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03020058CITY OFCUPEWrINO I*•" a�.�ra" BUILDING DIVISION PERMIT CUNTRACTORjINFORMATION f - 1 BUILDINGADDRESS: HANNA STEPHEN J AND CASSIE PERMITNO. EN J AND GASrTR APPLICATI A A2 /I Q PHONE: - SANITARY 907 CONTROL NO. ARCHITECDENGINEER: BUILDING PERMIT INFO ' BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION I hereby affirm Nn I em under provisions of Chapter 9 (commencing )Ob DCSCrlpt100 of Bu is in fu Section and IB of Division 3 of am Business and professions Code. and my license is in full cl„na`B"� � � � J6%� � ® ate.« BATHROOM REMODEL Dem Contractor ' ARCHITECTS DECLARATION IunderaanJ my plansARCHITECr das public recordsECLARATION - a7 L MAY 0 gy 2003 Licensed Professional OWNER -BUILDER DECLARATION 1 hcrthy amens that 1 stn exempt from Ne Contractor's License Law the BUILDING following mason. (Salton ]1131.5, Business and co ons Code: Any city county whish mgY1m3ne,mdl 1000ns aItAr.lic Ins de s improve. its poor to its the pouch Per fie a siganytlnKlum that he ceense dpa150mg.lthe theapplicanto 0.gash t.r'IO fdCa Lawhapistatement 9 Sq. Ft. Floor Area 5'lNtion (commencingwithgauon]11110) (mmomesBcenwdpSrsuammthepmvivision3oftheB strmr.uanrfssw(sCode) Code) or theeged exempton. Nat he is the basis for On vi Ihertfromcand the beers for the alleged a Any vlplationenalty of Any Section 31.5 b pliant to any applicant for a00). subjects the epplicenuoadvll penally of Occupancy Type rant more than five hundred aonem ($so0). . than five 3MP):1;YgI!er00 ❑ 1, as owner of the prepay, or my employees with wages As their sole compensation, will do the work, and the awmure is not intended or offered for sale (Sec. 7W, and Professions Cold: The Comma mt License LAW don not apply to an owner of 101 - FOUNDA)GIPHd Inspections j propenywhobuilds orimproves lherron, and whodms.whwod Monello, through his 102 - PIERS own employees, provided Nat such improvements are not intended oroRercd for ole. IL however. the building or improvement is sold within one year ofeompletion, Ne owner- 103 — UFER ' builder will have the burden of proving that be did not build or Improve for purpose of 104 - REBAR ole.). 01. a owner of the propeny, am exclusively contracting with licensed contractors to 105 — ANCHOR BOLTS construct the prejecl(Sec.7Da4, Business and Professions Code:) The Contncmr'a Lb 106 — 'SEWER & WATER cense Law does not apply to an owner of property who builds or improves themon, and who commcts for such projects with a contractor(s) licensee pursuant to the Contractors' 202 — UNDERFLOOR PLUMBING LI"rte Law. IAm exempt under Se - , B k P C orthi mann 203 - UNDERFLOOR MECHANICAL 2�g o 204 - UNDERFLOOR FRAME Dg�e ORKER' M NSATIONDECL.ARATO3 205 - UNDERFLOOR INSULATION Thereby am. under penalty of perjury one of the following declarations: 301 — ROUGH PLUMBING Dlhave and will mainbina CeniRumaf Consenuo Alf -room (or Worker's Compen' 302 — TUB & OR, SHOWER when. As provided for by Section 3700 of the Labor Code, for the pedormaae of the work for which this permitisiamed. 303 - ROUGH MECHANICAL Of have and wilt maintain Worker's Compensation Insurance, as required by Section '304 — ROUGH ELECTRICAL 37(g)of Oc Labor Code, for the performance of the work forwhich this permit is Issued. 3O5 FRAME — FRAME . My Workers Compensation lnsumpa carrier and Polity number are: Carrier: O: 305 — N6 HOLDO IONFRolicy CERTIFICATE OF E%EMPr10N FROM WORKERS' 307 - INSULATION COMPENSATION INSURANCE 308 - SHEETROCK (This secdmm need not incomplete! If cele peril aforme, hundred dollars (SIM) onuses.) 309 --EXTERIOR LATH I ccnify Nat in th t m(trmaac Af the work mr thH permh is issued, I malt nm 310 — INTERIOR LATH - croployanypc a man so hcc m suh'auAlhe Workcmi '011-110Compensation 0` ) P` 311 - SCRATCH COAT f Cal Laws -IC Appl, - n^^'s"'� 313 - 501 = ROOF NAIL - —' FINAL ELECTRICAL ENERGY ' NOTI AP I ANT: If ma:Ing Ihls Ccnilicam of EscmptinA, you should hec uhjealo the WorkeIt A, at,'hiscisinnsof the Lesion.'' youmust mnhwnh comply wins mch Previsions onnia Permitshs0 be Ain mvnkce. 