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04050033 (4) CITY OF CUPERTINO �t'a♦ BUILDING DIVISION PERMI03f*✓`iT RI{4, � 7'r'g� era „ .. ..... ,..?"_... �,�„ BUILDING ADDRESS: VANNI BROTHERS CONSTRUCTIO ERMIT 110 4'050033 15 ER'S NAME: PERMIT ISSUE DATE RONALD BERNARD PHONE: SANITARY NO. CONTROL NO. (408) 253-7028 ARCHITECIENGINEER: BLDG BUILDING PERMIT INF ELECT PLUMB MF.CH >?Op LICENSED CONTRACTOR'S DECLARATION CM t100 F 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing 17 with Section light)of Division 3 of Ne Busincs Professions C do,anti my license is o. in full fort�aqtl effect. - I b..L N,:,✓. ucenaechK i ue.x 3 2 ��$ HALL BATH REMODE ale G`- C,-a Commctor" '-'3- £C ARCHITECTS ECL TIONN >? lunderstandmyplans she llMuacde rccard. 2004 OWU I 3:,t' Licensed Professional c.0$ S R-OWNEBUILDER DECLARATION BUILDING)1 '`V■ c.<f 1 hereby affirm ffirm that 1 OWNER-BUILDER from Ne ATaelarl License Lew for the V i e RolloWing mon.(Section 703 1.5,Business and Professions Code:Any city or county m which requires a permit to construct.alcor,improve,demolish,or repair any structure I-4eprim to its issuance.elm acquires[he applicant for such permiuo file a signed statement that he is licensed puretwnto the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation ymF$ (commencing with Section 70(07 of Division 3 of the Business and Professions Code)or y .. Nat he is exempt therefrom and the bola for the alleged exemption.Any violation of ���tvamy,��xy Secilon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 t}dytill 4Ifd1Uer0 0 Occupancy e not mare then five hundred delta.(11500). P y�p ❑I,ss owner of the property,or my employees with wages as their sale compensation, will do the work,and Ne structure is not intended or offered forsale(Sec.7044,Business and Professions Code:The Columbus Lt...Law does not apply to an owner of Required Inspections property who builds or improves thereon,andwhodoessuch work himeelfor through his awn employees,provided that such imprownicaut are not Intended reoffered forsale.If. however,Ne building or improvement issaid within one year of completion,Ne owner- builder will haus the burden of proving Nat he did not build or improve for purpose of sale.). ❑1,as owner tuf Ne property,am eselinimely contracting with licensed mommom to construct Ne projem(Sec.7W,Business and Professions Code:)The Contractars Li- cense law does not apply in an owner of pmpeny who builds or improves themrn.and who contracts for such pmjecU with a contractor(&)licensed puravanuo the Convectors License Law. *1 am exempt under Sec. .B 8 P C for Nis moron er Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of Ne following declaration: ❑I have and will maintain a Certificate of Consent to self-insum for Warkces Compere &soon,as provided for by Section 37W of Ne labor Codc,for Ne performance of the work for which this permit is ini ❑1 have end will maintain Workers Campens.0m Insurer.,be rcgeimd by Section 3700 of the Labor Code,for Ne Performance of Ne work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: lu No.: CERTIFICATEOF ONI MWORKERS' COMPNURANCE (This aceflan need not he completed if the permit Is fortune hundred dollars(1110)) or less.) I certify that In the Performance of Ne work for which this permit 4 issued,I shall not employ any Person in ray mannerpnss 0hecomq subject the Warkcra'Compensa0on Lama of Califor 1. Ic d•"s3 ( Applicant_. NOTIC APPLICANT:IL after making this Cenificme of Exemption,you should becom jcm to the Workers Compensation provisions Of the Ichor Code,you must .J O bol with comply with such provision of this Permit shall be deemed revoked. ,Z_t 7) CONSTRUCTION LENDING AGENCY (—r I hereby affirm Nat More is a construction lending agency for Ne performance of Qa'r7 Ne work for which this permit is issued(Sec 3097,Civ.C.) W� QLender's Name E z Lenders Address V Q 1 certify Net 1 have read this application and sato that Ne shove information is - Corect.I agree to comply with all city and county ordinances and state laws relating to Q U buil)Iing construction,and hereby auNtunee mpresenbtives of this city to enter upon the W above-mentioned property for inspection purpams gy (We)agree Ire save,indemnify and keep harmless the City of Cupertinoagainst ria Vd liabilities.judgments,costs and expenses which may in any way mere=against said City O Z, in consequence of Ne gmming of this permit. ^' APPLICANT UNDERSTANDS ND WILL COMPLY WITH ALL NON-POINT Issued by:9162� Date SotRCE REGULATIONS. Re-roofs amen of ApplicamoContractor ..,_yr Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or Room building occupant store or handle haardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety ee, 0ybs �Nu Section 25532b.)