01020054 (3) CITY OF CUPERTINO
nun"°IN°DIVISION PERMIT CONTRACTOR INFORMATION:
/+ PERMIr NO.
BUILDING ADDRESS � ._�xiT2 L 01020054
21557 RAINBOW DR � �
OWNER'S NAME. APPLICATION SUI{DATE
KIMSEY ROY B AND SHIRLE X00 02/12/2001
IONS / T p �I) �, SANITARY NO. CONTROL NO.
—0 4�O.S �1 G cS�! 2i 17 S ,851
Most AHCHITEC171iNGINEER: BUILDING PERMIT INFO
BLUCr/ILECT' I''-UMP— MECIi
Cn'
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LICENSED CON TRnCnOR'SDECLsOfChat Job Description
pYn—D
1 hereby m)affind thin 1 ten I;cenxcd under provisions of o,Chapter ad it,l acing
G Cly with Sedinn](XNBalDiv:aan3of tone lhesinmx unA lknfeaiom Cele.nnJ my licunxe
fix= isin1.11face and 01 1' KITCHEN REMODEL
z ce< Liana Class Lic.p
Cnm:aranr
v1 3 u. Cflll liCl,S DECLARATION
Cap }um1 sl:. at ilan vhall be mad as public recon]. A I�
b p
s '! m casia"a ,v LED
% OWNER-BUILDER DECLARATION MAY
I hr¢ny.(Sec mm I am ewn,pt rmm the Comraaon e:A nye law for me 1 4
'Incholkwng one-, (Briton]lonoar. .ab".a and Pml i1eir lc Cale:My cony or wvmry �oo
d�ce prim issuance
ill I I 'I f I'.1 I'_ Yn'curc
a 3 Y Pnon I also y Ion PPI uor such permit infileasigned:,,num
mann l : IPS
urmaC mtfor L 1 v
Sq. FL Floor Area
Valuation
poo g tonSection
M0) ti til (❑ Business JP nn,Code)
or , l Inrchnianndtheleoty
ofSecion 31.5 bany dnlm Ipcnnt.njas the applicant ma cou Peonaby
,)fact Iraa than live hundred doll.....($51 )
A PN Number Occupancy Type
❑I,as owner of the pmryny,or my employees with wage as their sole cnmpcmmion,
will do the work,and the xtruncate Ix not Intended or offered for%ale(Sec.]a W,
Buxiness and 11 te..ion.Cole:'I he Cm+Imdnrx License law doe,am apply,..an Required Inspections
r of prnpcny Who builds or improves meter,and ebo docs such work hlmxclf
r through his own employee.,.provided that S.do impmwentemx arc nm intended or 101 — 'FOUNDATION
'offered for sale.IL howcvco the building tir in,prevctncn,is hold within tine year of
nnpl=ron,meo,,ane,build,will into,me b"rdenol moingm:n he did mil huBJ ar 102 — PIERS
t„prmefia,mrlactifxnh,.). 1.03 — IJFER
01.as owner of one ptopeny,am exclusively contracting with licensed communist to 104 — REBAR
conarua the prom(Sec.70,14,Busines,and Pro essionx Gale:)The Cnnnractai
1.ox.oc Law Joe o,llpTlym:m nwnunofPmper,y who build—,lmPfom',hrice..
amt who enmmdx Ira ash prnj¢ts with :I=mnra=tm(,) firmed puron:tm to the 105 — ANCHOR BOLTS
cnnlmdnra Lmensc IOs
Gl am cc_ toot r. .B k P C far this.,an
106 — SEWER R WATER
)nnd�,_=WO Uale y'6�o1 202 — UNDERFLOOR PLUMBING
- wo d BCD l'IiNS 1(N1VT'B'Aum 203 — UNDERFLOOR MECHANICAL
Increbyro matnderpenaltynrper;nryonetinhernun,%ingaenamnin�.: 204 — UNDERFLOOR FRAME
Ii,00c.,,itwill :nioainaC,riE,ateof Content ,n.,Ibia...ef..Wmker'x 205 — UNDERFL(IOR INSULATION
Gonpenavuon, as provided ,or by Scalae 3901 of the Lahor Cu Jr. lar the
perrm,nanceonhenorkfm»hi=nmi,permi,i.ix,"ed. 301. — ROUGH PLUMBING
❑I have and will maimnin WnrAcr's Cumpens:ninn Immm1c,:o rcywred by Section 302 — TUB & OR SHOWER
3]0(1 or the Lahor Inde,p,r'me performance of the work loo which at, cmil is
t.,aed.ny" ;rxettrpen,atim+mxSran=e=an;randrolieynSn+ossific: 303 — ROUGH MECHANICAL
( en Pau=y Nt.: 304 — ROUGH ELECTRICAL
/� 'IiRTII A'I ION OP ETI!M1119'IIIN PROM N'OHKIiRS'
CY>MPRNBAnuN INS'UHANGE 305 — FRAME
(Thissectian real non be cnn+pleteJ if lire permi,is Rpone hundred dollars 306 — HOLDOWNS
sla»anem,> 307 — INSULATION
1 cerlily the in the,fformame nhhe wad for which this Iwn til is(stated,I
%hall not employ any person m any marner,a)ze,In hamne subject m the workers 308 — SH EETROCK
Ctimpenwtion laws of cmmia
irn .DJ1e309 — EXTERIOR LATH
N(MC tit onCEubj APPLICnNDIL COmpetAln¢mi•:Cenihr,e of Labor Code,
fol and 310 — INTERIOR, LATH
become subject wittheh
such
h puCn:n i,Or hisoor pro n til e d tined Gvonil. un
O z0 rnnnw;m=n„+ply wimauen pmni.unnx or lm.per„nt.mnlw deemed revtiken.111 311 — SCRATCH COAT
F ^ CONSTRUCTION LENDING AGENCY 313 — ROOF NAIL
K.a ] 1 hereby at'Gnn that than N a conamdion lending agency for the perEnmance
,he work Ibr which pcnn;l Is i,nueJ(Sec.9197,Civ.C.)
