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06060250 > 0 (D a) a) a) M E o '6 m a_ a) 0 =�' a) a) CL a)sL 0 L) c a) OL . I CL CL P io 0 a) io 0 ;0 0 0 0 > -6 U LL [L < :r u U o LO z L u H _0 CD 0 Lo M u < W N .1 UU CD w O w 0 LO cr) 0 H 0 W -4 0 .4 0 LL. H 90 0 LD w 0 c 77 u FA FA FA 0 W < 0 TO xC14 N as_ L) u 0 CD z a) C=- F- Cl 0 F-I - LO uj < LLI a) CE CD = IL 0 o z LU F 0 u 0 CL 2L w �g F-I P� El :5 PG F-I 0 w 1-j CT) U m CL 75 43 a) Lo (D LO Q, z a) IL U < =i < u _0 A) d) CDd) W.O. CD _0 _0 0 0 LLI U lcrlI CE a) OL CL CLCL 0 0 0 0 0 CD c=, cD fel o LD CL w L— 0 CLLU C: IL a_ 0 >1 < z LL LU F- LU _0 LO W (D LLJ CD -0 CD C=, C4 CZ O CE Z LO CE a) 0 LO 0 CD M F- LU LU -6 w JI " 0 " C�j 0 CL -76 CD -2 - -, 0 Z _j Lu 0 .0 CT) 0 F- [L a) CD 1, LL- CL U C�j N L, L� LO Lo CD CD a) CD C: CD io a) cli a) -0 (D (D = a) 15 0 0 -0 CL (D fu a z 6 Q) Z CL E o 0 CD o :5al a) 0 -2 > 2' CL io E u E > LU -2 z 5, 0 (D a) a) u CD LL- 0 EL z -0 M io a) < 6—Z C, a) L) U4 u Z) CL A, Lul - -.f -If -= fu m 0 CL CL (L) 0 a) 0 CL IL < Lo U CL CD CL 0 l < CL u u u CLrc d) lLl is t! CL LU CITY OF CUPERTINO �� s -p INE BUILDING DIVISION i ��AAfa �N BUILDING ADDRESS: STUART & MARJORI E DUFOUR PERMIT NO.06060250 932 NEW HAVEN CT OWNER'S NAME: PERMIT I55UE DATE STUART & MARJORIE DUF UR PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH n o 0 0 00 LICENSED CONTRACTOR'S DECLARATION Job Description u t- 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing z w with Section 70(10)of Division 3 of the Business and Professions Code,and my license is �y infull force and effect. REVISION: ADD NEW KILN IN SHOP. MOVE ELECTRIC ^z LicenseClassc Lia OUTLET INTO KITCHEN. — Date Contractor a,a ARCHITECTS DECLARATION ORIGINAL PERMIT 05080160 a I understand my plans shall he used az public records 1aU L,ti Licensed Professional OWNER-BUILDER DECLARATION < 1 hereby affirm that I am exempt from the Contractor's License Law for the m C) 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 stateme :? = that he is licensed pursuant to the provisions of the Contractor's License Law( ntChaptcr9 Sq.Ft.Floor Area a uarion a �'•-m (commencing with Section 70(10)of Division 3 of the Business and Professions Code)or 0 .- that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by airy 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 az their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.70U,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of Q P 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 ar 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 docs not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a conlractor(s)licensed pursuant to the Coniractoes License Law. ❑I am exempt under Sec. ,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- sation,az 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,az 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 carrier and Policy number are: 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 the work for which this permit is issued.I shall not employ any person in any manner so az to become subject to the Workcrs'Compcnsaton Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must O forthwith comply with such provisions or this permit shall be deemed revoked. z, CONSTRUCTION LENDING AGENCY .- (—t�+ I hereby affirm that there is a construction lending agency for the performance of .� the work for which this permit is issued(Sec.3097,Civ.C.) W Q LxndersName 0 z Lenders Address V C) I certify that I have read this application and state that the above information is . correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorive representatives of this city to enter upon the W above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against �_q to liabilities,judgmeots,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. ►-t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature of Applicant/Contractor 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 Code,Section 25532(a)? ❑Yes ❑No All roofs shall be inspected prior to any roofing material being installed. 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 emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes C]No have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,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 requirements which must be met prior to issuance of a Certificate of Occupancy. Signature Of Applicant Date Owner or authorized agent Date All roof coverings to be Class "B"or better CITY OF CUPERTIN (p crj CUPEI�T ERT INO PERMIT APPLICATION FORM APN# 3 S�� %10 y Date: Building Address: Mailing Address (if different from building address): Owner's Name: �T- �..- M� a y e 1,h . D�POu Phone#: . y68- 9-9-3'-- 7617 Contractor: ` t_ License#: Contact: /� Phone: *Y- -2 S`70/7 Cupertino Business License#: Y rho `d► uY . Fax: Building Mermit Info: Qdd pw.,,o kiln w• gAcP, t7, nt.,e— eteRvit- Bldg ❑ Elect X Plumb ❑ Mech ❑ Job Description: eQ-., Residential 0 Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupanc Gro Type of Construction: Please check this box if the project is a second-story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1 M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC 1000 Elec 600V<= 1 OOOA ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 *TY OF CUPERI'INO CITY OF PERMIT APPLICA'T'ION FORM CUPEI�TONO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMIVIM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING _ BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3