Loading...
0701006502 Z CO F-4 ~ W� C4 :D UC wE o� '' G1 C OF CITY OF CUPERTINO7� �h � � �Q �E� RM T�© e BUILDING DIVISION pER T ' BUILDING ADDRESS: PERMIT NO. 44 ROSE BLOSSOM DR BATHROOTI OWNER'S NAME: PERMIT ISSUE DATE BECKY LEFEVRE 1422 Si ATOGA AVE 01/10/2007 ONE: SANITARY NO. CONTROL NO. (408)Y78-6700 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 ftheBusinessandProfessionsCode. Ilconacis in full force and if, t. � .7 REPLACEBATHROOM FIXTURES NON STRUCTURAL INCLUDES License Clas Lie. a TILE Date Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the 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 Sq. Ft. Floor Area Valuation prior to its issuance, also requires the applicant for such permit to file a signed statement 9 that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $$15394 that he is exempt therefrom and the basis for the alleged exemption. Any violation of 359040. 8. MN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). _ ❑ I, as owner of the property, or my employees with wages as their sole compensation, Required Inspections will do the work and the structure isnot intended oroffered 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 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.). ❑ 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 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 Contractor's License Law. ❑ I am exempt under Sec. , B & P C for this reason OwnerDate WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Workces 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 Workefs Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workcr's m ns a Insyfancc c d Policy number are: Carrier. /�f �rtcy 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 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 I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to { building construction, and hereby authorize 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 j liabilities, judgments, costs and expenses which may in any way accrue against said City r in consequence of the granting of this permit. APPLICANT UN ANDS AND WILL COMPLY WITH ALL N N -POINT Issued I y: Date SOURCE REG NS. Q/1)' Re -roof s Type of Roof Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future buildingoccupant 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 $h!o If a roo r is 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 Arca Air Quality Management all new materials for inspection. District? ❑ Yes Et I have mad 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 docs not currently a tenant, that it is my responsibility to notify the occupant of the requirements w ' use be met prior to issuance of a Certificate of cup 7 Signatu •e of Applicant Date c p / 111 All roof coverings to be Class "B" or better Owner authorized or agent Date _ v.» s,.,„„ " N u { :. 'r-,r-Nsi' ':ri - y �m d ""Y`" .�i " '?3 `' • i^ ' •'-sem, : h •5, a �-4. " N Y CUPWINO - Assessor's Parcel Number: Name of owner. Project address. Contact person. %t r ���ti Phone. Fax. Net square footage of lot. NITS THE CITY OR iN ACCORDAP.F r i RDINANGF.S Pro o oPERTIMO CO t Square footage: First floor. Second � _.. w Garage: MUST 4e a1GHE s-ec�iications <<� TOTAL: time it is un 1 itis s� tite ,�, -a}fan es 4r alteration, Are there at least two 10 foot by; 29, t ; a N tiw �.. ,i`4 Is privacy protection planting regi r9 f t44 " ' � ` , On what floors) is work being done` v Brief description of work. Code editions: 2001 CBC (Y -1)2001 CF- (Y - N)2001 CMC (Y- N) 2001 CPC (Y - I)2001 NEC (Y - N) Effective 11/1/02 Plan Review Process Work Book Page -8-Rev sed 8/22/05 I'GIVIS by Remodeling Specioaiists i 1-22 SAFI—ATOGA AVE. • SAIN JOSE, CA 9-51229 -1.61-E'HCiNL; (408) 378-6700 CON IRACTOI_S LTC. I -e- Fcv CAL a��M D.zteC! ----- --- - — �. - C�" � / fiS /v1C�L L'L- �Q ►.J I CITY OF CUPEI�TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDR S: PERMIT # v mss°` OWNER'S NAME: PHONE # Cabinets & Millwork GENERAL CONTRACTOR L22FAX # I am not using any subc�aictors: Signature Date Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature Date SUBCONTRACTOR BUSHNESS 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 C TY OF CUPEI�TINO CITY OF CUPERTINO 0,701000lb PERMIT APPLICATION FORM ,'N # e;1561 -04-01t Date: //gip/d Building Address: Mailing Address (if different from building address): o f'e la, rd a.� Owner' ame: Phone Con!t� r- License #: r, � Con Phone: (,a- Fax: Cupertino Business License#: Building Permit fo: Bldg ❑ Elect / n Plumb MeAtt—_- Job Description: %� al\ S tit w' ct Residential �4-u /� � � Commercial ❑ Sq.Ft. Floor Area: e ,T Sq.Ft. - // i x 6 / Cost of Project � / �; � Occupancy Group:�3 Typeof n on: _._, �T- Tv ' Please check this box if the project is a second-stor addition: ❑ e oject Size: Standard ❑ Large ❑ Major ❑ MECHANICAL Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boil ,-r > I OOK 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 Iitd/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Co nstax - Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Ilec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OF Cl IPFRTINO CITY OF CXPERTINO PERMIT APPLICATION FORM Quantity Fee ID BMISCELL BMITIGATC BNUCOMME BNUCOMMM BNUCOMMP BOVERTIME BPBACKFLOW BPCESSPOOL BPERMFEE BPFIXTURE BPGAS Fee Description Miscellaneous Fee Coinm. Housing Mit. Fee ° New Comm Electric New Comm Mechanical -,4ew Comm Plumb Inspection Overtime Atmospheric Vacuum Cesspool Blft Permit Fees Pblg Fixture Gas Piping System Fee Fee Group BUILDING BUILDING ELECTRICAL MECHANICAL PLUMBING BUILDING PLUMBING PLUMBING BUILDING PLUMBING PLUMBING BPINTERCEP Lid Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD P Lan Check Add Multi BUILDING BPLANCKREP P' an Check Repeat Fee BUILDING BPREPIPE ke i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLUMBING BPSTORM Stomi/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER InAall/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER AJC Unit > 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN ]Zelocation of Furnace MECHANICAL BREMFURNOV R elo Furnace > I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP R --m Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Pc wer Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood CAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP F_emodel Res Appliance ELECTRICAL 2 of 3 CUPEkT1NO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rr idl Signs Add Branch ELECTRICAL BREMSIGNS Renodel Signs, 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 remporary TemporaryPower ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE IE lee Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL / MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Permit Issue PLUMBING PPLBG -Ptimbing F lumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3