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04010071 CITY OF CUPERTINC " "r BUILDING DIVISION PER C�NTRIiTn72TN�© M N BUILDING ADDRESS: VANNI BROTHERS CONSTRUCTIO ERMITN004010071 OWNER'S NAME: PERMIT ISSUE DATE NIKLAS & A NE: SANITARY N0. CONTROL NO. 408253-7 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MEC14 30p LICENSEDCONRACTOR'S DECLARATION 1 hereby affirm Thal 1 am licensed under provisions of Chapter 9(commencing Job DOSCrIpI100 wish Scction ndt of pivision3 of the business antl Pmfeasiuns Code.end my license is N. mmnseClforce anaefta"' HALL WAY BATHROOM REMODEL j y, License Class LIC.M e'O Date Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records / DyU 2;Q„�, Licensed Pmfcssiunai �/ Z g �� OWNER-BUILDER DECLARATION C.OlmON �Tp ECC 1 naso .Section nt 1 1. exempt Gum the Canons Co License Law Tor the �C/ O which requires.Permt170JL5, t. l.r. end prove.demolish, Code:Any city or county J` which requires a permit m ennsuuct,alter,improve,demolish,ri repair any tatemme ai Pdormslicenedpursuanquims provisions for such Permit License Law stammem xa that heenta wiLlbSmdor-70(Bo(Disinnsnithe ftheBusiness ndfinseushosCapter9 Sq.Ft. Floor Area Valuation st$ (c-L he xempt therefrom andtfDivisiafr the Business prion.fAny violatiouttedn or of Nat he is exempt therefrom and Ne basis for the alleged exemption.Any violation of nn Section 9031.5 by any applicant for a Permit subjects the applicant to a civil penalty of 3'A'9&IZ•Iif�kberO O Occupancy Type not more Nan rive hundred dollars($500). _ D 1,m owner of the property,or my employees with wages as Spume compensation, will do the work,and the structure is not intended oraffaed for sale(Sec.7044,Business RC rated Inspections and Protections Code:The Contractor's License Law docs not apply to an owner of q p Properly who builds or impfoas thereon,and who does such work himself or through his own employees,provided that such improwmems are not intended proffered for sale.If, however,Ne building or improvement is sold within one year of completion,the owner. builder will have the burden of proving that he did not build or improve fur purpose of ��L es owner of the property,am exclusively contracting with licensed convectors to • Conswm the project(Sec.70M,Business and Professions Cade:)The Connectors Li- cense Taw docs not apply to an owner of property who builds or improves Merton,and who contracts for such projects with a contractor(s)licensed pursuanuo the Contractors License law. El 1 em exempt under S C. .B&P C for this raazo t O Game 'f 0 Oh A ION OECLARAT I hereby affirm and r Penalty of perjury one of Na following declarations: Pit haw and will maintain a Ceni0cnle of Consent to self-insure for Workers Compcn- sation,as provided for by Section 3700 of the Labor Cod,for the Performance of the work for which this Permit is issued. - D I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of Ne Either Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance Cartier and Policy number art: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE modu section need nal hecomplmed if the Permit is foronchundon dallars(5100) nrbessJ I certify Ihm in the porfotmence of the work for which this permit is issued.I shall not employ any person in any manner an as to become subject o the Workeri Corepensallon Laws of California.Date Applicant _ ^ NOTICE TO APPLICANT:If.after making this Cmdricate of Exemption,you should . became subject m the Workch Compensation provisions or the Labor Code,you most .J z forthwith comply with such provisions or this Permit shall he Jeemed revoked. ZV CONSTRUCTION LENDING AGENCY O [-. 1 hereby affirm that there is a emmimeoun lending agency far the performance or !yi > the work for which this permit is issued(See.3097,Civ.C.) W Q Lender's Name ] z Lender:Address O Q 1 canify that l have mad this application and state that the above brobandun is Ir. correct,1 agree to Comply with all city and county ordinances and stale laws relating to V building Construction,and hereby oulhnire mprescntatives of Nis city to enter upon the W above-memioned properly ror inspection purposes. gy (We)agree to save,indemnify and keep harmless the City of Cup Brom,against W liabilities,judgments.costs and expenses which may In any way see=against mid City U z in consequence of the granting of this Permit. APPLICANT UND RSTANDS D W L COMPLY WITH ALL NON-POINT Issued by: 6Date SOURCERE 1 %.! Re-roofs