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09040037 CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 21090 RAINBOW PL A 2 Z KITCHEN PERMIT ISSUE DATE OWNER'S NAME: qACA' TsAAtA�ytt. CONTROL NO. ^NONE: (408) 309-7296 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH a 0 a a Z LICENSED CONTRACTOR'S DECLARATION Job Description Im 0 I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Z m with Section 7000)of Division 3 of the Business and Professions Code.and my license is e y in full force and effect. ^t ADD NEW SUB-PNL FRM 2 0 DAMP EXT PANEL j ? License Class Lic• Date • Contractor Z 3� A CH rEECTS DELLA TION g g< 1 understand my plans shall be used as public records �uj 4 G y Licensed Professional y OWNER-BUILDER DECLARATION I hereby an.that 1 am exempt from the Contractor's License Law for the j:20 following reason.(Section 7031.5,Business and Professions Code:Any city or county Eg 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 Valuation F=G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Y r (commencing with Soction 7000)of Division 3 of the Business and Professions Code)or $2500 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 APN Number Occupancy Type not more than fire hundred dollars($500). 36626028 . 00 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 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 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 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 Ligpitse Law. am exempt under See ,B&P C for this reason Owner Date WORKER'S COMPENSATION 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 Worker's Compen- von,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 Workces Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance artier and Polity number arc: 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 theAo for which this permit is issued,I shall not employ any person in any man r as co ecu Workers'Compensation Laws of Calif o 'a Da Applicant NOTICE TO A P CA .-after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z Z CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of fY the work for which this permit is issued(Sec.3097,Civ.C.) WCL.Q Lender's Name Z Lender's Address V 0 I certify that I have read this application and state that the above information is LL" correct.iapplicant comply Ebuilding city and county ordinances and state laws relating to 0 V buildingion,and authorim representatives of this city to enter upon the U above-mpropertyection purposes >4 Wa e to savenify and keep harmless the City of Cupertino against V Z Itabilidn ospenses which may in any way acrnc against said City in con this permit. Date G ►� AP EAND WILL COMPLY WI ALL fl N-POINT Issued b,': ( � S L '\ y Re-roofs — Sig atul t/CoDate T Of Roof HAZATERIALS DISCLOSURE Type pplicant building occupant store or handle hazardous material as defined bythe Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? ��hhh 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 is installed without first obtaining an inspection,I agree to remove it hazardous air contaminants as defined by the Bay Area Air Quality Management all new r laterials for inspection. ct? ❑Yes No L have re the hazard aterials requirements under Chapter 6.95 of the Califor- a Ith&Sat Sections 25505.25533 and 25534.I understand that the building acs t currend ve tenant,that it is my responsibility to notify the upant of the meets wh be met prior to issuance of a Certifica Oc Signature,of Applicant Date { All roof coverings to be Class'n'or better w r r authorh.cd a l �0+00577 -aft CITY OF CXPERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # Date: Building ` Building Address: Mailing Address (if different from building address): Owner's Name: , bbp� Q o�P. c� n q Phone#: "�_ 1 O HOA: (Exterior work only) Yes ' No ❑ If yes, provide letter from HOA Contractor: Phone: oZ- ��' Qh'L Fax: - Contractor License#: (00 Cupertino Business License#: 3 `� Contact: Phone: ' 5 (�AL-L- Fax: v / Residential ] Commercial Job Description: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A 1-B II/III/V-A ❑ II/III B, IV-HT, V-B - Valuation: Square Footage: Project Size: Express H 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.builditreen.or Revised 02/05/09 CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEkTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1 GENCOM 1 STUCOAP Stucco Applications (up to 400 sf) B additional stucco application 1 WINREP Replacement windows/sliding glass B door (ea 3 windows) 1 WINMEWSTR New Winlow-structural shear B wall/masonry(includes plan ck fee) 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1 PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P I STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone I 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT I TYPES 1 BSEISMICR Seismic_Zesidential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel & Documentation B IBUSLIC Busines,, License B 5 of 5 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 r,UPEkTINO Building Department JOB ADDRESS: PERMIT �vO('CjD3 OWNER'S NAME: PHONE # r - L GENERAL CONTRACTOR: n FAX # A I am not using any subcontractors: C Si mature 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