03090133 (2) CITY OF CUPERTINO -'' V p;
BUILDING DIV11loN . PERMITCONTRAG—,AUORANF(SRMATION ",
Nir�4 �:-
• BUILDING ADDRESS: DENNIS & DEBRA FUTRYK PERMITNb3090133
)ii SEPTEMPRR. pp.
OWNER'S NAME: nRMR ISSUE DATE
NE: SANITARY N0. CONTROL N0.
ARCHITECT'/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
30p LICENSED CONTRACTOR'S DECLARATION
F 1 hcrcby 0)mr that I em limned under provision or Chapter 9 kommenseis `f �. lob Description
pma with Scarce andIIBoc Division]of Ne Rosinessand Profession Code.and my license is
v=y in en force and effect, s
? Lkcesc Class Lk.N BATHROOM RE DFL v
W a Date ContractorECL
ARCHITECTS DECLARATION
Q c 1 undcnunJ my plans shall W used a public fccnNs
M Licensed Pmressional
OWNER-BUILDER DECLARATION
£ I hemhy 416rm Ont I am exempt from Ne Contractors License Lew for the
COO following mason.(Sacha.7031.5,Businen and Profeaslnn Code:Any city nr county ! 1
$ which requires a Permit to Construct,Alen,improve,demolish,or repair any structure
.iy
prior it)its issuance,also requires the applicant for such permit to file a signed statement
—Q that he is licensed pursuant la nne
theprevlalaofBICComlafsLl,c.La.(Chapterp Sq.Ft. Floor Area a [tars
(commencing wi tis Section 7000)of Division 3of the B minas and Professions Code)or
L — that he is exempt therefrom and the basis for the alleged exemption.Any violation of 36215017 . 00
Section 7031.5 by any applicant for a permit mbjccks de applicant to a civil penalty of - APN Number I,
nm more Nan five hundred della.(5500). - -' - - ype -— -
I,as owner of the property,or my employees with wages u their sole compensation,
will do Ne work end Neswclurt is not inure@d or oRertd fmsak(Sec.704a,Basineu
and Professions Code:The Commuters Lt..law does not apply to an owner ofDAWi4t:RWed Inspections
property who builds or improve themomand whodas such work himsel(or through his 102 — PIERS
own employ=.provided Nal such improvements art not intended or offered for We.If. lO3 — UFER
however,the building or improvement Is sold within one you of completion.the owner-
builder .will have the Wrdcn of proving that M did not Wild at improve for purpose of 104 — REBAR
ask.). 105 - ANCHOR BOLTS
owner of the property,am Business
contracting with licensed contracts mon to
Ise La thedoes
not appl(Seey
ren weer of property
Profiesrty who orsWilds
ds or i The Conueron,Li- 106 — SEWER & WATER
ceesalawdmsr such pl.,Cu sin. ofpnpeny who an pursimprovea Neeson,and. 202 — UNDERFLOOR PLUMBING
who comncu for proKcu wiNaconwn (q limned punwm tithe Conwcmrs
License Law. 203 - UNDERFLOOR MECHANICAL
❑ Tema de_spq. Data for this moon 204 - UNDERFLOOR FRAME
Ow
ner ORKER'SCO PENS TIOlDECLARATION 205 - UNDERFLOOR INSULATION
I lot aRllm underpnW,yofec ars of[be PoRosving duclaration: 301 — ROUGH PLUMBING
than endwill mainuine Cerdfuncaf unuoslf-in.um for Warkcrs Compcn. 302 — TUB & OR SHOWER
rm.as provided for by section 3700 of the Labor Code,for the performance of the 303 - ROUGH MECHANICAL
k far which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section 304 - ROUGH ELECTRICAL
of thc labor Cedc.for the performance of the work for which this permit is issued. 305 — FRAME
Workers Compensation Insurance carrier end Policy number am3O6 — HOEDOWNS
ier. CERTIFICATE OF EXEMPr10NYFROM WORK ERS' 307 — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
or less.)(TMs union need not W complcwd if the permit H for one hundred units.($100) 309 - EXTERIOR LATH
I certify Our in the Performance of the work for which this Permit is issued.I shall not 310 — INTERIOR LATH
employ any person in any mannerso as to bccumc subject o tMWahers'Compensation 311 — SCRATCH COAT
laws of California.Date
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT:If.alter making this Cenilica,e of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation previsions of the Labor Code,you most
Zz forthwith comply with such provisions or this permit shall W deemed revoked. 502 — FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
-1herehy,fOrm Nat dere is A construction lending agency for the performance of 504 — FINAL BUILDING ENERGY
3.Y> the work'sName enNi,p mnlsissad(sa.309 ,cn.0) 505 - FINAL ELECTRICAL
0 Lender's Namc
z LendersAddreas 506 - GAS TEST
J Q I certify Nell have read Nis application and state the,the salve information is 507 - FINAL PLUMBING
y conal.1 agree to comply with all city and county ordinances and state laws totaling to
7U Buildingconswnion,andherebyauthorimupreunutivnorOilCitytoemerupnnlM FIN ME#NWG(CAL
above-mentioned properly for inspection purposes.
