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05030021
z Zv` a� gL C oz UG o t LL UV. CITY OF CUPERTINOzztM::+-'�' BUILDING DIVISION PERMIT Comr"q-'bi�+IINIHUItMATIQN: �> � t.uKAwu.�=xra BUILDING ADDRESS: 77n PRNTNRTjTAP A17 OWENS CORNING ......05030021 OWNER'S NAME: PERMIT ISSUB DATE JOSEPH YOUNG ONE: SANITARY NO. CONTROL NO. (925)245-5238 CHITEC (ENGINEER: BUILDING PERMIT INFO ELECT PLUMB MECH jIBLDG LICENSED CONTRACTOR'S DECLARATION I hereby arfirm Net L am rammed unit, pmvisiow of Chapter 9 (Com emcut Job Descri tion P withSrctiw TMId.rDivuian 3ofthe Bugneasmd PrafwdmCode, and my license Ls mfull mrce and e(feet. $ KITCHEN REMODEL eCl ��"• DLIC ata .-� d�ARCHffECfSDP.Cr N t 1 undersand my plans shall he used as public records lJ Licensed Professional OWNER -BUILDER DECLARATION ©U 1 hereby a111'nm that I em exempt from the Conuctor s License law for one, .�y following recon. (Section 7131.5. Business and Profoedaw Cade: Any city or county ( (T rte; which requires a Permit In construct. alter, Improve, demolish, or repair any structure ln.ci pilar n is issuance, also mquhea the applicant nonsuch pnmit to rile aalgned su¢mcnt that he islicewed romanticism provisions ofao Contracnsfsl.tense law(Chapter9 Sq. Ft. Floor Area Valuation (cornmecog with Saction 700(r d Division 3 of sea Bwineuand Pmrmiona Code) or dot he u exempt aerefrom and the basis for the alleged eaempd.. My Nolauw of 3 2AffHI9lbdbel0 0 Occupancy T7 P y 7Pe Seeing 7131.5 by cry applicant for a permit subjects the applicant be a civil pcwlty of Inst mare than five hundred dollars (M). ❑ 1, u owner of the property, or my employes with wages as dock sole Compensation, e Required Inspections will do the work. and the structure is not Intended ora@sed for aaIc(S.C. 7044, B.M. an r of and Prnfessiow Code: The Common's License Law does not apply to an 9 P Property who Wilds orlmprocs thereon.and whodoessuch work himselfw through his own employees, provided don such improvemenu are not Intended woffered forssa.If. bo arum, the Wilding or improvement is mid within one year of completion. the owm- builder. will wolo do bodies of proving WI he did set With or improve for purpwe of sale.). ❑ 1, as owner of the property. am eanwhely contracting with flawed toms mere m construct the project (Sec. 7094, Business and Profeaam Cade:) The Commences Lt. come law does not apply to an owner of property who Wilda or improves demon. and, who convects for such Projects with acomrecmna) licensed purawnt W the Commences License Law. lammemptunder See .B&PClmthismmon Owner Dau WORKERS COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury meg the following declmti.= Nes and will maintain a Cenifinaof Convent mo ul6iwure for Wmkcr'aCompcn- n, as provided for by Section 3700 of the labor Code, for the performance of the for which this permit is issued. have and wgi maintain Worker Compcwadon Insurance. as required by Section 3 of0w Labor Code, for the performance ofume work for which this permit a bled. y Induces Compensation Insurance carrier and Policy number are: My, Cartier. (j4D Qiv�lf Ai Policy No.: G CETI�TE OFEXEMPI70N FROM WORKERS' COMPENSATION INSURANCE (This section need notbecompleud 11the permit is foronehundred dollars ({100) or WI 1 certify that in the performance of the work for which this permit m issued, I shall nm employ any persan In any manner an as to become subject to IN Workem'Compewation Laws of Califomie. Dam Applicant NOTICE TO APPLICANT: If, After making this Certificate