502 — FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I thereby storm that then its eminrth,, on lending agency for On performance of the Work IWhich this Perot laissued (Sa.3W7,Che. C.) 504 - FINAL BUILDING ENERGY Lenders Name 505 - FINAL ELECTRICAL Lenders Add 1 ccnify Net 1 have read Nis application and some that the above informaaun is 506 - GAS TEST .. correct. l agree to comply with all city and county ordinances and nate laws relating to 507 - FINAL PLUMBING building convection, end hereby Authorize mpresentatim of this city to enter upon the ahovDmcminned property for inspection pompous. 0 - FIN MEC IC (We) Agra to save, indemnify and keep harmless the Ci ly of Cupertino against O 9 F I liabilities. judgments, tutu and expenses which may in any way accrue against City in consequence of the granting of this Permit 5 NG NT ANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: C WORKS Date SAPPLIOUR ATIO Re -roofs 4- Acnalt uurt can on to Date A DOUS MATgocc a DISCLOSURE Type of Roof ' Will for future building handle aadal , e. Chanlsmreor ytepp a deaSea by the Cupertino Municipal Code, Chapter 9.12, end the Health and Safety Health And Section 25532(a)7 (]Yes �n All roofs shall be inspected prior to any roofing material being installed. mlare buildingequipment If a roof is installed without first obtainingan inspection, I agreeree to removewin the applicant or l use ur dwhich o Dill nanNm air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection. - Oistricll A� ❑Yes rpgN I have mad the ha gramme materials mquiremcnu under Chapter 695 of the Califon ' nig Health@ SarmyCodc, Smftxo 5505.25533 and 25534.1 undersand Nam ifac building does not cu All here A m n it i responsibility m censor rccupw of do requt wbmh n.R met am amceo(eCithi umof p y. Signature of Applicant Date All roof coverings to be Class "B" or better nes nr nnzcdam �0, 4 z Z? �i L1s Gi �z UO 0U U U� 0 CITY OF CUPERTINO W'Ma ,1 V I ".''01-pR F„..,, hy�y BUILDING DIVISION PERKff {�isx �'`".�1.1�?IL`I,4';pR:: till •'�'. - BUILDING ADDRESS: HANNA STEPHEN J AND CASSIE PERMIT NO. OWN2kV _ APPLICATI A PHO SiE SANITARY 0. CONTROLNO. ARCHITEC (ENGINEER: BUILDING PERMIT INFO BLODG ELECT PLUOMB MECH 0 i LIC ENSEDCONnsed Od R'$DECLy, Of chap 1 ion? affirm that I am licensed under provisions of chapter 9 (commencing with Section DiWsion 3 of the Business And Ro(casiana Codgend my license is Job Description in full force entl eflttl. and erfec ' License Class Lia. Is BATHROOM REMODEL Dam Conlncmr w■ E ARCHITECTS DECLARATION 1011 1mounds 1 undenlend my plans shell Ted as public AR�3 a \■B!�' MAY 0 6 200% ' LmcnsedPmfcsronel i OWNER -BUILDER DECLARATION - 1 hereby .(Sinn on I am exempt from Wer Cssion o e: Any c Law for the n] followi county Any city mmenum which squires a whichingmosoa Permit to cnnetncl, elms. Improve, construct. aluessand m, demolish, sig any xwment ' i u cc ua ,also t ce the applicant Permit to h Permit 1 fi c a INIM Rai hePrior ofibemch Nal he is llcenscd pursuant to the previsions of Ne Conuaclmh Ucensc Law (-mills d purses nt to mens Law Ineremcm Chapmr9 Sq. Ft. Floor Area (Commencing with Section 7000)nf Division 3 oflhe 8usinessand Professions Coae)ur SV,a�latlOn l/ V . that he le exempt Nemfmm and the basis for the .tinged exemption. Any violation of Section 7031.5 by Any aPPHWdd for a permit subjects the applicant to a civil penally of Out... than rim hundred dollen ($500). 