02070194L
CITY OF CUPERTINO 6(qj-
627; r -f -
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
APN #
T Date:
Building Address:
2k0cy-,�> 'P, --d IF-xr- COuv-*
Owner's Name:
Phone
7b r'-1`( ay-rlk--fie.
-; -� C-- >=� - 4,-2
Contractor:
License #:
Contact:
Phone #:
C
Applicant/Contraptor:
Fax #:
er Appliances
FRAN
Building Permit Info:
�Edg) ATe-c-t urn ec
Job Description:
Residential: ercial:
Sq -Ft. Floor Area:
$/Sq.Ft.-
lnd/Off/CoqT�Quasi
Architect/Engineer:
V ation:
i Con. Tax for BQ Zone
Type of Construction:
ccupancy Gro
I 11 W,
1 of3
Fee Description
Fee Group,
EACH STORY OVER 3
—3-
er Appliances
FRAN
I—C 0 nstructi- o-n—T-a-x
I Mon
lnd/Off/CoqT�Quasi
METArAlAbIgm-4,��,
i Con. Tax for BQ Zone
BCONSTAX11
I 11 W,
IBCONSTAXR
I
1, Constax - Resi/Mobile
I BELEC 1000
ELECTRICAL
BELEC1001
7 Elec 600V > 1000A
ELECTRICAL
BELEC200
Elec Svcs 600V <-- 200A
BUILDING
Energy Add Multi
MERL:"$ I
STIGA
M.
Comm. Ho Mit. ee
BMITI
3430vlvll���!
New Multi -Family Re s
Uv I as) va ij layn
New Multi-�_
1 of3
_C F C ERTINO
%LD N
0 JNC��Jo
PEV IT
N,'CO, T '0
"N Wt +t
ADDRESS,
PERMIT NO,
,21093 RED FIR CT
KITCHENS BY MEYER
02070194
OWNER'S NAME:
APPLICATION SUB DATE
TONY :OIKEEFE
278 CASTRO ST
07/30/2002
PHONE:
'(415) 968-8318
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
L_:J C_J LL:J
LICENSED CONTRACTOR'S DECLARATION
a'. I� licensed hereby
I b it aide P'ov"'i us of Chapter 9 (coaunencmg
with Section7 7 Division B
Job Description
KITCHEN REMODEL
is fall for elf
i: i License Cl Lic,
Date Crurnar
ARCHITECT'SDEC N
'is my
I understand used
all hense as pu 'records
Licensed Professional
OWNER-BUILDFR DECLARATION
o I hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 70315, Business and Professions Code: Any city or county
atter,p. y
which requires a permit to con,* c,,ah improve, demolish,for
$10000
priorwitsissumpe'also mqu diesplific such permit ire.—
ker
3 5-�10?0 95
V
Valuation
that hqWUqn*d pursuant retire provisions of the Contractor's License Law (Chapter 9
(cmimie�cistg withSectipit -7,000) of Division 3 and Professions Code)
of the Business a
or that he is srul the basis for the alleged exemption, Any violation
of Section 7031:5 -by any -applicant for a permit subjects the applicant to civil penalty
.of not more than fiye hundred dollars ($500).
10 1A'�N �6'8WbAT ION
OccupancyType
Cl 1, as owner of the property, or my employees with wages as their sole compensation,
1 P I R. 2
B.!I`,�Adj,tbe_ and timstructui�&-not*intendtdoroft'eted-for sale (Sec. 7 W,-
and'Professions Code: The Contractor's License Law does not apply to an
-02
103 UFER Required Inspections
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
104 REBAR
ofretid for sale. It. however, thebiulifing or impr&eiiiiii6i sold_%�iihin 6ru: year of
completion, the owner -builder will have the burden of proving that he did not build or
AN ANCHOR ' _1 _ - ' -_
ib�' C 4O"R BOLTS
improve for purpose of sale.).
106 SEWER & WATER
Cs 1: as owner- of the property, -' 'am exclusively con a =-_ t ini'l with licensed - ', contractors ,
'2 0 2- UNMRFLOORPtUMl3_INC 7',
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's
License Law does not apply to an owner of property who builds or improves thereon,
203 UNDERFLOOR MEcHANiCAL '.
_'And,whQ, comm ts for &ucb projects- with a contractor(s) licensed- pursuant, to the
Contractor's License Law -
204, - UNDERFLOOR-FRAMR- -
0 1 am exempt under B & P C for this reason
205 - UNDERFLOOR1"kStitATION
Date
301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
302 - TUB & OR SHOWER
4 hereby affirm under penalty of perjury one of the declarations:
, 11 i
303 - ROUGH MECHANICAL
0 1 have and will maintain s-C.rbfitate of Consent to self -insure for Worker's
�",as
304 - ROUGH ELECTRICAL
C'm ' provided for by Section 37M of ft Labor Code, for the
pirf(MMe 0,the work for which this. permit is issued.
