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05070192 CITY OF CUPERTINO " `
BUILDING DIVISION PERb _ �,CON,TRACCIR
TIN, QRMQ_N
BUILDING ADDRESS: PERMIT NO.05070192
10943 WILKINSON AV
10 EWS NAME: PERMIT ISSUE DATE
SPIELMAN MARVIN AND BARBA n7/2S /2 05
PHONE: SANITARY NO. CONTROL NO.
ARCHITECTMNGINEER: BUILDING PERMIT INFO
BLOC ELECT PLUMB MECH
+Op LICENSED CONTRACTOR'S DECLARATION Job Description
u G I hereby affrm Nat 1 am licensed under provisions of Chapter 9(commencing -
U with Section 7")of Division 3 afore Businasand Profusiarm Code. dmyliccnsc is p
"z' in full far.Ind Re �� KITCHEN D %e1 j(/]�lIL `S OWER REPLACEMENT
j 2 License Claza .�1 0 G a Lie.M "J / {�,1 J(�i> I�.3,�In PI
y❑ Dam Contractor u u WWIfII]'�MC\
ARCHITECTS DECLARATION
;>U 1 undervand my plans shall W used as publi��`��� `l (`
koH Licensed Professional -AN 2006
S OWNER-BUILDER DECLARATION
<� 1 hen,hy affirm that 1 am exempt from Na Contractor's License Law for the n
p o following reason.(Section 7W 1.5,Business and Profession Code:Any city or county RN fi gI pl �t pa p y� 2 5
which myuires a permit to contract,alter,improve,demolish m repair any struclure Ij t'n !I N A fY
prior ht its issuance.also mquiresthe applicant for such permit to rile asigned stammcat y s 1` �'
z< chat he is licensed pursuant to the pravisiom of dm Cantraewr's License Low(Chape,9 Sq.Ft. Float AreaLtl �- Valuation
y'r•� (commencing with Section 701 of Division 3 of the B usinesa and Professions Code)or
y
that M is exempt themfrom and the basis far dos alleged exemption.Any vim.don of
Section 7031.5 by any applicant for a permit subjects the applicmno a civil penalty of 3r Occupancy Type
not mom than fin hundred dollars($500).
❑1,as ownu of ttie propcny,or my employees wib wage u d¢ir sole compensation,
will do the work,and Neswcwre is not intended or offered Tarsale(Sec.7044,Business
and Profoesions Code:The Contractors License taw does not apply to an owner of Required Inspections
propen y who bui Ids are improves common.and who docs such work himsr3 f o r through his
wn employees,provided chat such improvements are net amended.,offered forest..if,
however.Ne building or improvement is sold within one you of completion,Ne owner-
builder will have she burden of proving bat he did not Wild or improve far purpose of
Wk.).
Q I,as owner of an property.am exclusively contracting with licensed contractors to '
construct the pmjccs(See.7044.Business and Professions Cade:)The Conamars Li-
cense Law docs not apply to an owner of propcny who Wilds or improves thereon,and
who contracts for such projects with a constacsor(s)licensed pursuam to be Contractor's
License Law.
❑1 am e..mpc under Sec. .B @ P C for this on
Date
WORKER'S COMPENSATION DECLARATION
1 hereby of arm under penalty of perjury one of the following declarations:
❑1 hem and will maintain a CaniOease of Corrector self-intim for WorkereCamper.
sation,as provided for by Section 3700 of the labor Code,for Ne performance of the
work for which this pcman is issued.
❑1 have and will maintain Worker's Compensation Insurance,es myui.d by Section
3700 of the tabor Codc,for dm performance of the work for which bis permit is issued.
My Workers Compensation lnsumnez carrier and Policy nuurnth ramp, (J(,t
Camaa�' e T �j,([yolicy No.:L�(�[1=..t�6
C FICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
QTis section need not W completed ifthe permit is fm one hundred dollars($1010
nr less.)
