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CITY OF CUPERTINO
-
' CONTRACTOR IN lop ATII�N:
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
CLEAR OAK
DESIGNS
PERMIT Na03060022
11073 BEL AIRE CT
NEWS NAME:
1723 B ROGERS AVE
PERMIT OVMfO3/2003
,TZEL ALLEND
NE:(408)436-54T—B—
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG "0
o 0
LICENSED CO AMR'S DECLARATION
Job Description
1 hereby am, that I am I under provision of Chapter 9 (commencing
withS do 70W)af D)vbion 1of usiness and Professions Code. and my license in
innull o anderc
KITCHEN REMODEL/UPGRADE
Lice av �.•
Da Con
ww
P11\1
gas ARCHITECTS DEC ATI .Fll)cx N40
/°'�LED
1 understand my plans shall be used at public mcords
S E P 2 2003
d.icanted Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Commences License Law for the
following rutin. (Soctior 70313, Businns and Profndous Cade: My city m county
.
BUILDING
which mquims a permit m eensunn, aline. improve. demolish, or mpair my structure
! prior to its Issuance, also requires the .pplleatnfor such permittoriileIsigned MMMCnt
Lune Law(Chapter9
Sq. Ft. Floor Area $2OTQIQ14i[IOn
Nat he is licensed pursuant to the provialons of the Contractar7
(commencing with Section 7000) of Division 3 of the Business and Pmfessions Code) or
that he is exempt therefrom and the bub for the alleged exemption. My viondem of
Secdon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty Of
eruu Occupancy Type
nut more dun five hundred dollars, 04004
Q I,uo oftliepmpcm,wmy=ployeeswiNmles a trmle=puwdon.
do the work. and theewnum 1. OuOrdendedor Offered for We (Sm. 70th, Eastmana
will k
and Professions Cod. The Contractor) Licence Law dean not apply man owner of
102
Ulred Inspections
- PIER S q p
propertywho bulldsor impmmat thescamand wbodoutwhwork himsel(erthuough his
103
- UFER
Own employee,, provided thnauah improvements art notintended oroffered for sale. if.
humour, the building or improvement is sold within one)ea u(umpleuan, then Owner-
104
— REBAR
Wilder will haw den burden of proving that he did ret build a Improve for Purpose or
ANCHOR BOLTS
105
—
Q 1. as owner of the pmperty, am exclusively contracting with licensed centraemr. to
106
- SEWER Sc WATER
convect the project (Sec. 7014. Business and professions Code:) The Consomme, LI -
cents Law docs not apply to an owner of properly who builds or Improm desmon. and,
202
— UNDERFLOOR PLUMBING
who contracts for such projects with a contractor(s) licensed pursuant to the Contnemr's
203
- UNDERFLOOR MECHANICAL
Licence law.
Q lam exempt under See .B a P C for this mason
204
- UNDERFLOOR FRAME
an Data
205
301
- UNDERFLOOR INSULATION
— ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION'
I hereby ammt under penalty ofperjury, one of the following declaration,:
302
— TUB & OR SHOWER
Q INveaM will malnulnaCeNncate ofConsemmxelf-lusum far WektM1 Camper-
303
- ROUGH MECHANICAL
union. of provided for by Section 3700 of the labor Code. for the perfarmana of du
wok for which this permit is issued.
304
- ROUGH ELECTRICAL
Q 1 haw and will maintain Workers compensation Insurance, m required by Section
305
— FRAME
37 ofth Labor Code, for the performance of me wok for mh this pemsitie lssuN.
M°r aCnm naWan lusunnu carrier end Poli rue:
.306
— HOEDOWNS
ry�" 12 `C� PengNn.:
307
- INSULATION
CERriFl NFRANCE ERS'
308
- SHEETROCK
COMPENSATION INSURANCE
COMPM A71ONI
309
'
- EXTERIOR LATH
(Thlssection need not be completed lithe permit is fare= hundreddollm(SIM)
mics6)
310
- INTERIOR LATH
1 eenify that In the performance of the work for which this permit is issued, ),hall not
311
- SCRATCH COAT
employ any person in tiny muneran u to become subject to the Worker' Compcmadon
Laws of Callfomia. Date
313
501
- ROOF NAIL
- FINAL ELECTRICAL ENE
Applicant
NOTICE TOAPPLICANI'.If, after making this Cerineste of Exemption. you Maul)
become anbjm to the Woker's Compeusation provisions of de Labor Cade you most
502
- FINAL PLUMBING ENERGY
'^ forthwith comply with such provisions or this permit 0,11is, dumcdrewkcd.
