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04050162]CZ e0= E SIDn 0z ;C a.0 t k26 al�c 2:a c CITY OF CUPERTINO PONTk'A' BUILDING DIVISION PEIZMI ,, BUILDING ADDRESS: STONY RIDGE CONSTRUCTION PERMIT NOU 4050162 10706 PINOLE OWNER'S NAME: PERMIT ISSUE DATE QUAMEET LAMBA 214 ALICE A E. SANITARY NO. CONTROL NO. (408)866-8922 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing Job Desoo pt) II�� wire S.mion7 )orDivision3ofthe Businassand ProfcssloneC d„d license is L \YI REMDOEL In full tame anteEt. Lie.» KITCHEN ' - Contractor f: AUG 11 2004 Doens°Ga Dam _ RCHITECTS DECLAgA ION ✓ � ah^all'=S as pub ITE records '(r^' ��'�®��� i Licenudu n' ess� OWNER -BUILDER DECLARATION I herchy affirm Nal 1 am exempt from the Convectors License Law for the i following mason. (Section 703 1.5, Business and Professions Code: Any city or county which requires a permit to cnustrucL alter, improve, demolish, or repair any structure I prior L. is issuance, also requires the applicant ror such permit o file a signed statement Sq. Ft. Floor Area Valuation a thathcislicensedPursua.OnthepmvisionsoftheCommon''sLicenselaw(Chapter9 (commencing with Section 7BOB Or Division 3 O the Business and Professions Code) ser Net he is exempt therefrom and Ne basis for the alleged exemption. Any violation of er 0 0 Occupancy Type Seaton 7031.5 by any applicant for a permit subjects Ne applicant 10 a civil Penally of On more man five hundred dollars ($500). ❑ 1. as owner of Me property, or my employees with wages as their sole compensation, Required Inspections 9 P will do me work and the m nun, is nut intended or offered for sale (Sec. 7(M4, Business and Professions Code: The Canuactor's License Law does not apply m an owner of Property who builds orimproves thereon, and whodoes such work himself or through his own employees, provided thmsuch improvements on notinumded or offered forsals. If, however, the building er improvement is said within one year of completion, me Owner. builder will have the, burden of proving mat he did not build or improve for Purpose of sale.). ❑ 1, as Owner of the properly, am exclusively contracting with licensed .nhacmrs m construct the project (Sec. 7044, Business and Professions Code:) The Contractor's U. cense Taw does not apply to an owner of property who builds or improves memon, and who contracts for such pmjecm wit a contractor(s) licensed pursuant to the Contractor's License Law. ❑ I am exempt under Sec .B&P C for mice rcazon Owner Data WORKER'S COMPENSATION DECLARATION I hereby M. under penalty of perjury one of me following declmmbms: 1 have and will mainain a Cen rlc w of Consent to self -insure for Workei sComPm- satier.. provided for by Secdun 37W of the labor Code for me perform... of me work far which this permit is issued. ❑ 1 have and will maintain Workers Compensation Insurance, as required by Section ' 370DufubcL41WrCoda, for the Performance Otte work for patent is issued. �which lthis andPolicy smion MyWork � 6av `' • CERT(FICA OFCEXa PPmgfe. Policy No,o�ON FROM WOYKERg' co INSURANCE (this union need not becompleted ifine Permit Isforonc hundred dollars ($100) or leas.) I cenify mal in the performance of me work for which this permit is issued. l shall not employ any person in any manner so az to become subject to the Workers' Compensation Laws of California. Dam Applicata NOTICE TO APPLICANT: If, after making this Cenifcam of Exemption, you should become subject in the Workers Compensation provisions of Ne lahnr Code, you must forthwith comply with such provisions of this Permit shall he deemed revoked. . CONSTRUCTION LENDING AGENCY 1 hereby alErte mal mire is atinn lending agency for da performance of > the work for which this permit is issued (Sea. 3097. Civ. C.) Lender's Name Lender's Address � 1 centry ten I have read this application and sate mat me above infocom hni is come.. