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07010112J00 to o<a -may Sv�z 2 ti= Lae v n�t YpC Lo� y=v _z> CITY OF CUPERTINO BUILDING DIVISION PERMIT C� I�1FC?RM TIS 1� gACTOR BUILDING ADDRESS: PERMIT NO. 10706 t1-2 OWNER'S NAME: PERMIT ISSUE DATE WOO & DE LA GIROND'ARC 01/19/2007 SANITARY NO. CONTROL NO. JNE: ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 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 of the Business and Professions Code, and my license is BATHROOM REMODEL, NON STRUCTURAL in full force and effect License Class Lic. # Date Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Cotte: Any city or county which requires a permit to construct, alter. improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statementValuation 9 Sq. Ft. Floor Area that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter $9000 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 3 5 6 0 8 0:21 . Number Occupancy Type not more than five hundred dollars (5500). ❑ I, 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 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 corppiction, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). Eq 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 La - 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. ❑ I am exempt undo Se ( B & P C for this on D Date Owner f 7 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following I ns: ❑ 1 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 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 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 in anytitan ras the Workcrs' Compensation Laws of California Applicant NOTICE TO APP ANT: 1, afVmakiA this tefflricatc of Exemption, you should become subject to the Wcrkcr's Compsrislition provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. j CONSTRUCTION LENDING AGENCY 1 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 L.cnders Address 7 I 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, andbereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. L (We) agree to save, indemnify and keep harmless the City of Cupertino against n liabilities, judgments, costs and expenses which may in any way accrue against said City Z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOU REGULATIONS. n6 z:;1 Re-roof s S phcan8Le AZARDOUS MATERIALS DISCLOSUR T of Roof 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 Cede, Section 25532(a)? All roo-'s shall be inspected prior to any roofing material being installed. [3 Yes 4efnu If a foo' 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 Area Air Quality Management all new materials for inspection. District? ❑ Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Cade, 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 Date ssuance of a Certificate of cop r• Signature of Applicant �/ ® d ;M6�,Em_ All roof coverings to be Class "B" or better Date 150 11 �0Ir yJAN zuu� 1 APPROVIEU ,M ACCORDANCE WITH THE CI Tl U "'UPERTINOfCODES AND ORDINANCE )ATE 31GNEU�, This set of plaqs and specifications MUS oe kept on the jr,15 at ail times and it is ur !avUful to make cny changes or alteration )n �,arne wi°!,.out vv itton permission fro.' iiie building Dept., City of Cupertino. Tile stamping of this pian and specsiicati� 'HTM.. N01 be he'd to he..: mit or to be )oproval of the vi',Cation of att ^ prcvv ;, f,wv c,of l a4i , • SCOPE OF WORK �A eL —REPLACE T[IBISHOWEEL —II4SrALL PRESSURE BALANCE VALVE AND TEMPERED GLASS DOOR —REPLACE TUBISHOWE[L SURROUND 'WITH CULTURED MATERIA —RREPLACE TOILET VY TH L6 GPF. —REPLACE VANITY CABINET. TOP 6; FAUCETS f n —REPLACE EXHAUST FAN —REPLACE LIGHT FDCTURE h'60,1 4N I-,46 �� Side tj-Ptf SFA- Gt=Cr or ba J) 5i�R CPQer) SNPQTp�)cK 0r"vLl117 d -rub c`nC lvv.` >JA )Ti' S' iy woo � 1011 iS m. h �,q (f' Aop A)� IO'70C 11tJN v19'1,q PR. 'i ? 1/1 T ](/10 C_1 q '(01 � CITY OF "UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: 16 06 i N p Tfi �R . C�� P� 1J� C q�6 ��� PERMIT # �� D U � OWNER'S NAME: p e Ren )' Ri i vie' PHONE #�2' GENERAL CONTRACTOR: vo FAX # I am not using any subcontractors: a{ i-rlp I✓ lel 16 7 S- gnature Date Please check a licable subcontractors and corn lete the followimy, information: 1%4 lk'oN /q Owner/Contractor Signature Date SUBCONTRACTOR BUSI]vESS 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 1%4 lk'oN /q Owner/Contractor Signature Date CITY OF C1LJPERTINO 0q0 C C) ( 112. CITY �,OF PERMIT APPLICATION FORM CUPEkTINO CPN # Building Address: (Date: 1/IgIv? Mailing Address (if different from building address): vl� v►►ri ,.. �nP 11N1�got/,- --I Owner's Name. Phone #: ��Rri'7y W00 x �ve�i Cl? o '�U License #: Contractor: _1RA P l c, Cul'' S'i << `�' �'� C ' 7� r7 r Phone. Cupertino Business License#: Contact: Fax: _ Building Permit Info: Bldg Elect , Plumb Mech Job Description: Residential RDUbr r Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Type of Construction: G�_w a, om 00 Occupancy Group: �z — 3 Please check this box if the project is a cPennd-story addition: ❑ 'roject Size: Standard K Large ❑ Ma or U I ' ree yewnpuy., Other Appliances Boiler <= 100,000 Btu Boiler > 100K to 500K Btu BOl' er > 500K to 1M Btu Boilor > 1M to 1.75 M Btu )=,oiler > 1.75M Btu Construction Tax In d/Off/Coinm/Quasi Con. Tax for BQ Zone Constax — Resi/Moone Elec 600V <= 1000A _Elec 600V > 1000A Elec Svcs 600V <= 200A 1 of 3 - a(t�-, CITY OF CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID BMISCELL Fee Description Miscellaneous Fee Fee Group 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 P tmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE BldIZ Permit Fees BUILDING 12— BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP I -1d Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP P an Check Repeat Fee BUILDING BPREPIPE (Zepipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK L,Lwn Sprinkler/Backflo PLUMBING BPSTORM BPTRAP Storm/Rain Water Kitchen Trap PLUMBING PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER InAall/Alter Water Pipe PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER PJC Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT BREMFURN Lighting Fixtures P elocution of Furnace ELECTRICAL MECHANICAL BREMFURNOV Relo Furnace >I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD [nstallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BgEMNAPP R, -.m Non -Res Appliance ELECTRICAL BRE POLE ?ole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT BREMRELOCA R --ptl, Switch & Outlets Relocation of Hood ELECTRICAL MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY of CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rntdl 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 EPERMITFEE E lec 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 a LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin : Long Range Residential PLANNING _ ZADDCHG Address Change BUILDING 3 of 3