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03120085CITY OF CUPERTINO - "- —0N40RBUILDING = `try DIVISION PT�1 •' STACK - PERMIT `0 3 12 0 0 8 5 BUILDING ADDRESS:ANDREW PERMIT L4UE DATE OWNER'S NAME: 2 ANDREW STACK SANITARY NO. CONTROL NO. E: BUILDING PERMIT INFO ARCHTIECIENGINEER: BLDG ELECT PLUMB MECH LICENSED CO R'S DECLARATION Job Description 1 hereby affirm Net 1 am licensed under provisions of Chapter 9 (commencing wINScI Wir 7IXIfi oDIVlalI Soii Mc Buainus and!po Pili... Of Code.9(mylicenseis in full mueandeffeet. BATHROOM REMODEL--HOT RNMED License Close Lic. N Dam Compactor - ARCHITECTS DECLARATION I uncersund my plans shall be used as public mamas gig 2004 FEBr DD L l Licenua Pmfcuiansl OWNER-BUILDER DECLARATION I hereby OLiccnu Law for Inc n 1 am cacmpe Gum Ne Comon, ac;nnn Code: Any city orcounty (section and P Co i followingoups.mtto DI mJLS,Busite,. ,dunes t Or repair any Nudum do Permit { which sequins a pmmil re quires the almq top,., for such the applicant mmman Law(ned lmcmenr !in.,Wsli,c.nec.also S Area aluation q•(commencing the Commend uant inithe the Comedosi Liccnu law (C (comm lading wit puauan(MM)) of Division 3 od)))or with Seniors ]a0)) of Division 3 of the Bulinus antl Pn.My Vi Ction OfNet he is mempl dxmffom and the beau for Me alleged talent n. My vinla0on of.wn.w,NSuit. 7031.5 by airy applicant for a permit subjects Ne applicant m acivil penalty of EFLFloor 302*e;00 Occupancy Type net mom Nan fwe hundred delta. (5500). 1,uowner property,remy employees wfowaguu Nei(sole u0an. Required Inspections .the will and the nuts r add 0".Business oan B not apply t neo of and Profusions Code: The Conbaetorf License Law darn not apply tort owner of Pr lesion. hs, Contractors Lim e, Law own enywhobreiIdsorimpratuch and who doessuch work nimulf or through his own employees. improvements . uiprovided ear oftlaroRemdfor weerk. provemimprovementsseenot bowewq Ne building or improvement h sold within one year of completion, Ne owner Me builder will have Mo burden of proving Nn he did not build or Improve for purpose of .R.). ❑ 1, as owner of de, properly, am uelusively commuting with littered contractors to construct the prej9Fl (Sec. 7144, Business and Profusions Code) The contractors Li- law does d l to an owner of property who builds or improves Mercer. and cense pply wM10 comncu fon ch prokcu wilheeonoamm(r) licensed pursuant in the Conmaclors Li se w. I a rapt un1 S .B&P C for this moon ' I Owner Da ) lORB R'. CPENSATIONDECLA N Ok 1 hereby affirm uMer penalty of perjury one of Ne following decimations: I "wind will maintain a CamBcom of C.a seal r)utpWure for Worker-Compere- ulke. as provided for by Section 37M of the Labor Code. for Ne performance of the work for which Nis permh is issued. I] I haw and will maintain Workers Compensation InNnnGe. as; required by Second 37M of the labor Code, for the performenec of the work for which Nis permit is issued. My Workers Compensation Insurance carrier and Policy number au: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATIONINSURANCE (rds section need no( he completed if the Permit is for one hundred dollen (SIM) or lest.) I unify that In Me performance of the work for Which this permit is issued. I shall or employ any pcnon in any manurse as to become subject to Ne Workeert' Compcnsadon Lowe of California. Data Applicant NOTICE TO APPLICANT: If, afro( making Mis Cenifmam of Eaempdon. you should become subject m the Worker's Compemation provisions of the labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. - y - CONSTRUCTION LENDING AGENCY I hereby Orion that there iraconsWctinn lending agency for the performance of - > Mc work for which this permit is issued (Sec. 3097• CO. C.) Lenders Name Lenders Address r I certify that I haw read this application and cum Nat Mc above information is 'a COOMCL I agree to comply with all City and County ordinances and nem laws mating In building construction. and hereby amhorire mprountati m of this city to enter upon the purposes. propertyma cost for Inspection expenses shove-mej diorama 1 (We) agree to ave, indemnify and keep harmless the City of Cupertino against n Ili ajudgmcn costs and ea pensnwhich may in anyway accrue against mid City \l / 11., 1. z, in eo uensc o e gaming of this permit. I A RSTANDAAND WILL COMPLY WITH ALL NON-POINT Issued by: Date OP G I A 0 9!• Cj , Re-roofs Type of Roof igKelum of Ais HAZARDOUS MATERIALS DISCLOSU Dam Will Me applicant or future building Occupant mom or Middle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.11, and the Health and Safety Cade, S))))don 25531(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yu No If a roof is installed without first obtaining an inspection, I agree to remove Will the air unun or Iviu as a ffined occupant y A m Alf Qu or Ma as which emiI us air contaminants ss dc0ncd by the Bay Area Air Quality Management all new materials for inspection. District? Disuieti ❑Yes �No I haw .