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03080013 (4) CITY OF CUPERTINO ,1 ` >" BUILDING DIVISION PERMIT C01N'TRA TOW, NEORMATIQ BUILDING ADDRESS: PERMIT NO0 3 0 8 0 013 OWNER'S NAME: PERMIT ISSUE DATE JANA & JIM WEBER 08/04/2003 NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: - BUILDING PERMIT INFO BLDG ELECr PLUMB MECH 0 � 0 I O Zp LICENSED CONTRACTOR'S DECLARATION N❑ I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description ?WithS wection TOX)nf Division Sof be Business and Poirmaimm Code,ind my license is in fell for. ad free,. KITCHEN REMODEL y�,? License Class Lit.% Date Contractor ' fWU I understand my pins shall used Ds public records ` y0G Licensed Pmlessional vol 03 S OWNER-BUILDER DECLARATION <f 1 hereby affirm that 1 am exempt from the Cmideemr's License Law for the p o following reason.(Scedon 7(131.5,Business and Professions Codc:Any city nr county e m which requires a permit in construct,alter,improve,dearth.h,or repair any structure 000 prior to m osuuna,also requires the applicant for such permit to rile a signed Statement < that he is licensed pursuant Lo the provisions of the Contractor's Liccnac Law(Chapter 9 Sq. Ft. Floor Area. Valuation 2mFn (commencing withSection7")ofDivision3oftheBusinessandPmRssinnsCode)or 32639005 . 00 W E fast he Is exempt thc,efmm and Ne basis for the alleged exemption.Any vitiation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy e not more man ham hundred dollars($500). P YTYP 0 1,as owner of the property,or my employees with wages as their sole compensation, will do the work.and the structure is not intended or offered foraale(Site 7W,Business — a and Professions Code:The Contractor's License taw docs not apply In an owner of 102 - PIERS d Inspections Property who builds or improves thereon,and who does such work himself or through his own employees,provided that such ire prommenta are not intended or offered tarsale.If. 103 — UFER however,the building or improvement is sold within one year of completion,the Owner, builder will have the burden of proving mat he did not Wild or improve for purpoac of 104 - REBAR sale'. 105 - ANCHOR BOLTS 0 1,as owner of the proprrL,am exclusively contracting with licensed contractors to 10 6 - SEWER & WATER construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li term law does not apply he an owner or property who builds or improws Beaman.and, 202 — UNDERFLOOR PLUMBING Lwho ctions Law�for such projects mites conmanor(s)liccnuapursuam to me Contranar's 203 UNDERFLOOR MECHANICAL ❑I am exempt under See. .B&P C for this reason 204 - UNDERFLOOR FRAME Owner Dam 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 301 — ROUGH PLUMBING l have oad will maintain a Certificate of Consent to sidNosim for Worker's Compen- 302 — TUB & OR SHOWER satins,as provided for by Section 3700 of the Labor Code,for the performance of the 303 - ROUGH MECHANICAL weak ter which this permit is issued. 304 - ROUGH ELECTRICAL ❑1 have and will maintain Worker's Compensation Insurance,az required by Section 3700 of the Labor Code,for me Performance of Ne work for which this permit is issued. 305 — FRAME My Worker's Cnmpenstorm lnsumme carrier and Policy number am: 306 — HOLDOWNS Carrier: Policy No.: 307 - INSULATION CERTIFICATE OF EXEM MON FROM WORKERS' COMPENSATION INSURANCE 308 - SHEETROCK (This section and not he completed if the Permit is for one hundred dollars(5100) 309 - EXTERIOR LATH less') I 310 - INTERIOR LATH e certify that in faman t performance of the week for which this permit is issued,I ahnll not employ any named in any mnncr anaztu become subject to the Workers'Cnmpcnsatimn 311 - SCRATCH COAT Laws of California.Our 313 - ROOF NAIL Applicant NOTICE TO APPLICANT:If.alter making this Certificate of Exemption,you should 501 - FINAL ELECTRICAL ENERGY became subject to the Worker's Compensation provisions of the Labor Code,you must �z forthwith comply wife such provisions mthis mail shall the,deemed revoked. 