08120116 CITY OF CUPERTINO
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BUILDING DIVISION PERNHT ,r °AzT. Ios�
u Per.
BUILDING ADDRESS: ` PERMIT NO.
22638 OAKCREST CT INTERNATIONAL
OWNER'SNAME: BATH CORP. PERMIT(ISSUE DATE
ONE: S CONTROL NO.
(408) 296-3055
ARCHMICTMNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
uoo LICENSED CONTRACTOR'S DECLARATION lob Description
rd Z C 1 hemby"m Nal 1 sm Iimw uMcr pmrisimu of CMPier 9(commencing p
<U withS=don70Ck)af Division3ofdw Businc dProfeWOMChide.a mylkc=4
a inf[if edeifca
LTUPGRD ELECTRCL SUB—PANEL, 200AMPS
jtg_ Li-toxan, !Y.•
nFp Dax —1 Contrcmr
A " liRSDECLARATION '((,
I understand my Mans,MalI be used as public mcoraa
1.0
g G In Licensed Professional
y3 OWNER-BUILDER DECLARATION
i<F I bereby alarm that I into exempt from Ne Conuacmrs License Law for me
D o following reason.(Section 7031.5,Budnws and Profesdmw Code:Any city nor county
which xquims a permit to ce nvmc,alcor.improve.demolish,or tepalr any suuctum
M2 poor m its issuance.also requires the applicant forsuch permit to rile asignml stamment
pr`
that neisBanxdpmmmwmmthe provisions; ma
ofdecomxmrsuxLaw Sq. Ft.Floor Area Valuation
Yds (commencing with section 71)(R)M Division 3 of the Business and Profession Crux)or
Nat be is exempt therefrom and the basis for time alleged exemption Any violation of 1 0
SeNon 7031.5 by any,appliurt for a permit subjects dm applicant to a civil Penalty of APN Number Occupancy Type
not room man five hundred dollars(gsoo> 34248004 . 00
0 1,u owner of the property,m mY wploycas with wages as Ibev sole compewaUon,
will do the work.and the swemm or rotimsended oroRee d forsatc(sec.7014,Business
and Pmfcssiom be Code:TContrcrors License Law chin not apply m an owner of Required Inspections
property who builds orimprovu theseon.and who does suchwork hirma for Wough his
own employees,pmvided that such improvements arc not intended oroRcmd for sale.IL
however.the building or improvement is sold within one year of comPlethm.the owner.
builds wdi have the burden of proving that M did rot bold or improve for purpose of
sky
O 1,as moor 9 abc property,am exclusively contracting wim licensed conuactms to
wwuuct
the project(sec 7064,Business and Professions Code:)The Contraehirs W.
cemx law does not apply m an owner of propery,who builds or improves moron.and.
who eontmets for such projects with a conmeor(s)]icemd pursuant to the Contractors
license law.
1I him exempt undo Sec ,B&PC for mu mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 bereby dnmt under penalty of perjury este of Ue following declaxuome
I have and will maintain a Certificate of Consent o self-imum for workers compen,
.mon,as provided for by Section 3700 of me latter Code.for the performance of the
work for which this permit is iasued.
I have and will maintain Workers Compensation In mean¢,as required by Section
37W of the labor Code,for me performance of Ute work for which this permit is issued.
My Works�c-r-"kvc.�om�,p���emuaoon Imorurara�me ori ra Iiry,number am:
Cartier. Verga.+] — PolicyNo.: 51
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This xNm need notbecnmpleted if t e permit is to,.hundred dollus($10(1)
m leu)
1 comfy that in the Performance of the work for which this permit is issued.I shall nes
employ any person in any maoncrw as ta become subject to the Workers Comperuati0n
Laws of California.Data
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation previsions of Ue labor Code.you most
.J z fethwnh comply with such provide.ur this permit rind]be decreed revoked.
z O CONS RUCTIONLENDINGAGENCY
I herby drum mat Orem is a coewmction lending agency(or Ute performance of
a the work for which this permit 1s issme(Sex.3097.Cm C.)