305 - FRAME
0 1 have and w"ll ruslatamrWdiker's Compensation I Insomnia, as required by Section
306 - HOLDOWNS
3700 of the Labor'Code, for' the perfoiiiiance of the work for which this permit is
issited.'M Wor 6Compensation'Insurance carrier and Policy nuth66rare:
"o
307 - INSULATION
--SHEETROCK
'PoficyNo.:_`�_
3'G-�-
y �CEkTIRCATIOX UPIXEMPTIO RKERS ,
W91
0 j EXTERIOR`, LATIt''
le CbMP'ENSATIO IN .. AN
3 10 ERIOR: N ILATH-,'
T
(rhis sectic;n'need not be completed if the permit is for one hundred dollars
($100) or less,)
I � I
311 SCRATCH COAT
' ,f certify that'in the performance if the work for which this permit is 'issued. I
libail not �mp ;y'ady Pierson in my manner so as to become subject to the Workers'
313 ROOF NAIL-
501 FINAL ELEC-tRI CAL' 'ENERGY
Cot
mosation Laws ofCalifornia. Date
Applicant
" Min
502 FINAL PLUMBING ENE
ENERGY
c�"
NOTICE TZO—APPIACANtIf, making this Certificate of Exempt you should
bedoinesubject to the Wdiker's Compensation provisions of the Labor Code, you must
503 FINAL MECHANICAL ENERGY
forthwith comply with such I provisions . I r or this permit shall I be deemed . revoked 1
5,04- -.FINAL BUILDING ENERGY__
LENDINO AGENCY,
I luitiby'affirm ihat th6ri is'a construction lending agency for the performance
505 - FINAL ELECTRICAL
of the �wbrk fdr'which this permit is lsivuerf(Sec, 3N7. Civ, c)
506 - GAS TEST
Lehiler's Address
507 - FINAL PLUMBING
"CAL
-I certify that I have, read this application and state that the above information is
comet.
508 - FINAL ME CHA-141
4 agree to comply,with all city and county ordinances and state laws relating
509 - FINAL GRADE
to building construction, iful hembyauthotize representatives of this, city to enter upon
the above-mentioned property for inspection purposes.
510 - FINAL PLANNING
(We) agree to save, ind &Y and keep hamiles s the City of Cupertino against
I liabilities judg costs a nses which may in any way accrue against said
'is
514 FINAL UBIsiTC WORKS
City lmits n , the, g p : 1L
EItOMPLYVITHPI L -L
SQU9Dat
by: e
3,2/,Issued
of App tear — Date
Will h-4 applicant or future or handle hazardous
a I � defined Cupertino Murucipa,�,CudF store inaterial
Chapter 9.12, and the Health and Safety
Re -roofs
Jype of R , oof
C4e,Sectiort 25,532(a r
All roofs shall be-iR!�p(,-(ztedprior,.to.-any,,roofi4.g,mat��nal,bgijig installek,
ba g occu t u
-cap.
Wi!I die applies, tare buil agn use equipment or devices.which
g
emit hazardous
dou
/_
If a roof is installed Without first obtaining an inspection, I agrbelo'kdmove
air As med e
red by the I
is by the ay Area Air Quality Management
District?
all new materials for inspection. Applicant understands and will comply with
Yes No
all non -point source regulations,
I havb read the 114,ardous materials requirements under Chapter 6.95 of the
Caliiumia Health & Safety e, Sections 25505, 25533 and 25534, 1 understand that
ifilt qff n not have a cant, thatit is my responsibility to notify the
occt dire hi h" u t be met prior to issuance of.a Ce 'ficate of
(kcu
-�7Zoo-
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner' authorize Date
OFFICE
} � F
O O z
zww
Om
itis - z QJ,
r> w0x
x
Opww
wwv
64LLJ
R zwwa
It
43
Oywj-jO
d,- d 0
nzv 0
" yrn-uija
z
` j s IWi
E
.ew s0
43
!^l l U
h
� f
zr
A
4-1
p - O 7'y
.. 0+?u.