503
— FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
504
- FINAL BUILDING ENERGY
1 bereby.lftrm that then is a construction lending.gcm7 for de p info m ons of
> live work rmwhich lids Permit bauw(se 3Bm,Ci, e.)
505
- FINAL ELECTRICAL
LanderaNamp
506
507
- GAS TEST
- FINAL PLUMBING
Letters Addmu
yIcenifythat] bloomed thsapplieationand mtethntheabowlnfomtadohis
cmmcL lagoon to comply withall city and county ordinances and sun laws relating m
5
FINAL MECHANICAL
building construction, and hereby mtnadxe mp—uuvea of miscky to Order upon the
U .bove-mendoned property far inspection purposes
0 9
FIN GRADE
1. (We) agree to taw, indemnify and trtep hsrmleas the City of Cupertino against
r7 liabilities, Judgments. eons and expectant which may many way ancoen.galmtaaid city
expectantin
FIN G
consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by51
WORKS Date
SO RCE REGULATIONS.
Re -roofs
Type Of Roof
Si of Appncan✓Cerumm, Dam
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding asupant nom m Nndlc hvudous material
U defined by tae Cupertino Municipal Code. Chapter 9.11, and the Health and Safely
de, section 25531(a)7 \�
All roofs shall
be inspected prior to any roofing material being installed.
r r
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or Tut m building omupam tae equipment or devices which
emit harudnus air onuminanu de0ned by the Bay Area Air Quality Management
all new materials for inspection.
DiW cl?
r Yes No
1 have read the haurdousmadedals requimment, under Chapter G95 orthe Califor-
nia HcoIN✓E SofctyCodc, Sccuons25505, 25533 and 25334.1 unOcrnand thatif de building
Jana t fitly haw a tenan4 Net h b my rupomihirnmroufy the occupant or Nc
require uwhichmlWbemctpdarmissuancoofsclod a .roccupency.
Signature of Applicant Date
W
All roof coverings to be Class "B" or better
Owner unwhodsd satire Dau
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y I
U
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CITY OF CUPERTINO �,gr
`A*16�'" "'VN''�'";k: &r+*aa1z4 "`�0
CNb,�N,�)TkX&COWIl FORMAT.I.
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
CLEAR OAK
DESIGNS
PFRM1TN003060022
11073 BEL AIRE CT
OWNER'S NAME:
1723 B ROGERS AVE
PERMIT /2003
TZEL ALLEND
NE:
(408)436-5448
SANITARY NO. CONTROL NO.
ARCHI7EC1'/ENGINEER:
BUILDING PERMIT INFO
ELECT PLUMB MISCH
O O
LICENSEDCO AM'SDECLARATION
Job Description
I hereby affirm Nat 1 ma It under provision of Chapter 9 (rommcnems
withtiO 7011a)afDivisl0n3or usinwand NofudomCade,And myficanur
in full a arta cffm
ww,,A
KITCHEN REMODEL/UPGRADE F',VALE®
Lice w Lk. M
°a `°n ��Na
ARCHITECTS DEC ATI
SEP 0 2 2003
I understand my Alam shall be used u public rcmrds
@s
BUILDING DING
el-kcnud Pmfceuional
OWNER-BUILDERexemptDE Ce ON
li I harcby.('firm that 1 Comir License Law for Ibe
exempt from the Cssion$
ra�/tV • .
o
following.i..moon. (Section 1. Business and Profaysiom Code: Any city orcounty
1703.
