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07010024 777777 77777777 :i CITY OF CUPERTINO BUI'DING DIVISION PERMIT �OR INFRIYIATI�1 � PERMIT NO. BUILDING ADDRESS: 93 BARNHART AVE MRS DELI PERMITISSUEDATE OWNER'S NAME: MRS DELIA CESENA 2745 WIESLOW WAY 01/04/2007 SANITARY NO, CONTROL NO. .ONE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH j0p LICENSED CONTRACTOR'S DECLARATION Job Description 4 U P I hereby affirm that I am licensed under provisions of Chapter 9(commencing =z W with Section 7000)of Division 3 of the Business and Professions Code,and my license is BATHROOM: REMODEL REPLACE 1 FIXTURE & TILE 65 ' D y in full force and effect TUB/SHOWER AREA j 'M? License Class Lic.8 [—aDate Contractor ts ARCHITECTS DECLARATION J W U 1 understand my plans shall be used as public records a i G y Licensed Professional r„, OWNER-BUILDER DECLARATION <2 1 hereby affirm that 1 am exempt from the Contractors License Law for the %0 O following reason.(Section 7031.5,Business and Professions Code:Any city or county rE which requires a permit to construct.alter,improve,demolish,or repair any structure Z} ;prior m its issuance,also requires the applicant for such permit to file a signed statement ,Ft.Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ` q $400 yF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or A 9 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 7 5 0 9 0 3 C . Number 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 We.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 11 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 docs 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, 0 lam exem nd r Sec. .B&P C for this reason Owner Date WORKER'S COMPENSATfON DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 1 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. 0 1 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 Workers Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for 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' any ner so as to become su t rs'Compensation Laws of Glifp AppBcattt NOTICE TO A PLICANT: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. Z O CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of a+> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lenders Name 0z Lenders Address U C) I certify that I have read this application and state that the above information is LL correct.I agree to comply with all city and county ordinances and state laws relating to U building construction,and hereby authorise representatives of this city to enter upon the to above-mentioned property for inspection purposes. �'d W (We)agree to save,indemnify and keep harmless the City of Cupertino against tF-t liabilities,judgments,costs and expenses which may in any way accrue against said City i U Z in consequence of the granting of this permit. Date — U APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REG TI F.IFs��l 1-2— 7 Re-roofs ���� Signature o! pplicant/Contractor Date T Of):OOf HAZARDOUS MATERIALS DISCLOSURE Type 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 roofs shall be inspected prior to any roofing material being installed. 0Yes If a roof s installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 0 Yes 'E(No I 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 responsibility to notify the occupant of the require w most 1>c me or to issuance of a Certificate of cupancy. Signature:of Applicant Date C�*k r�'—,Q 7 All roof coverings to be Class"B"or better Own or authorized agent Date Community Development 10300 Torre Avenue ' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPEkTINO Building Department JOB ADDRESS: PERMIT # �o `l3 Earn hve o CSG 2 " OWNER'S NAME: e C a ( f5S e kla. PHONE 6V 7. .sly GENERAL CONTRACTOR: FAX# I am not using any subcontractors: i ��� T 7 Si;;nature 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 4=el�, 7' Owner/Contractor Signature Date OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent,spouse or child) will perform 3"S elcQ C'- - pw e r A. _V" All the work authorized by this permit B. — A portion of the wo rk �G�Y Cis (Som C. _ None of the work ©S y� C�mss., 6; If B or C is checked,complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. — A portion of the we rk (complete section below) Contractor Phone # State License #71-- Address/City.. Type jo �!orkto.. 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understanc.that I may be an employer(see reverse side). A Certificate of Insurance covering workers' con Lpensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be erformed .................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information(reverse s' e). 7 Date: Property Owner's Signature: /�r job Address: l �-� u � fy'e Permit# all9lOOo� Any changes to the information provided o this form shall be submitted to the City of Cupertino Build Department. CITY OF C UPERTINO bel D I C�2 - CITY OF PERMIT APPLICATION FORM CUPEt�TINO _LPN# 3 750 '7 & 3a , ad Date: Building Address: Mailing Address (if different from building address): rI _3 ?�atrn hu 1, Oc -04y`fl o o Owner's Name: Phone#: _2>CllQ 0-es en--u Contractor: License#: DGohev- Contact: Phone: Cupertino Business License#: (Q 07 393Z� 4 Fax: Building Permit Info: rcvAh rDa"7 e rhoc�eL, ,e �&fC !'yt! ��C GY-e -e � Gels h MAv-+- a-yea Bldg ❑ Elect ❑ P lumb El' Mech ❑ Job Description: Residential 5'r-a a.be Ye Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: _ ,/�O��� Occupancy�GrouZ � Type of Construction: Please check this box if the project is a 40 second-story addition: El project Size: Standard ❑ Large ❑ Major ❑ Qua_ntity Fee ID Tee Description Fee Grou BAPPLOTHER Other Appliances MECHANICAL 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 BBOILERS Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX InUOff/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Coristax—Resi/Mobile BUILDING BELEC1000 Elm 600V<= 1000A ELECTRICAL BELEC1001 Elec 600V> I OOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL ' BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA nvestigation fee BUILDING 1 of 3 CITY OF C'UPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME N,-.w Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atnospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Incl Waste Interceptor PLUMBING / BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plzn Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lavin SprinklerBackflo PLUMBING BPSTORM .Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Inst ill/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT reinspection Fee BUILDING BREMACOVER A/('-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 Rdocation of Furnace MECHANICAL BREMFURNOV Re]o Furnace> 1O btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD In stallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 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 :' of 3 CITY OF C UPERTINO CUPaCF PERMIT PERMIT APPLI=CATION FORM Quantity Fee ID lee Description Fee Group BREMSIGNAD Rind Signs Add Branch ELECTRICAL BREMSIGNS Rem)del Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD E cb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM 30wimming Pool BUILDING BTEMP Tomporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Ellectrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Meeh Permit Issuance MECHANICAL / PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning_Long Range Residential PLANNING ZADDCHG .address Change BUILDING 3 of 3