03090171 (4) CITY OF CUPERTINO �,� IIVFiN WT
ORIO tee'
BUILDING DIVISION PERMIT
BUILDING ADDRESS: P..,r NO.
MOSSOTTI VICTOR G ET AL 03090171
PERMIT ISSUE DATE
OWNER'S NAME:
SANITARY Ni OIAOL NO.
BUILDING PERMIT INFO
ARCHITECIENG1NEER: BLDG ELECT PLUMB MECH
0 0 0 0
j0 LICENSED COMRACfOR'SDECLARATION Job Description
G 1 hereby.(rine that 1 am licensed under provisions of Chapin m
9(comencing
g with Secuon7")or Division3ofthe Businessand Prvfcasionx Codc,andraylumacts
in full moa.nd`ff"`t' KITCHEN REMODEL ado
a= License Class Lt..M
-w Do,—CanlncC /-$ We
ARCHITECTS DECLARATION Y
I undcmanJ my plans shall he used as Public menthe
tryLicensed Pnr(cesional
n g OWNER-BUILDER DECLARATION
I hereby.(firm tort I.m exempt from the feaaoamors License Law for the
10 whichfollowing reason.umph t 8e s5,Business and Professions Code:Any city or county
ante
$� which rcyuira a permit m cnnstrw:L siren,improve.demolish,or repair any awcmrt
zy prior to its issuance,also requires the applicant for such Permit mriteasigned statement S 'Ft.Floor Area Valu tion
L that he is licensed pursuant to the prnvisions of the Contraemr's License Law(Chapter 9 tl•
—$ (commencing with Section 7000).(Division 3 or the Busmaeand Normal..Code).1
i.. that he u exempt therefrom and the baso far Ne alleged eump0on.Any violation of
�424no22 nn
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy Type
not more Nen Bw hundred dollars($500).
❑I,as owneroftheproperty,army employ=with wegmas theasole compensation,
win do the work,and thwu
escture is not inndes
cdorOffered fondc(Sec.7044.Busins 101 — FOUND QNd Inspections
and Proreuiona toys Code:The Can o Liam Law docs not apply la an owner or
prolunywho buildsor improves themon,and who doeasueh werkhimulf or though his 102 — PIERS
own employ..provided that...h improvements are not otandl warfare](a,suit.If, 103 — UFER
however,the building or improvement is sold within am year of completion,the owner.
b veer will ban the burden of proving that he did not wild or improve for purpose of 104 — REBAR
ml`')' 105 - ANCHOR BOLTS
1,as owner of the property.am exclusively contracting with licensed contncmrs to
construct the project(Sec,7044,Business and Profmsinns Code:)77e Conwetw's Li- 106 — SEWER & WATER
came law docs not apply to an owner or property who builds or mprows thereon,and, 202 — UNDERFLOOR PLUMBING
who contracts for such projects with a c.naactor(a)licensed pursuant to the Contractors
(,ken=Law. 203 - UNDERFLOOR MECHANICAL
`1 ren ea rd d¢ Sec 0 Sk sCfm n sea o
2 204 - UNDERFLOOR FRAME
°t"dor 205 - UNDERFLOOR INSULATION
O KE COM ^1 ON LAN
1PI hereby affsrm under penalty of perjury,ane or the fallowing emanations: 301 — ROUGH PLUMBING -
awand will maintain aCertificate ofConsent toalf-laumfar Worker's Counter. 302 — TUB & OR SHOWER
.s on,u Provided for by Section 3700 of the Labor Code,for the performance of the 303 - ROUGH MECHANICAL
work for which Nis permit is issued.