(We)agree to save,indemnify and keep hsmless the City of Cupertino against 09 FI
r h ItebiliBu,judgmenu,costs endexpenuswhich yin any way,ccree again.said City 5 IJ z in conuyancc of the graining of This pc .-;13vict7
PLICANT UNDERSTANDS WILL MPLY WITH ALL NON-POINT Issued by:S RKS Date
UR ONS.
Signature ppheam/Cmnrumr / Date Re-roofs
HAZARDOUS MATE DISCLOSURE Type of Roof
Will theapplicantor for..building cuss store or handle hellohms material
defined by the Cupertino Municipal Code,Chapter 1.12,and,he Health and Safety
Code.secti.zss]xa)7 All roofs shall be inspected prior to an roofing material bei.
❑Yen naso P P Y g g installed.
Will the applicant or for..Wilding acupan,use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
i,hanrdnus air contaminants as de red by the Bay Area Air Quality Management all new materials for inspection.
4 D4.
/
❑Yes D .
I have mad the ha.ardous materiels oxiciemcnts undorchapur 6.95 of the Califon
Iia HcalNkSxrCy Code Smdoos 2330 land 534.Iundemmndilmifdcluilding
does In -urrcndy have a In In in re,p. ihilits to redly the mcup.[of Ne
require I, a Tem ; accruncauoroccupancy. Signature of Applicant Date
o n2'r ONOCIII.d agent D,te All roof coverings to be Class"B"or better
ti
CITY OF CUPERTINO
t CUPEf�TINO PERMIT APPLICATION FORM
IPA-PN# J 2 ( Date: / Go 2
Building Address: /
Owner's Name: Nlsi �� Phone#: 0 6p 2s2 ^
Contractor: V r License #:
C)
Contact: Cupertino Business License#:
Building Permit Info: —g A 2 00 g m D v -
Bldg ❑ Elect G]Y Plumb 0/, Mech ❑
Job Description:
Residential Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: 3 f7 O Occupancy Group:
Type of Construction:
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> 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 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
231
1 of 3 �/
CITY OF CUPERTINO
CUP TYOF O PERMIT APPLICATION FORM
QuantityFee 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
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 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 cfrn 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> 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
2 of 3
a
CITY OF CUPERTINO
CUPEftOFFINO PERMIT APPLICATION FORM
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 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
PPERMITFEE Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
3 of 3
• • Scott Futryk
1011 September Drive
. Cupertino, CA 95014
March 12, 2004 RECEIVED
City of Cupertino Building Official
10300 Torre Avenue
Cupertino, CA 95014 MAR 12 2004
Subject: Permit: #Q309003--Batfirnom"Zemodel CITY OF CUPERTINO
Dear Sir or Madam: D-3o g01,3-3 BUILDING DEPARTMENT
Due to circumstances beyond our control we have been unable to focus sufficient resources
on our Bathroom remodel project since we applied for it in September. Unfortunately, my
wife's stepfather's stroke in Southern California has caused us to divert both critical time
and money to this family emergency.
I discussed this verbally with Greg and he indicated that I must put it formally in writing.
Therefore, I am hereby requesting an extension of 6 months to get the project back on
track and work on this much needed remodel for our home.
Sincerely, /o
ee
Dennis Scott Futryk fhl� �� ehSlO�
0.��rc�V��1 �rorr
408-569-5900 311.7 0 win e r r D
� reC.ei� e
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
_ 8 k
PERMIT ppl�p WpQ T �- �Gfit�IMl�r �L�FFOGiT G'flIJff 8Li1P�l PiAR BJP
pdate};,am,existing permit record
Notepad
- - Cancel
PERMIT NO:
STAiU
MASTER N0, 030 NOTESS 0 OPEN PERMITDISSUED 09/17/2009/17/2003IOPER con mew —
J Quit
03 OPER connlew
PROJECT .. -- - _� Vit, ;CERT ISSUED OPER
PROJ DESC CERT NUMBER 'TYPE
RPN UPDATE ADDRESS, N
PARC ADDR' 11011 SEPTEMBER DR C/S/Z CUPERTIHO SCA 45014
OWNERI DENNIS DEBRA FUTRYK JOWNER2
0 ADDR IC/S/Z CUPERTINO CR 95014-41281
PERMIT TYPE SFDWL-REM US.0-404 TYPE:' 434 ENRGY CODE
USAGE CLASS DWL-WREN PERMIT FORMiRPPLICATIO TANK/SEWER ��
APPLIED VALUATION 3300,' APPRUD BY:1
CALC VALUATION SQUARE FT. _ 0; _ 0' OWNER PH# 4082522249
OWNERSHIP 1� PRIUATE NOTES (Y/N/D) J CONTR PH#:
—SPECIAL CONDITIONS/NOTES - - ESCROW
BATHROOM REMODEL UERIFIED
- FILL LUU1111
3/12/04 REC'D PERMIT EXT LTR-PENDING W/GREG
Perunits-Permit Application Maintenance
Aid
�PERMILI, O�P.EtUL JU�� I Rf�f�T� _PJ3(N��YfvfPllEL�'_frflP1(L��.FJIIE_I-F.YAffi - --
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PERMIT NO03090133 36215017.DD — 11 DENNIS & DEBRA FUTRYH Rel�alp --
PERM TYPE SFDWL_REM 11011 SEPTEMBER DR
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