l which
Sq. Ft. Floor Area
$ 2 O YSaUtion
I Sirinytale-Ire
JC applicant meal
itsisu•permit reuims Char@aImprove,h renin fill
pilar m its sucC.Mmrm111a Rl.. Law,
law
or this
denR3
ed paalso
n provisions ONE umrs (C
i Ihar he is ner, to
tel Prof ode) ar
(commencing with Sutton sand of Division 3 of al Business ARAM I Professions Code) ter
nciaS with Sud 7") of ft Bu
Rut io r exempt rhertfrom and bur for Any violation of
alleged rxmsent
0 Occupancy Type
W
for a permit subjects the eppirunt m •mars( pendty of
Section 7031.5 by Ory or bj cts
red doll
not roam Nan Ow hundred dolma (f50a}
,
❑ 1, u man, of the property, m my employees with wages u their sale compensation,
d theabue isnotin¢ndedaroRemdforsak(SttJOµ Bu Must
rwillda theworkanttut
And Pmfecalm s Code: The Commutes Limtue Law does ant apply man "net of
102
a ulred Inspections
— PIERS q
propenywho Wildsor improver Nereemand whodoessuch work himmlforNrough his
103
- UFER
own employees. provided that such impruvemcmta ma not Intended oraaered for sale. If.
however, the building Or improvement is old within oft year of completion. the owner-
104
— REBAR
tel)er will have the burden of proving that be did not Wild or Improve for purpose of
105
ANCHOR BOLTS
—
1• u Owner of she property, em eac(usively commuting wish licensed cunhacrora m
106
- SEWER & WATER
construct Ne pmjen (Sec. 7014, Business IM PmfcWM$ Cents:) The Contrsamrs U.
terms law does not apply m anownu of property who Wilds or Improves Damon, and,
202
— UNDERFLOOR PLUMBING
who contracts rarsuch projects with a,antr,.tart) licensed pursuant toNecmttranmra
203
- UNDERFLOOR MECHANICAL
License Law.
E]I ma exempt under See .B At PC fm this moron
204
- UNDERFLOOR FRAME
Owner Date
205
- UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION'
301
— ROUGH PLUMBING
10 I hereby Affirm under Penalty of perjury am of Ne following decimations:
302
— TUB & OR SHOWER
❑Ihave and will maintain aCe"Rosm arcorwan to self-Insum for WmkcrsCompen-
303
— ROUGH MECHANICAL
noon, as provided far by Section 37M of Ne labor Code. for the perfonname of no
work far which thin permit is issued.
304
- ROUGH ELECTRICAL
❑ I have and will maintain Workers Compensation Imorm cx, as required by Section
305
— FRAME
37 Of LAW, Cod,, far the pirformanccof Ne work forAlen this permit r issued.
M r s Cam nudon Imamnm camas fid Poli r art:
Y Pc
306
— HOEDOWNS
urrl cihl,2 9R€C� PaneyNa.:
307
- INSULATION
CERTIFICATE OFEXFMP`nON FROM WORKERS'
308
- SHEETROCK
COMPENSATION INSURANCE
309
- EXTERIOR LATH
(Tar=I. maximal be completed irate permit rfmam h.WimidaBw(SIM)
mlesa)
310
- INTERIOR LATH
I eemfy that In the performance of the work for which this Permit is issued, l shall not
311
- SCRATCH COAT
employ any person in any munerso as to become subject t0 the Workers•CamICOUthn
313
ROOF NAIL
Laws of California. Dam
501
—
- FINAL ELECTRICAL ENERGY
Applicant
rfOTICE TO APPLICANT: IG after making this Cenirs.k of Exemption• you should
become subject ro the Workers Compensation previsions of the Lahr Cade. you must
502
- FINAL PLUMBING ENERGY
foMwiN comply with such provision or Nie permit shall bedccmM reveled.
503
— FINAL MECHANICAL ENERGY
504
- FINAL BUILDING ENERGY
yCONSmisacmONLENDINGAOENCY
' rNeI hcmtythi Nal Nim its construction len ding agency for Nrm
c perfuenvn of wstir(mMch wxnthis permit iaissued (see.3w
7.civ.c.)
505
— FINAL ELECTRICAL
] IemersNmae
506
507
- GAS TEST
— FINAL PLUMBING
lenders Address
�
y - 1 acridly that 1 have read this application and sum Net the above information r
come, l agree as comply with all city and county aminantts and state law mating 105
FINAL MECHANICAL
an
.i building cmuction. and hereby autbodm representatives of Nin city m enter upon the
far inspection
O 9
FIN GRADE il
above-mentioned property purposes.
