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07030181
CITY OFC T7� .... *�T BUILDING D-41S1ON PERMIT 0 .. BUILDING D ESS: PERMIT NO. 10 � TERRY WAY #3 TBD TD BE DETERMINED 070301 Q`r OWNER'S NAME: PERMIT ISSUE DATE 10292 TERRY WAY LLC 03/22/2007 )NE: SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH 0 0 0 i p p LICENSED CONTRACTOR'S DECLARATION Job Description UF I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z, with Section 7000)of Division 3 of the Business and Professions Code,and my license is KITCHEN & BATHROOM REMODEL—NON STRUCTURAL a in full force and effect. j ? License Class Lic.# t–wDate Contractor L9 ARCHITECTS DECLARATION 7 e�C< I understand my plans shall he used as public records >A.0 u-y Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the 0 o following reason.(Section 7031.5,Business and Professions Code:Any city or county e which requires a permit to construct,alter,improve,demolish,or repair any structure Z r prior to its issuance,also requires the applicant for such permit to rile a signed statement Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area K l-- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $3000 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 ofNumber Occupancy Type not more than rive hundred dollars($500). 3 5 9 17 0 13 0 I,as owner of the property,or my employees with wages as thew sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business "Re wired Inspections and Professions Code:lite Contractor's License Law does not apply to an owner of q p property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.IL however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). t,991,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. 0 1 am exempt underec. B&P C fa rthis reason Owner `�J/A Date �, G 2 WOR R'$R'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: AlF 1 have and will maintain a Certificate of Consent to self-insure for Workers 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 I?y 3700 of the Labor Code.for the performance of the work for which this permit is issued. N I TA=01"L 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 any manner u W%copf subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT.If,after making th' e ' of Exemption,you should become subject to the Worker's Compensation provi io of the Labor Code,you must 0 forthwith comply with such provisions or this permit shall be deemed revoked. z " CONSTRUCTION LENDING AGENCY .� 1 hereby affirm that there is a construction lending agency for the performance of ai> the work for which this permit is issued(Sec.3097,Civ.C.) Cw Q Lender'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.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorise representatives of this city to enter upon the a above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against Fy t) liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. ? 1 �� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date J ? SOURCE REGULATIONS. 2!�o? Re-roofs Signature ofApplica*,Conufiit4 0 Date HAZARDOUS MATERIALS DISCLOSURE Type of FLoof 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 No Will the applicant or future building occupant use equipment or devices which If a roof s installed without first obtaining an inspection,I agree to remove omit hazardous air contaminants as defined by the Bay Area Air Quality Management all new n laterials for inspection. District? ❑Yes 66r— I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safcty Codc,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 requirements which be tpej prior to d cc of a Certificate of Occupancy. Signature of Applicant Date �a 31-w-2 All roof coverings to be Class"B"or better Owner of authorized 4CnL Date CITY OF CUPERTINo 7��,��yTT T BUILDING DIVISION PE1�lY111 ":� � jOn PERMIT NO. 13UILT?N�5DgESTERRY WAY #3 TBD — TC BE DETERMINED 07030181 l UU G — PERMIT ISSUE DATE OWNER'S NAME: 10292 TERRY WAY LLC 03/22/2007 SANITARY NO. CONTROL NO. NE: BUILDING PERMIT INFO ARCHITECUENGINEER: BLDG ELECT PLUMB MECH p Q LICENSED CONTRACTOR'S DECLARATION Job Description m P I hereby affirm that I am licensed under provisions of Chapter 9(commencing i U with Section 700(1)of Division 3 of the Business and Professions Code,and my license is KITCHEN & BATHROOM REMODEL—NON STRUCTURAL ?=w in full force and effect. v�Z License Class Lic.