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09050077 .777777777 CITY OF CUPERTINO BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 21504 CONRADIA CT TBD — I'0 BE DETERMINED- PERMIT ISSUE DATE OWNER'S NAME: , SA CONTROL NO. NnUNE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH REMODEL 200 SQ TO KITCHEN, app LICENSED CONTRACTOR'S DECLARATION ]rj SQ TO BATH AND 5 0 Jr�4Descriptlon m 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 ode.a d my license is 2'y in full force and effecL� 12? License Cla Lic M n-a Date C;=—/lam' Contractor ARCHMCTS DECLARATION < I understand my plans shall be used as public records J UJ 4 O y Licensed Professional OWNER-BUILDER DECLARATION .< 1 hereby affirm that I 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 prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation _Z_,. Ft.Floor Area < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq YC (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y 5 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 five 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 offered for sale(Sec.7044,Business Required Inspections 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.IC 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 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 Contractofs License Law. ❑1 am exempt under Sec. B k P C for this reason --miner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: Q„I 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. ❑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 Warker's Compensation Insurance carrier and Policy number are: Chu; Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Chis section need not be completed if the permit is for one hundred dollars($100) or less) I certify that in the f e of the work for which this permit is issued,1 shall not employ any perso in ner so as m become su 'ct(o the AF � 'Compensation Laws of Calif- is Applicant NOTICE A C r making this Certificate of Exemption,you should become s ' to the Worker's Compensation provisions of the Labor Code,you must ,Z forthwith comply with such provisions or this permit shall be deemed revoked. z O CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of a+�✓ the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name 0,z Lender's Address U 0 I certify that I have read this application and state that the above information is (7. coned I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorim representatives of this city to enter upon the W above-me4pmrty f0 inspection purposes(W ,rn rectify and keep harmless the City of Cupertino against rA liabilities, s expenses which may in any way accrue against said City U Z in conseqg of this permit. Date�+ APPLICANDS ND ILC ITH ALL NON-POINTIssued b'✓: SOURCES( :5'-1f--07 Re-roof: Signatu ofA ontrae DaleType Of �OOf HAZARDOUS MATERIALS DISCLOSURE I the applicant or future building occupant atom or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety rode,Section 25532(a)? All roof:,shall be inspected prior to any roofing material being installed. [:]Yes If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 4ctyC - nuts materials requirements under Chapter 6.95 of the Califor- nia HeaSections 25505,25533 and 25534.1 understand that if the building does noten that' my ity to notify the occupant of tlhe requirebe t i a Certificate of i panty. Slgnatur-_of Applicant Date All roof coverings to be Class'"or better Own rn Date f �� PERMIT r1O. O pEgNIIT PERMIT is$1JE°ATE CITY OF CUPER rIN co igOL NO. BUILDING DIVISION FIVE SrI S A BUILDING ADDRESS: BUILDING pERMrr 1NFO MECH 21470 O L B L� EQ PL OWNER'S NAME: 3'S 31 BD (4081370- lob Description GINEER: KE FRONT OF HOUSE ARCH1fECr RATION ening IKE4Z'I Aerofis DELI A of Chapter 9(commencing is PL W IND J S L 1(CENSE amO�uocler��t duns SA that R C that rtes+ `"'c�� jo S-on 10affirm -W)of Div,sron 3 of the Bas with Lc.>< y tit.Cull fora and t ContraC. ON 2 y Lcense pRCHrMC7rS°�p•,RC records +t.a Date lans shall be used as P'h ValuatlOn 1 understand my P 5 ug U Lce,hsed Pm[cssional OWNER-BUILDER D ,, nu2,,O�,A Y e1. °r couw for p Y FIOOi Area 5 50� Type w q.F pccupancy y S e atT,rm that 1 aI.egusir css and Prof mo,mh.or rePx!r any ent t °< I hc�asoYn.($Ccuon 1031.5. alter.imPrpVC'h it to file a signed ter 9 Law (Chapter nr dumber following a fmmtit w cO applicant for sue permit s(,icense►� Code) a DN t � which Mis;ss de in visions o(the Coniine ineand Pro ions on of t� e that $ecrion?000) is Cor°ihe alc8 d exW9 (� it penalty o[ AS a�y or w uanc• It to t1u P'O . •• Ica„t to a crud Pe 36205002 -20 Required Inspections _Z> be is license P o(Dtv,s,on 3 uon•Any Y a (Commencing,teWS for a penpit subjecis u,e PP uon. a ' utas 11e u1031 S by espy dreg dollars(S5o0)• as otic sole compe^� Secof not m�u,ao five him do orsyn m employees ndtd Or Wages�r an,--4y I owner his 1>s owner of ttw Pro a�yture La WITIt or through 0"S" do fops Code:ore Con e°n anL yte u i0twended anoedn(die oMmer- and Professions but or improves ch imp Q��in ort year of comp (a puproperty �0ic°f own emvepr`the 1d nS�,of pmvtng that he did not build or;mprOve d con tractorsw builder will have rite contraeong wtut lice•he Contract°sr Li. sale.)