I<JdsNnmc 501 — FINAL ELECTRICAL ENERGY
Lender's Address 502 — FINAL PLUMBING ENERGY
U O 1 cnifym:,, tons,mad nft,apph=ar:niand state hear be ab'ooein[nnnmhon is 503 — F'INAL MECHANICAL ENERGY
E.: mrreel.I agree to Comply with all c;ty and cuumy obbratmo and male awx relating
O U to Wilding construction.and thereby and, oe"'a,'enatioc,of this rily to cone,."a 504 — FINAL BUILDING ENERGY
the alnwementioned property for now sahon purpnas.
} y (We)agree to%avc,�aq nily and Acep hurndess the City of Cupenlno against 505 — FINAL ELECTRICAL
ti V] o,ludguente,apt orenrhich:uuY is any way accrue apooina saidcincauena o gmmingr Ion,KITANDSA )WILL COMPLY WI rl1 ALL ')N DINT rec ' IONS. Issued by:��orApphumt Imdur' ante Re roofs 508 — FINAL MECHANICAL
HAZARDOUS MAI'I!RIAI.S 1)].Cl I(E
W;BtheapphcammfutureWildiri II -orhandleB dan,mled.) Typeot'Roof 509 — FINAL GRADE
as defined by the Cupenmu Municipal CW s.Chapter 9.12,and the Health and Safely
Cn it.Scdion 255321aff $10 — FINAL PLA NING .
Dye, //]N+' All roofs shall be s ecte(i ��yry;Ip[yt,,an ng installed.
Will mea applicant npTumre hilJin ,once lar Jevicex which �[ � ( Dt �� � � 1
pp gmcSpam vttipmen If a roof is installe without firs o inning an ufspec[u)n, agree[o remove
emit hmadiu,are amtmnmanu m dctined by the Bay Area Air Quality Management
,;.a,ric,p all new materials for inspectiorrL.. Applicant understands and will comply with
eye, N all non-point so "'e regul• 'ons.
1 Hove read the has ¢rials r menu under Chapter(a95 of me
Cnlifnmiu Ncnnn.@S:del Cr+I .cctiuns"' 05,25533"nJ 25514.1 unJcrtlanJ nM1m
Ifine builAing Dues nen yhave vl unt.mmi,i,my respon,ibil'ny to nnGly the
..Spam of Ibe a• isab m ,nS mot I:r'lor m t%.oaor of a L'enircnw of
o,c"pan a[ure of Applicant Dat
b +artrc All roof coverings to be Class `B++or better
OFFICE
C) 0 Z C S
CITY OF CUPERTINO
BULDING PER111T APPLICATION FOBS
Building Address: ,
Temporary Bldg Permit
BUILDING
Owner's Name: ,
Phone No:
BENERGY
Contractor:
BUILDING
License No:
o�GV-0
Contact: 6P
BOVER71"IME.
Phone No:
j�
Architect/Engineer
Bldg Permit Fees
License.No:
BMITIGAT
Applicant/Contractor:
BUILDING
BPLANCHK
Plan Check Fee
Buil4ing Permit Info: (circle o e
Bldg Elect
]Plutab
C�Mech)
:Tob Description:
Residential: k% i" ; Yn o 06L
.
Commercial:
Sq. Ft. Floor Area:
BUILDING
S/Sq. Ft.:
Scb Specific Plan
APN # (Must provide): S 0
'valuation
-s � D p �:
Type of Construction:
BSEI.SMICRE
Occupancy Group:
Qty. if Fee ID - Fee Description Fee Group
Anollcable
BTEMPPERM
Temporary Bldg Permit
BUILDING
BCONSTAX
Construction Tax
BUILDING
BENERGY
Energy.