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorim represenatives or ibis city to enter upon me for inspection above-mentioned property purposes. ys (We) agree to save, indemnify and keep harmless the City or Cupertino against n liabilities,judgmcna. costs end cxpcfaseswhich may inanywayaccmeaga st said City Z in cones ncE or me granting at this permit. COMPLY WITH A NON -POINT Issued by:9 Date APPLIC fb�DERSTANDS AND WILL SOURC ECf/LATIONS. /' - `Ov Re -roofs Type of Roof Signaulfear Applican mmacmr Date HAZARDOUS MATERIALS DISCLOSURE Will me applicant or future building occupant store or handle harafdous material az defined by the Cupertino MonteCode. Chapter 9.12, and the Health and Safety Code, Section 25532(.)? op All roofs shall be inspected prior to any roofing material being installed. ❑Yea If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hamrdous air comearmams az defined by the Bay Area Air Quality Management all new materials for inspection. DisuicR ` ❑Yes @yll I have read the hazardous materials requirements under Chapter 6.95 ofth. Caliror. rainficalm&SafatyCodc,S.6.ns25505,25533.d25534.1undc,S=dmotifthn Iwil ing does no ndy, have a mnanL mat it is my map..,Mility to notify the Occupant or me reqs whichmowtiomelprinrmismNeq'i]r.cc fiaamyrOc.Pdcy. S _L �y Signature of Applicant Date All roof coverings to be Class "B” or better owner or authon7egigam Dam • , � con� � i 6Q FWi;ceo, 150 3030 e I9 a Ki s . — --0 — — -- � 0 CSS M .12 App's F�otesca�� l � Z�ffwvftr THE 05 DC3:oDy isand MUST j�'�" rimes and 'R is ung ( ges or atteratfons I permission. foam CUPERTINO aUOL CDIN(t DEPARTMENT G uaw.eA �RO- f- cl C, 10 70(� ?\r01 e C oust adirla t>cgt., C' ,)f Cupert no. 'he stanm of this p and s +HA!: NCT be held to wMA at W he aD S; D"i A the rioiftA of 1" D M 00 adilvs CITY OF CUPEkTINO 0 PITY OF CUPERTINO 0 PERMIT APPLICATION FORM N # ��? .3 0 ZZ_ Fee Description Date: 5 -4-0Li Building Ad' �y ss: MECHANICAL Mailing Address (if different from building address): O 1 1n C BBOILER1 Sam ti 0er's Nam : rLAAVV%P.� L&, BBOILER2 Boiler > 100K to 500K Btu Phone #: BBOILER3 Boiler> 500K to 1M Btu MECHANICAL ns-17i Cn or. BBOILER5 Boiler> 1.75M Btu MECHANICAL License J„t9DSYS C� BCONSTAX Ind/Off/Comm/Quasi BUILDING ! Qq Co act: pp Phone: 7 t1076 Cupertino Business License#: ♦1^h 1� OS Fax: Constax - Resi/Mobile BUILDING uiding Pe it Info: Elec 600V <= 1000A ELECTRICAL Id! — / ELECTRICAL - Elect Lei' Plumb Mech ❑ Job Description: /I// BENERGY Energy BUILDING BENERGYADD Residential0!._ /C BUILDING BINVESTIGA Investigation fee BUILDING Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of roject: Occupancy Group: Type of Construction: Please check this box i %the project is a second -story addition: ❑ Project Size: Standard ❑ Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other A liances 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 I of 3 CITY OF CUPEkTINO SfTY OF CUPERTINO 0 PERMIT APPLICATION FORM aauuL ree W Fee Descri tion Fee Grou BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housin Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL 13NUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW —Atmospheric Vacuum PLUMBING BPCESSPOOL i Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING 2 of 3 OCITY OF CUPERTINO* %10F PERMIT APPLICATION FORM ri JPFRTINO uanti Fee ID Fee Description Fee Group BRENfRESAPP Remodel Res ADDliance ELECTRICAL BREMSIGNAD Rmdl Pivnq Add Branch ELECTRICAL BREMSIGNS Remodel Si s. Marquee ELECTRICAL _ BREMTHEATR Theatrical Lijzhting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems_____—L MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection BUILDING BS WIM Swimming Pool BUILDING B Temporary Power LECTRICAL BTEMPPERM Tem ora BldgPermit BUILDING. !ELECTRICAL BTEMPSVCS Tem Dist Svcs ' BUSLIC Business License BUILDING ELECTRIC Electrical so foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL 1 MPERlvIFEE Mechanicals .foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbin2 Permit Issue PLUMBING PPLBG Plumbing Fee so foot PLUMBING ZADDCHG Address Chan e BUILDING • 