}' 0
a v N
-
o
g d u�z
Lu3LLU pz00
a
z
4
cc
0
In w
�w o O
w
w
N �
w
QU d K N z
0
z
I
O
a
u
�a
H
osy
a-�
ybf
d0
u�30
F vO
dto
y6
vai �
�3
CITY OF CUPERTINO
_ BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
21093 RED FIR CT
KITCHENS BY MEYER
02070194
OWNER'S NAME:
APPLICATION SUB DATE
TONY O'KEEFE
278 CASTRO ST
07/30/2002
HONE:
SANITARY NO. CONTROL NO.
(415)968-8318
i ARCHITECTIENGINEER:
O
BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
J u o 1=7
Z LICENSED CONTRACTOR'S DECLARATION
Job Description
(coencing
1 hereby aRrm tha 1 am licenxd under prvvivpp9qna of chapter 9 mm
,° Sim Sectmn7 lof Division3of the Business andypzasions code. and my license
in full for d
KITCHEN REMODEL
off •/�k�s
a License Lic. p
Cla.
Date
OCT 2 1 2002
SDE LA`
G ARCHITECT'S DEC N
g 1 undo i my plans shall ,, used as pu records
cLicensed Profesai...I
p- OWNER -BUILDER DECLARATION
BUILDING
1 hereby a1Brm ma( 1 am exempt from the Contractor'., License law for the
following reason. (Section 7031.5, Business and Professions Cade: Any city or county
$10000 O
O which requires a permit to construct. alter, improve, demolish, or repair any structure
,rea prior in its issuance. also octanes the applicant for such Permit file a signed statement
---
- mathellli¢nxbpursuanuamepmvisiomoftheCiml„I ,LicenseLaw(Chamer9
(camme iogwim.5rction,]Op0)of Divisionloftx eusirass orb Professions Codel
�r oprATQa-,. 5
T. 35?�0 (] 3.`(/'lJ r;t1Yi. 9.1 t, i'``v
Valuation
or mat nc Is eaemPi durifieinm and the basis forme alleged eiemptioa Any violation
t�!vs T.
—°f Section 703 LS by any applitam fora permit wbje t die epplicam m v civil pe,uBy
°r nor home mm rve hundred calls, (s5fii
,k�e=
101APN �&YMAT I ON
' '' Occupancy Type
❑Lo aownerofineprcpcnriotmy employee with wages as their sole compensation,
-
- - -- _
103 - UFER Required Inspections ''"' 1•
-'wi11 d 'tae work:- ad Professions odesurachureTh C nor intended a Li ore Law for woe (Sec 70W'
'Baa nna.nd Proreaamna code. The Contractor a u«an law does not apply ro an
owner of property who builds or improves thereon, and who does such work himself
10 4 - REBAR
or through his mon employees. provided that such improvemmna art not intended or
-bRered for sale. If; howevt{ the W ildin -- int Movement is wld vdthin one y ear of
gm °
the owner -Milder will has the When of proving that x did not build or
- - - --- -—'------- — "'" -'- _ _. ....,._. .
105 - ANCHOR BOLTS '
Iompinion,
mprove far farm, of sate.).
106 & WATER ,
'or y nnep p nr m <inni eiy t (gwtnl«� a Dorm t rste
_-_SEWER
-. _._--
202 � = UNDERFLOOR PLUMBING r.. tr .Pitt
o sen th P Ject (S 7044 B nes nd N f tom Code) The Cot etor s
— LicenseLaw succinct a,), loan mune, of property who Wild,., improves mcreon
"”' ' 1st ,: -' •-
203 - UNDERFLOOR MECHANICAL
' _and who commas. for such projects with a conwuorts).licensed.pursuam.m the
-----___--.__-..-----.----- _--
—" "- 204—=' UNDERFli00R'-FRAME-"'—
,. c�mm coar m mu Law. _ .:. .., ` ,, .•.. ,: ,., -
_; ❑I,mexemPtaneersa. • '-.BePcfnrmi.reawn
205 - UNDERFLOOR r' INSULATION
n
own€,'"'.''r„ m301
- ROUGH PLUMBING
" WORKER'S COMPENSATION DECLARATION
-
�Ihereby,fli.
302 - TUB & OR SHOWER
' ade,peaabynrp<rjarybq�ofinerminwmgattl.mti°"::
303 - ROUGH MECHANICAL
0 1 hived6diin'Irurthdo ,Cb ifiodheofconsect to xlf-insure for Workers
304 - ROUGH ELECTRICAL
s Compgm,tion. as -provided for -by Section 37W of the Labor code, for the
pirtonnariee Orme work rot wnien mi.a per1.mit is Issym.
