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07010009 CITY OF CUPERTINO BUILDING DIVISION PERMIT � ' �� BUILDING ADDRESS: PERMIT NO. 20002 N RTH REST SO MDAM__ZEPFR PERMIT ISSUE DATE OWNER'S NAME: ADAM ZETER 01/02/2007 SANITARY NO. CONTROL NO. )NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH O p LICENSED CONTRACTOR'S DECLARATION Job Description t UI hereby affirm that I am licensed under provisions of Chapter 9(commencing ZW withScction7000)ofDivision3oftheBusinessandProfessionsCode,andmylicenseis KITCHEN REMODEL NON STRUCTURAL y in full force and effect. �Z Licensc Class Lk.g t p Date Contractor ARCHITECTS DECLARATION 9041" I understand my plans shall be used as public records a U.H Licensed Professional n y OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the i G O following reason.(Section 703 1.5,Business and Professions Code:Any city or county K which requires a permit to construct,alter,improve,demolish,or repair any structure Z} prior to its issuance,also requires the applicant for such permit to file a signed statement 3 .Ft. Floor Area Valuation _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $14000 yF $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $14 0 0 0 y .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of �p Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 31638065 .` bT Number Occupancy Type not more than five hundred dollars(5500). ❑I,as owner of the property,or my employees with wages as their sale compensation, will do the work and the structure isnot intended oroffered for sale(Sec.70",Business Required Inspections 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 completion,the owner- builder will have the burden of proving that he 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: ❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Work-s Com on IrtsurarAtea arIlcyolio-numbeam- - _ Cartier.l /�fc� ��iC)J l�Poli No.: CERTIFICATE OF EXEMP77ON FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is Cor one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.1 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 ,J Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY E~t I hereby affirm that there is a construction lending agency for the performance of C4> the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name Z L.cndees Address U C I certify that 1 have read this application and state that the above information is L4 O� correct.1 agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. �'d a (We)agree to save,indemnify and keep harmless the City of Cupertino against ,,may rA liabilities,judgments,costs and expenses which may in any way accrue against said City U 2 in consequence of the granting of this permit. 1 J r ►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by Date o- Z SOURCE REGULATION Re-roofs Signature of Applicant/Contrietor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or futum building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ONO 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 _mit hazardous air contamimnts as defined by the Bay Area Air Quality Management all new rr aterials for inspection. District? ❑Yes ❑No I have read the hazardous materials requirements under Chapter 6.95 of thc 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 responsibility to notify the occupant of the requirements which must met prior issuance of a Ceniftcate of Occupancy. Date Signature of Applicant Owner orauthorized ag Da All roof coverings to be Class"B"or better Community Development : 5� 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 7UPEkTINO Building Department JOB ADDRESS: PERMIT # )(00 0 o P T-q C e �'T p Odd OWNER'S NAME: PHONE4G S -6-' �/- 4 3 3 GENERAL CONTRACTOR: A 0 C- 6 , S FAX # ;�-0— -Ji -- '3 6',�' I am not using an subcontractors: C 7 i,pature [Date Please check applicable subcontractors and complete the following information: 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 — - - -- - - 777 _.- W5l0W',W3336BUTT 1236 ` 1236 WA243 n 24.DISH-IQ1 EZRl N ' i N li CT) pp `� ' C.0 p EC �H�CxL`:� tNCES 0 0 WI it co rN N� _ uri,al J N be Gu r On S r tJ r` ` ap "' aCi x,1,1 , .�•ti �t t(.�� Cil?U 11^n Ot 't•tl' Y i ' �LntR d7 co om JTA LL � AL I'I ill --------------------- Q rf hm FHVI ILL, Lj 12" 30" 12" 36" 00 o W3018 WR3618 N WA2436L W1236 W1236 MWHOOD co REP1 1/ 0 _ _ 36REF-3D1 EZR36L.SS BD12 M � 3 12 36 , <; 3G„ 4 ; 2 51 " 64" 18" 6" 33" 12" 354" 12 " 24" (0 VVEOSt W3336BUTT W1236L W1236 WA2436L U) LO 0 M M PBBC48R 24.DIS'H-101 SB36BUTT EZR36L.SS ch 24" 26 36" 36" 384„ 29 54 6' co W3336BUTT I LO BD30.3 PBBC48R M I 30" 47 3" 4 r, 4 68" 12" 80" CITY OF CUPERTINO 0g01 0 009 5101.0 OF PERMIT APPLICATION FORM CUPEkTINO ADDITION/REMODEL APN # Date: 31 �o"3� OCA Building Address: 00 00,-2 C k Oto 'e 04 . Mailing Address (if different from building address): Owner's Name: Phone#: Ac►'1 Ze-��" 6 S—O — eE 7 — 95-3 C Contractor: _ Phone:6S-0-631-q 3 30 State License#: (1-C'' (-A)S Fax: Contact: Phone:6-0-71.2 4,21?.,? Cupertino Business License#: 01ekIC,(( Fax: -6"3 1-3,Kk 7 c Building Permit Info: Bldg O /l Elect ❑ `Plumb ❑ Mech ❑ Job Description: What is being added? NIA What is being remodeled? 1;-rc/-/c-w Residential Commercial ❑ Remodel Includes Re-Roof. Yes ❑ No 1A Remodel Includes Structural: Yes ❑ No Square Footage: Addition: Remodel: S��'�I (-T. Garage: Porch: Deck: Other: Cost of Project: /4,000 OpOccupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ Project Size: Standard Large ❑ Major ❑ *For office use only* r ❑ Over the counter 1 of 3 CITY OF CrUPERTINO Cin OF PERMIT APPLICATION FORM CUPEkTINO ADDITION/REMODEL Quantity Fee ID Fee Description Fee Group BREINSPECT Reinspection Fee BUILDING BREMACOVER A/(.' Unit> 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Re]o Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rer1 Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER PoiN er Device/Apparatus ELECTRICAL BREMRECEPT Rc itl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT R e air/Alter Heating MECHANICAL BREMRESAPP Re nodel Res Appliance ELECTRICAL BREMSIGNAD Rnidl Sign Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Tr eatrical 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 Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP remporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Flee Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE M ech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC PlannirLg LR Comme/Multi-Fam PLANNING PLLONGRNGR Plannir.g Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3 of 3