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07100179 ' CIT�' OF CUPERTINO ' ' BUILDING DIVISION PERMIT +C��7f`JEt� �TC�� I��ION` ; _ : ; _ _ _: PERMIT NO. BUILDING ADDRESS: 21194 LAURFTTA 1�R F�TF — P RMIT UE DA ER'S NAME: . _ S . CONTROL NO. PHON : BU[LDING PERMIT INFO ARCHITEC'C/ENGINEER: BLDG ELECT PLUMB MECH � � � 0 ' z UCENSED CON'fEtACTOR'S DECLARATION : � Job Description I hcrcby �rm that 1 am licenscd uncicr provisioos of Chaptcr 9(commcncina • J wiih Scction 70b0) of Division 3 of �hc Busincss and ProCcsn�ns�Code, and my liccnsc is � infullforceandcCkc �js �y 5 REMODEL EXISTING BATHROOM; NON—STRUCTRL & INCLUDE : ? Licenu Clus L�• � = p cont�acwr LIGHTIN(i & NEW PLUGS : � � ARCHITECI'S DECLA ATIO - c [ undcrs�and my plans shall bc uscd az public rccords � Liccnscd Pn�fcssional � a OWNER-BUILDER DECLARATION .� 1 hcrcby atTirm that 1 am cxcmp� Crom thc Contractor's Liccnsc L.aw for ihc � O (ollowing rcazon. (Sccuon 7031.5, Business and Prokssions Calc: Any ci�y or county ;,�, which rcquires a pc�mit to cnnswc� altcr, impmvc, demolish, or rcpair any swcwrc , y pnor �o ils issuancc, also rcquircs �c applican� for such permit to filc a signcd sta�cment � q . Ft. Floor Area Valuation - a �hat he is licensed pursuant to the pmvisions of ihe Contractor's License Isw (Chap�cr 9 � �$ (commcncing wi�h Scction 7000) o( Division 3 of thc Busincss and Pro@ssions Codc) or �.. that he is exempt theictrom and the basis (or the allegcd eumpdon. Any violaGon o( Section 7031.5 by any applicant for a permit subjccts ihe applicant to a civit penalty of APN Number Oeeupaney Type not more than five hundred dollars (5500). 0 I, as owncr o[ ttie property, or my employca wiN wages as thei� solc compensauon, 3 2 6 5 4 01 � 3. � � will do Ihe work and ihe sttucture is not intendcd or oftered for salc (Sec. 7044. Business Re uired In s ecti on s and Professions Code: The Conuactor's License Law does noi apply w an owrrcr of 9 P property who builds or improvcs thereon, and who does such work himsel[ or �hrough his own employccs, provided that such improvements are not iNended or oRered for sala IC. however, the building or improvemenl is sold wi�hin onc year oC complebon, the owmer � � builder will have the burden oC proving Uiat hc did not build or improvc for puryau of [(� salc.). \ ; ' ❑ I, as owner o( tfx property, am raeclusively conuacting with licensed rnntractors to � construct �he projea (Sec. 7044, Business and Professions Code:) The Contnetnr's Li- � r ' F. •, cense Law docs wt apply to an owner o( propeny who builds or improves Uurcon, and , who conuacts for such pmjects with a contractor(s) licensed pursuant w Ihe Convactor's License L.aw. Q I am exempt under Sec. , B& P C for �his reuon .� Da[e WORKER'S COMPENSATION DECLARATION I hercby affirm under penalry of pe�jury one of the following declarations: I hsve and will maintain a Cenifica�c of Consent to sclf-insure for Workcr's Compcn- ' ion, u provided for by Section 3700 of the Labor Code, for ihe perfortnance of Ux wort for which this pertnit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as �cquired by Section , 3700 oC ihe Labor Codc, Cor tAc perCormance of the woiic for which �his permit is issued. My Workers Compeosation L�sonnce cacrier and Policy numCer arc: Carrier. �1�Y �� CERTIFlCATE OF EXEMP'ITON FItUM WORKERS' COMPENSATION INSURANCE (7his section necd rrot be complc�ed if the pccmit is for onc hundred doltars (S 100) or Icss) I certify th�s in thc pertormancc of ihc work whic permit is issucd, 1 shatl not employ any person in any manncr so as to bcc ject rke ' ompcnsation Laws of Califomia. Date Applicanl `� NOTlCE TO MPLICANT: If, aMr m ng thi� Ccrti�ca�e of Excmption, yau ahould bccome subjca to thc Warkcr's Compcn 'on p visions of ihc L.abor Codc, you muu � O [orthwith cpmply wi�h such provisions or ' pe il shall bc dccmcd revokcd. i ""' CONSTRUCTION LENDING AGENCY �.