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05010102 (2) CITY OF CUPF.IL'1'INO `' '"a<z �dr+*;,: BUILDING DIVISION PERMIT 4C0NTR°ACT0R INFORMATION BUILDING ADDRESS: JAY SYLVESTER CONSTRUCTION PERMIT 1 U5010102 R'S NAME: PERMIT ISSUE DATE "NE MICHAEL & MAUREEN QMEARA 109 MICHAEL WAY 01 /18/2005 PI ONE: SANITARY NO. CONTROL NO. (408) 307-2770 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH _00 LICENSED CON'IRACfOR'S DECLARATION Job Description u❑ I hereby affirm that 1 am licerved under provisions of Chapter OOSCfIp r 9(commencing £�W with Section 7000)of Divixion 3ofrh Business andr fessiom do cid my license is mu raroe arta ermn. �f ( �n REMODEL KITCHEN/REPLACE WINDOWS (2) j i Licrnu Clan Lic.a e t-p Dam Contrazmr I ( ny ` RCIIITECTS DEC A r C n U 1 understand my plans shall be used u p is mods a o H Licensed Professional g OWNER-BUILDER DECLARATION am 1 hereby affirm that I am exempt from the Ctntracier's License Law for the 00 flowing reason.(Section 7031.5,Business and Professions Code:Any city or county <m which requires a Permit to construct,alter,improve,demolish,or repair any structureO °i„ prior to its issuanee.alau requires the applicant forsueh permit m File asiFned statement _r0 that he is licensed pursuant to the provaioa of the Contractor i Lianas Law(ChapterY Sq. Ft. Floor Area Valuation en-a (commencing with Section 70(10)M Division J of the Business and Profession Cook)or _ that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to acivil penalty of 3 4Aa141l9u_t6bet0 0 Occupancy Type not more than five hundred dollars(S500). ❑ I.as owner alum pro,terty,or my cmployca with wages a their sole compensation, will do the work,and the structure is not intended or offered foraale(Sec.706J,Business and Pmfessions Code:The Contactors License Law dux nal apply to an owner of Required Inspection property who builds or improves thereon,and who does such work himulf or through his own cmployca,provided that such improvements are not intended or offered for ale.It. / however.ithe ho,e ft onimprovement ent o having robe did rote year of completion,the owner. of builder will have 0m burden of graving Nat he did rwr build ar improve(or puryose or 0 salt.). ^ 0 1,as owner of the property,em exclusively contracting with licensed contractors to vJ� consumer the pm*t(Sea 704,1,Business and Profusions Code:)The Contractor's Li. ecom Law docs not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractors)licensed pursuant o dm Contractor's License Law. El 1 am exempt under Sec. .B&P C for this reason Dau WORK ERS COM PENSATION DECLARATION -' I hereby affirm under penalty of pcijury arc or the following declarations: l have and will maintain a Cenineme of Coaenuo xl6insum Be Worker's Compen- sation.as provided for by Section 3700 of the labor Code,for the performance of the work for which Nis Permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the labor Code,for the performance of hoc work for which this it isWake. � My Workers`Cn/99tt�reen. to In ealrtier and Policy numMra / / _ Carrier. 31�Y/ �n wit, No.: Off✓V (! ( 3./o J CERTIFICATE OF EXEMMON FROM WORKERS' COMPENSATION INSURANCE mus section necJ nm be complexed if tle permit is formic hundred Joltaa($100) ,it less.) , 1 certify but in the pdformenec of the work for which this pymit is issued,I shall not - employany�mi ny man CTs anis 1 the Workers Compensation LawI Ca . te TIFrT!1 a c iakinF Ibis Ccnincatc of EacmPtion,you shoulJ Workcra Compensation provisions of the Labor Code,you mum �Z. forthwith comply with such provisions or this permit shall be dcemW revoked. - ZO CONSTRUCTION LENDING AGENCY I hereby affirm than then is a construction lending agency for the Performance of Z the work for which this permit is issued(Sce.3097,Civ.C.) i1 Q Lender's Name ? z Lender's Address J Q 1 certify,that 1 have read this city and coon and sou that the above information