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07090077V CITY OF CUPEK1.1. BUILDING DIVISION BUILDING ADDRESS: OWNER'S NAME: ARCHITECT/ENGINEER: PERMIT LICENSED CONTRACTOR'S DECLARATION 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 in full force and eff ,qt. Z 2U License C s —• N Date — Contractor JE LONST /�l r ARCHITECTS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's 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 prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (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 not more than five hundred dollars (SSW). ❑ 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 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 Convactoes 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. ❑ I 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: have and will maintain a Certificate of Consent to self -insure for Worker's Compen- -_.ton, 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 Workees Compensation Insurance carrier and Policy number are: Carrier ✓ T%fTe C & R Policy No.: Z 0 -571� 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. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Dare 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 1 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, 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 Liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCEIZi�Tj[)NS. A w � �� II ��(// ✓vim Signature f Applicant/Contractor Dae HAZARDOUS MATERIALS DISCLOSURE 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)? ❑Yes ®No Will the applicant or future building occupant use equipment or devices which it hazardous air contaminants as defined by the Bay Area Air Quality Management Yes &No 'gad the hazardous materials requirements under Chapter 6.95 of the Califor- �ly Code, Sections 25505.25533 and 25534.1 understand that if the building •have a tenant• that it is my responsibility to notify the occupant of the st be met prior to issuance of a Certificate of Occupancy. t Date Job Description KITCHEN REMODEL—NON STRUCTURAL INCLUDE (E) (M) (P) LIGHTIN3. 3q. Ft. Floor Area APN Number 35708042.00 Issued by: Re -roofs Type of Roof uati on Type Required Inspections All roofs ,,hall be inspected prior to any roofing material being installed. If a roof i;: installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant All roof coverings to be Class "B" or better Date a,11TYF CUPEkTINO (070��e07-7 CITY OF C'UPERTINO PERMIT APPLICATION FORM ,,CPN # 351weoly& D0 Date: C?_ 12- -D Building Address: Mailing Address (if different from building address): p I Q3 @02 1 v -e re-,- q Cv Q (- nD CA. ef SD Owner's Name: Phone #: J-eor 2vo 4ok- qLf 78,&3 Contractor: C M ICove 5-�-rvC-h License #: Contact: Phone: `Io " 21 l7 "bsZ? Cupertino Business License#: Cgr(os eFa S Fax: 2%4 %9 Building Permit Info: �/ Bldg El Elect [9i Plumb El Mech E� Job Description:"'r a -k �-^ Re V140 DCommercial ❑ Residential ElK(+6Aevn Sq.Ft. Floor Area: Sq.Ft.: Cost of Project:L 1 Df �D t� G ,. j — Occupancy Group: � Type of Construction: Please check this box if the _project is a El civv second -story addition: Prniart C17P• Ctnnr1ard ❑ Large ❑ Maior ❑ BCONSTAXBQ Quantity Fee ID BAPPLOTHER Fee Description Dther Appliances Fee Group MECHANICAL BBOILERI BcHer <= 100,000 Btu MECHANICAL BBOILER2 Boile r > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX In d/Off/Comm/Quasi BUILDING BCONSTAXBQ Un. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Ccnstax - Resi/Mobile BUILDING BELEC 1000 E' ec 600V <= 1000A ELECTRICAL BELEC1001 E,lec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING of 3 CITY OF CrUPERTINO Cin F PERMIT APPL=ICATION 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 Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Ga: Piping System Fee PLUMBING BPINTERCEP Incl Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Pla i Check Repeat Fee BUILDING BPREPIPE R,, -pipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK La -An S rinkler/Backflo PLUMBING - - BPST0PM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT A. t of Drain & Vent PLUMBING BPWATER InstaWAlter Water Pie PLUMBING BPWHEATER W ater Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C' Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT bighting Fixtures ELECTRICAL BREMFURN Re: ocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT I ';eater Installation MECHANICAL BREMINHOOD Iwtallation of Hood MECHANICAL BREMMISC Mise Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Po [e/Platform Fixture ELECTRICAL BREMPOWER Powt-r Device/Apparatus ELECTRICAL BREMRECEPT Repi], Switch & Outlets ELECTRICAL BREMRELOCA R -,location of Hood MECHANICAL BREMREPALT Rc pair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 aCOF CUPEkTINO CITY OF CUPERTINO PERMIT APPL[CATION FORM ')uantity Fee ID :Fee Description Fee Group BREMSIGNAD Rmcll Signs Add Branch ELECTRICAL BREMSIGNS Remadel 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 T -mporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC E.lectrical sq foot ELECTRICAL EPERMITFEE Ele c 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 3 of 3 CITY OF CUPERTINO 9 ITEMS OF 9 PERMI'' RECEIPT Sec: Twp: Rng: Sub: B11:: Lot: APN ......... 35'708042.00 DATE ISSUED.......: 09,'12/2007 RECEIPT #.......... BS1)00002630 REFERENCE ID # ...: 07090077 SITE ADDRESS .....: 10380 RIVIERA RD SUBDIVISION ....... CITY .............. CUPERTINO IMPACT AREA ....... OWNER ............. JET -N ZUO ADDRESS ..........: 10:580 RIVIERA RD CITY/STATE/ZIP ...: CUPERTINO CA, 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: CM11 CONSTR. INC. CONTRACTOR .......: CARLOS FARIAS LIC # 27978 COMPANY ..........: CM11 CONSTRUCTION ADDRESS ..........: 3451 SPURLING CT CITY/STATE/ZIP ...: SAN JOSE, CA 95127 TELEPHONE ........: (41)8)210-6527 FEE ID UNIT QUANTITY i',MOUNT PD -TO -DT THIS REC NEW BAL ---------- BENERGY ------------- PERMIT FEE ---------- 453.60 --------------------- 217.73 0.00 ---------- 217.73 ---------- 0.00 BPERMFEE VALUATION 40,000.00 453.60 0.00 453.60 0.00 BPFIXTURE UNITS 1.00 9.00 0.00 9.00 0.00 BREMFIXT NO. FIXTURES 8.00 9.60 0.00 9.60 0.00 BREMRECEPT NO. OUTLETS 8.00 9.60 0.00 9.60 0.00 BREMVENFAN NO UNITS 1.00 45.39 0.00 45.39 0.00 EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 ---------- TOTAL PERMIT ----------- ---------- 867.29 0.00 ---------- 867.29 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- CHECK --------------- 867.29 -------------------- #3810 --------------- TOTAL RECEIPT 867.29 CITY OF CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # 1©380 ����2r� D, C v e-A"O c A, IS -P('( '7 � ��117% OWNER'S NAME: COLD 5 FA -(u ik S PHONE # t-102 "- Z ( C) -6-5-2--7 GENERAL CONTRACTOR: (? /.k F C dA, STn vc i ! v FAX # (409, C12 -3 -9q2 -9- I 23^9qZ9- I am not using any subcontractors: Signature Date Please check applicable subcontractors and com Clete the followinz information: Owner/ Contractor Signature Date 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 CUPERTINO Assessor's Parcel Number: Name of owner. —sTeCck) L) o 9/ 0 12-c q5 Contact person. ty&f'-10� -Phone. qo&— 2-3 Sq 2—& Fax. Net square footage of lot. DLkR9 Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are there at -least two --10 foot by -20 -foot clear spices inside the gqr4ge?-,-..,..Y,-- Is privacy protection planting required for the prject? On what floor(s) is work being done? GL e "I e - Brief description of work. Code editions: 2001 CBC 2001 CFC &--�2001 N)2001 CMC N) *-N,) 2001 CPC 1NEC Effective 11/1/02 > C/) Cn M Cn Cn 0 0 0�' c Plan 7eviewProcess Work Book Page -9-Revised 9/22/05