# - CDam Contractor F LU ARCHITECTS DECLARATION i 5--] < I understand my plans shall be used as public records >aU u.l- Licensed Professional O a 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 u y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation Z a that he is licensed pursuant to the provisions of itis Contractor's License Law(Chapter 9 q .Ft.Floor Area $3000 e.a=-O (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Q�3N Number Occupancy Type Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of 3591701") .; CTL not more than rive hundred dollars($500). ❑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 bffered forsale(Sec.7044,Business "Required Inspections and Professions Code:The Conuactoes 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.). 5I,as owner of the property,am exclusively contracting with licensed contractors to fonsttuct the project(Sec.7044.Business and Professions Code:)The Contractor's 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 underS c. B&P CC for this mason Owner Date — WOR E C PENSATiON 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 Workers 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.: ff t> v CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or Icss.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any mannero as to be ore subject to the Workcrs'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Ce tit Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must 2 forthwith comply with such provisions or this permit shall be deemed revoked. Z 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(See.3097,Civ.C.) W Q Lender's Namc 2 Lcnder's Address U 0 1 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 .J J building construction,and hereby authorize representatives of this city to enter upon the a 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 U Z in consequence of the granting of this permit. Date "+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. WW v 7 Re-roofs e Signature of Applican Date Type of Roof HAZARDOUS MATERIALS DISCLOSURE yP 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. ❑yes Will the applicant or future building occupant use equipment or devices which If a roof:s 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.)aterials for inspection. District? ❑Yes 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.I understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the Date requirements which mus b met prior to i anco of a eenirtcate of oceapancx Signature:of Applicant !h 3 2 All roof coverings to be Class"B" or better Owner or authori-)ed agW Date CITY OF CUPERTINO 6 ITEMS OF 12 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN . . . . . . . . : 35S17013 .02 DATE ISSUED. . . . . . . : 03/22/2007 RECEIPT #. . . . . . • • • : BSC00000757 REFERENCE ID # . . . : 07C30181 SITE ADDRESS . . . . . : 1092 TERRY WAY #3 SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : 10' 92 TERRY WAY LLC ADDRESS . . . . . . . . . . : 10,''92 TERRY WAY # 2 CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : TBI) - TO BE DETERMINED LIC # 00096 COMPANY TBI) - TO BE DETERMINED ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY �NOUNT 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 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 550.66 1031 --------------- TOTAL RECEIPT 550.66 CITY OF C1JPER'TIN® C Ty PERMIT APPLIC"ATION FORM APN# Date: 3 955f1)Z, 312-210-7 Building Address: Mailing Address (if different from building address): IO2g2 7yrn y of t�P IfA"U Cts UN IT #3 Owner's Name: Phone#: iol?z -r L zC_ 6r-0 Contractor: License#: Contact: V u�L Yo P Rhone: Cupertino Business License#: Fax: &ry 8 97--2Zb Building Permit Info: '� w �,� � 1?h-r+0ZQ0� &Joti= Sire U c Tu(1 k t-- Bldg ❑ Elect COY PI-amb 2� Mech ❑ Job Description: Residential Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: 3 a Occupancy Group: Type of Construction: - Please cheep this box if the project is a S econd-story addition: El -o ect Size.-=.:St _ _ El , — ❑ Quantity Fee ID F-�e Description Fee Group - _ BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boilcr<= 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 BBOILERS Boller> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Dff/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC 1000 Elec 600V<= 1 OOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL y BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Ir.vestigation fee BUILDING 1 0'3 CITE' OF CUPERTINO CITY OF� PERMIT APPLICATION FO. CUPEkTINO Quantity Fee ID -F--e Description Fee Group BMISCELL M:scellaneous Fee BUILDING BMITIGATC Comni. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New :�onun Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL -j-- Cesspool- BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE PbIR Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind "Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re ►i a Of Fixtures PLUMBING BPSEWAGE SEwa a Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn SprinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING, BPVENT Alt of Dxain_&_Vent PLUMBING BPWATER InstaIJAlter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING - - —BPWSVCS Ma-ii Water Service PLUMBING- - - - BREINSPECT Reinspection Fee BUILDING - BREMACOVER A/C-Jnit> 10,000 cfrn MECHANICAL BRE A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI A-)pliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo :furnace> 1 O btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem IZon-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL A— BREMRECEPT Rc tl. Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Rep air/Alter Heating MECHANICAL BREMRESAPP Remc del Res Appliance ELECTRICAL 2 ol'3 CITY OF C UPERTINO awOF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmd'. Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD &;b S ecific Plan BUILDING BSEISMICOM Sei'mie Commercial BUILDING _ BSEISI FC1 1 eismir Fee Rei: -� R'UyI JF)_fN(1 BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temy orary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mec:i Permit Issuance MECHANICAL PPERMITFEE Plurrbing Permit Issue PLUMBING PPLBG Plwnbing Fee sq foot PLUMBING PLLONGRNGC PlanninLR Comme/-Mu1ti-Fam PLANNING PLLONGRNGR_ --Planning hong Range Residential _`w PLANNING ZADDCHG Address Change _ BUILDING 3of3 ` ' Y � 10292 Terry Way, Cupertino Ca AS-IS Kitchen Plan V 2 0 1'2" 2'5 1/2" Ce Rect"Itacle Outlet 2 Fridge 0 0 216 Sink is tip fron ze Wa !:P Or Xyaf6yH Sink 1 +-r-~�----�/xr----� =--x�--� ^ . . 10292 Terry Way, Cupertino Ca Unit#3 $ Kitchen Remodel Plait 000 Fridge Legend: 0 0 T6" Receptacle OLA16 S Light Switch Sink 4 .- GLighting 2A Scope of Work -------- Kitchen: 1 .Demolish Existing Kitchc' DEW counter,and floonng 1'6' Remove old appliances Add two Receptacles aw in order to have one ic,every 24" of counter space Install new Maple Cabint�!.:—js diagramed Install Granite counterTop •%.'4' hack splas Install new 18"DJW Install new 30"Stove Water Heater Install new 30"Fridge Install new Bamboo i Erni nee ed Wood [KD Flooring(also install in ha('„ay and living 51 4'8 112- room) 1/2 Bathroom: Sink -Demo existing linoleum I:, -Install new the floor t!:--X L Ser tNC— C oee-0;'T Z-cL,U.W 0 V 3" $ o '>A) AL-L vcr-Tc ti eP 0 Or4-erS w I [ 5A) . "SNT"A,00k 0 VT F/ Febrt-Cta PI-AT&- /2 o/ Z 10292 Terry Way,Cupertino Ca Unit 2 Rat"" _ BathroomOmM'el Plan Units ;S- i- Legend: 49 Receptacle Outi(it $ Light Switch Glighting Scope of work -Demo Existing Flooring(linalcu. Vanity Cabinet,remove bathtub,sht,t. T- enclosure,and shower back plash -Install new vanity cabinet and granite counter and sink -Install new bathtub,shower enclosure, and file shower backsplash -Repair any water damage,if any -Install new tie flooring UP U\ L5 -Reuse existing toilet If possible -Add new medicine cabinet g'6" s i I 3 \j c .. I „ . z'e 1/4„ . i ( Vanity Cabinet 4= W Sink 1 --._..._.. �.._.----------._...__ ,.4 +f.___-.__� ,lig...-_'_•_. f-""-_..,....._.._.� 1 aiz � L t i 10292 Terry Way, Cupertino Ca 2j�2Zr© 7 Bathroom Remodel Plan Units Legend: 40 Receptacle Outlet $ Light Switch (D Lighting Scope of Work -Demo Existing Mooring{Ilnaleu.. Vanity Cabinet,remove bathtub,shay.. enclosure,and shower backsplash -Install new vanity cabinet and granite counter and sink -Install new bathtub,shower enclosure, and tile shower backspla5h -Repair any water damage,if any -Install new file flooring -Reuse existing toilet if possible -Add new medicine cabinet UW tT g,6,. q 7z I 2'8 t/4" Bathtub t - j • 1 _ 1 I _ I Vanity Cabinet � W1.Sink i L 4 f Community Development 10300 Torre Avenue Cupertino CA 95014 C! Telephone(408)777-3228 CITY OF � 1 Fax(408)777-3333 JPEkTINO Building Department JOB ADDRESS: PE # OWNER'S NAME: t 0 2 k 2 TC-12A w Y L — PHONE# C SLy- y 4y-6 y / GENERAL CONTRACTOR: ? FAX# I am not using any subcontractors: :IT?D Signature Date Please check applicable subcontractors and com lete the following ' ormation: 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 er/Contractor Signature Date