-�+ I hcmby attirm that thcre is a consvuction Icnding agcncy Cor thc performance of ;� thc work Cor which this permit is issucd (Scc. 3097, Civ. C.) � Q L.endcr's Namc � � z l..ender's Address � � 1 ccrtify �ha� 1 havc rcad �his applicadon and statc �hat thc above infortnauun is ►� cortec� I agrce �o comply with all city and county onlinances and state Iaws relating w j U building consuuction, and hercby authorin representauves of �his city to enter u�n the � w above-mcntioncd pmperty for inspecdon purposes. (Nc) agrce to save, indcmnify and kecp harmless thc City of Cupertino against �� liabilitiu, judgmcnLS, cosls and ezpenses which may in any way accmc against said City ) z in consequcncc oC �hc granting of ihis permi4 �"� APPLICANT UNDERSTANDS AND WILL COMPLY W1TH ALL NON-POINT Issued by: Date G—Z � SOURCE REGULATIONS. Re-roofs SignatureofApplianUConuaclor °i Type of R�►of HAZARDOUS MA7ERIALS DISCLOSURE �'�' ' Will Ihc applicant or fuiwc building occupant storc or handlc harardous matcrial dcfincd by �tre Cupenino Municipal Codc. Chaptcr 9.12. and the Hcal�h and Safety c. Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. � Ycs ❑ No Will the applicant or fuwrc building occupant use eyuipmenl o� devices which If a roof is installed without first obtaining an inspection, I agree to remove cmit ha�ardous air contaminan�s as dcfincd by the Bay Arca Air Quality Managemcnt all new m� �terials for inspec*.ion. District? ❑ Ycs ❑ Nu 1 havc rcad ihe ha�ardous maicrials requircmcn�t undcr Chap�cr 6.95 of ihc Califor- nia Hcal�h & SafctyCode, Sections 25505, 25533 aru125534. ! undcrstand thatiCU�c building docs not currcrnly havc a icnan4 �at i� is my rcsponsibility w noufy �hc occupan� af thc rcyuircmcn�s which mun bc met prior w issuancc of a Ccnificatc of Occupancy. SIgi18tUI2 ��f Appl icant Date All roof coverings to be Class "B" or better Owncr or authori�cd agcnt �� d� � � � l -� °l A� q: CITY OF CUPERTINO �� F PERMIT APPLI CATION FORM cuQF�T�No Date: APN # � � Y' � 0 . � � f 0 '�°1'�''� �7 Buildin ddress: Vlailing Address (if different from building address): �� Owner's Name: Phone #�� (�, l s � ;�� Z574� � �� M��- y Contractor: License #: � �,� � Q � �-` 4 ,� i .'..J��. � Contact: Phone: e� u � as4 Cupertino Business License#: -�� „` Fax: �313 3�r � 3 �- Building Permit Info: Bldg � Elect IZr lumb ,� Mech C� Job Description: �� -� �,•�� +G�:��--� �{� i�c�-s Residential � ��/`� a a Z ��S�1nG �A' �t�' � l`� r`"' { 5 �� Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: �S, Do� - � Type of Construction: Please check this box if t� project is a v � ,�� 5�,,.,c L�a �" �1% �- second-stor addition: Project Size: Standard ❑ Large ❑ Major ❑ Quanti Fee ID Fee Descri tion Fee Grou BAPPLOTHER Other Appliances MECHANICAL BBOILERI Bo:ler <= 100,000 Btu MECHANICAL BBOILER2 Boile -> 100K to SOOK Btu MECHANICAL BBOILER3 Boil�:r > SOOK to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILERS B�iler > 1.75M Btu MECHANICAL BCONSTAX l�onstruction Tax BUILDING BCONSTAX In� VOff/Comm/Quasi BUILDING BCONSTAXBQ Co l. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Co�istax - Resi/Mobile BUILDING BELEC 1000 El�;c 600V <= l 000A ELECTRICAL BELEC1001 E lec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD �;nergy Add Multi BUILDING BINVESTIGA [nvestigation fee BUILDING 1 of 3 CITY OF C'UPERTINO CuPE TiNO PE�IT APPL][CATION FORM � Quantit Fee ID ]?ee Descri tion Fee Grou BMISCELL N[iscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME Nf;w Comm Electric ELECTRICAL BNUCOMMM Nev� Comm Mechanical MECHANICAL BNL7COMMP New Comm Plumb PLUMBING BOVERTIME In �pection Overtime BUILDING BPBACKFLOW Atinospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLLTMBING C BPERMFEE E�ld Permit Fees BUILDING BPFIXTURE Pbl Fixture PLUMBING BPGAS Gas Pi ing System Fee PLUMBING BPINTERCEP Inc Waste Interce tor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plaai Check Repeat Fee BUILDING BPREPIPE R�� i e Of Fixtures PLUMBING BPSEWAGE ��ewa e Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lav� n Sprinkler/Backflo PLiJMBING BPSTORM �torm/Rain Water PLUMBING BpT�p Kitchen Trap PLUMBING BPVENT A_t of Drain & Vent PLIJMBING BPWATER Inst:�lUAlter Water Pi e PLUMBING BPWHEATER V� ater Heater/Vent PLUMBING BPWSVCS M ain Water Service PLUMBING BREINSPECT lzeinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHA1vICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI .�ppliance Install MECHANICAL BREMBUSWAY F_emodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Re location of Furnace MECHANICAL BREMFURNOV Rel�� Furnace > l OK btu MECHANICAL BREMHEAT �[eater Installation MECHANICAL BREMINHOOD In �tallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREl��N1ZApp Rerr. Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Powr,r Device/A aratus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHAI�TICAL BREMREPALT R�;pair/Alter Heating MECHANICAL BREMRESAPP Rer.iodel Res Appliance ELECTRICAL 2 of 3 CITY OF C'UPERTINO CUPEI�TI�10 PERMIT APPL�[CATION FORM Quanti Fee ID Fee Descri tion Fee Grou BREMSIGNAD Rmcll Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR The atrical Lighting Fix ELECTRICAL l BREMVENFAN Ve��t Fan Sin le Duct MECHANICAL BREMVENSYS VEntilation S stems MECHANICAL BSCBLVD ��cb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE �ieismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM 3wimming Pool BUILDING BTEMP T��m orar Power ELECTRICAL BTEMPPERM Tem ora Bld Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC ��usiness License BUILDING ELECTRIC I;lectrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Me��h Permit Issuance MECHANICAL PPERMITFEE Plutnbin Permit Issue PLUMBING PPLBG P1Lmbin Fee s foot PLLTMBING PLLONGRNGC Plannin LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin Lon Ran e Residential PLANNING 3 � �f 3 CITY OF CUPERTINO 10 ITEM$ OF 10 PERMI�' RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN ......... 32E�54018.00 DATE ISSUED.......: 10,'24/2007 RECEIPT #.........: BS(100003075 REFERENCE ID # ...: 07:.00179 SITE ADDRESS .....: 21:.94 LAURETTA DR SUBDIVISION ....... CITY .............. CU]'ERTINO IMPACT AREA ....... OWNER ............: MUI:DOCK RICHARD A AND DIANE C ADDRES5 ..........: 21:_94 LAURETTA DR CITY/STATE/ZIP ...: CUl'ERTINO CA, 95014-1657 RECEIVED FROM ....: STI�VEN'S INCREDIBLE CONTRACTOR .......: STI;VFN KATKOWSKY LIC # 21828 COMPANY ..........: ST],VENS INCREDIBLE KITCHEN ADDRES5 ........... 