(We) acne to save, indemnify fid keep hamdw the City of Cupertino against
A liabilities.judgmcnu•cosunslcapcmeswhichmayInanywayaccrmegainstmidCity
5
FIN G f�
In consequence or the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by51
WORKS Date
SO RCE REGULATIONS.
Re -roofs
Type of Roof
Sign roof Applicant/Conuums Date
HAZARDOUS MATERIALS DISCLOSURE
Wul Ne applicant Or future Wilding occupantsaom or handle huardan material
as deaned by the Cupertino Municipal Code. Chapter 9.11, aM the Health fid Safety
Code, Sacalon 25532(,)7 \-�
All roofs shall
be inspected prior to any roofing material being installed.
❑Yu -"u
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant m ful rc building Occupant use equipment or devices which
emit haumous air contaminants an donned by the Bay Arca Air Quality Managemcm
all new materials for inspection.
Dla,IcO
❑Yes Nu
I have teed Ne lb.dnux matarl.ls mq.kcm,m under CW,ua695 of the Califor-
nia Health �Safcty Code,Sccdans25505,25533and25534.1un&.m thaif Ni Wilding
does not ntiy hove a anent. NaI it r my rcspons@i0Ty7Ynati1'y Nc Occupant of the
Ccni,cs tpancy.
Date
rcyuircQ(r(u wnicn mast be mel priorw rsuan,c nfa Or
Signature of Applicant
,,h (Q3Dam
All roof coverings to be Class "B" or better
Owner or wrhorisd e,cnl Dale
. d.d
0
CITY OF
CUPEkTINO
C*Y OF CUPERTINO 0 03 6 a-1) ZZ
PERMIT APPLICATION FORM
N # 7 r O
22%
Date:
Building Add :
Owner's Name:
Other Appliances
Phone #:
BBLDGFEE
Bldg Permits . foot
OLF�T
Contractor:
License #:
MECHANICAL
5
Contact
Cupertino Business License#:
Building Permit Info:
Bld Elect Plum Mec
Job Description:
'Residential
Z-- rc>
Sq.Ft. Floor Area:
$ q.Ft.:
Cost of Project:� ��
I
Occupancy Gr
Type of Construction:
BCONSTAX
Quantity Fee ID
Fee Description
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
BBLDGFEE
Bldg Permits . foot
BUILDING
BBOILERI
Boiler <= 100,000 Btu
MECHANICAL
BBOILER2
Boiler > 100K to 500K Btu
MECHANICAL
BBOILER3
Boiler> 500K to IM 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. Housing Mit. Fee
BUILDING
W
1 of 3
CITY OF CUPERTINO 0
PERMIT APPLICATION FORM
Quantity Fee H)
Fee Description
Fee Group
BMITIGATR
Res. Housing Mit Fee
BUILDING
BMNEWMULTI
New Multi-Famil 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
Blft 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
Appliance Install
MECHANICAL
BREMBUSWAY
Remodel Busways
ELECTRICAL
BREMFDCT
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
2of3
a�J
ci of
CUPEkTINO
CITY OF CUPERTIA
PERMIT APPLICATION FORM
,Qqantity Fee ID
Fee Description
Fee Grou
BREMPOWER
Power Device/Apparatus
ELECTRICAL
BREMRECEPT
Rc tl, Switch & Outlets
ELECTRICAL
BREMRELOCA
Relocation of Hood
MECHANICAL
BREMREPALT
R air/Alter HeatingMECHANICAL
BREMRESAPP
Remodel Res Appliance
ELECTRICAL
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
13UILDING
BSWIM
Swimn-dng Pool
13UILDING
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
M1'sCHA1`IICAL
MPERMITFEE
Mech Permit Issuance
MECHANICAL
PPERNHTFEE
Plumbing Permit Issuance
PLUMBING
PPLBG
Plumbing Fee sq foot
PLUMBING
ZADDCHG
Address Chane
BUILDING
3 of 3
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