07030179 CITY OF CUPERTINO
PERMIT �1 'g ),GTQR INFOR11r��Ti�1�,
BUILDING DIVISION
�.
PERMIT NO.
BUILDING ADDRESS:
10292 TERRY WAY #2 TBD — To BE DETERMINED 07030179
PERMIT ISSUE DATE
OWNER'S NAME:
10292 TERRY WAY LLC 03/26/2007
SANITARY NO. CONTROL NO.
INE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
i p p LICENSED CONTRACTOR'S DECLARATION Job Description
V F I hereby affirm that I am licensed under provisions of Chapter 9(commencing
;ZUJ with Section 70(X))ofDivision 3 ofthe Business and Professions Code.and my license is KITCHEN & BATHROOM REMODEL—NON STRUCTURAL
H in full force and effect.
;^? License Class Lic•#
2 Date Contractor
ARCHITECTS DECLARATION
J,< I understand my plans shall he used as public records
)yU
u.l- Licensed Professional
h OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
p O 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
a Z} prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area $3000 3 O O O
4 t_ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 7
i 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 Number Occupancy Type
not more than five hundred dollars(5500). 35917013
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 contractor's License Law docs 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.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to }
construct the project(Sec.7044.Business and Professions Code:)The Contractors U-
ccnse 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
n n LLicense Law.
0 I am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION I
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 Worker's 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 I have and will maintain Worker's Compensation Insurance,as required by Section Ry
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' fA
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
,J 0 forthwith comply with such provisions or this permit shall be deemed revoked.
Z, CONSTRUCTION LENDING AGENCY
[.�Cn I hereby affirm that there is a construction lending agency for the performance of
a> the work for which this permit is issued(See.3097,Civ.C.)
QLender's Name
a z Lender's Address
U 0 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
rJ Jbuilding construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
G3. (We)agree to save,indemnify and keep harmless the City of Cupertino against
Hliabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b): Date
SOURCE REGULATIONS.
Re-roofs
Signature of Applicant/Contrac or Date T Of Roof
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.
0 Yes 0 No
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r laterials for inspection.
District?
Cl Yes 0 No
I have read the hazardous materials requirements undcrChaptcr 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
docs not currently have a tenant,that it is my responsibility to notify the occupant of the
requirements which must be met prior to issuance of a Certificate of Occupancy. Signature:of Applicant Date
All roof coverings to be Class"B"or better
Owner or authorized agent Date
CITY OF CUPERTINO
6 ITEMS OF 12 PERMI- RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: B11c: Lot:
APN . . . . . . . . : 35917013 .01
DATE ISSUED. . . . . . . : 03,122/2007
RECEIPT #. . . . . . . . . BS,)00000757
REFERENCE ID # . . . : 07030179
SITE ADDRESS . . . . . : 10292 TERRY WAY #2
SUBDIVISION . . . . . .
CITY CU:?ERT INO
IMPACT AREA . . . . . . :
OWNER 10.292 TERRY WAY LLC
ADDRESS 10 ?92 TERRY WAY # 2
CITY/STATE/ZIP . . . : CU?ERTINO, CA 95014
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR TB:D - TO BE DETERMINED LIC # 00096
COMPANY TB:) - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
BENERGY PERMIT FEE 83 .16 39.92 0 .00 39. 92 0.00
BPERMFEE VALUATION 3, 000.00 83 .16 0 .00 83 .16 0. 00
BPLANCHK PERMIT FEE 83 .16 110 . 98 0 .00 110 . 98 0.00
BREMRECEPT NO. OUTLETS 2 .00 2 .40 0 .00 2 .40 0.00
BSEISMICRE VALUATION 3, 000 .00 0.50 0 .00 0 .50 0.00
EPERMITFEE FLAT RATE 1. 00 38.37 0 .00 38 .37 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 275.33 0 .00 275 .33 0. 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
101 FOUNDATION 102 PIERS
103 UFER 104 REBAR
105 ANCHOR BOLTS 106 SEWER & WATER
202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL
204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION
301 ROUGH PLUMBING 302 TUB & OR SHOWER
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
305 FRAME 306 HOLDOWNS
307 INSULATION 308 SHEETROCK
r CITE' OF CUPERT'INO
C CITY OF PERMIT APPLICATION FO �
INO
APN# Date:
l� - Ot3.O / 3�ZZ o7
Building Address: Mailing Address (if different from building address):
?12, 7 ['✓� 2't/ego CP" U k) IT Z
Owner's Name: Phone#:
,�1�;2 ,Enr�Y way Lt 6S0 - Y6 L tr s�,
Contractor: License #:
Contact: AJ6 k- Yvu� phone: 6 rO 'Y6-9-o N J� Cupertino Business icense#:
Fax:
Building Permit Info: ��r�H�N �2�-r�,o8 �� j„�,� - AJLW- STr2vcruarl-(_.
Bldg ❑ Elect Q- P:umb 27' Mech ❑
Job Description:
Residential B Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: 3 w J Occupancy Group:
Type of Construction: - Please check this box if the project is a
second-story addition: El
olect Size: Stazrdarcl- -- -- JVlajcr El
Quantity _ _ _ Fee ID` Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boil-.r<= 100,000 Btu MECHANICAL
BBOILER2 Boiler > IOOK 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 G)nstruction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUII,DING
BCONSTAXBQ Con, Tax for BQ Zone BUILDING
BCONSTAXH )_ otel and Motel BUILDING
BCONSTAXR Con,tax—Resi/Mobile BUILDING
BELEC 1000 Elec. 600V<= 1 OOOA ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Er.ergy Add Multi BUILDING
BINVESTIGA Ir.vestigation fee BUILDING
1 0'3
r
CITY OF C UPERTINO
CITY OF PERMIT APPLICA'T'ION FO.