1 certify that in be performm¢c of de work far which this permit in;issued.l shall not
employ any person in any manner so u In become subject to the Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this C.Illfeme of Exemption,you should
become subject a the Workers Comperaetion provisions of done Labor Cod,you muse
,JO foMwish comply with such provisions or this permit shall W deemed mwkcd.
z Vy CONSTRUCTION LENDING AGENCY
E1 hereby affirm that there is a coesttupthm lending agency Tore the performance of
> the work for which this permit is issued(Sec.3097,Co.C.)
W 0 Lenders Name
z Lenders Address
a
V Q 1 ccnee tom 1 ham read this application and sue bat be above information is
0 U corms.1 agree m comply with all city and county oNinnnoes and slate laws relatingupthe�(J building construction,and hereby forimpmhonpuMo csentativesaf this city mentor upon be
r above-(We)a cd gree to amysave find mpeNon keep es
(We)agree to save,indemnify and keep harmless be City of Cupertino against
F'Z liabilities,judgments,costsandof this Permit. may in anyway acerae against said Ciq
U z A consequence of UNDERSTANDS
of chis permit.
1) 60
rti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
B 29,-V—
Signawr p eanV ontracmr Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will be applicant or fume building uccap..,wane or handle havallous material
as dcfinca by he Cupertino Municipal Code,Chapmr 9.13,and the Health and Safety
c,Station 15532(a)7
❑Yes ON. All roofs shall be inspected prior to any roofing material being installed.
Will be applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haxordaus air contaminants n defined by the Bay Arca Air Quality Management
DistrictT all new materials for inspection.
❑Yes ON.
Iban mad thohvardeus materials25505,25533 Ind
under Chaper695o the Caldinr- / © � 0
rias not ur Safety Cale,Rectenant shat it i my mad15534.1 undersand that illW Wilding
Jos ams currently base a tenant that it my mspomihility rem notify bda<upant of IL
nequircmena which must melp�iyyrr to lssaanecorac mfeamorwrapm,cy. Signature of Applicant Date
>cS P �6C[ C2�/r/J HGF S
G ermaubarlvndagem D„e All roof coverings to be Class "B”or better
0 0
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: quem
COPY # 5
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35613028.00
DATE ISSUED. . . . . . . : 07/28/2005
RECEIPT #. . . . . . . . . : 30567
REFERENCE ID # . . . : 05070192
SITE ADDRESS . . . . . : 10943 WILKINSON AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER SPIELMAN MARVIN AND BARBARA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4774
RECEIVED FROM . . . . : BOBS
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZfP . . . . ,
TELEPHONE . . . . . . . . :
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00
BPERMFEE VALUATION 25, 000.00 331.56 0.00 331.56 0.00
BELEC200 METERS 1.00 29.43 0.00 29.43 0.00
BPINTERCEP NO OF INTERCE 1.00 17.99 0.00 17.99 0.00
MPERMFEE SQUARE FEET 200.00 16.00 0.00 16.00 0.00
BSEISMICRE VALUATION 25,000.00 2.50 0.00 2.50 0.00
BUSLIC FLAT RATE 1. 00 102.00 0. 00 102.00 0.00
EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
" ---------- ---------- ---------- ----------
TOTAL PERMIT 572.71 0.00 572.71 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 572.71 MASTERCARD
TOTAL RECEIPT 572.71
•
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OFFICE egpy
1793 Lafayette St., S• 200
Santa Clara, California 95050 I}c h E n
Phone (408) 248-4050
Fax (408) 248-4060 Jn
Web www.KitchenGatteries.com
c;l�
ELECTRICAL INSTALLATION NOTES
Marvin & Barbara Spielman
• 'Wilkinson Ave
Cupertino, CA 95014
101 —single pole for fluorescent recessed cans, mounted 21" away from exterior wall
1013—fluorescent 3-way located in eating area.
102—switch/dimmer for incandescent recessed cans mounted 21"away from the walls.
1023—incandescent 3-way located in eating area.
103 - switch/dimmer for incandescent fixtures over the table
104 - switch for fluorescent undercabinet—buffet area
105—switch for halogen "puck" inside cabinet. 12v Class 2 60w transformer location
subject to job conditions. Suggested location top shelf of wall cabinet. Unit must not be
buried in insulation or in wall.