502 — FINAL PLUMBING ENERGY �O CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hmchy frod that there is a constructions lending agency forte Performance of 504 - FINAL BUILDING ENERGY :6> the work far which thin pem,i,isissued(St .3097,CIv.C.)Lender's Name'A 505 - FINAL ELECTRICAL Q- jz LnaedsAadreas 506 - GAS TEST ;,)p 1 certify that I have read this application and stale that the above impounded is 507 - FINAL PLUMBING y (~ emarel.l agree to comply with all city and county ordinances and state laws relating to U budding construction,and hereby authorise representatives of this city to cnmr upon the — FIN MECHAN CAL . DO shove-(Wo) gree On averly rte inspection keep 09 FIN 4 U (Wt) need or save,indemnify rinspaedand keep harmless the City of Cupertino against _ q rq liabilities,judgment.costs and expenses which may in any way seem=agai net said City 5 'A NG of the grarai ng or this Permit. J z APPLICANTOUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 WORKS Date V ✓✓ SOURCE REGULATIONS. Re-roofs HAZARDOUS Signature of ApplicarData HA2ARDODOUS MATERIALS DISCLOSURE Type of Roof Will due applicant or(Muni building sec,Chantstereor hanand the Health and Safety as de,Sed ren the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code, r7 es 23532(a)7 - All roofs shall.be inspected prior to any roofing material being installed. ' r7 Yes Cl No Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove tit hazardous air contaminants as dcMcd by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes C]NO I have mad the hnaardnus materials requirements under Chapter 6.95 of the Califon .is Hcalfa A Safety Code,Simmons 25505,25533 and 15534.1 to dersolod me,iftht building does not currently have a¢Stant,fast it is on,responsibility m and l'y flat w:emeant of the regeiremerewhich must hemet prior It)hummer,or aCerdficamofOcopnry. Signature of Applicant Date Owner or mmurfaed agmd Dare All roof coverings to be Class "B" or better AY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO "KPN # 3 Z _ 2 0��" Date: $- Y -03 Building Address: Mailing Address (if different from building address): .2d006? Owner's Nam Phone#: _ Tat) a. i -&,-- Contractor: License#: 6A V,( Q It-cm Contact: Phone: Yo r 111 01 Z3 Cupertino Business License#: Fax: Building Permit Info: Bldg ❑ Elect, l Plumb [�K Mech ❑ Job Description: I, I // Residential k r(-4 6 /`CA-0 C� Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: .3 � au7 k Type of Construction:/I Please check this box if the project is a Gw boar �cvti second-sto addition: ❑ 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 BELEC 1001 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 � 2 -7 1 of 3 �� C*Y OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPER,TINO @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 BOVERTMIE 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 Repipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING Alk I BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo 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 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace 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 BREMPOWER Power Device/Apparatus ELECTRICAL 2of3 mw r CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group f 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 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 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 Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL J PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING • 3of3 - /mete <<U-01 at PRii E E Curtlno, Came ACCDRDANCE WITH THE CITY OA o2 y�009 UP NO DES AND ORDINANCES (E) (N) A Y,70 3 Dish �":n � X NO r- washer r FPy his se of pians and sl ifi uss 45" De keoon lice job at all fi (�E) 36" Double Sink (Y°S) yyb oss is males airy dianges a ft Dog, Cbl d O E) a " al thisp i ii:E om O (E) 3t aL be rbi arc Coy be A Pas thru opening art f am of SIN prmdsti611' o0 O 4 �� or "� e gas Gowndraft, slide in 1 16 ' A (E) ® ookt p/oven (N3) 48111 48" 1116" 0 0 31 " 0 Microwave (E) (N) E) 'A it ele one Jack Full 45" 1 Height a-nRefri g E E (E) I : P-220 oven (E) 42" 32„ 28„ Scale 1/2" = F AUG 4 2003 D THIS PLAN SHALL 1= "o removed ) Revised 8-1-2003 By SHE JOB AT ALL TIMES DURING, CONSTRUCTION_