is y F cording l agree m comply with all city and county ordinances and sum laws relating to C) building construction.and hemhyectionp rcoses, aiw of this city menter upon Bte w ahpvomadanm PmPcou for inspection am � _ (We)agac to save,indemnify and keep huream.the Ci Ly or Copenmo against fA inconsegenceo the grand ad either., anyway acme>gamn said City J z in consequence of the graining of this permit. '—' APPLICANT U DERST NDS}}��ND�—WILL COMPLY WITH ALL NON-POINT Issued by: Date 56 CE REG ATIO u / �IfL�Lyr�✓'"t/1 Re-roofs Signator of Applicant/ tractor Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or for..building occupant score roommate baarduus material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety CoJc, Oy�35532(a)? ON. All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future batwing occupant use equipment or devices which .If a roof is installed without first obtaining an inspection,I agree to remove . emit hazardous air canaminanu as defined by the Bay Area Air Quality Management all new materials for inspection. Drmric4 ❑Yes ON. / 1 I heveaaJ thchaza ousmaterialsmqulmmenuundcr Chapter6.95afthe Califor nia Hdalm&Samtycadc,Sadans 25505,25533 ud 2553x,l undcmwd thmirJv:Wilding Jots non currenlly have a mean.Nat it u my resptaihility m m ry do mcupant of the mg Jormemx which m.L W mel prior W nonlinear.eerurieam err DCCapaney. Signature of Applicant •Date Owner or authorised agent Dale All roof coverings to be Class "B" or better CITY OF CUPERTINO i�� (-� "a*i'!"I��n4�Awt c�S ' a �' n 8 T t`r�i '_..- BUILHING DIVISION PE IT c CSN°�1��'>•�T`/RI INI'�4` T}ON BUILDING ADDRESS: JAY SYLVESTER CONSTRUCTION PERMIT N%5010102 W NER'S NAME: PERMIT ISSUE DATE MICHAEL & MA R E 5 HONE: SANITARY NO. CONTROL NO, (408) 307-2770 ARCHITECTIENGINEER: - BUILDING PERMIT INFO BLDG [CECT PLUMB MECH sato LICENSED CONTRACTOR'S DECLARATION �] O O O mp 1 heathy affirm that 1 am limned undo,pr WiSiomS or Cnaptcr 9(Surrounding 'Job Descpripti(on with Scrdm.oPPB)orDivision Sof Uc Business and Prufessinns d andmyliccrecix r�� 1�u/.�� t! rT•u�l� atch in mumrreanderraet. 9 G G ay, REMODEL KITCHEN REPLAOE�WINDOWS 2 y vJ Y Liccnx Class �� Lic.p emoraetaf � C t,' -ARCHITECTS DECLARA v I (r4 I understand my plans shall x used as public rccards ZQOPy )yU J satin Licensed herebyProfesTonal a����� <S OWNER-BUILDER DECLARATION '/yr��}`g Ra u� y I hereby affirm that I nm exempt from the Contractors License Law far the �[a�\VW`n1 00 following mason.(Section 71n 1.5,Businus and Professions Code:Any city nr county which aquira a permit to construct,altea narrow.demolish,or repairany structure 5zQ Prionto its issuance,also requites the applicant for such Permit to file a agnedstaxment 820000 ?So that he is licensed pursuanttothepmostrasoftheContractor''sLicense aw(Chapter 9 Sq. Ft. Floor Area Valuation rl- (commencing rerun Section 7I%lB)of Division 3 of the Businessand Prufessinns Orde)or ]hat he is eacmpt thcmffom and the buss for the alleged exemption.Any violation of Section 7031.5 by any applicant for apamit subjects the applicant o a civil Penalty of ane T t$'.N$®Li3u"be100 Occupancy not ream than five hundred delta. 34 P Y YPe I,u Ownef of the popcny,or my employco with wages as their sole compensation, Will do the work,and the Someone is not intended or offered for sale(Sec.IDK,Business and Firearms Code:The Contractors License Law does not apply to an owner of Required Inspections property who builds or improves thereon,and who does such work nimwif or hrough his own employees,provided Nat such imprommenu are not inxnded or oRetetl for vlc.If. howemr,Ne building or improvement is sold within one year of completion,the owner- builder will have the burden of roaring Nal he did not Wild or improve for purpose of sale.). ❑1,as owner of me property,am exclusively contracting with licensed Contractors to Sommer the pmlect(See 7014,Business