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07010010 CITY OF CUPERTINO BUILDING DIVISION PERMIT � � I }RMATIf�N. PERMIT NO. BUILDING ADDRESS: 22332 REGNART RD SA�OS css DA OWNER'S NAME: WALTER JOSEPH F TRUSTEE 12361 :ARATOGA—SUNNYVALE RD 01/02/2007 SANITARY NO. CONTROL NO. 'ONE: (408) 2c- 2-9404 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH O p LICENSED CONTRACTOR'S DECLARATION Job Description U I hereby affirm that I am licensed under provisions of Chapter 9(commencing =z with Section 7000)mf Div 'on 3 of thc Business and Professions C ,and my license is KITCHEN f REMODEL, NON STRUCTURAL, OVER THE COUNTER =y j�? License C1 Lic.S nin full force and effect, i,tp, RECEPT1tCLE FLOURESCENT LIGHTING & PLUMBING 3—,m Date • • Contractor L-tiARCHITECTS DEC N a U l understand my plans shall be used as public records u.H Licensed Professional n 0OWNER-BUILDER DECLARATION < 1 hereby affirm that 1 am exempt from the Contractor's License Law for the o O following mason.(Section 7031.5,Business and Professions Codc:Any city or county K$ which requires a permit to construct.alter.improve,demolish,or repair any structure z; prior w its issuance•also requires the applicant for such permit to file a signed statement S Ft.Floor Area Valuation < that he is licensed pursuant to the provisions of the Centractmr's License Law(Chapwr 9 fl' $60000 yI=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or J3 that he is exempt therefrom and the basis for the alleged exemption.Any violation of �p Occupancy Type Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of 36639005 :'l7�Number P Y YP not more than five hundred dollars(5500). 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 for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractors 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.). 0 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contracwr'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 Contractor's License Law. C:]I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Workers 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 Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workc s Comp nation Insurance carrier and Policy num r arc: a Carrier. Polity No.: CERTIFlCATE OF E CEMPTION FROM WORKERS COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(5100) or less.) I 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 Z forthwith comply with such provisions or this permit shall be deemed revoked. O CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency far the performance u( p� > the work for which this permit is issued(Sec.3097,Civ.C.) L17 Q Lender's Namc L1. Lenders Address U C—) I certify that I have read this application and state that the above information is II ► correct.1 agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against „Eyliabilities,judgments,costs and expenses which may in any way accrue against said City00 V Z in consequence of the granting of this permit. Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued hy: SO E TIQ9►S 1-2-07 Re-rooms Signature of Applicam//CCon r Date Type of Roof HAZARDOUS MATERIALS DISCLOSURE YP Will the applicant or future 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 roots shall be inspected prior to any roofing material being installed. 0 Yes )kNo Will the applicant or future building occupant use equipment or devices which If a rocf is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 0 Yes [�Nu 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcalth&Safety Code.Sections 25505,25533 and 25534.1 undcrstarid that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the require is which m be met prior w issuance of a Certificate of;cup�pcyo Signatt re of Applicant Date !2r All roof coverings to be Class"B"or better Owner or authorized agent Date sta Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 *UPEI�TINO Building Department JOB ADDRESS,.- PERMIT # O QD O/ OWNER'S NAME:, -fie PHONE GENERAL CONTRACTOR: f I FAX #-Vo - KZ I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 21 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/C tra or Signature Date SARATOGA BUILDERS(408)252-9404 ' } , 194" , e ' A ACCORDANCE WITH THE MY 0 JOB NAME � � � �ol GUPERT(NO CODES AND ORDINANCES 31 i 21" 36" 21" 84z" DATE 1-2-09 REV SET )ATE / Z—c�� 0z' 7 13" 35i" SIGNED ��,= . 31i" 21" 3 " 21" 18" fl 24% �'�• s�j. chis set :.semvv kept or, the 1 , a� )e .:.::........ .. ��= oil tt7` S �,. lawful to rnal;e �,1y � ?s cl,rrt :::; , Joseph F. Walter ,= ..,, , .,, W2139L w3618BD w2139R r orl same with,,,,t d�,c,tc n 22332 Regnart Road N e F �, the buildingr Dept., Cts s, Cupertino, CA 95014 TOVYM1593 llROTS 1--BW1318-2 OB1BF3v Ni7�,of lhlW 3 dos - SMALL WTI be he;d sh tiZv V F pprojal of the vii)lat;Gn of art, f anA MY Oroirt: ice nr )T'lp t co CD D-rTF02-2493L-UE"2 74 7� e,8R0 �9-N7� y'LV rrl�/ilJ6 �' X .. � m a �, , to to " O W a Qea 013 25z" 33z 12 m € ' /fffff � Y 65i" 4 4" � v w U.4 132" s s � co N Q N jet to 70 CD N All dimensions _size designations given are This is an original design and must not be Designed: 7/18/2006 20", subject to verification on job site and TECHHOL6GIESFA released or copied unless applicable fee has Printed: 10/27/2006 adjustment to fit job conditions. been paid or job order placed. regnart A11 Drawing M 1 CITY OF (vUPERTINO �� 00i O cuPEF PERMIT APPL[CATION FORM R_ _&N4 Date: Building Address- Mailing Address (if different from building address): a Owner's Name: honeC#: mi�q* Contractor: License�#�2 61� Contact: ntact: Phone:I?" Z "9yby. Cupertino Business License#: Fax: (j — Building Permit Info: Bldg l� Elect C dumb E ' Mech ❑ Job Description: rc► E,-,'1DPt--) NM 7ZUCfJ1ei� f�� -? ` Residential n d► .,t,, ommercial ❑ 70 2C Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupanc Grout Type of Construction: Please check this box if the project is a secon -story addition: El i jeroject Size: Standard ❑ Large ❑ Major ❑ Quanti Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Bailer<= 100,000 Btu MECHANICAL BBOILER2 Boilor> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boil:r> 1 M to 1.75 M Btu MECHANICAL BBOILER5 Moiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ir d/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 Ele.- Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 r . CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Grou BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW A tmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE ---Bldg Permit Fees BUILDING / BPFIXTURE Pblg Fixture PLUMBING BPGAS G3.s Piping System Fee PLUMBING BPINTERCEP Lid Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD P tan Check Add Multi BUILDING BPLANCKREP P'an Check Repeat Fee BUILDING BPREPIPE _Ae i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK U.wn Sprinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER In,-:ta11/A1ter Water Pipe PLUMBING BPWHEATER Water Heater[Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/:� Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFLXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV R-,lo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD :Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rom Non-Res Appliance ELECTRICAL BREMPOLE ]'ole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT R. tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CXPERTINO CUPEk ANO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rnidl Signs 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 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 l EPERMITFEE E..ec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE M!ch Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Plannin T LR Comme/Multi-Fam PLANNING PLLONGRNGR Plannimg,Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3