305 - FRAME
_ „
D I ha Je and'da(md nt n W'rk i C canparmation"in;uranoe, as na uired by Section
306 - HOLDOWNS
9]00 crane Labor Cod for `thepert ret of the work f which thisperi i'
307 - INSULATION
'. n' d M Lao <r'a ompe t I. _' ,ane Pbny
y--..._
;G Yyf-i-v% jpp 73 01
7 \ I O
_. _. _ f
30pp - SHEETROCK.` ...: m .
y,,,: _ .
Cam PoLcY No
CERTIFICATION OF E%EMP IO WORKERS ;
...
3 0 9 I'' EXTERIOR' -LATH
COMPENSATION INSURANCE Al dra.
.,,....... ,..._. .....:.-" .._..-.:_.._..._.-_.310"'j
tiINF'ERIOR...LATH.__
rs r I't, 1y1d:Y.: 151?U
•:''t't obi scctionrieed not tie completed if the permit is for one hundred dollop
311 - SCRATCH COAT
taloa) mss.l
' l mart dorm -nr kwedl
313:: -ROOF NAIL :
Intninth petro(ia
f'b
' itiall not employ dny pc�n any man w as t becomeb)ttt to th<' Workers' ^ _ -,501
j. ,
- FINAL ELECTRI CAL' 'ENERGY
Compensation Laws. tCahfomle Dam
Applicant �'r "' ° ��' "
--502----F-INAL--PLUMBING—ENERGY -_ -- -
NOTICETOAPPLICANT
503 - FINAL MECHANICAL ENERGY r
becomesunittt to he Woher s Compensaton promons of the Laor Code; you must
rorthwimeomPlY with nsomis Permit shall x deemed revoked.
5.0.4 .... -FINAL-.BUILDING..ENERGY_,_._....-..-._.. _ -,--
CONSTRUCIONLENDINonceNCv '
'ag
505 - FINAL ELECTRICAL., ,
I h reby Rrm (bat there . a conswcuo leading r, for m perfmmance
,ofm work far hichm Permit is awed,(sen3os],civ.C) -',
506_ GAS TEST _.__. _
❑.. Lenders Name. _'. -.
_- ... ..
_ -. _ _.._ ._._._.
507 FINAL PLUMBING,
2E emmsAddn.
y, tl
1 1 have read t d state tat the above information is
508 - FINAL MECHANICAL C
y., y certify that t�h s appli
cntrtm. Pagrce to comply with all city and county ordinances and state laws relating
509 - FINAL GRADE
j) waudding consuuction:and hereby kahorin representatives of this city m enter upon
4 theabove-menaonedprdPerty for inspection
510 - FINAL PLANNING
y (We) agrtt io save, rode ify and keep harmless theCity of Cupedino igainst
514 - FINAL UB C WORKS
A Iiabihdes jndg t cows a nus wnien may in my way t said
-
, ,gain
zCity in n n the go this permle •.; '•
APPLIC .x ER $'AN sl•ILI 'ONPSVW'ITHTL'�OV�P)INT
r
Issued by: Date
Re -roofs
_Type.of.Roof
' {. %�:. .�. ti.; v .:,.n•,
'.'
r PAPP anVc t t - , ; - oat ;
HAZARDO S MATERIA ISCLOSURE
! Will txpplr t fmmeWldig pacrorcn,handle haaardpu.matenb
as deredbrm epem MNcpallC Chapt q12. adm x Int dSafety
Cod S 255320 't
t o
' J I t s•- I'Ca •.
❑Y.' ' ' p
y...
All be to any roofin material being installed
roofs shall inspected prior. g g.
Wad, appd a t ! Wil gocc p t equipment., devices which
If a roof is ifistalled without first obtaining an inspection• I'agree`to remove
emth d atm tat m d by,he By Area, Quality Management
D t ret?
N.r
nspection Applicant understands and_will comply with
all new materials for inspection..-
regulations
all' non-point96 rcc ,, ,,: ,(„ ,,-, ,:,,,. <. .... r
1
e,rtadlhc R'iallous maieribs requirements under Chillier h.0i or the
califi rnia xeolth& Safety c. Sections 25505:25$33 and 25534. 1 understand that
-if yx Min note aWind nmet Ci, nmifr the
.. .
'dc t e hire p f a Cc edea¢ of
prirmy.....csi.f.
ih'mutx ( n this once °,,,
I. n
Oc t.
"
Signature of Applicant Date
All roof coverings to be Class "B" or better'
• ,' Dae
Own s ,am oche- +.,
.. , ... .. ,. .'
• . _ -_ .t...... OFFICE ....... _ .........._.._. _ ... ._.... _ - .. ..
r'