- am exclusively Cessions Code' C tturcoo, 1.a owner of the property.A-Business and P y who build a wn�° ,e Contrutoes [3 1. �oes ttapPly 1O a°owner wl crn,tractor(s)licensed p n Cease Law for such P1O1eeu B&P C for this r°aSO License LAW- under See- C3 ee- D — ❑ aPt TOl, R Nmons: OEROwrur SCOMPENSA of following nasty of peQttry°°e for s C Pe' Worked om 1(.insure ytce of the I hereby affirm under C nt to se Gate of consent (or the perform have and will maiaw O�uioo'n'3100 of tete r Coda ,n.as provided for Y_ . a as required by Section ,s issued. aaauon lnsurs'h m„t,s issued. work for which oris permit ,porker's Compe sats work Cor which this Pe yid will maintain xnce bgr sm I have C ode - In Insurance and Policy O 1 311X1 oC the LaborlnsuonCe Nu.: a ompe . pol'tey WORKERS• MY Workei f,r�'✓f� 10P EXEMPCfON FR�ONCE Carnia �(10ERT11lCAo PENSATIONINSU doll's k$100) Perm is(a one hundred CTW,s sect1On need not be completed i[the Pe ail not itis iss°ed.1 shall uon of die work for which this C1CnpWo 'ComPeOsa 11 ) r formanCO t to the tv that in the Pe ner so as to become subject any person in any,pap on,you should employ certificate Of must Laws of California.Date r making this C Applieant�APPLICANT:It,aCtc „sauon provisions) dcc d[evoked to tem WOrke O1° tx is it shat h r n subject) with It proVWO'm of nuc Z forthwith Comply UCTION LENDING AGEN g agency[or the performance Co NSM .�.O I herewh-h this pertmhi ism constree. IlenV' ued(Sec. 7 utc work Cor a ate above infon„a. is /� c 04 r' i ender s Nam w / a A Lente{s Address this apptiestiOn nl�oarx sand state laws relating Date I Certify that I have ad D cell city and county 0 t2.; o[this city to enter upon the U 0 correct I agree to comply hereby authorize rep s of Cupertino against tion. euon d Wp the City t said C,ry b Lt+E'' building constr a peny(or insp� and kxp halo!" way act agarns ed y' O C.) above-menuorte Pro to aaVe indemnify which may m any N N•POINT ISSN >4(3a (We)ag1eC andexpe"� Wlr"A [-{a' liabilities judgments casts of oris Pe `1 hest R . e ranung WILL COMPLY r Y �J[l C-rOOfS installed UA 1°consegUe UNDE S NDS AND (1J ,hype of Roof material being .+ A G LATt Date an a ree °vi s riot to y roofing inspection, g to rem torALS DISCLOSURE materia[ in p obtaining an insp Sig ApPlicanN�ARDOUS t store or handle hazar th a Safety O{S shall be pa1O t or Druce buildin8R�C9�°wr 9.12,and the Health and All to installed Without first rte applican too Muni�iPnl C°de•chapter If a roof is insta «ion. �Ji eW materials for inspec as defined.0.25532(1)� ,vbic n Code,Sce ° equipment or devices cmc a al n ❑Ycs occupant use c a K Quality Manag building the Bay Area Air Wi11 the aPPl;cant or[awn ticGned by Date t has ill the air contaminants coli mr- �(�.•r or better rict? NO a tcr6.95Ofthe ClassIt ❑Yesmadibehazardous 25505 25533and25534�nou y "�`°11i�" Signature licanpill roof cO be that I of ApP verings to thaw pons nslbil;ty i rH_calth&SafetyCade Sant•dmt it is mY 1 oC a C-Air-'e of c°P ��nt�h,I have be t prior to i Date ocja �o CITY OF CUPERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN Date: B iAfldresrvbffiDo� Mel, 1• ) h 0 D 9501+ Mailing Address (if different from building address): Owner's Name: CA Phone#: ri r work ❑ (*93) 9(✓ HOA: (Exterior only)y) Yes No❑ ( If yes, provide letter from HOA Contract r: Phone: 6 qy- win�00,5 Fax: Contractor License#: (p��? Cupertino Business License#: 22D�99� Contact: L L� �(� Phone: D ? Q- J1, ) Fax: Residential Commercial ❑ Job Description: fopleIL4 Wirr10(,j5 die" Pu- h� � Building Permit Info: Bldg 0/ Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: I-A, I-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B a- �J Valuatico 5 �O Square Footage: c Project Size: Express �iandard ❑ 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.or Revised 02/05/09 CITY OF (__ UPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEkTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1 STUCOAP Stucco A)plications (up to 400 sf) B additional stucco a plication 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1 WINMEWSTR New Window-structural shear B wall/mas.)nry(includes plan ck fee) 1 EPERMITFEE Electrica: Permit Fee E 1 MPERMITFEE Mechani,;al Permit Fee M 1 PPERMITFEE Plumbing;Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standarc.Plan Check (when no E/M/P) B when not over counter) hourly-stand alone 1 BCBSC Cal Bldl; Standards Commission Fee B ALL PERMIT TYPES I BSEISMICR Seismic Residential B IBSEISMICO Seismic Commercial B IT AVDOC Travel &Documentation B 1BUSLIC Business License B 5 of 5 10. 1 L Parcel 21470 Columbus Ave 9A Front - North .............. ...........:......A....... ..... 40 pvef A5 -------- -07 7-F ................ ................. ............ ................. ................... .......... Y. .................................. ASSESSOR Cop, F Back - South Parcel 21470 Columbus Avek,,,kA-5 Front - North vw ndbui r. .............. .............. :........ ................I C �� 4 ,s rov M 4t Neef iejjVeI-A PV5 7fa 1464 K151- IL50," #z J (� .................... ................... ..... ....... ........................................ ....................... ..... Liu A6wA '100 ................................. -P-T ]E) MAY 11 009 BY: Back South Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ,UPEkTINO Building Department JOB ADDRESS: PERMIT # .2-14-70 wlonibv,,� Aviv. 4, c)n i-/+ 0 0`(6 OWNER'S NAME: RIAVC PHONE # 0'335'1 GENERAL CONTRACTOR: 5 5tur 65 FAX # ;10-3 i(b J?�by� I am not using any subcontractors: �7 S gnature V Date Please check applicable subcontractor d com lete the following information: SUBCONTRACTOR BUSIIJESS 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