation
Laws of Califon Dau
APPlicar I a
NOTICE TGAPPLICANT.If wirrAfrakirri this CCAUreMe or Exeemmption.you should
become&Object In the Worker's ComPensaion provisions or me labor Code,you mug
.J O forthwith comply with Such provisions or this permit shall W deemed invoked.
r y CONST RUCTION LENDING AGENCY
[—t I hereby slDtm that then lasconsl.d..lending agency for the performance of
gY,> On work for which thin permit Is Issued(Sec.3097.Civ.C.)
G.Q. Lenders Name
QLenders Addma
V Q 1 cenify that I haw read this application and sub Net ton aWw hurmal.d..I.
i,, Correa I agree to comply with all city and county ordinances and auto law,totaling to
Q U building construction.and hereby authorbe mpscsenutins of his city to enter upon the
Uabove-menti.red propeny for hopectian puriwes. 17
(We)ag.10 save,indemnify and keep terminal the City of Cupertino against
q) Imbilida,judgments.costs and expemm which may in any way aceme against aid City
U in eomequena of the granting of this permit.
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU RE LATIONS
� � ��,��, .— f L—S'�S Re-roofs
Sign re of ApplicaUCOnuacbr Dam
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicant or future building Occupant store or handle hmmdous manurial
defined by the Cupertino Municipal Code.Chapter 9.11.and this Health and Safely .
a.Section 25532( ? �(('''' All roofs shall be inspected prior to any roofing material being installed.
[]Yes mNb
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cmll horardous air contaminants an deMcd by the Bay Area Air Quality Management all new materials for inspection.
Disulct4 C
pros �t�u
I haw mad the hmumms materials requirements under Chapter 6.95 of the Califon —y
iia HcalW&Safety C.de,SCcu.os Vi5B5,15533and7553a,lundcrstandmtM W �
atlfilding
dom not et rcmm
ly haw.unl Nat it 4 my rmsihil
ponity m notry du occepmt of tM r L
�
realm laic mngWnetpd.dmi+&Oatuc.r.Ltrtirm+te.rQeup.
ey. Signature ofApplicant Date
� ��5 All roof coverings to be Class"B" or better
Owner tar..mono<d agent Dale
i MUM
- w i l � id xr�ia riY
141W.#i .f ..d�.}J a�. r�,.�t ry� «4- is-. �t+}{UF �.iE c4a"a 4
• - �i x X6R-s;S AhE 5s rL s '�3 E x- 1d' L 5 '�'
RESIDENT-1 Iff OJECT,COVER SHEET f�
f v? SVM T,F ,4
UIITYO A� Fv^ i - 1q� f+ ac181PR Y- riN ni*b. r.E 1 h w'tr,tx9�� �.4'Y'y* r s� f
CUPE3�TIN0 1F- I I , r an$146s NIF,
Assessor's Parcel Number:
Name of owner.
Project address. L---
- - y'5 8& 7- 72-660)
Contact person. JU0 'C Phone. 4/1 S ' Z 37- / 15 5
Fax. qv 5 - 537 - q1 Iy
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL: O
• Are there at least two 10 foot by 20 foot clear spaces inside the garage? l_/ N
Is privacy protection planting required for the project? Y N
On what floor(s) is work being done? r Guh/
Brief description of work. �C✓��C��F' ki �C�cN 6- tejrJ�uJ (•��W�l� J��acS
/ ZFAPJ4 e en v
Code editions: 2001 CBC (Y -N)2001 CFC (Y -N)2001 CMC . (Y-N)
2001 CPC (Y -N)2001 NEC (Y - N)
LL .J3 IS rn d iI u
'Effective ll/1/02 NQS 9hG7-)-,)z&L
DEC 05
2005
1
Plan Review Process Work Book Page-8-Revised 4/28/04
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• �� � �a .RESIsN�Th L�PRO �C-� COs s� SH°EE�T� ��
CUPEI�TINO le
Assessor's Parcel 1Number: tP t0 LGO�/
Name of owner. J V 2 f �1 � 7L 1 CJO-1 V--
Project
Project address. W A �—
��- y�5 8(0�' 7ZrnnB
Contact person. ` mo e Phone. S - Z 3 (-
Fax.
t'-Fax. zV/5 - 5137 - Z/1f?i
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL: O
• Are there at least two 10 foot by 20 foot clear spaces inside the garage? C N
Is privacy protection planting required for the project? Y N
On what floor(s) is work being done? I
Brief description of work. 1� �✓��G��P K i �Gl1eK 6-a�
� (00u Ta-Nr W� ( -Jv-fa-S
e� —�' ert e�c
u
Code editions: 2001 CBC (Y -N)2001 CFC (Y -N)2001 CMC . (Y-N)
2001 CPC (Y -N)2001 NEC (Y - N)
Effective 11/1/02 /V6
w
RECEIVED
• DEC 0 5 2005
Plan Review Process Work Book Page-8-Revised 4/28/04
CITY OF CUPERT
CUP 7Y OV IT APPLICATIONWRM
11 N# 3 /O 063 Date: 1 Z - CS
Building Address: Mailing Address (if different from building address):
1658 J
Owner's Name: Phone#:4,�o b' -3 6 6 - 18.9 2-
ST, C(a)v,
Contractor: License#:
NOEL GOr)(DAJA/ �"o373 B Cj
Contact: C- v15 Phone: N1S•z3Y-/3s3 Cupertino Business License#:
/VoF L X67-77,68Fax: 4/1S 7- yit�-
Building Permit Info:
Bldg Elect zi Plumb Mech ❑
Job Description.- -TV sn2u LTV 044- C ka K[•eco
Residential G e K Commercial ❑
Sq.Ft. Floor Area: q.Ft.:
Cost of proiect: Occupancy Grouro:
Type of Construction: Please check this box if the project is a
second-story addition: ❑
ro'ect Size: Standard Laze ❑ Major ❑
Quant ity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BB01 LERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBQILER3. 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
1 of 3
h ✓ CITY OF CUPERTIN
CUPEi�TINO MzT APPLICATIO�RM
QuantityFee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMTTIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMNM New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum . PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Pioing 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 rinkler/Backflo PLUMBING
BPSTORM Storm/Rain 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 c$n MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFIIRN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREWMAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood IITECHANICAL
BREMMLSC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMR.ECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Ap liance ELECTRICAL
2 of 3
Cft OF CUPERTINO
CUPEI�TINO PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
13REMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS I Remodel Signs, Marquee ELECTRICAL
BREMTHEATR I Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems AfECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISAIICOM Seismic Commercial BUILDING
BSEISAHCRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMY Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Per BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
j9 MPERMFEE Mechanicals . foot MECHANICAL
MPERMI'TFEE Mech Permit Issuance MECHANICAL
O PPERMTTFEE
Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Commel Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Chane BUIDDING
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