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07080209BUILDING DIVISION PERMIT ALDERBROOK LN OWNER'S NAME: RUTH ASKENAZI NE: ARCHITECT/ENGINEER: 0 Z LICENSED CONTRACTOR'S DECLARATION 0 v I hereby affirm that I am licensed under provisions of Chapter 9 (commencing Z m with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. 2 License Class Lie- 8 p Date Contractor I m RCHITECTS DECLA N i aJ a I understand my plans shall be used as public records �yV W ti Licensed Professional a OWNER-BUILDER DECLARATION ) a m I hereby affirm that 1 am exempt from the Contractors License Law for the p o following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure t prior to its issuance, also requires the applicant for such permit to file a signed statement z < that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 t= (commencing with Section 7000) of Division 3 of the Business and Professions Code) or ? `3 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 a civil penalty of not more than five hundred dollars (5500). ❑ 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 for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of compietion, the owner- builder will have the burden of proving that be did not build or improve for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law. ❑ 1 am exempt under Sec. B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: �z zC p„ A �z U Ct. E~- O V a Uz SEARS HOME IMPROVEMENT 1024 FLORIDA (925)245 -2000 PERMIT NO. 07080209 PERMIT ISSUE DATE 08/23/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ELECT PLUMB Job Description KITCHEN REMODEL, INCLUDING ELECTRIC HOOD, CCUNTERTOP & FAUCETS 5q. Ft. Floor Area 3691702r .WN j I have and will maintain a Certificate of Consent to self -insure for Workers Compen- ation, as provided for by Section 3700 of the Labor Code, for the performance of the vork for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 1700 of the Labor Coda for the performance of the work for which this permit is issued. vly Worker's Compensation ^p'Insurance carrier of �jplJ�umberam: = artier. M 1� tryICTo CE R FI A OF EXEMPTION FROM WORKER ' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) l certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT. If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address 1 certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorise representatives of this city to enter upon the above- mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against !, liabilities, judgments, costs and expenses which may in any way accrue against said City in, consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL CJPMPLY TH ALL NON-POINT SOURCE REGU ONS. ..( \ ) ' w t// Y iiZ_A Signature of Applican ontractor - , Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipa ode, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑ Yes o Will the applicant or future building occupant use equipment or devices which at Lazardous air contaminants as tncd by Nc Bay Area Air Quality Management ,istrict? D Ycs o 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a tenant, that it is my respensihility to notify the occupant of the rcuuircmcros which mlawbe rpet p�r to ILQQ of a Certificate of Occupancy. Owner or authorized Issued by Re -roofs Valuation $34730 uccupancy Required Inspections Type of F.00f All roofs shall be inspected prior to any roofing material being installed. If a roof ;s installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant All roof coverings to be Class "B" or better Date -�� '� �, � r � �� }�� vx`•�� "1" ` k..i"_ 2'.v', 1� i �yq xY.� `'^"� ,� - �`� � � �-�a 3� 3� `�- d, Y"a. r c - Ci7Y of , Assessor's Parcel Number: — Name of owner. IZu r4 45 t4 xcAL 1z -- - -- - - -- - -- _ Phone. poa Contact person. �? �B ' "J�' Fax. ` a- — g U Net square footage of lot.� — h?js,ting Proposed Square footage: First floor: _ ----- Second floor: ---- Garage: TOTAL: Are there at least two 10 foot b 20 foot clear sp 1ces inside the garage? N Is p rivacy protection planting required for the pr :)j Oct? Q-N On what floor(s) is work being done? of work. !N f K r • C 8 COv�v�e J yP /i6 A6M /✓mow % Brief description D. c Rc{, iJPG9A� Code editions: 2001 CBC 2001 CFC ?- N) 2001 CMC- N) 2001 CPC Effective 11/1/02 N) - N) 2001 NE' \ - N) �o\ COO Pc t tPO A 0 to�\��ot� S\ampo xb�e v\6\1� V VVN�� G �; '4 f� Plan Review Process Work Book Page - B- Revis -,d 8/22/05 08/09/2007 11:13 19252452017 SEARS HOME IMPROVE PAGE 05 ITV tl QFCU30 W r I o d 3 AH Sfigft N. 11 l7k/ o or rn E3 0 R, m - CL T. 0 t/1 Ix fb V. x CL 0 ID 0 tr CL w 0 0 ir m lz 0,0 Z - . C r. � rn F :p rm A rri e) 71 b 00 ;C X cn QFCU30 W r I o d 3 AH Sfigft N. 11 l7k/ o or rn E3 0 R, m - CL T. 0 t/1 Ix fb V. x CL 0 ID 0 tr CL w 0 0 ir m lz CITY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM 07060;oq P # 36q - /� -0 .2 5 Date: 07 Building Address: Mailing Address (if different from building address): LD . Owner's Name: Phone #: 01 e BBOILERI Contractor: � License #: Contact: Phone: Cupertino Business License #: -S0q6t<1 Nf} FaxqAS"v2`fS- 1 Building Permit Info: Y 1Z- ( pert, PJoN Sr9vQ1,vL_ Nv L I Cgr/ N G Bldg Elect ❑ Plumb ❑ Mech ❑ Job Description: s CL �c� 1�..� �' cA 8 n! 6�s �Nt ,,��,�vv Nom,, lw v cf F�,�3 a Tg / Residential r l ommercial LJ Sq.Ft. Floor Area: L-1 (wh4r1N & Sq.Ft.: Cost of Project: 2 Occupancy Groin Type of Construction: Please check this box if the project is a El Boiler > 1M to 1.75 M Btu second -story addition: BBOILERS Q +.,,,a „-,i n T .arve F1 Maic,r F- MECHANICAL 1 V l l.\.L villa.. — Quanti Fee ID BAPPLOTHER F ee Description Other Appliances Fee Group MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER I Boiler > 1M to 1.75 M Btu MECHANICAL BBOILERS Bciler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind'Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Motel and Motel BUILDING BCONSTAXR Constax - Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 El,:c 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 A3 08/09/2007 11:13 O 19252452017 I--- SEARS HOME IMPROVE QOu30 u -4 0 d3 A�— jewe 11 .;x a4o/ I OF - " otr_ � W- I I Vk,/ C) PAGE 05 T m ul NOW f Ulm tad . 0 > 3 (D 3 A) 0 < (A 0 0 42 ;p G n CL cc fb X tv EL CD rr 0 cl w O 0 tr 0 m Imll z Z 04 0 p Z -C r rn iq cn tJ jy QOu30 u -4 0 d3 A�— jewe 11 .;x a4o/ I OF - " otr_ � W- I I Vk,/ C) PAGE 05 T m ul NOW f Ulm tad . 0 > 3 (D 3 A) 0 < (A 0 0 42 ;p G n CL cc fb X tv EL CD rr 0 cl w O 0 tr 0 m Imll CITY OF -,UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777 -3228 Fax (408) 777 -3333 Buildin De artment JOB ADDRESS: PERMIT # 070�O�o9 OWNER'S NAME: U 6 K fJ z 1 PHONE # - — GENERAL CONTRACTOR: 49 FAX # I am not using any subcontractors: Signature Date li bl be tractors and com Lete the followin information: Please check a ca e su on SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date