07110145 "'PERTINO �L��T�! �{�� ���}����N � ,
,:ON PEx�T ; `.
...
pFRMIT NO.
�NG�.DD ess: SEARS H()ME IMPROVEMENT 07110145 .
2015� APPLE TREE LN
pIItM1T LS6UE DATE
IER'S NAME:
KURTZ FRED N AND DONNA L 1024 FL()RIDA CENTRAL PK� SAMTARI'N0. CONTROLNO.
P"o"E: ( g25 ) 24'i-2000 •
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
� � � �
� p a LICENSED CON7RACf�R'S DEC[ARATION IOb DCSCilpt10I1
u � � ��rcby �� tha� � am Gcenscd under provisions af Chaptcr 9(commencing REFACE CITCHEN CAB INETS � INSTAL NEW CABINETS �
� Z� wi�h Scction 7000) of Division 3 of �hc Busi�css and Profcssians Code. and my liccnx is
�� y in full focce and cffect / RECONNE'�T S INK AND FAUCETS
� v� z Licenae C7ass � ' Conuacto
_ F p pelC � r
� CHI7'ECI'S D
l undcrstand my plans shall bc used as public recordc
m
J
; u. y Licenscd P�uCcssional
� O � OWNER-BUILDBR DECLARATION �
� �� � hcreby e[(irm ihat 1 am excmpt from �hc Con�ractor's Liccnsc Law far thc
L p O following �cuon. (Sxtion 7031.5, Busincss and Profcssions Ca1c: Any city or caunty
y�� which requiros a peemit to conswct, alter, improve. demuiish, or �epair any swcture Valuation
prior u� i�s issuancc alw reqwres thc applicant for such permi� to filc a signcd smtcmen� g Ft. Floor Area $ 3 91
' Z< �hat hc is licenscd pu[suant to thc provisions of ihc Canuactur s Uccnsc law (CAaptcr 9 q•
x t� = - �(commencing wiih Section 7000) of Division 3 of Ihe Busim�ss aod Profcssions Codc) or
y�� thsl he is exempt Ihe�efrom and Ihe besia for ihe allcgcd exemptiuo- MY ��olation o( QCCU ai1C T e
Section 7031.5 by a�ry appGcant for a Perm�� s�bK�u the applicant w a civ�l pu�a�ry af 316 3 3 0 7 8`.`�� Number p y yp
not mme than five hundred dollars (5500�
❑ I, u owner oC tt�e propaty, a my employces with wages u their solc compensadon,
will do the worlc. end t6e sttu�wee is not Intended ot ofkred for aslc (Sa. 7044. Business Required Inspections
and Professions Code: The Conusctor's License Law does not apply �o an owner of
property who builds or improves thereon, and who does such wort himse�f or throug6 his
own emplayces. provided t6ei such improvemenu ue not intended ar olfeeed for sale. l[.
howeva, the building or imp�uveme�� is so�d wiihin one year ot compkdon, the ownu-
builder will have the Durde� of proving �a� he did no� 6uild or improvc (or purPose of
saleJ.
❑ 1. �� o(' the property. am acclusively contncting wiih iianaed convumrs w
conswct the p�oJea (Sec. 7044. Business and ProCessions Cade:)'[2�e Coatractor's Li-
�cnse Iaw docs w� apply m an mvner of property who b��ids or impmves U�ereon, and .
who convacts [or such projecis with a rnnvactor(s) iicensed pursuant to ihe Convxtofs
L �" 8c � , B 8 P C for Ihis rcasan
r'1 1 am exempt under Sec.
,ner
Date
WORKER'S COMPENSAT[ON DECLARA7'ION
1 hercby atTicm under penalty of perjury one o[ the foUawing declarationa:
❑ 1 hsae a� will mainuin a CeniGcate o( Conaent to xlf-insure for Workcls Compen-
sallon, u provided for by Section 3700 of �he Labor Code. for �he performanx of the
woric tor which this permit is issucd•
❑ I havc and will maintain Workers Campensation Insurana, as �cquited by Scction ,
3700 a[ �he Labor Codc. Cor thc petformance of the work for wAich �his permi� is issued.