❑l haw and will maintain Worker's Compensation Insurance.as requited by Section 304 — ROUGH ELECTRICAL
37W of rim Labor Code,far the performance of the work for which this permit is issued. 305 — FRAME
My Worker's Compensation Insurance carrier and Policy number art: 306 — HGLDOWNS
Cartier: Policy No.:
CERTIFICATE OF EKEMPnON FROM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 — SHEETROCK
CrMs section read not wcompleted ifthe Permit is for one hundred dollars,n 100) 309 — EXTERIOR LATH
or less)
1 eenify Nat in the perrnrmamc of the work for which this permit is issued,robot]not 310 INTERIOR LATH
employ any person in any manners as to income subject in the W"rkesi Compenaa0on 311 — SCRATCH COAT
Laws of California.Dow
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT':If.after making this Ccnificam of Exemption.you should 501 - ' FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation provisions of Ne Lmnr Cade,you must
)ZO forthwith comply with men pravisionsorthis permitshall law deemed revoked. 502 — FINAL PLUMBING ENERGY
y CONSfRUCfIONLENDINGAGENCY 503 - FINAL MECHANICAL ENERGY
I wmby.fr,.Nat then ism comtrvetion lending gency for Performance of 504 - FINAL BUILDING ENERGY
'> the work for which this permit is issued(Sec.3097,Civ.C.)
i q Lee&,',N.th. 505 - FINAL ELECTRICAL
i z L'`"°ersA°dere 506 - GAS TEST
oI carfify that 1 have read this application county
ordinances state Nat the show iws rmaing is 5 0 7 - F I NAL PLUMBING
building 1 ague to comply with ell city ad county owoof and state laws elating e
above-mentioned
forcbyathoriumosed. ivaofNiuitytotouruponthe FIN MEC CAL
r 4L7 above-mentioned property for inspection pugwua
(W.).gree to saw,indemnify and kap harmiess the City of Cupertino against 0 9 FI
y fad limilitlesjudgments.costs and expenses which may in my way seem.against mid City
'
APPLICANT V IDERSTANDSIAND WILL COMPLY WITH ALL NON-POINT Issued by'S 5992Q1&%9WC WORKS NG Date
S R ATIONS. k
Re-roofs
Sign sere ofdadoinuCominackar
Got.
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant connote building occupant slam orhanelc havudous manurial
as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Code,Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ya IRnPo
Will the applicant.,for..building occupant vac ey.ip oml ar devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
lux rroc..a,m tominants as defined by the Bay Area Au Quality Management all new materials for inspection.
7urtenthdr'ized
ict7
❑Yes �o
In ave mad the haardausaigerialarcquiomcnu undcrCWpur 6.95 of the Califon
.10ISafety Code,Sau..7 M5.25533.nd25534.1undcrsendthatifthe wilding
not cumentl how a IenanL Nal it la my mapamlblllty m naY Y IM RNPNt M IIM
mm a mug pimwasu.na.ra m.ra"raex o_py_y. SignatureofApplicant Date
agent/ 7 Dai All roof coverings to be Class"B"or better
BUILDING PLANS
Kitchen Renovation
Expo Design Project; 3551
,�/- 2
Final design
September 15, 2003
RECEIV
Victor G. & Kathleen M. Mossotti SEP 2 3 03
22964 Longdown road
Cupertino, CA 95014 B .----
Contents
Design plans
• Parts & labor summary
Parts & labor break-06.
OFA
COPY
A,P PROV90
W ACCI)RDA � My all
�A N NANCES
CU1�6t11'1�0
DATE,,.
Tills ant t sr.+- �,rc�
bn kept an U+� !
, �• ;,�; riinos and it it un
Iwo to make ar•v ro<.°„e or alterations
on samo witi;::u ,.,:n parmissfon from
the Uuildintt Lal i• ^ty of i,upeAiM
Tho stamping of th;a plan and speclfioetlonl.
SHALL NOT ba hold to permit or,to bb bt
approval of the violation of illy groY.talm
• dt bnY eity grftellft at
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6200CEB3 Scale:112 V Design: 0620/03
All dimensions 8 size designations THE This is an original design and must Date 09/10/03
given are subject to verification on EXPO not be released or copied unless VICTOR job site and adjustment to fit job MOSSOTTI
job - applicable fee has been paid or job 22964 R MOS O TT ROAD
conditions. order placed. CUPPERTINO CA 95014 SUSAN BAILEY
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All dimensions 8 size designations TAE This is an original design and must 6200CEB3 - Scale:12"=1' Dwg no.
given are subject to verification on not be released or copied unless esigner
job site and adjustment to fit job EXPO applicable fee his peen paid or job VICTOR
I TO MOSSO NIROAD SUSAN BAIL Y _
conditions. - order placed. CUPPERTINO CA 95014 WaIUC Line N 8
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All dimensions&size designations THE This is an original design and must 6200CEB3 S"SAiLE
Dwg no.