106—switch for garbage disposal use.
107 -switch for fluorescent undercabinet—main countertop area.
• Special Installation Notes
N1 - 15a receptacle for refrigerator and freezer use. See manufacturers
specifications for proper installation
and height for these units.
N2 — 15a receptacle for microwave/hood combination use. See manufacturers
specifications for proper installation and height for this unit.
N3 - 240-208/120 VAC, 60hz for range/oven use. See manufacturers specifications!
N4 - receptacle for electric cooktop. See manufacturers specifications for proper
installation for this unit.
N5 - 15a receptacle for dishwasher use. See manufacturers specifications for
proper installation for this unit.
N6— 15a receptacle for garbage disposal. See manufacturers specifications for proper
installation for this unit.
•
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O CITY OF CUPERTIN#
CUP OF TYO PERMIT APPLICATION FORM
APN # 3 5� ` 13
-029 Date:
/;7 z8 , c�
Building Address: Mailing Address (if different from building address):
O ` So eAT, v 04 S /
Owner's Name: Phone#:
6 aA Apia i ' Ie_b
Contractor: License#:
Cont t: Phone: 6C6),2XYS22S Cupertino Business License#:
a, -' C4J-1 6> Fax: 0 31SZ;Z3q
Building Permit Info: 7AE 45VV 5VU'461GPr—V
�Cc e%hce 0A,,.4( Ad—,q/e—&-
Bldg ❑ Elect ® Plumb ® Mech 12
Job Description:
Residential ® Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
X00 1
Cost of Project: c9" Occupancy Group:
Type of Construction: — Please check this box if the project is a
second-story addition: ❑
Project Size: Standard ❑ -- - _Lare ❑ Maior ❑
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 Investi ation fee BUILDING
1 of 3
CITY OF CUPERTIN(*
CUPEI�TINO PERMIT APPLICATION FORM
QuantityFee 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 BldgPermit 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
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER InstaWAlter Water Pie PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRI AN 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 A liance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/A aratus ELECTRICAL
BREMRECEPT Rept], Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
AbL BREMREPALT Repair/Alter Heating MECHANICAL
Iry BREMRESAPP Remodel Res A liance ELECTRICAL
2 of 3
;��`�� OITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEI,TINO
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
ELECTRIC Electrical sq foot ELECTRICAL
41W EPERMITFEE Elec Permit Issuance ELECTRICAL
p U MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERNHTFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
•
3of3
CITY OF CUPERTINO a <' ` e'0
BUILDING DIVISION PERMIT kCONTRACTOR INFORMATION
BUILDING ADDRESS: PERMIT NO.0 5 0 7 019 2
10943 WILKINSON AV
ER'S NAME: PERMIT LSUE DATE
SPIELMAN MARVIN AND BARB 2005
PHONE: SANITARY NO, CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+Op LICENSED CONTRACTOR'S DECLARATION
U I heroby affirm Nat 1 am licensed under provisions of Chapter 9(commencing Job Description
with Section RIIgB or Division 3 of the Business and Profession Code,and my license is
in full force and e • 51-Y061 KITCHEN RMDL, TILE/SHOWER REPLACEMENT
j}a z Liccve Cress :J
Fp
Dam Contractor
'pry ARCHITECT'S DECLDELL
ARATION
e(-s I understand my plans shacoed u puM1lic
y4� ll be_� "�i`f0
Incensed Pmfcssionel
3 OWNER-BUILDER DECLARATION
ZQ C 1 mors affirm Net 11. exempt from N.Canlns CO License Law for the
p O following moron.Permit
1 ]IDL;Business and Profession Code:Any city as county
u29 which its requires a permit se toms;Me alts.improve.h Permit t fie a sig any .cutructure, $25000
°z„ priarmiss issuance.also requires Ne applicant for inch permitmfileasigned mtemem
m, Oat las islicensed pursuant mNeprovisions ofthe Contractor's License,Law(OwincT9 Sq.FL Floor Area Valuation
x (commencing with Section]DDB)of Division 3 of NC Business and Professions Codi or
y $ Nat he is exempt therefrom and the has¢for Nc alleged exemption.Any violadon of
Section 7031.5 by any applicant for a permit subjects Ne applicant 10 a civil penally of
not mom than me hundred donor($50B). r Occupancy Type
❑1,u owner of the property,or my employcu with wage n their wlc compevalion,
will do the work,and Ne structure Is notimanded of.Bered forwle(Sec.7Os4,Buelirss
and Professions Cade:The Contractormm
Contractors Liece Law dors not apply an owner of Required Inspections
property who Wildeorimprov Nercon.andwho dMssuch werkhimseJfor through his
awn employers,provided Nat such improvements are not intended oroRcrd forests.If.