BUILDING
BENERGYADD.
Energy Add Multi '
BUILDING
BOVER71"IME.
Inspection Overtime
BUILDING
' BPERMFEE
Bldg Permit Fees
BUILDING
BMITIGAT
Housing Mitigation Fee .
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
' BPLANCKADD ..
BPLANCKREP
Plan Check Add Multi
Plan Check Repeat Fee
BUILDING
BUILDING
BREINSPECT
Reinspection Fee.,
BUILDING
BSCBLVD
Scb Specific Plan
BUILDING
BSEISMICOM
.Seismic Commercial
ISUILDING
BSEI.SMICRE
Seismic Fee Res
BUILDING .
BSPECIAL
Special Inspection
BUILDING
BSWiM
Swimming Pool
BUILDING
_ZADDCHG
Address Change
BUILDING
10 60 TORRE AVENUE '
CUPERTINO, CA 95014
(408) 777-3219
CITY OF CUPERTINO
BUSINESS LICENSE APPLICATION
ACCOUNT #.
HOME BUSINESS APPLICANTS LOCATED IN CUPERTINO
cMUST COMPLETE BOTH SIDES OF THIS APPLICATION
NAME OF BUSINESS (� �nr �12c �L� lyc.���Y� ��? N7`!2 6`3c-ro1z
LOCATION OF
STREET
,Z
9C -1-T&14 L C a ! & %�o f PHONE 333
CITY STATE ZIP
MAILING ADDRESS IF DIFFERENT THAN ABOVE
NATURE OF BUSINESS n1/4'& Com ST'/?u r.:n Oro HOURS OF OPERATION ` L4, 3 U
IF NATURE OF BUSINESS IS' AN APARTMENT, PLEASE STATE NUMBER OF UNITS_
SQUARE FOOTAGE OF YOUR BUILDING SPACE IN CUPERTINO (NON -HOME BUSINESS ONLY) - -
4%l S,OF BUSINESS____CORPORATION _PARTNERSHIP SOLE PROPRIETOR
START DATE OF BUSINESS IN CUPERTINO a bo Lo
ARE YOU PURCHASING AN EXISTING BUSINESS? YES ::�O
STATE EMPLOYER IDENTIFICATION NUMBER—.-
FEDERAL
UMBER_FEDERAL EMPLOYER IDENTIFICATION NUMBER
STATE BOARD OF EQUALIZATION TAX NUMBER
OWNER/OFFICER NAME SQQN 6i2 C SOCIAL SECURITY NUMBED -O - 006 6
1.9 . S 11 boy(;! PHONE ( )
STREET ADDRESS CITY/STATE/ZIP
OWNER/OFFICER NAME_, SOCIAL SECURITY NUMBER -______z
_ PHONE( )
STREET ADDRESS CITY/STATE/ZIP
OWNER/OFFICER NAMESOCIAL SECURITY NUMBER _ -
PHONE( )
STREET ADDRESS CITY/STATE/ZIP
TO THE BEST OF MY KNOWLEDGE, THE ABOVE INFORMATION IS TRUE AND CORRECT. '
S 91 NATURE
FOR OFFICE USE ONLY
ZONING APPROVAL DATE APPROVED
D TE
DATE PROCESSED RECEIPT NUMBER AMOUNT INITIALS
HOME BUSINESS QUESTIONNAIRE
YES NO
Is your business a private school with organized classes?
(
)
( )
Is your business automobile repair including paint and body work, upholstery;
welding, etc.?
(
)
( )
Is your business a barber or beauty shop?
(
)
( )
Is your business a medical facility or other practitioner facility?
(
)
( )
Is your business a veterinary clinic or kennel?
(
)
( )
Is your business conducted in the garage?'
(
)
( )
If yes, will the hours be between 8:00 p.m. and 8:00 a.m.?
(
)
( )
Will materials be stored in the garage, which would eliminate car parking?
(
)
( )
Will materials be stored outside the residence?
(
)
( )
Will the home business utilize front yard or driveway?
(
)
( )
Will products be displayed on the exterior of the residence?
(
)
( )
Will products be displayed to the general public?
(
)
( )
Will the residence be receiving more than one delivery per day?
(
)
( )
Will more than one vehicle be used for business purposes?
(
)
( )
Will the business vehicle(s) be larger than a passenger auto, pickup truck or
similarly sized van? ( ) ( )
Will exterior signage be used and will the appearance of the home be modified? ( ) ( )
Will more than one additional person, not living on the premises, be employed?
(exclude employment of domestic servants, gardeners, and janitors) ( ) ( )
To the best of my knowledge, the answers on this form are true and correct. I have ,been given a copy
of the Home Occupation Ordinance and I agree to comply with all City Codes and Regulations.
Signature Date