given are subject to verification on EXPO not be released or copied unless VICTOR MOSSOTTIjob site and adjustment to fit job applicable tee his 4een paid or job 22964 LONGDOWN ROAD Sconditions. order placed. V
CUPPERTINO CA—I-
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All dimensions 8 size designations THE This is an original designand must 6200CEB3 Scale:112•=1' Dwg no.
given are subject to verification on not be released or espied unless Designer
job
o site
and adjustment to ft job EXPO applicable feens. _bp been paid or job VICTOR
22954 ONGDOWNIROAD SUSAN BAILEY
order placed. ' CUPPERTINO CA 95014 Wall/C Line# 6
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AJC .IVSD
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Must
of
OFFICE capY
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Note:This drawing is an artistic THE 6200CEB3 Dwg no.
interpretation of the general EXPO VICTOR MOSSOTTI
appearance of the floor plan.It is — — 22964 LONGDOWN ROAD
not meant to be an exact rendition. CUPPERTINO CA 95014
Sep 1'7 .03 04: 15p Community Management Ser 408 559-1970 p. 1
COMMUNITY MANAGEMENT SERVICES , INC .
• 1935 DRY CREEK RD , SUITE 203
CAMPBELL , CA 95008
( 408 ) 559 - 1977
FAX # ( 408 ) 559 - 1970
FACSIMILE TRANSMITTAL SHEET
110-: VROM:
VICTOR MOSSOTTI Bill Hubbard,Association Manages
COMPANY: DATE:
September 17,2003
FAX NUMBER: 'I WAL NO.OF PAGIS
650-329-5491 1 RECEN M
PHONE NUMBPRSEP 2 3 2003
RF..: DeAnza Oaks HOA BY:
❑ URCEN'P El FOR REVIEW ❑PLEASC COMMENT ❑PLU.A514 REPLY ❑ PLEASE RECYCLE
NOTR9/COMMF:NI '':
• The association grants you permission to complete interior upgrades inside your unit at 22964
Longdown Road. Please make sure that you obtain any necessary permits from the City of
Cupertino.
PRE COPY
r •
OWNI&BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform
• A. All the work authorized by this permit
B. A portion of the work
C. _ None of the workfin
��, I�� �
If B or C is checked,complete 2 or 3 2003
2. A state licensed contractor will be hired to do:A. All of the work
B. A portion of the work (complete sow)
Contractor Address/City, Phone # State License # Type of work to
' VC CLL VLitLG4
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 side). A
Certificate of Insurance covering workers compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
erformed
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 Owner's Signature: 4�t- T/ �i � Dat��52,,Z CD3
Job Address: L " Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
•
City of Cupertino Building Department
CITY OF 10300 Torre Averiu�
C 1 I P C KT I N N Phone: (408)777-322
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:
If 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 compensation•
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 Internal 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 an Recycled Paper
44_ COV OF CUPERTINO U 3 L>
CUP TYOF O PERMIT APPLICATION FORM
N# 02,-_2�
Building Address
ZZ9G �se2 j W67ell G� v��ir,o e,4 9So � Y
Owner's N e// Pho e #:
fv ✓ osSo �ddf�1�/G— 9gS 3Z�j-528 (
Contractor:>l License#:
L/G✓ n � S C
Contact: Cupertino Business License#:
B i di P�rmit Info: i
.13ldg ct ve Pl Me
escription: i
Residential BGA,10 ✓jr�,'A,-0r'1 Commercial ❑ `
Sq.Ft. Floor Area- $/Sq.Ft.:
Cost of Pr ect: Occupancy Group
Type of C truction:
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 BUILDING
z 3 23
1of3 Q�
CIlW OF CUPERTINO
`Ilk CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee 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 Multifamily Res PLUMBING
BNUSFD New Single Family Res BUILDING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
t 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 Repipe 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 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
40 CITY OF CUPERTIOJ
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity_ 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 Sips Add Branch ELECTRICAL
BREMSIGNS Remodel Sips, 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 hisection• 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
EPER vHTFEE 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
•
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