and Prafessions Code:)Tie Comracteri Li ceue law docs not apply IS,an owner of property who Wilds or impraw,;thereon.and who conGacu for such ptojeela with a eontraeo,B)licensed pursuant o the Contractor's License law. 0 l am eacmpt under See. ,B&P C far this reason wncr Dax WORKER'S COMPENSATION DECLARATION 1 hereby affirm under Penalty of perjury ane of the following d¢lasations: ❑1 haw and will maintain aCenificate of Consent to xlr-insure for WoracesCompon- sation,as provided for by Section 37M of the labor Code.for the p rformanoc of the work for which this permit is issued. ❑I have and will maintain Worker's COmpensatlon Insurance.as oqulRd by Section 3700 of the labor Cadc,fa the performance of the were for which doirnar,is issued. My Work rs�C/9tp�ens(�nn Insu ¢carticr and Policy numbs a / Cafricv_ /.JT ��1�% Policy No.: E� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu Section need not or,completed R OO permit is far one hundred dollars(SIM) or less.) 1 Unruly that in the ycrfarmanec of N k for which this grmit is issued,1 shall not craployany persoppin any mm rs o esu �otne Workcrs'CDmpensation Laws of Californil.Da¢ l Applicant V /i NOTICE r0 PIC .].altekihakng this Cenificao of Exemption,you should become subj&l to th Worker's Compensation provisions of the labor Code,you must Z forthwith comply with such provisions or this Permit shall he deemed revoked. Z O CONSTRUCTION LENDING AGENCY I hcrcby affirm That dere is a coutmctinn]ending agency for the performance or Yr the work fur which this permit is issued(Sec.3091.Co.C.) y Q Lenders Name z Leader's Addmes J Q 1 rectify that I have read this application and sox that the above information is ' / ]. t.., correcL l agree m comply with all city and county ordinances and slate laws relating to th (A j�-Ji building construction,and hereby aumim rcpnt reseatiMs of this city to carer upon the a(/ Ck7 abovcmemioned pmpeny fon i S a,c,fion pusjwxs. � (We)agree m save,indemnify and keep harmleas the City of Cupertino against Jr raj] liobiliar,omu orthe,ruing of this csmit. may in any way aamc againstsaid City Z incnnu9ucncc NDERSTANuftbinpermit. ^ SOURCE R U;JDERSTANDSIAND WILL COMPLY WITH ALL NON POINT Issued by: Date SOOACE REG AT70p5.�y� � GGP LG. Lbl / /ate—OSS Re-roofs Sishmure of Applieun' on�soar— Dare / HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant sore or handle hawrdous m ncrul at dc0ned by Ne Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25533(a)? ❑rON. All roofs shall be inspected prior to any roofing material being Will the ippfcam or room building orcopaal use equipment Of devices whieh If a roof is installed without first obtaining an inspection,I agree to remove - emit hamrdnus air contaminants as defined by the Bay Arca Air Quality Management District? all new materials for inspection. ❑Yrs 0 N / l %r,,�/ [have read thehamrdousmaorialsmquimmcnuunder Chapxf&95oflbc Califon r ^� ria HMItr&Safety Code,Seedons25505,25533end25534.1 undcrsland thatiftoc Wilding .x i docs not cimendy have a coo.,tom it is my responsihility In nouly the account of the !% / l ,C Ct ,L %.._/i,3 --J� reciimmen0 which mus,M met pdonn issuance of a CcNficur,of Occupancy. 'Signatllre Of Appli6aot 'Date Owner or autnarixed agent Dax All roof coverings to be Class"B" or better i r( CITY OF CUPERTINO S j Z CITY OF PERMIT APPLICATION FORM • CUPEkTINO APN # 3V L 15e 032— Date: 1-19— a5— Building _G8' ©rBuilding Address: j� Mailing Address (if different from building address): /197/ (�o c*/.0 o-O cY J i/ cel 04ki 'D C�pc Owner's Name: Phone #:Contractor: License #: Contact Phone: Cupertino Business License#: J"ii // 936-71-270 Fax: Building Permit Info: Bldg 9 Elect Plumb ® Mech ❑ Job DescriptionP f {/qw(� 2 a W`r✓ aW S/�� Residential � 9,Q-m0dll,1 Commercial ❑ v' �e s•©'V� Sq.Ft. Floor Area: $/Sq.Ft.: I 12 O - Cost of Project: v Occupancy Gh oup: O p tsa K ` AliType ofConstruc ton: Please check this box if the project is a g A41t-ka owv second-story addition: ❑ Project Size: Standard ®. Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100Kto500KBtu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> IM 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 Elee 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 2 �3 "`� 1 of3 I r ) 3/ CITY OF CUPERTIN CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee 1D Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME 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 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 J I BPSEW AGE 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 BPW14EATER 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 BREMBUSWAY 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 Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 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 2 of 3 *ITY OF CUPERTINO CITY°F PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL J BREMVENFAN Vent Fan Single Duct MECHANICAL BREINIVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection 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 Elee Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Change BUILDING • 3 of 3 3 y ? : i , � II fge1 s Cgsi la a. 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Drawint:N: 1 'C ME r£._ y:.r t.<£�3 ; 'r�••ys 5:::'>.\ .:'>Z' 3>¢' ,:y:>.. vyfy r. s..o��• h, ' <rsl�' < k"+ykF:>u!d�?.G Now:This drawing is an artistic Designed: 12/3/04 interpretation of the general appearance of Prin[ed: 12/3/04 the design.It is not mean[to be an exact rendition. z. ' �Ju »,`iL••�k`t;�.G.E�::n<i c..$�� � ?TE ji :./......:F...`(< •',�'S "'.gin`$ ->L e :S , .s: Note:This drawing is an artistic Designed: 12/3/04 interpretation of the general appearance ofPrinted: 12/3/04 the design.It is not meant to be an exact s rendition. ' -------- B230b63d.kit � If S Cc 136 ' 6" 6" 4 24" 46" 12" 24" 12" o CW2442R SE SE W124 WEA iD W W 2R 1242 CO (D (D rn Cn I -N. M BSS36L SB39 24.DISHW DB214DW BEA 12 -- 36" 39" 24" 21" —( 12" I 4 49,n z All dimensions_size designations given are s"'"^.�""`4'4 CC(to verification on job site and �gg `e This is an original design and must not be Designed: 12/3/04 adreleased or copied unless applicable fee has Printed: 12/3/04 justment to litjob conditions. ` been paid orjob order placed. I _ ._ I I3230l1,63d.kit 136 ' 6" 6" 4--" ' 24" 48" 12" 24" 12" i a _IN CW2442R SESE W124 WEA (0 W 2R 1242 M cp G> pie co toto BSS36L SB39 24.DISHW DB214DW BEA 12 i 36" --f— 39" 24" 21" 12" 54T i 324 494, L a; All dimensions size designations given are 'g�"5"`M'f This is an ori sinal designand mus[not be Designed: 12/3/04 E Y' 6 sol?iecl to veril icatian un job Me and 'Ei< released or co ied unless applicable Cee has Primed: 12/3/04 "> P PP aQl u.vlmm�l to litjuh conditions. �' b. been paid or job order placed. Yaffe. a I3230663d.kit Ili ' 123" 24" 12" 36" 27" 24" CW2442L W124 W3642 W2742 B CW2442R `k. 2L (n BSS36R DB36 B15R BSS36L i -- 36" 36" 15" 36" i All dimcnsi,ms si<e Jesinations arej'W�r, �• { This is an original design and must not be wbj n9 m verilic;nion un joh site and y r/ 6 Dested 1: 12/3/04 °� �'�F released or copied unless applicable @e has Printed: IZ/3/04 uljusbn em o'III o j h conditions. >•��` "' been paid or job order placed, sk• t,n�''x.� 'esa^q s 5� I3230663d.kil i 135" 45n 15,. 36" 18" —f— 30" 21" 24" W3618X24 W3018 N W1842 W2142R CW2442L MW.HOOD r7 N i t0 lA k 36REF-2D N to ce) B18 TB9 BSS36R 2 R 2 }a"— 36" 5 18" 30^ g" 36.. 8 22g' 52g' 60" i j All dlmensiun.s size designations given are .,, �� This is an original design and must not be Designed: 12/3/04 subject to verification on job site and released or copied unless applicable lee has Printed: 12/3/04 adjuumrnt to lit job conditions, ` v been paid orjob order placed. �y•°`3 >s _. ___1132301,63dki1 -- EI1 Drawineq 1