11Ei20 AIBA RD CITY/STATE/ZIP ...: BETd LOMOND, CA 95005 TELEPHONE ........: (8()0)374 FEE ID UNIT QUANTITY �iMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BENERGY PERMIT FEE 331.56 159.15 0.00 159.15 0.00 BPERMFEE VALUATION 25,000.00 331.56 0.00 331.56 0.00 BPFIXTURE UNITS 3.00 27.00 0.00 27.00 0.00 BREMFIXT NO. FIXTURES 5.00 6.00 0.00 6.00 0.00 BREMRECEPT NO. OUTLETS 8.00 9.60 0.00 9.60 0.00 BREMVFNFAN NO UNITS 1.00 45.39 0.00 45.39 0.00 BUSLIC FLAT RATE 1.00 107.00 0.00 107.00 0.00 EPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 -•--------- ---------- ---------- ---------- TOTAL PERMIT : 808.07 0.00 808.07 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 808.07 #0968 --------------- TOTAL RECEIPT : 808.07 b � , ,R �� ,^� t� � t ": z � � - {'�. �+� �k- ��, _� �n�-s w ��., � ' , g '�,��„� � `�� S�df`� �`+.�`�" ,�y � �� `kx� � '�' 's ' �. z , l ,��, � � �m��€�`� �� "�a.�� ar< � � ?�.,�� . �.,�`� �°� .��=� � � �� R� G - � � ��.� : � �'^��.�� xz W �'�� h` � �` ,:.. P�''�r�,c�� _� .,��ri:� .. �� ^` �� s� - �� ``��,�,� , � _ ��'�� .��'�, CI7Y OF ��'� ��`r.�s��` "'��t� � :.c ,�� :'�� r as �;� - ��-�'��.�� .»�� >, .� � CUPE��INO � � a � � � ," � "`�� , xu re � ,:.� . u ,... r.�...: ,.��. �, � _�. - Assessor's Parcel Number: 3'Z- � V S`� --� l�- Name of owner. � <<� �� M� `�c� Proj ect address a � � q y�� Contact person. s� � � Q ✓` � � `-'�S � Phone. � � � �� S � Fax. �3 l 3 3�� — Net square footage of lot. Ex _stin� Proposed Square footage: First floor: Second floor: Garage: � __ . TOTAL: Are there at least two 10 foot by 20 foot clear s��aces inside the gaxage? �Y�`" Is privacy protection planting required for the p:�oject? On what floor(s) is work being done? _�`� � l tl!"� /�PP'K �OVI � � ��I�c�.-,�£ �-lL��i�J�lr �- �1 �S Brief description of work. �ft`^•- � �� , �+„U✓1 S c�r Code editions: 2001 CBC N)2001 CFC' �(Y�I�2001 CMC � 1� 2001 CPC 1�2001 NE(; � I� �',"� 2 `� ��-�v.s" .'+>>.�,� Effective 11/1/02 ,�:✓?_ . ,~� �r,..- Ci c� ,; i . � �`'��'� � ,��?,,, � � �.; � ��.� � �;,;- �� 0 � `'� � �� Plan Review Process Work Book Page -B-Revis�:d 8/22/OS � , � � ^ � ' . s aMr Y. x � : .. - _ _z= _ . . � � ,.��'�� ! #�-��,�� P�OJ��.C'�' CO�Ei� SHEET �� CfTY.O.P �7 � y s�_ s '�, �z�ss..a ��..,r��a .�, �?� k� ,z, f �.`�'?'�"�'��,�: '. '��. * ' �� '� �r'� f ; � r�E� v �'�-� .r�'�..�.�a.�. .",.�� .'vP .s ...,.t.�,> „ �; : �CUPE�f�TlNO .,.,N�.. �..�.... �_. ,,.., .�. ,... ,� . .., .�--...� ,Rt � Assessor's Parcel Number: 3 2- �� S`� -� Z�- Name of owner. � l� �� M� �� Proj ect address. 02 �� 4 y � p" �� Contact person. �� °-�` � � �5 k Phone. � �' � ��-� �� ° - Fax. �3 t 3 3b�° � � Net square footage of lot. Exi s� Pro�osed Square footage: First floor: S econd floor: Garage: � TOTAL: Are there at least two 10 foot by 20 foot clear sp aces inside the garage? �� Is privacy protection planting required for the pi oj ect? On what floor(s) is work being done? �`�"� � ovi " � L��af � �- ��S Brief description of work. �fr� � ��'°�"` - -SP� � r.,w� s� ��e/1 Code editions: 2001 CBC I�2001 CFC �(�1v12001 CMC � 1� 2001 CPC N)2001 NEC' � 1� �;"�— �- `�"� 200� ��i44J Y' �� ',f1 1 a' ` ° .l� �N ACC�JRDANCE VdITH TNE CITY ��+ + Effective 11/1/02 �Up��TiNO L'UDES f�ND ORD�i�ANCE� �j� � �/�� D�Z �.�- ��j ��oi aaY� � — '-� `aiG��U,.�,.a.... ..._ _� � --, �fliS S� C�1 �),�� . �!��IiiC�llll�RS Y�UC' ""� _ i7@ �',E�� Gli L�'+' ; iL� 8�' 8 i t{�ii�S �!flt� {t kS Ufi � 13�n�fud t� n;:;i�� _.:�.; c`��:;;r.,�s or ait�ratior on sarr�e v��h_;:.:t t•r,i�i�:r7 pe,m'.ssi�n frr,n the buiid�;��, ��,., u �y c:f ,,,,��t:no. � � 1 he stampin� ot ii�is ,�n �n ; spe�.ilu �tion� �► ;�I �'! ��1�T be he�d to �� mi� �;r t�� e a� , v6� � �� _. ' � vi�lati011 Of bily 4�r�; �� , ,• � -, tirata ! ��. . Plan Review Process Work Book Page -8-Revise d 8/22/OS ^ ..p � � ..