of Exemption, you should become subject in the Worker's Compensation provision of the labor Code, you mug forthwith Comply with such provisiaw or this permit Mail be deemed revoked. CONSMUCTION LENDING AGENCY 1 berehy allbm that them is. Conawctiion ending agency for the perfum mance of the work for which this permit Is issued (Sm. 3097, CIV. C.) Lender's Name Lender's Address and sum then the above information e 1 cense that 1 ply read thirty ad county and Som laws relating m correct 1 agree u comply with all my nil canny / matimcea Wildingconstruction,iroand hereby authenticpurposes. oes of Ne city center upon the property for inspection IMF hu. above- (We) against (We) egme to colo, indemnify and htt0 harmless the City of G/ �ljJ rueupenits expenses which may In any way accroc against said City Ilaconsequenc In consequence of tho {renting of ao permit. or the J APPLICANT DERST D ND WILL COMPLY WITH ALL NON -POINT r� Issued by: Date S N, Re -roofs Type of Roof onuanor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or fnure Wilding occupant Blom or handle hvardous materia as dented by the Cupertino Municipal Code, Chapter 9.13, gd the Health and Safety Cade, Section 35533(7)7 Yas All roofs shall be inspected prior to any roofing material being installed. ❑ If a roof is installed without first obtaining an inspection, I agree to remove \ Will the applicant or future Wilding occupant see equipment or dcvima which t hvardous air conumiwnu as defined by the Bay Am Air Quality Management all new materials for inspection. ict7 ❑Ycs 1 have and the havardnusmaterals requirements underchapterg.95 of the Calder. nia Hcalth.kSafcty Code. Sccuow35505.35533 and 35531.1 understand thetifac Wilding des pot cumcnIt ho dna oat y responsibility 0 noddy tiro occupant of the e r cummoncemNfictearDcun *3 Signature of Applicant Date All roof coverings to be Class "B" or better ria,4 D7te CITY OF CUPERTINO g O < $ Qforthwith y QLader! z Q W fa/3 7 '7 ?" BUILDING DIVISION PERNIIT C(SNTCt._®RN012MATT0 BUILDING ADDRESS: 770 PF11JTNRTTT,AP Alf OWENS CORNING PERMIT N%5030021 OWNER'S NAME: PERMIT ISSOE DATE JOSEPH NE: SANRARY NO. CONTROL NO. 25 245-5 ARCHTIECT/ENGINEER: BUILDING PERMIT INFO BLDG EIPCr PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description P I booby aflem duel 1 am ikeuod under and Erol m ons Code. 9 (mmmcnse is MthSmdaaby anofDWWoo3 of the Bu ono pevishom or Cade, 9 orIbcna4 in full eGea KITCHEN REMODEL LICWrCOCCIM utR Due A/ rZT Co. AR"'S D 6 / I understood my Dow NJI hea w aced an puNk rtcoNo �O Licensed Profmuonal DECLARATION OWNER-BUILDERp,from Lbma taw for de 1 hereby a(Se that 11. exempt from the Conine l\ 7831.5, Bualnnae and Professions Code: Any city m aunty moon. Co which V emdun which aguima a puma in anmun, alser, wPmse, domnlW, m urucera ret e a sig ed fm the appBmntformush Permit b0kseLw(Wmmenl B LiardiLJv(ClodeCo Sq. Ft. Floor Area Valuation "mI,liaod resonantto orowenlan¢dpW{WnlbNeO(DMnmofalio umandes (cane is n with Sedan refrom and Use iviponl Orione Budrcampti— yACade)m dos M b mamq these(rora and tle bade fm rw alkgod eampdm My viobda of 3 24aWNLffib 0 Occupancy Type wi� It objects the applicant b e civil penalty W �rta nSuuda more than dollarso� ❑ 1, u owner of the pmpmy, m my wployeu wlth mgu u t e4eole compenudon, Required Inspections N, Budrcu dolhewmk,cede!he not {acv dam not apply b an owuer OrtutsnoesUcede Law doesapply he cab Ro(eWom Code The Cenuulore and 9 P it whotlououch work Mouffeerfassol hit pfapem