My Warkels Compenaation lnwnnce ��, Po , I � ' num6er a�e:
cem«: q�F M�E21CA��f;�r�:�Yb�
CERTIFICpTE OF EXEMPI70N FROM WORKERS' •
COMPENSATION INSURANCE
(This section need not be comple�cd if the permit is for onc hundrsd doilua (S 100) •
nr Icss)
i anify Ihat in thc performancc of 1hc work (or which lhia permit iS istucd, [ shall not
e�nploy any pceson in any manncr so as w bcrnmc wbject to the Worlc�s' Compensation
Laws o! Califamia. Daie
Applican�
N(717CE TO APPC]CANT: If. aftcr making �his CcrtiGca�c of Excmp6on, you sAould
bccome subjcct to ihc Worker's Compcnsation provisions of �hc Lalwr Codc. you muu
��.., (oMwilh comply with such provisions or lhis permil shall bc dtxmcd revokcd.
� � CONSlRUC170N LENDING AGENCY ,
(� n � Mroby a[lirm that there is p consuuctinn kading agcncy for thc performana uf
p�„ � ihe work for which this pertnii u issued (Scc. 3097. Civ. C.l
W Q Lendcr's Namc
� z Lender's Address '
V Q ( certify that 1 have resd Utis applicuion and suic U�at thc abovc informauun is
w � cortcc� I agrce w comply with sll riiy and counry ordinsnces and stam laws mlating w
building consuuction, and he�eby authoria representativcs of this cily to cn�cr upon It�
� V alwvc-mcntianed p�uperty [ar inspection purpases.
�" a (Wc) agree to save, indcmnify and kecp harmless the Ciry aC Cupertino against ,, �
�� liabilitiu, judgmcnls, cosLS and expenscs which may in any way uccuc againsl said City 2��
V z in consequence aC thc grandng of this permi4 Date � i�
►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued ty :
SOURCE REGULA�J�L ^ � � //� � '"�—�
��. ��� ? -� Re-roof �
Signume of ApplicanUConuacwr �°� T of Roof
FIAZARDOUS MATERIALS DISCLOSURE YPe
�11 the applicant ar fuwrc building occupant storc or handle ha•rardous malerial
; defincd by the Cupenino Municipai Codc. Chap�cr 9.12. and the Healih and SaCcty
�. Scction 25532(a)? _/ All rool's shall be inspected prior to any roofing material being installed.
� p'�` If a roo' is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building accupant use equipment ar devices which
emi� haiardous air coniaminanu az dcfincd by the BaY Area Air Quality Managemcn� all new materials for inspection.
�15W��� �
❑ Ycs
1 havc rcad the ha�ard�ws maicrials requiremcn�s undcr Ctupicr 6.95 of d+c G1iCor-
nia Hcalth dc Safcry Codc, Scctiais 73505.25533 and 25534.1 undcrstv�d �hm iCthe building
does not cwren�y havc a tcnan4 �at it is my responsiAiliry w noufy thc oc�upant nf the Date
rcqui mcn�s which mus(6�1Qet a issu cc o[ a ccnit�l=( oca Signatu re of Applicant
o\� � Ail roof coverings to be Class "B" or better
Owncr or authori�cd agcni Da�c
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Assessor's Parcel Number: �� r 33 — d� g
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Name of owner. � 2� U �� Z '
Project address.
aol � 1� PP�E ?'(?F� [-n� .
Contact person. � � �� Phone. � S ���� °�'��
Fax. �f S �i!
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Nct squarc fi�tage of lot. ��N�� �r� S�N�� d� �7�
F � Proposed
Square footage: First floor: –'�
Second floor: —�
Garage: �
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside the garage? ` N
Is privacy protection planting requited for the proj ect?
On what floor(s) is work being done? �'� ���
Brief description of work.
Code editions: 2001 CBC -1�2001 C]?C ��2001 CMC �`i- I� �
2001 CPC I� 2001 N�C (Y -� ��
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Assessor's Parcel Number: �� v 33 — d7 g
Name of owner. �' ��� � V ��
Proj ect address.
ao�� � PPr,E �'��Fe � .