3 of 3 BUILDING DIVISION PERMIT CONSTRUCTION 1"w""11"004050162 NAME: Dam Am licensed a3ofdm Bu KITCHEN REMDOEL I hereby affirm that I am exempt from the Contractor's License Law for the following moon. (Stenon 7031.5, Business and Professions Code: Any city or county which mqulres a Permit At constmct, after, improve, demolish, nr repair any structure prior m its issuance, also mquinss the applicant forsuch permit m Ole a signed stamment thathe is licensed p rmantto dm pmvisionsofthe C.ramemr'a License law(Chapmr9 (commencing with Section l") of Div'vion 3 of the Business and Professions Code) or that he As exempt therefrom and dw basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more dmn five hundred della. (5500). ❑ 1, u owner of Ne pmpcny, m my employca with wages u thetrmle compensation, will do the work and the swctum is not intended or offered for sale (Sec. 7044. Barriers .it Prolnsiou Code: The Commerce's License Law does not apply m an owner of property who builds or improves thereon, and who does such work him aelf or through his own employees, provided that such Improvements am not imm�tled m offered for ask. IL however, the building or improvement is said within one year of completion, the owner, builder will have me burden of proving Net he did not build or improve for purpose of ale.). ❑ I. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Profusions Cede:) The Contractor's Li. cove law dots not apply man owner of property who builds or improves themon. and who contracts for such projects with a conuacmr(s) licensed pursuant to dm Comsetoes License Law. ❑ 1 am exempt under Sec. , B A PC far this reason Owner Da¢ WORKER'S COMPENSATION DECLARATION I hereby, dfmm under penally of perjury am of the following dedamikuts: 1 have and will maintain a Certificate ofConsenuo xlf-insum for Worker'rCompen- as pvidcd for by Section 37X1 of the Isbm Code, for dm perfarmace of to or which this permit is issued. I have and will maintain Worker's Compensation Insurance, As required by Section 3700 of the Labor Code. for the pcAonnence of the semi forwhich this permit is issued. My War ke) Mir nsadon lira rance al ier and Policy nynlber ares � 1 (This rection need not M completed if the permit is far one hundred dollars (51011 or lest) I certify that in the performance of the work for which this permit is issued. l shall not employ any poison in any manner An ss to become subject to the Workeri Compenadan Laws of California. Dam Applicant NOTICE TO APPLICANT: If. after making this Cenificate of Exemption, you should become subject in me Worker's Compensation provisions of the labor Code, you must forthwith comply with such pmvisinrm or this Permit shall M deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that mere is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Ci, C.) Lender's Name 1 certify that 1 have mad this application and sum that the above infotmatiun is 1 agree to comply with all city and county ordinances and state laws relating to I construction, and hereby athartae mpruentstivu of this city in enter upon me harmless the City of Cupertino against \ may is any way seethe"a rl old Cily COMPLY WITH A NON -POINT Issued by: HAZARDOUS MATERIALS DISCLOSURE Will the appliam or future building occupantsmre or handle haradous material nod by the Cupenino Municip Code, Chapter 9. 12. and the Hcelth and Safety Section 25532m)? C] Yes o Will the applicant or future building occupant use equipment or devices which vardnus air comuminays As refined by the Bay Arca Air Quality Management ❑Yes ' ai iia HcalthAs SafetyCiek, Sections 25505.25533 and 25534.1 am emsend this if the building does noytif# tly have A tuna, Net it is my reapgniihility to Amity me occupant of the Re -roofs Type of Roof 199P!Ia�4tY44131n SANITARY NO. CONTROL NO. iaVILVnVU YC.." uniYV Job Description Required Inspection Date 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 all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better