whe ndwhw s. proriimorose!Ihefern.and ownemployee,providod Ina not imeodod oroRued fmcab. l(. bold within arc yw of ampletim the pose+• however, de m p. in to wind. be or east wedv will haw de wrda of poNnC thu w Old nm wild m Mprow for purpose of ran Me us,.). ❑ 1, a owner of the propmY, am w udwly contruting with licensed mnouiess in construct the project (See. 70M, Business and Proem ons Code:) The Carmichael U. curse law dots not apply to an owner of property who wilds or improve! Demon, and. who contracts for such projects with a eonrn er(s) licensed pursuant in the Contnetoto LwWw law. 0 lamuempomtler See.B&PCI-dills mmor Owe Dae WORKERS COMPENSATION DECLARATION I hereby Nim under penalty of perjury one of the following declautionu 10 ❑ I Ma and will mainnin ec"omm orcownt w alf-Insum forWorkces Compen• nation, an provided fm by Section 3700 of the labor Code, for the performance of we work fm which this Permit is laud. �Qvf haw and will maintain Workers Compensation Imuran, as required by Section 3 of Melabor Code. far the perforaxwe of On arms, fWwbiN this permit ins hued. My Workers Comnper/uWa W6ar.m-s artier and Policy number m: Cadcr.CZ62 U f & Policy No.: t� CE0.i1FlGTE OF EXEMPTION FROM WORK COMPENSATION INSURANCE (This action need act be ampleed ifthe permit Is for ono hundrod doBaa r5108) or Inst) I ceNfy that in the performance of the work fm which this permit is Wood. I dull not employ any person in ay manors, u m bamne wbjm b the Workers' Compewtion Laws of Califomis Dam pm&Wng NOTIC this Exemption,tec you Nab NOTICE TO do If, atom nta.Cenilicawor the become subject it Worta'o Compcoada pmvit Mai or tide labor Coda you roup ct an Worse, pared comply WIN such provisions or this peals Nall w tluemod rooked. y CONSTRUCTION LENDING AGENCY 1 hereby urn that dem is a construction lending aRncy for the pedarmame of the work for which this Permit ts issued (Sec 30 . Ch. C.) None Landers Addun 1 certify dos I Nos rad thinapplicationNow in(mmatia b cad Ne that and and county cad pus hose noting b correca 1 spa b wmply with all city and nary ordinm or wRdhLanapuctia,end wmbY wNon purposes. ftiws of bb cityaata upon de aww-awe) all Property fm WpectlonkwCupertino agtlnal (we) acne b caw, Indemnify and keep hamlets the I /` y a n gaos tau and expenam which rosy In anyway aaeue agalvn Wd City Ibdruesq encs of gra in <aneegmnee of sou Panting of bh D WILL APPLICANT ERST D NO WILL COMPLY WITH ALL NON -POINT r 1 J Issued by: Date S J Re -roofs Type of Roof t HAZARDOUS US MATERIALS DISCLOSURE �e Will the applicant or rubra building occupntpms m handle hauNam maedal a defined by the Cupertino Municipal Code, Chapter 9.13. and the Health ad Safety Code, Section 25533(.)1 Yu or All roofs shall be inspected prior to any roofing material being installed. op❑ If a roof is installed without first obtaining an inspection, I agree to remove wu wc.pplicat or town wilding ommant uta cquipmem at devices which emit hrardom urconumimnu a dertned by the Bay Amo Air Quality Management all new materials for inspection. District? +✓ CYa �° 1 haw mad the hundtms materials requimmantunder Chaper6.95 of the CRlifm. nia Health & SafciyCodc, suctions 25505.25533 m02553k 1 understand da If de wilding alma not eurantl ha once Wt y mapouihlllty b notilq de aeuPat or de ro be r numceoraccrtifkaeara I SignatureofApplicant Date All roof coverin a Class "B" or better er ge • CITY OF CUPERTINO Item 1 of 1 PERMIT RECEIPT C, J Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32603051.00 