02090072 (4) CITY OF CUPERTINO -
BUILDING DIVISION FERMI ' CONT'RACTOR INFORMATI tV:
BUILDINGADDRESS: W PERMIT NO.
OWNER'S NAME: APPLICATION SUB DATE
_ TOENSFELDT HANS W AND LORRAI E278 CASTRO ST 09/11/2002
(� PHONE: SANITARY NO. CONTROL NO.
(415) 968-8318
O ARCHITECT/ENGINEER: a BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
in 2 LICENSED CONTRACTOR'S DECLARATION rR B
•5 L_ Job Descrition
jZ o Ihertby afBrmmllom licensed Inde provisions of CM1opmr9(commencing
�GyPy
m E win Srin a 7000)of Div'simn 3 of the Bu i ss end Profcssiolrs Code,and my liccnu L',�
3xx- isinf mean rc«l. KITCHEN REMODEL
< Liana Z A10 9 2�0
a Da Co
O U NNpt�/�o
ARCHITECT'S DrW.IAR TION `r 2
g I Indeed and my plans shall be used des pA6blic records
3:p Licensed Professional 13
��`D ��
OWNER-BUILDER DECLARATION
1 hereby elated Nat I am exempt from the Contractor's License law for the
?a following mason.(Section 7031.5.Business and Professions Code:Any city or county
F o which an uims a Permit to construct.eller,improve,demolish,or repair any structurece
C 14 O O O
a3°-° Prior to its issuance_,also requirtsthe applicant for such permit flee signed statement
that he is licensed isuiilt 16th[ --
pu provisions of Ne Contractor and Pr Law ,,.� S Ft_Floor Area .
(commencing wlsh5«lionoun adites Division theBusinessssalal Professions Code qq •,t 5 '�'-,,. Valuation
or thei Wisuemps themfrom endtrc basis for m<alleged uemgioh.Any violation � t !32647�003 .'00 " re"
of
•ornot
man Ira
arelM1an eiv<mhundred
dollars
r as5p0em).tll subjecrs Ne opplicom m v civil penalty
APN Number •. Occupancy Type
°I.as war,of me Properly.or my employees with wages as their sole compensation, 101 - FOUNDATION
`
wit[do the work.era the'stmcturt is trot intended or offered for sale(S«:701 -
tBuimmis and Pmressions Code:The Contractor's Licenx law docs not apply to an Required Inspections"
owner of property Who builds or improves mercer,and who docs such work hinoe f 103 - UFER
or Through his own employres.provided that such improvements ere trot intended or 104--- REBAR---
-oRered for sale.H,Wwoilde w Wilding or im en of Prov n sold within one Year of - - ---'- - _ - ._...._.._. . . .. _...... ...
parivaon,mmpose..baimer will neve the otpmving that he em not bond or 105 - ANCHOR BOLTS . . .• ,1
improve far purpox or salc.).
..-.. SEWER &...WATER.
❑Las owner o(the 'o'en ...
pr ec X em Business
d Profseximas Cod,:)
C..mors l0 "--
p ) 202 - UNDERFLOOR PLUMBING
eonswn the project(Sec.]OIs,Business oral Rofessions Coded Thr Cmnts«mr's
' Lic<nx Law docs f apply uc man owner of property who builds Or improves mto the s
--
-and.who es License Lawum projects wim,e.conlracmrtn.Ecemed pursuant to the. .. ...........2�.3_ _. _UNDERFLO.O-R..MECHANICAL
Contractors License Law. 204 - UNDERFLOOR;. FRAME,,,,-
❑1 stn exempt under Scc. ;B'&P C for This rtmon
Date
205 - UNDERFLOORhINSULATION
OwMr WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
- Thereby affirms under penallyofgcrjury one ofthe following E«Iamtions: 302 - TUB & OR SHOWER
° I have and will mainiam is Cenifierm of Ci axnl to selr.inslR far Wmk«'s 303 - ROUGH MECHANICAL
} compensation,-as provided Tor by Scrams 3700 or the Labor Code, for the 304 - ROUGH ELECTRICAL
performance of wask far which mil pera t is issued: 305 - FRAME
01 have oral will insulation Woikei s Compensation loo m er,as required by Section 3 06 - HOLDOWNS
3700 of'he Labor Code,for the pcRomunce of the work for which this permit is
issued.My Workers C°mpenulion Issuance carrier and Pai num ,am
.. . , ..,. • ..ym .307.. ,-. .INSULATION
.--.