3 M$1-M161§@F 0 0 Occupancy Type ❑ l,uownuofthe Pmpeny,ormycmployeTwiNwagesuarcirsolecompenutlon, will do the work, end Nearnmure is not intended or-UA.d finale (Sec. 7004, Business and Professions Cade: The Comicrors License Lew does not apply W an owner of 101 llnigC — FOUNDA.I�yd Inspections property who buildsor improses thereon, and who doessuch work himselfor through his own employees, provided that such Impmwmenu ase not intended oroBered forsale. If, 102 - PIERS however, the building or improvement is sold within one year ofeempletion, the owner 103 — UFER builder will have We burden of pmving Nat he did not build or improve for purpose of sale.). 104 - REBAR ❑ 1, as owner of the PmPeny. Am exclusively canuscting with licensed currencies, to 105 - ANCHOR BOLTS - construct the pmjem(Sec.]044, Business and Pmtessions Code)The Conusewri u" mese Law docs not apply Nan owner of propeny who Wilds or improv lhemon, and 1O6 — SEWER & WATER who contracts for such proiecu with a comrsctor(s) licensed pursuant to the Contractors' 202 — UNDERFLOOR PLUMBING myLimit. law. lam Tem (uddA,S ,B&PC or thi reason 203 - UNDERFLOOR MECHANICAL opsr Da{e 2/$'p 204 - UNDERFLOOR FRAME YORKER' �M. NSATIONDECLA'RAYK) 205 - UNDERFLOOR INSULATION I lumBoyaRtmunder No BY o(perjury one ofthe\following dmlanruu: 301 — ROUGH PLUMBING ❑ l have and will mainulna Certificate of Consent to salf-insure fur Workeb CTnPen- 302 — TUB be OR SHOWER Aided, as provided for by Section 3700 of the labor Code, for the performance of the work for which thisrermhlsJaime. 303 - ROUGH MECHANICAL ❑ I have and will maintain Worker's Compensation Insurance, As required by strand 304 - ROUGH ELECTRICAL 37M or the Labor Cade, for Nc pedotmarm of the work for which this permit is issued. My Worker's Cohort,...ura NR Insnce ar came, end Policy number e: 3O5 — FRAME Carrier:Pouey rva.: 306 - HOLDOWNS CERTIFICATE OF EXEMPTION FROM WORKERS' 3O7 — INSULATION COMPENSATION INSURANCE 308 - SHEETROCK (This section need nothamropleted Edna Permit orlcu) 309 - EXTERIOR LATH I certify Net m th once of We work for which Nis permit is issued, l shall not 310 - INTERIOR LATH - 'in oyan'N man an c �subjmuotheW-do".Compcnsa..0 311 313 - SCRATCH COAT - ROOF NAIL a"' NorArid, OAP 1 ANT: If m sit this GCr11BCa1C of Exemption, you should bre We hjttuolheWorke ompenntionprovisio.ortheLaOuCudc,youmun forthwith comply with sock provisio. or thhre.hahall W accmtd revoked. 501 - FINAL ELECTRICAL ENERGY 502 — FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY I hereby affirm Nat Nem is a conswceion lending agency for the performance or 503 - FINAL MECHANICAL ENERGY the work for which this permit is issued (Sm. 3097, Civ. C.) 504 - FINAL BUILDING ENERGY LenLa.d.es Name Name 505 - FINAL ELECTRICAL Lenders Address 1 unify that 1 hive read this application and sate the, the above information is 506 - GAS TEST correct. 1 agree to comply with all city and county ordinances and state laws relating 1° building construction, and hereby Aulhorim represenutim, of Nis city to enter upon the 507 - FINAL PLUMBING mom-memiuncJPmPcny to, inspection purposes. O — FIN MEC ICAL (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities.judgments, costs and expenses which may in any way am.e-911.1 lid City O 9 F I YZ In consequence of We granting of this Permit. 5APPL NG SOUR NT UNDERRSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date C WORKSDate Re -roofs - ME,en on In Date A DOUSMATERIALS DISCLOSURE Type of Roof - WilltheAre 1orfuture building om.pamsmro or handle hauNous matede, As defined by the Cupertino Municipal Code, Chapenr 9.12, and the Health and Safely Code, Sc 25532(a)? ❑ yes Yes �No All roofs shall be inspected prior to any roofing material being installed: Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove .mit ha'urtlous air contaminants u darned by the Bey Area Air Quality Management District? all new materials for inspection. ❑YcA kNo I have mad the haoardousmamriais requirements under Chepmr6.95 orthe Califor- niAHealth&SefctyCWc,Seedo.25505.25533ud25534. lunmrst dNmlfNc Wilding rc m a u n hat it