CUPEk NO
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Ins Rection Overtime BUILDING
BPBACKFLOW Atrr ospheric Vacuum PLUMBFNTG
--DPC'ESSPOOE.- - - j --- -- Cesspool t I E'1\/t'Bij\'( -
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pble Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
/ BPLANCHK Plan Check Fee BUILDING
A BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Rei a Of Fixtures PLUMBING
BPSEWAGE Sewage Dis osal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawr. Sprinkler/Backflo PLUMBING
BPSTORM St)rm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING-
BPVENT Alt of Dxain &_Vent PLUMBING.
BPWATER InstalUAlter Water Pie PLUMBING
BPW -HEATER Water Heater/Vent PLUMBING
B?WSVCS 1Vlairi Water-Service PLUMBING - -
--- - -- BREINSPECT Rains ection Fee BUILDING-
- BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C L nits <= 10,000 cfrn MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relccation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP 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 Rep air/Alter Heating MECHANICAL
j BREMRESAPP Remc del Res Appliance ELECTRICAL
2 oi"3
CITY OF CUPERTINO
OR-
CUPEkTOF.
PERMIT APPLI.ICATION FORM
Quantity Fee ID lee Description Fee Group
BREMSIGNAD Rmd Signs Add Branch ELECTRICAL
BREMSIGNS Rem Adel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Veut Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
_ BSEISMICOM Sekmie Commercial BUILDING
_ C SEISI�✓1FC 1
eiismic l c c Rei HU1,1, D,F,N
BSPECIAL S)ecial 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 Ele,-- Permit Issuance ELECTRICAL
MPERMFEE M;chanical sq. foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plunibing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot -- PLUMBING
PLLONGRNGC Planning LR Comme/-Multi-Fam PLANNING
PLLONGRNGR_ - Planning:Long Range kesxiezitialPLANNING
ZADDCHG Address Change BUILDING
3 of )
2'7 112"--
10292 Terry Way,, Cupertino Ca
Unit #2
AS-IS Kitchen Plan tMOU -STk(-'rAA4L-) ]
1-3- $
Sink
Legend: 3'
Receptacle Outlet 2'1
4'8"
S Light Switch
$
" Sink
Lighting APPRC)
V=D
AN A "r
n ME cTy of 11 9"
RECETV" ' CUI E.
U CODE AND ORDINANCES
4-4"----
MUS-,
J'�
ID/W
F�
42 6" nr
v b4) 2� 1v
frcn
3'
' lt (D.r tolbe a,
6' Sink 2,
of
2 6
2-
0 0
q Fridge
(zo 0001
�,rvcw C-t-Y 2 V 3 112"
X5
........................
10292 Terry Way,Cupertino Ca - N e)wt SJOd CTQkA'b-
Unit #2
Kitchen Remodel Plan 2'2 112•'-----
------------
Legend: —
10 Receptacle Outlet 4 �'
$ Light Switch 1'T'
Sink
0 Lighting
tit `
2 1'—" 4'8 112..
Scope of Work v
Kitchen: Water Heat r
-Demolish Existing Kitchen cabinets,
counter,and flooring
Remove old appliances _4.4...-.__ ..-.-."..
Add two Receptacles over counters,
in order to have one receptacle cvery 24"
UV LUUJILef bpdLU ( ( - a 11s.' ;
Install new Maple Cabinets as diagramed 1•
Install Granite countertop wr'4"back-splash 2'6" 2'3" D�W
Install new 18"DAV
instal(new 30"Stove
Install new 30"Fridge
Install new Bamboo!Engineered V'Jood __._...-. --
Sink 2'3"
Flooring(also install in hallway and living 6' 1CJ
room) I
112 Bathroom:
-Demo existing linoleum tioorinq ! 3'6"
Install new the floor 0 0
xl�ti 2 Fritlg.n
C1 c.0 IT Lfuepo 1' ' a F�'
OxO I
I t4k) W44-40 L
t_ li
"7"►I
h
7 t 7C K 1TLA+eO; U VT L,rCS '9 C:F Y t.'T-uL tL,p
`f� L1.A
10292 Tarry Way, Cupertino Ca Unit 2 Bathroom
AS-IS Bathroom Plan
Units 2 O
rJ'
Legend:
Sliding Shower Door ----�_.
40 Receptacle Outlet
$ Light Switch 2' 1J�"
GLighting f� 5,
V t—{--/ Bathtub
Vanity Cabinet
w/Sink 0 1
I+ ----- - ,i .. _.�.r._ _3' 1 112
? E� a
F' O'V
p
i
4 r'
10292 Terry Way, Cupertino Ca Unit 2 Bathroom
Agais Bathroom Plan CR Cr j oc-L P LIW)
= Units &V �uccuizAL—
Legend:
Sliding Shower Door ---�_-
410 Receptacle Outlet l
$ Light Switch 2 114
4--F—it Lighting ? 5
V/ L (D
Saathtub
$ Vanity Cabinet
T w/Sink
Ad-
_..��
.-r aT`cTEv
f L
C%
Community Development
a �) 10300 Torre Avenue
(1 Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
7UPERTINO
X � Building Department
JOB ADDRESS: , PERMIT # -7q
.
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
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
Owner/Contractor Signature Date