DATE ISSUED.......: 03/02/2005 RECEIPT #.........: 28764 REFERENCE ID # ...: 05030021 SITE ADDRESS .....: 10770 PENINSULAR AV SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER ............: ADDRESS ..........: CITY/STATE/ZIP ... RECEIVED FROM .... CONTRACTOR .......: COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP ... TELEPHONE ........: JOSEPH YOUNG OPERATOR: conniew COPY # : 3 CUPERTINO CA, 95014-0100 BRUCE CALA CHUCK STIEN LIC # 24239 OWENS CORNING 3037 INDEPENDENCE PKWY, STE A LIVERMORE, CA 94551 (925)245-5238 FEE ID ---------- UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL BPERMFEE ------------- VALUATION ---------- 32,900.00 -------------------- 393.12 0.00. ---------- 393.12 ---------- 0.00 BPFIXTURE UNITS 1.00 9.00 0.00 9.00 0.00 BPLANCHK PERMIT FEE 393.12 524.62 0.00 524.62 0.00 BPREPIPE NO OF FIXTURE 1.00 9.00 0.00 9.00 0.00 BPSEWAGE UNITS 1.00 67.14 0.00 67.14 0.00 BPTRAP NO OF TRAPS 1.00 9.00 0.00 9.00 0.00 BPVENT UNITS 1.00 10.79 0.00 10.79 0.00 BPWATER UNIT 1.00 9.00 0.00 9.00 0.00 BENERGY PERMIT FEE 393.12 188.70 0.00 188.70 0.00 BREMINHOOD NO UNITS 1.00 10.26 0.00 10.26 0.00 PPLBG SQUARE FEET 150.00 12.00 0.00 12.00 0.00 BREMVENFAN NO UNITS 1.00 45.39 0.00 45.39 0.00 BREMVENSYS NO UNITS 1.00 10.26 0.00 10.26 0.00 BSEISMICRE VALUATION 32,900.00 3.30 0.00 3.30 0.00 ELECTRIC SQUARE FEET 150.00 12.00 0.00 12.00 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 MPERMFEE SQUARE FEET 150.00 12.00 0.00 12.00 0.00 MPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 TOTAL PERMIT ---------- ---------- 1440.69 0.00 ---------- ---------- 1440.69 0.00 METHOD OF PAYMENT AMOUNT NUMBER - ------------ ----- ------- ---- -------------- Oa 1440.69 VISA TOTAL RECEIPT : 1440.69 W • CUPEkTINO 46 0 CITY OF CUPERTINO PERMIT APPLICATION FORM APN #9�0306S1 Date: Building Address: Mailing Address (if different from building address): O 7 " .0u<rtZ AvF Owner's Name: Phone #: J. -0;5r -e8 ak&J 4 —oIzv Con actor: License #: 4itit�i� •r 78 f0 3 Contact- /� Phone: "-g"7/- m �jruCe Cupertino Business License#: l G w Fax: yob 71-095-1 BBOILER4 Building Permit Info: K iTe�i6� P25r.1, W4 /40 :SF , Bldg ❑ Elect 0 Plumb 9 Mech Job Description: KirCHS.%J s;,so16L, dcj Wwx", gDO47�t�cG s, G- Ts'�, hL-A erQ;eRC Residential /sem J,# __ -• -__ Sq.Ft. Floor Area: -~ $/Sq.Ft.: Cost o14roject: Occupancy Group: 2. 6 Ind/Off/Comm/Quasi Type of Construction: Please check this box if the project is a a o in second -story addition: ❑ Project Size: StandardV, Laze ❑ Major ❑ Hotel and Motel Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M 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 BELEC1000 Elec 600V <= 1000A 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 -76 � CI _ CUPERTINO to CITY OF CUPERTINO PERMIT APPLICATION FORM uantl Fee ID Fee Description Fee Grou BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM 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 Cbeck 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 BREMAHUbkN A/C Units <=10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Fumace > 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 I ELECTRICAL 2of3 CUPEI,TINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM "Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING SO ELECTRIC Electrical sq foot ELECTRICAL J EPERMITFEE Elec Permit Issuance ELECTRICAL /S'O MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING s'v PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING • 360