? All roofs shall be inspected prior to any roofing material being installed. ❑Ye Will the applicant or future building a.aPanl use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove emit h iulmhu a air coomminanm as dc0ned by the Bay Am.Air Quality Management all new materials for inspection. Diacid' El yes [F(Nu I have mail the hvardnus materials requirements under Chapter 6,95 of the Cali For, ainHealth&Safety COdc.Section 25505,25533 ad undcrsmnd Nat if the building does not currently have a meant.Nat it is my resisinsibifl(yta-zearg[ji Me mcupmt of the roquircmcoo,which most be met poor to issuance of a Cert fmato mf O.upaney. Signature of Applicant Date own .awhori,.adogcnt Dae All roof coverings to be Class"B"or better 4'�I� � Gy. 001i Lir 'S ry 10 WA GL I) Tv3 su/Caov�!/JS { 6/Allecvvv7-�2 rrn 2! To/LET TO �E TUTO LUbv FG✓s H _ 3J G/fNErS sTa/4tGTc.AYl1A Dov/t5 To/d45 .07A NT A/aB. • �) . �/�c.ac�r GA�vt vie�,o to/P�t R/S�rrzr �cw AME/CA -ST 2A0z-u1wtgl,v6. sl iusnc4.t /yOly PLvr�t/�iw� r-lxrvrrr¢5 ✓ACAol "L.00Arl$A/ a/< WALL S OIL OT-HeA SrrzuLtu2A � coMpONjrMT$ -- - 5yrrf ------ #4'9/ 7V TO To/LjCr — - , - /1CRsW CA /31�V.�•T' Doc/Z:a' r ..:.� .�..,�-.�:..� �� .- <r..� � . . ,4atiA 1 g a , ;- . - AY- h $Cv 7) NO -s4.CeTZCAr�L WDIVC OrHE Z CITY O1 CUPERTINO TKA N ".2�n�a t�.aj aNT O W ate- .p�uG'S `AaD Swlfc .v,s'S, "SDA ®RA '�I�ill�h�T APPROVE INACEORDAN" tfHT; 8J /HS,— �t ' ,y¢wM�/licint � w GtiPtTU j NA _ .. )yew CA4/rv)r�7- 0o,J,4t IY(cCl /3!Nd�' _ 1114. SIGNED_ r • ---- This set of p a... specie rat ns ;1t ire kept on t „ job at a!I times (awful to ..ake any changes or alter tin on sari wahout written.perm: Sion At�w eo![cci[ fhe dding Oept., City of Cupe,kino. si,y,C 'Th�j stampfiig of dris plan and sp citia p is G LL NOT be held to permit o top ,: p L/N-� N (� _ f PPicval of the violation of any Ipro�; at any of�W-a -------- - - - - - - -- - --- ---- -- 13 C2tiA.20 eerslVeWC,5 WAY M/45R CuPe/r rlivo CA qsID/u APA/ _;�;6 -/-r- OZ Q ITY OF CUPERTINO CITY Or PERMIT APPLICATION FORM ' 'S '3-3 CUPEkTINO APN # Date: _ G G ls- o � Building Address: po/7hy , Fa Mailing Address (if different from building address): Owner's Name: }� Phone #: 6 CJ ry Contractor: / License #: 7 VA/\)/V,, �j/2jt/n1t�S �' c, ' S 7Z— FJ Contact: Phone: Cupertino Business License#: /U C— Fax: ' 2 S3-7c z, Building Permit Info: Bldg ❑ Elect ❑ Plqrrlb 0' M Job Description: i Residential ©' er Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Gro Type of Construc ' 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 BBLDGFEE Bldg Permits . foot BUILDING BBOILER1 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 ZS s, lof3 ��� � C, 61TY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO AWL lip Quantity Fee ID Fee Description Fee Group 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 Pb1g 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 d BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING l 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 cfin MECHANICAL BRENLA KHAN A/C Units<= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM 3USWAY 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 II BREMREPALT Repair/Alter Heating MECHANICAL 2 of 3 1 4ITY OF CUPERTINOi 1 CUPEI OF PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Sips 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 ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERNH FEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING • ZADDCHG Address Chane BUILDING 3 of