`qm: '_e�{aet ^Plic '1T•i�e/ r ;308-i!:-JSH'EETROCK '' If',`-..: ,::Lts .•'<.
CERTIFlC knON OF EK ON FAx WORKERS'.
COMPENSATION INSURANCE .-_ -„-- ,309_.__-,EXTERIOR--LATH;..,-
' (ThkscctionncednotIs,completed hlthepermilisto,onehundred dollars 310'' '-- INTERIOR LATH ... , .
OHIO) rl ss.) - 311 - SCRATCH COAT
i really Inst in the pen'ommanee of me work Tor which Oil rannil is issued,I 313 - ROOF NA I�L. .. . .. .
shell not employ any of
any manner sed u l0 become subject to IM1e Workers' 501 - FINAL ELECTRICAL ENERGY
Comicant on Lows of California,CDale
Applicant
NOTICE TOAPPLICANT:If,after making Nis Certificate of Exemption,you should 502 - FINAL PLUMBING ENERGY -
Z become subject to me worker'sC°mpconationpmvisonsoftheLaWrCode.you must 503 - FINAL MECHANICAL ENERGY
O forthwith comply-with such provisions or Nis permit shall be deemed revoked.
:� CONSTRUCTION LENDINGADENCY 504 '- 'FINAL 'BUILDING ENERGY.;:;;
W'',> I hereby affirm that mems'a construction lending
is agency roc dhe peddrmance 505 - FINAL ELECTRICAL -
W ., of the work for which Oil permit is issued(sec.3097,Civ.C) 506-- GAS TES T-
g� Q 'Lender's Name `. _.I_... _ . ._: .. _ .
O meabove—shim<a evened is 5 7 - FINAL PLUMBING
Z LenderaAdamss • 0 F PL
1 me m1rityantionand statethat imea, a ,amva law,
is 5U- INAL
NAL MECHANICAL
COmr[L I a rtt In comply WIIIh OII Clly and COYmIy ordlnen[CS ad x101[IBWS R101ing (�
. O'U to building conswction, d hereby authorize representatives of this city to enter upon 5 E
>,,W _ .. .P.Fr.y for Impact' purypsea.., N
M'0.. (We)agree ib save,indemnify and keep harmless the City of Cu;,amo against 5AL ham0aes,judgments,roars and expanses which may in any way accrue ,111.1 said 5A RKSCity in consequence or the gaming of this pmniz 'APPLICANT UNDERST NDS AND N' L COMPLY WITH ALL NON:P 11 c Issued bDate
_ ignamr,ofwpplic cmaracmr"' , '. :' - .Da -' Re-roofs
HAZARDOUS MATERIALS DISCLOSU
. W'riuTinaoe0ltuseWddingaccu Type of Roof
pP Chapter
r 9.12..handle Health an Safer l - - ..
as defined ion 23 Cupertino Municipal Cade.Chepl«9.12.end the Health and Safety - -
Code,13 tion 25532(+)? . . 'r
°Yes
Z. j`j All roof
s.shall be inspected prior to any-roofing material being installed..
Will the it lioanl or furorbo
e 'Idi g .Pat x equipment or devices which - - "
ems haz4dous air carrurnnar.as defined by the Bay Area Air Quality Management If a roof is insialled;without fust obtaining an inspection”, I agree to remove
D1triet'°Yea all new materials for inspection. Applicant understands and will comply with
all noti-point source reg lations. .
1 have and'd e boa iddus materials mquiremems under Chapter 6.95 of the h
Celirtimia Hevith&Sid ly Code.Section,25505,25533 and 25534.1 understand Net
if the boilOng docs not nncmly have aamount,that it is my responsibility to notify the '
«cupam of me mann//jpp^nn¢��wtthich must be mn prior to issuanc�r ofyC�mif�ate of
o«u ^ .��5"r__ Signature of Applicant Date
Gwser pr nuthmaar aseml DDaUte All roof coverings to be Class"B" or better '
11
.':. .., .. - OFFICE. .. . . . . .. ..