� � C.v/� Phone. � S ��J ' �
Contact person. c� S - �, �
Fax.
t. �F c �c r. rt�s��a�- ` Nc�-� �N�-- �d � .
Nct square footagc �f 1� �D���N�_ �� S�NI� d� �� �
��-��� Proposed
E xi stin�
�.�
Square footage: Fizst floor: ��
Second floor:
Garage: _
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside e garage? ` N
Is privacy protection planting required for the proj ect?
On what floor(s) is work being done? �'� ���
Brief description of work. .
Code editions: 2001 CBC - �
2001 Cl � C � 1� 2001 CMC �- �
2001 CPC 1�2001 N�C (�Y - �
Effective 11/1/02 ' �
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Plan Review Process Work Book Page -B-Re��ised 8/22/OS
11/08/2007 08:37 19252452017 SEARS HOME IMPROVE PAGE 10
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IVFW CA,.BINETS 1'�$ Cl O NOTFS� .
REFA,CL YES 1vC1 O MJLES TO HOIVIE
CITY OF CUPERTINO
CuPE�,TiNO PERMIT APPLICATION FORM
D7ll D1�5
APN # Date: �_ 2 � _ Q
3� - 3-0�8 1
Building Address:
. � t s� A p c.�` 2� L.�✓
Mailing Address (if different from building addrf;ss):
Owner's Name: Phone #:
�Efl � C� 21 Z- � 1 ° - �- � � � S�
Contractor: Phone: ��S_ a S(J �Up U
��f� S 1��� �-t)f�'_i�lE/�- Fax: �IaS "d 2 �S '�o/
Contractor License #: �13 ? Q
/
Cupertino Business License #: �„e� a�� �
Contact: ^ Phone: �S = Z�L.j `a..-ClG�O
N «� Lc
F�: � a.�-�'2-��
Building Permit Info:
Bldg ❑ Elect ❑ Plumb Mech�
Job Description Residential: Job Description Commercial:
�E-FAc�c K!'f' CqB,/ /�ST4c.L ,J�.--�, �
C�v,�T�� Tv P�2�Guni�/C�T �iN�= c� �i�Y'uF� New TI ❑
Cv c:� e � cs�-Y-•,�� Gc � ' � ��'l.'� `�-� ,
Sq.Ft. Floor Area: Sq.Ft.:
Occupancy Group: Occupancy Group�
,�
Type of Construction: � Type of Construction:
�
Use:
Bank � Laundromat ❑ Medical Office ❑ Office ❑
Project Size: Standard Large Major . „
Green Building: Attach LEED Checklist to p lans and identify in sheet index.
LEED Points Achieved:
� � � -�.
�.�
CITY OF CUPERTINO
4 ITEMS OF 4 PERMI�' RECEIPT OPERATOR: bethe
COPY # : 1
Sec: Twp: Rng: Sub: B11;: Lot:
APN ........: 31f;33078.00
DATE ISSUED.......: 11,�27/2007
RECEIPT #-•-•--•-•= BS�)00003334
REFERENCE ID # •.-: 07:L10145
SITE ADDRESS .....: 20L50 APPLE TREE LN
SUBDIVISION .......
CITY .............: CU?ERTINO
IMPACT AREA .......
OWNER ............: KU2TZ FRED N AND DONNA L
ADDRESS ..........: 20150 APPLE TREE LN
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-2002
RECEIVED FROM ....: TOniN & COUNRTY PERM
CONTRACTOR .......: MARK C GOOD LIC # 23097
COMPANY ..........: SEARS HOME IMPROVEMENT
ADDRESS ..........: 1024 FLORIDA CENTRAL PKWY
CITY/STATE/ZIP ...: LOL�GWOOD, FL 32750
TELEPHONE ........: (925)245-2000 "
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- --------
1BPFIXTiH2E NO OF FIXTURE 1.00 8.16 0.00 8.16 0.00
1BREMINH00 NO UNITS 1.00 10.26 0.00 10.26 0.00
MPERMITFEE FLAT RATE 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 : 100.00 0.00 100.00 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ----------------
CHECK 100.00 1513
---------------
TOTAL RECEIPT : 100.00