however,the building or improvement is mid within one year of completion,the owner.
builder will have the burden of proving that he did not Wild or improve for purpose of
tile.).
❑I,as Owner of the property am exclusively...tiefir,with licensed contracmn to ®�
construct the projm(Sec.]044.Business and Professions Cade:)The Contractor's Li
cense Law does not apply u,in owner of property who Wilde or Improves Norton,add
who concocts for such projects with a canuactods)licensed puumnt in the Contractor's
License law.
❑1 am exempt under Sec. B 6:P C for Nis mason /
DauA'
or WORKERS COMPENSATION DECLARATION
r 1 hereby will
ai under penalty or e of
one of the following dalaeeuons: �/
❑inner.
as and will maintains rom 33au of the Labsent r Code,
for Wmkcr's Cruice of th-
81Aine,,for
for by Section 3]00 of the Labor Code.for the performance of iW
work for which this permits orker
❑1 have and will maintain he pcof rmance of the w Insunna,h re,his Per by Section
ss u d,
3]00 of Nc labor Code.for the prance can..of d work for which this permit is issued.
My Worker's Compensation Insurance eartier and Policy number arc:
Cmrismes6r
1160V
- CERfIFlC OMPE SATIONNSURAN WORKERS'
COMPENSATION INSURANCE
(Ihusettion need not W completed!Btis Permit is forum hundred dollars(SI00)
or less.)
I anifv Nat in the performance of On work for which this permit is issued.I shall not
Morin;any person in any summer an as in become subjttuo the WorkertCompensation
lawn of California.Dau
Applicant
NOTICE TO APPLICANT:If,afsr making this Cenifiam of Exemption,you should
become subject to the Worker's Compensation provision of flus labor Code,you most
.Jz forthwith comply with inch provisions or this permit shall W named waked.
Z O CONSTRUCTION LENDING AGENCY
(-+ I hereby affirm Nat there is a construction lending agency for the performance of
C(. Ne work for which this permit is issued(Sec.3097,Civ.C.)
CQ Lender's Name .
Z)z Lemicrf Add.
U Q I comly Nal T have read this application and sus Nat On above information is
correct.1 agree to comply with all city and county ordinances and sum laws relating to
U Wilding construction.and hereby authorns representatives of Ois city to enter upon the
r W aWvedmenudgm property for inspection expenses
which may
a
F 0. (We)agree to Yve Indemnify and loop harmleII the City of Cupertino against
TTI lieconeo,mence of the
gratsing expenses which cosyin any way¢true against said City
U Z his crunit.
APPLICANfeUNDERSTANDSOf tAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS��)
29 IV— Re-roofs
Signaler p¢andConuacmr Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will IW applicant or future Wilding ocemp tit gore or handle hanrdous mamtud
dcfrnd by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
C.Section 25532(a)7
. ❑Tea 0 N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupam use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit M1arard ors air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District? P
❑Yes ON.
Ihavemad Nehua ousmaurialsmquimmenmunder Chapmr6.95offtCalifor- !�
niaH.Il aSafctyCoda SccE..25505.25533wd25534.Iundmsund Nmiftbe Wildingr+--
docs not cmmmly ham a u enk Nat his my responsibility to notify the uc.upent of C J
tequiremcnu winch mug be
mt pmss.nceaa comfit=oSignature of Applicant Date� a�a. aS©s
own—cr car autboricd seen. Data All roof coverings to be Class "B"or better
i>