0 Lendors Name ,
a z Lenders Address
U O 1 country ren 1 haw mad this application and seam that the above information is
Iy r Correa I agree to comply with ill city and county eminanvs and sane Iowa relating to
0 U building construction,and hereby adhorine representatives o(mis city m enter upon me
[27 abew-mcommad property for inspection purposes
F 6. (We)agree to save,irdcmnify and keep harnlus the City of Cupertino against
h liabilidw,juigmcnu,costs and expenses which may in any way aarne agdnst said City
U Z, in consequence of the Zooming of this permit. �y G
APPLICANT UNDERSTA 4DS AN WILL COMPLY WITH ALL NON-POINT Issued by: Date Z—I7 — O
$OURC6�E tj T1 IS l Z�t1 O�
Re-roofs
Si —'um—'m ``rAA.ppplliicx.WCantrcto r a—a
HAZARD MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or hxrWk hovsNous oriental _
as defined by Ue Cupertino Municipal Code.Chapter 9.13.seat the Health and Safety
Code,section 25532(a)?
t]Yu C` All roofs shall be inspected prior to any roofing material being installed.
I No
Will the applicant or fuTutture building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t havardow air comaremanu ss deflated by the Bay Area Air Quality Management all new materials for inspection.
time?
❑Yes r No
L have mad the hvasdmesmamriaH requimmcnu under Chapmr e.95ofthe Cali(m.
nix Health&SafctyCo ,See6au25505.M33andZ534.1undersund Nmi(me building
docs not Currently have a moon.that it u my eespe uthdoy m noufy Ue occupant of Uc
uUgmcnuw ' hmuube norm amxer Ccnlficaeof0cxparty. Signature of Applicant Date
Duan Tor thodr .MZ 1 p, 6 All roof coverings to be Class'W'or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . .. 34248004 . 00
DATE ISSUED. . . . . . . : 12/17/2008
RECEIPT # . . . . . . . . . : BS000006844
REFERENCE ID # . . . : 08120116
SITE ADDRESS . . . . . : 22638 OAKCREST CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KATO MERVIN TRUSTEE
ADDRESS . . . . . . . . . . : 22638 OAKCREST CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0830
RECEIVED FROM . . . . : INTERN'L KKTCHN&BTH
CONTRACTOR . . . . . . . : JULIE GAYLORD LIC # 29094
COMPANY . . . . . . . . . . : INTERNATIONAL KITCHEN & BATH C
ADDRESS . . . . . . . . . . : 1175 E HOMESTEAD RD
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94087
TELEPHONE . . . . . . . . : (408) 296-3055
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 1, 800 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1ERT<200 UNITS 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 122 . 87 0 . 00 122 . 87 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
-- -----
CHECK 122 . 87 #1799
---------------
TOTAL RECEIPT 122 . 87
•
a1 �, Community Development
�� 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
*UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
a. aCo3�' OAO -Lr?E*�:>T -r
OWNER'S NAME: e*-�J W-A-M PHONE # 3qc�-
GENERAL CONTRACTOR: I NTS-•(t�JA}T iot3&L FAX # 40$ 4 _ arra 1
1LLZ g- aa
I am not using any subcontractors:
Signature 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
•
Owner/Contractor Signature Date
J
0kl.;
CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # , ay 8 o o L4 . op Date: D f 1-1 aOos
Building Address:
aaU36 oAke��st ct , c�pe�-;�lo� cA gsoi�
Mailing Address (if different from building address):
SAme.
Owner's Name: Phone #:
efJ�n1 4CI�ro (�So °Ibl- � $�
Contractor:
11� Phone: (y+Drd> cl(D 3 O��
�►.It,�. KI ,Lrr� -- ''�N � C3ATH Fax: O
Contractor License #: 842�gq t D
Cupertino Business License #: O q
Contact: Phone: �zAcel>
ae�(Q . 305
• Residential Commercial ❑ Fax:
Job Description: p
UPaI(A� Elec�',rtcnC_. JUS-v At�P�`
�a/tom pS
Building Permit Info: CS 1 0 Oo 3 5
Bldg ❑ Elect D1 Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, I-B ❑ II/Ill/V-A ❑ 11/111 B, IV-HT, V-B ❑
Valuationl O Q� Square Footage:
Project Size: Express Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set& the sheet index.
Points Achieved:
• For help,contact Build it Green at www.builditgreen.orll
Revised 7/01/08