iym(responsihiliey to nndf c occupant of Ne esu mel nor d (yuanec oft Cenircam of0 1.4W1;2chw y' Signature of Applicant Date All roof coverings to be Class "B" or better or.sired ate 65-1/4" • • SUBMITTAL 101" C K K K C K K C K C C C z YxKYZKYZKYxK,xK,z,a Yx •x Yx YxKYxKYxK,z Yx •z YZKYz,s Yz Yz YxK,xKYxKYZKYZK,x Yz Yz YxK,z,,i,z,x,x Yx x Yx <1 ixK<] YkKYS YxKYx Yx,x,x Yk YxKYx Yx Yx,x,xKYx Yx ix <kKixKYx,x.xKYkK<k YkKrkKrj rxKYx rx rx rx CyK C Y Y Y Y Y YKYK<C< Y Y YC C< yC K <C K C< yCyRYCyKyCf.CYC�.C�.K 8" 47-1/2" �— 33-1/2" APPROVED IN ACCORDANCE WITH THE CUPERTINO CfDFS AND D I This s(p� specifiratiens i19U5t be kept on the job at all times and it is un lawful to make any changes or alteration€ nn same without written permission front ,21u,,I,dingDept., City of Cupertino. stamping of this plan and specifications f_NOTbe held to permit or to be an Iofthe violation of any provisions 'yity Ordinance or State Law. 28" ►�� 39-1/2" 5-1/4" z.z.z. 45-1/2" Rl l iiiz Ot<x Yk YxKrx ', CES Y]<k' YVYx.................... This s(p� specifiratiens i19U5t be kept on the job at all times and it is un lawful to make any changes or alteration€ nn same without written permission front ,21u,,I,dingDept., City of Cupertino. stamping of this plan and specifications f_NOTbe held to permit or to be an Iofthe violation of any provisions 'yity Ordinance or State Law. 28" ►�� 39-1/2" 5-1/4" i L CITY OF CUPERTINO CUPEPNO PERMIT APPLICATION FORM �Irl diad oosS� APN # 52jo ate:. 6 I Building Address: 3 %loel lye.. Owner's Name: 1 ,54 l �ah Phone #: �%. a -410 g -2s3 67 9 Contractor: seI f License #: Contact: Cupertino Business License#: Building Permit Info: Bldg Elect Plumb Meco Jobescription- ��" I/ Residential �7 n 1'nov� '��yz pc�e Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: BBOILER4 Cost of Project: Occupancy Group sDDC7��' Type of Construction: BBOILER5 Quantitv Fee ID BAPPLOTHER Fee Description Other Appliances Fee Group MECHANICAL BBLDGFEEBldg Permits .foot BUILDING 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. I Construction Tax BUILDING BCONSTAX Ind/Off/COmm/ uasi BUILDING BCONSTAXBQ Con. Tax for BO 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 BENERGYADD I Energy Energy Add Multi BUILDING BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit, Fee BUILDING 1 of OCITOCITY OF CUPERTINO CUPE(� TINO PERMIT APPLICATION FORM 2 of 3 Quant i Fee ID Fee Descri tion Fee Grou BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Famil Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bld s MECHANICAL 13NEWMULTI 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 Sin le Famil Res BUILDING BOVERTIME Ins ection Overtime BUILDING BPBACKFLOW Atmos heric Vacuum PLUMBING BPCESSPOOL Cess ool PLUMBING BPEPI E Bid Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP . Ind Waste Interce for PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADDPlan Check AddMulti BUILDING BPLANCKREP Plan Check Re cat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewa a Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER InstalIIAlter Water Pi a PLUMBING BPWHEATER WaterHeater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVERA/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <=10,000 cfm MECHANICAL BREMAPPLI A liance Install MECHANICAL BREMBUSWAY Remodel Buswa s ELECTRICAL BREMEDCT T,' -U,: --Is ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL B 00 OOD Installation -PTI )od MECHANICAL BREMMISC Misc A aratus ELECTRICAL BREMNRAPP Rem Non -Res A Iliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 'rCITV'OF CUPERTINO CUPEt�Two PERMIT APPLICATION FORM uautiFee ID Fee Descri tion Fee Grou 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 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 . MPERMITFEE Mech Permit Issuance . MECHANICAL PPERMITFEE' Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3