� � � y � � t�.� s it°� � �C r r �'��-�� ------------ �� ^�'� �� C/\ ° A � c �� 3� . � �. � � J ., � � � � � � � � d o � — .S � j F . � ' $ � �� G . � \`� O` � � � .� � 1 '"� � � � , 1 � � � � ��°� � � � � � ) � �', t � �' � ' � t�� ` ^ � _._ __.._-____� �� , ; ' _ � b � � � �� t� e~ � ``.. . R' � ._._. _.� , a �� r �- , ��,-�. � i+, �. � o-4 `� ��'�> �' �� `7 � -�_ `' `�i �� r � ,. � �I �_"_-- ' ^ L� ^ ��J � � i � � �` � �` � , � A ' a, 't 4 �, `- � � `; � , � � ; `"�; ,; �1 '�� I c � � � i'� � ;, , ; .� �, , ,; , � , ; � �. 1 � ' I ��'� ''� i � ! ��—� {'� � � (� l � �"\ in Community Development ' �" 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 CUPE�T Building Department All Cupertino building permits must r.leet certain conditions related to maintaining environmental quality and public peac e and safety. The two most common conditions are described below. STORMWATER POLLUTION CONTROI. State law requires that Cupertino, 12 otFier Silicon Valley cities, Santa Clara County and the Santa Clara Valley Water District cortrol stormwater pollution. Educating local residents and businesses and enforcing :�tormwater pollution control laws are key parts of the City's compliance efforts. Stormwater pollution prevention: It's up to us In northern Santa Clara Valley, storm dr3ins flow directly to local creeks and San Francisco Bay, with no treatment. Storniwater pollution is a serious problem for wildlife dependent on our waterways, for people living near streams and baylands, and for the local water supply. Common sources of �tormwater pollution include: • Dripped oil, fuel, and antifreeze fi•om vehicles and heavy equipment; • Construction debris, including diri:, concrete and paint; • Landscaping runoff containing pe��ticides or weed killers; and • Any material dumped or spilled irto streets or storm drains The property owner and the contractor s iare ultimate responsibility for activities occurring at a construction site and will l�e held responsible for any environmental damage caused by subcontractors or employees. For more information on construction-related stormwater requirements, see the Stormwater Quality Regulations section ��f the City of Cupertino web site at: http://www.cupertino.org/city gc vernment/departments and offices/ environmental services COMMUNITY NOISE CONTROL The basic noise control requirements for construction sites are as follows: • Typical construction work hours are: - Weekdays - 7 a.m. to 8 p.m, - Weekends - 9 a.m. to 6 p.m. • Construction other than street co��struction is prohibited on holidays. • Residential daytime noise levels f complaint site - 60 dBA • Nonresidential daytime noise levels from complaint site - 65 dBA For more information on noise coi�trol, please see Chapter 10.48 of the Cupertino Municipal Code, which can be acc�ssed at http:/,lwww.amfeaal.com/cupertino ca/ Greg Casteel Building Official „ �;�. , Community Development 10300 Torre Avenue �' ' ` Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 CUPEf�TINO Buildi:n De artment JOB � i ( DRE�S�S J�� PERMIT # � � l � ( � � v OWNER'S NAME: R►��,.p,�-� �vro o�-1� PHONE # o,�a� �'� 5�r GENERAL CONTRACTOR: $ � cv� �� c,,s s � FAX # � 3t 3 � !� � � 3 �- I am not using any subcontractors: �� ° �� Si�;nature Date Please check a licable subcontractors and com �lete the followin information: SUBCONTRACTOR BUSIrfESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Fini.shing 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 ontractor Signature Date