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09050027 CITY OF CUPERTINO BUILDING DIVISION PERMIT ` BUILDING ADDRESS: PERMIT NO. 10563 ESQUIRE PL KLAUSER EL _-T_FLC_3EB=F1 09090027 OWNER'S NAME: PERMIT ISSUE DATE S A 9 9 CONTROL NO. LONE: DT DDTD (408) 377-4388 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 me apo LICENSED CONTRACTOR'S DECLARATION Job Description m CI hereby air,_that I am licensed under provisions of Chapter 9(commencing i m with Section 7000)of Division 3 of the Business and Professions Code.and my license is ELCTRC L W I RNG FM MN PANL TO POOL EQUIP(3 0 AMP y in full force and effect. License L'� D "Contractor SUBFEED) ; INSTL NEW ELCTRCL ALL-IN-OPNE PANL Dam ARCHITECTS DECLARATION W/TIMECLOCKS;RECONNCT EXSTNG POOL EQUIPMNT I understand my plans shall be used as public records Deu 4 y Licensed Professional Q OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the °O following reason.(Section 7031.5,Business and Professions Code:Any city or county K io V6 which requires a permit to construct.alter,improve,demolish,or repair any structure y"- prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation Z< S that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q Xi-rc° (commencing with Section 70D0)of Division 3 of the Business and Professions Code)or $1685 13259 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 70315 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). 32644020 . 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 Contractors 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 ;lesa .,as owner of the property,am exclusively contracting with licensed contractors W construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law docs not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractors)licensed pursuant to the Contractors License Law. 0 I am exegr=nder B&P C for this reason Owner L ��_ Date WORKER'S COMPENSATION DECL-ARATTON 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- .don,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 mquired 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: Via; Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (►Lis section need not be completed if the permit is for one hundred dollars($100) Of Icss) I certify that in the performance of the work for which this permit is issued,l shall not employ any person in anyn�f�o-u�Q b let o t to the Workers'Compensation Laws of Californt tc Nr�"" - Applicant dT-- a NOTTCE TO APP CA :If,after making this Cerufrcatc of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must 0 Z forthwith comply with such provisions or this permit shall be deemed revoked. ZO CONSTRUCTION LENDING AGENCY [.t tA 1 hereby affirm that there is a convection lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.) W A Lenders Name Z Lenders Address U 0 1 certify that I have read this application and state that the above information is cored.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the L>a above-mentioned property for inspection purposes CL (We)agree to save,indemnify and keep harmless the City of Cupertino against r, y liabilities,judgments,costa and expenses which may in any way accrue against said City U'Z in consequence of the granting of this permit. Date 9 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b) SO R GULATI "7rll`20T Re-roofs Si taro of Applicant/Contractor t Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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 Cak,Section 25532(a)? v All roofs shall be inspected prior to any roofing material being installed. 0Yes No 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 it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. strict? 0Yes Nu 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&SafctyCode,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 reyu' cols hich m met - iasuance of a Certificate of Occupancy. Signaturc of Applicant Date r ,. All roof coverings to be Class'] `or better Owner of authorized agent Date `A0600, -a-F CITY OF C.UPERTINO CUPEkTINO GENERA] BUILDING PERMIT APPLICATION FORM APN # I o . d o Date: /Y\A y (0 2UD�1 Building Address: I C)E 63 1=S Q V 1 RE- F'LA 4F— Mailing Address (if different from building address): Owner's Name: KJ(4AV} -V BAPROtd Phone#: e�o6 `-7 .�o— HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA Contractor: je–,LA U5� j&LES– F->4 Phone: �Q-D ) 7"7 Fax: 6W) 7 7 - 391 Contractor License#: 73"]-'19I C- i() Cupertino Business License#: 2-113 3 Contact: Z1 G4A" Phone: Z400-73g—Z-713 Fax: Residential Commercial ❑ Job Description: j-r-�crcQ tt,I tf tt.� -- '��y, �A WI-t G- V ► 1, " 30 /As rr1 u�� 1 UI$'k LI neLd 1C�CK Qu~i v►— +�—y Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: 1-A3 1-B ❑ II/III/V-A ❑ II/III B, IV-HT,V-B [I---- a _ e3 Valuatum: � 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: L For help, contact Build it Green at www.builditgreen.or Revised 02/05/09 amCITY OF CUPERTINO 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 additiona. stucco application 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1 WINMEWSTR New Window-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 Arne Electric Pln Ck (hourly) E 1 MECPLNCK Stand Al ane Mechanical Pln Ck (hrly) M 1 PLMBLNCK Stand Al ane Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-sand alone 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B ' 1 TRAVDOC Travel 8;Documentation B 1BUSLIC Business License B 5 of 5 1 zN1 ��. \ x Y - s � F l -_� ✓c Assessor's Parcel Number: SHtkT Name of owner. �LN�� 1�; -4n !J Project address. 0 3G��►U L PP Contact person. ��Gu� N Phone. `4 b g 7 30-2713, Fix. t Net square footage of lot. ` Existing Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are thereat least two 10 foot by 20 foot clear spaces inside the gar e? privacy protection planting required for the project? N On what floor(s) is work being done? / Brief description of work. -Fkzh W--A�L M-16 i w . r Code editions:2008 CBC (Y -N)200 CFC (Y -N)2008 CMC (Y-N) 2008 CPC (Y -N)2008 NEC N) g-Air-rr<0v RECEIvED ORDANCE WITH THE CCP 0i Effective 1/1/08 ,UFIERTINO CODES AND ORDINANJES MAY © 7 2009 )ATE S' —7 BY: 'IGNELr this serations--�"Hus; De kept on i and it is un lawful to ma,� ar alter diom In same mission fron - the buidng the stamping pecification, SHALL NOT be lie a -pit or to b, ar pproval of the violation ail<< provi Dior, Plan Review Process Work Book Page-8-Revised 1/1/08 'x �4 ; z # �: ,1 ,M �`�x _,,.{•E: � '5t srF * r_ 't S F `k' Assessor's Parcel Number: Name of owner. RI 64APID N Project address. D '� ��U L P Contact person. �Gu� N Plione. �bg 739—271 3 Fax. Net square footage of lot. - �_ Existing Proposed Square footage: First floor: Second floor: Garage: -- TOTAL: _/� Are there at least two 10 foot by 20 foot clear spaces inside the gar e? /Y N \ .6 privacy protection planting required for the project? N On what floor(s) is work being done? -- Brief description of work. how 1 I w° ` . 1 7�u GCJ'14-�j -'Z5 dW Code editions:2008 C C (Y -N)200CFC (Y -N)2008 CMC (Y-N) 2008 CPC (Y -N)2008 NEC CN) Effective 1/1/08 Plan Review Process Work Book Page-8-Revised 1/1/08 Community Development kffl 10300 Torre Avenue ? Cupertino CA 95014 F„ Telephone(408)777-3228 CITU OF Fax(408)777-3333 -UPERTINO Buildi:n De artment JOB ADDRESS: PERMIT # 0 1654P3 �-7,S&v l PL AGrc- ::�) - -2�7 OWNER'S NAME: R 1C. 7 1O PHONE # qDAS 739' Z-71,3 GENERAL CONTRACTOR: - FAX# 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