125
62 34 �— 29
UTL
f cC�s s 36 � SEP i
GflN 20 q1
FLO
sw; -T107
72 -- --- . .-; IT R
(Ala :
CIApa
252 # 252
55 – SICU 47
------ ------- --- -- WITH THE CITY 01
• nND ORDINANCES
IN ACCORDANCE I CITY Of _ _--- -
CUPERTINO 2D D ANANCES
C ,,eclflcatlons MUS
times and J is 11'
)ATE ages Or al'p(atio' :I
SIGNED n pe:missi in tr, m
This set of plans and sne i cations MUST f CupeAff)
be kept on the job ;t64 t and it is un n no specya:=
lawful to make any ch;ng x alteration p- mic or
on same without w itt m f . mission from n of any jr ,uisi n' 98
he building Dept., ;ity of u ertmo. r State U P
The stamping of this pl m .I I specifications
>NALL NOT be he!( 'tc PE or to be ai•
pproval of the viol Iti( r t my provision
nar-e or Its a I All,
25
L 23 J 39
AGensions&size designations «
given are subject to verification on
Lo<fb Fi s an df gine design and must Toensfet Scale:maximum Design: 05/31/02 Dwgno'
job site and adjustment to fit job Up.Q(' t no a released or copied unless Date : 08/06/02
conditions. '--1 � applicable fee has been paid or job
0 �'/ 0rder placed. Designer
-ax OITY OF CUPERTINO � q 7
CITYOF PERMIT APPLICATION FORM v2 ` 6/ Z
CUPEkTINO
• APN# - /7OD3 Date:
Buildin Addr ss:
Own r' ame: Pho e #: /
745
Co c or: License#: 0 /
Contact: / o;r/ • r Pho e #:
Ap li t/Co fraptor:
FQ �5`c5�
uil 'ri Permit Info:
Bldg Elect P1 Mech
J escription:
Residential: Commercial:
Sq.Ft. Floor Area: 2/8 $/Sq.Ft.:
Architect/Engineer: D Valuation: ! O@��
Type of Construction: t/ Occupancy oup:
•
uanti Fee ID Fee Description Fee Group
APTFEE EACH STORY OVER 3
HOTELFEE EACH STORY OVER 3
OFFICEFEE EACH STORY OVER 3
BAPPLOTHER Other Appliances 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 Ener BUILDING
BENERGYADD Ener Add Multi BUILDING
BINVESTIGA Investi ation fee BUILDING
BMITIGATC Comm. Housin Mit. Fee BUILDING
BMITIGATR Res. Housin Mit Fee BUILDING
BMNEWMULTI New Multi-Famil Res MECHANICAL
• BNEWMULTI New Multi-farm] Res ELECTRICAL
Iof3 41, l g16 �;e
;qL s 7• `-`f
CITY OF CUPERTINO •
CITYOF PERMIT APPLICATION FORM
CUPEkTINO
uanti Fee ID Fee Description Fee Grou
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multi-family Res PLUMBING
BOVERTIME Inspection Overtime BUILDING
BP13ACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cess ool 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
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal 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 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 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI A liance Install MECHANICAL
BREMBUSWAY Remodel Buswa s ELECTRICAL
BREMFIXT Li "in Fixtures ELECTRICAL
BREMFURN Relocation of Furnace =ELECTRICAL
BREMFURNOV Relo Fumace> lOK btu
BREMHEAT Heater Installation
BREMINHOOD Installation of Hood
BREMMISC Misc A azatus BREMNRAPP Rem Non-Res A liance
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/A azatus ELECTRICAL
BREMRECEPT Rc tl Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT I Re air/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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i4u CITY OF CUPERTINO
"Y0 PERMIT APPLICATION FORM
CUPE TING
• uanti 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
1 BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial . BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSF&2FAM Single & 2 Family BUILDING
BSFNA Single Family New Add BUILDING
13SPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Ternp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC — Electrical s foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane 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> 1.75 M Btu MECHANICAL
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