#eh. trials rtquimmenmundcr Chapmr6.950f&clifao- nu Hcaldi ctyA odc.secdom 505,25517 sed 2553d.lundcrsmnd MoifNc huilding docs n merely w r mnan4 d a it is my ruponsihility w nodl'y the mcupanI of Mc - Date mur ts vhic us cto pp wiaru.ne nratxnirmamywf.gccup. -D (G Signature of Applicant All roof coverings to be Class "B" or better 'oven)) tsps Ihori'rc ascot Dam OWER -BUILDER VERIFICATIW 1. (Check one) I or my immediate family (parent, spouse or child) will perform • A. All the work authorized by this permit A portion of the work C _ None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work DEC A portion of the work (complete section belo ) 2003 Contractor Address/City Phone # St to 'erase # Type of work to be performed 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or • portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of hnsurance covering workers' compensation must be on file at the City of Cupertino Building Department office. 0 Person/Firm Address/City Phone Number Type of work to be _performed I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner -Builder Information r erse idd . Property Signatvs DateV Job Address: f' / Permit # AM anges to the information provided on this form shall be submitted to the City of Cupertino Build DeRartment. Dear Property Owner 0 City of Cupertino Building Department 10300 Torre Avers An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner -builder you are the responsible party of record on such a permit.; Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of Califomfa and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: . If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers compensation insurance, disability insurance costs, and unemployment compensatioe contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers compensation insurance. For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner -builder building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors maybe obtained by contacting the Contractors' State License Board in your community or at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner-builiier verification form so that we can confirm that you are aware of these mattes. The bvilding,pemdt will not be issuednurntil the verification is returned. Very truly yours, Building Department, City of Cupertino Printed on Recycled Paper %5mm, CITY OF •CUPER-TINO *ITY OF CUPERTINO* PERMIT APPLICATION FORM v 3 � z ° APN # - --> C;� Fee Description Date: BAPPLOTHER Building Address: MECHANICAL BBLDGFEE (4-0 d BUILDING a Owner's Name: MECHANICAL Phone #: Boiler > 100K to 500K Btu Contractor: / BBOILER3 License #: MECHANICAL Contact: Cupertino Business License#: Buildin Permit Info: Boiler > 1.75M Btu MECHANICAL B g Elec p/1 Plumb a Mech BUILDING J b e c 'ption: Ind/Off/Comm/Quasi BUILDING Rest ential 12'- 11oF PN)r S �? Commercial ❑ BUILDING Sq.Ft. Floor Area: �cJ Hotel and Motel $/Sq.Ft.: BCONSTAXR S BUILDING BELEC1000 Elec 600V <= 1000A Cast of Proje S( . W BELEC1001 Occupancy Gro-"-: ELECTRICAL BELEC200 Type of Cotruction: G I ELECTRICAL BENERGY Energy m BENERGYADD Energy Add Multi BUILDING r LJ 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 BMITIGATC Comm. Housin Mit. Fee BUILDING L 1 of 3 CITY OF CUPEkTINO OITY OF CUPERTINO * PERMIT APPLICATION FORM ISQuantity Fee ID Fee Description Fee Group BMPTIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING 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 Repipe 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 WaterHeater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cf n MECHANICAL BREMAEU-LAN 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 LJ 2of3 IR In of CUPERTINO WITY OF CUPERTINO* PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group 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 BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, 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 Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Bldg Permit BUILDING BTEMPSVCS —Temporary Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERNUTFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chanc BUILDING U 3 of 3 IFjr'M D ppPROVEN VE ctn oa 1 1. INTE _L0 Bmm�AR SET 0$c 2,INTERAKTIV STRATOS SERI 06 0 R 06621000 THERMOBALANCE UG Must ThN set of P' s and ap times and it is im 101SCHIKER 3/8" GLASS ont a iob es or a4teraho�► CHROME FINISH AG -91 be a p make .t varitten p"misswn fmR witt+q, lino• TeD \411 C ani ca6nns 2 G' RovT �t.oR — uildmBa�+, sty ' he OomP�`� 11" d to .Permit or to be + GRoc�r �PACINCn— U $NALL , of the �-ola6on of any pTovi C aPjP pvdmance OT hate La's. 10 THRESHOLD FOR THE SHOWER PAN ® PLUMBING ELEVATION /o-� vo %rt -4 Cjty �� I+S Wtf- �N7� 1 C� TILE • LEGEND (,IM❑SIRRAH 30A C,MARFIL POLISHED 12X12 7, IMOMK,SIRRAH 12X12 C,MARFIL MESH 1X1 8, 01013 1X1 ON 12X12 MULTICOL❑RED SLATE G'Rour C-oL�oR - T1p wart cocmomaz aR 00r 99AC.I NU - ►. 6ec T+"A4'3 %iro" arra ELEVATION 11 tETE---loi IATUI3E FEE corm, 1 • •