at roof Applica pryry actor Data HAB'ARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant Or furore building occupant amre or handle haysrduus material as defined by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safety Code,Section 25532(a)? ❑Yes All roofs shall be inspected prior to any roofing material being installed. . Nu Will the applicant or mture,building occupant use equipment or devlocs which If a roof is installed without first obtaining an inspection,I agree to remove mil Immmous air conmminanu at dcfncd by the Bay Arca Air Quality Management all new materials for inspection. Dinria? Dyes I mw,mad the hvaNnusmmerials rcquiremenn under Chapmr695 of the CnhfC, nit Health h5afety Code,Secdom]5505,1553]anJ 25534.1 understand mm if the building does not eerom ly have a rant.Net un my res onsihility to nmil'y the nO upaut of the requirements which erpdo tt eau oraccnmeato of Occur, C Signature of Applicant Date own roe mmo;Cdagc Data d� All roof coverings to be Class "B" or better *CITY OF CUPERTIN* CUP TYOF O PERMIT APPLICATION FORM 'RIPAPN# Date: �r 0 Building Address: 0 f�%G G'�vv2T �277/�17 Cil ?iD/fD Owner's Name: one #: Nl AGL//l� ZS'3 67�P Contractor: / License#: Contact: il/�/L Cupertino Business License#: i/A�iV! Building Permit Info: Bl Elect Plumb ech JA 14 Jobrbesial g R : �� � Residenttial 51 ,U-0 Sq.Ft. Floor Are $/Sq.Ft.: Cost of Prct: /© Occupancy Group: Type of C n: 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 1M Btu MECHANICAL BBOILER4 Boiler> IM to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/ uasi 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 Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of b( - *CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family 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 BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit 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 rinkler/Backflo PLUMBING BPSTORM Stomi/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent 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 BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFI NOV Relo Fumace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BRENR RAP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL • 2of3 r WITY OF CUPERTINOO CUP TYOF O PERMIT APPLICATION FORM Qup6titA Fee ID Fee Description Fee Group 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 Signs,Marquee ELECTRICAL i BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Seb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection 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 BMISCELL Building Misc Fees BUILDING i 40 3 of 3 ~r� � Ir 1 _ _ r d 1� 1 '— r �I rt r T �� _74 � f � f r r I ii I } Fo dt 2, 11 i I r I fi — Qy O f �' 1 f 1 _ r- � rt I ,1 1 —f— C _ Li � � 11-- 1 - Z L d — ___-_ ._ --F—r d 1 - _� ' � - +1 -11 -` ? i_—C1 j 1 i L 1 - T cam, /1 r . aEaTiNoP POVED- - r III ! I N ACCGRDANC IN THE' hryn' a -1 11� �"�TD - _T F 1 t li �r. t rj �' 1 GhED wftirtoOf- ake a-a ll tiT(or a tera —I � I � o fl�3C�! !¢,SiGIS'✓ I I e keptlon ellob�t:all hm an i r �, r �g 1. L DZ _i o seine-without} rif t -ermissioa ram =� jl' ! t - .t—i'-� r� I� t e boil in' pept', City-of .Cupertino 1 _F +ate 4 mp{rg of this-play end speciflee�Ons aHAL _NOT be held`�_to. ermtt or_EOi4 arl 7`7�( - 1-1Rilq C�r11ln8L'�tlIT T � 4_1 i_ 1 f __ i I rI-.., I �1' I I a rl �I I� r�. ii .._�.._i— � y I _�1.�LL_J<l_...._4..-�._r - 1 Li 1_ ..1_.'...J.__�_� ��SIJ i_a__..._ Ir_! t , _i. �- L I-j__ 11 �.._.._l._I_. CITY OF CUPERTINO "` �• ' BUILDING DIVISION PERMIT ,GONTRACTnR INFORMATION.' BUILOINGADDREEB: VANNI BROTHERS CONSTRUCTIO ERMfPN004010071 ER'S NAME: PERMIT ISSUE DATE NIKLA & C SNE: SANITARY NO. CONTROL NO. 408253-7 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH t� (� (� u O O LICENSED CONTRACT'OR'S DECLARATION Job Description up 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing p �ie with Section 7").f Division 3move Business and Professions Code,and my license is o°i L License Class areae'' HALL WAY BATHROOM REMODEr-'NALED y So Licenu ea La.M o F a Dale Contractor ,e 6 qq ARCHITECTS DECLARATION y a I understand my plana shall he used as public racnrds FEB 2 012004 sr ia�D Licensed Professional 3 OWNER-BUILDER DECLARATION o��■ i<x I hereby affirm that I am exempt from Ne Comment's License Law far the BUILDING o O fulinwing reason.(Section 7031.5,Business and Professions Cade:Any city or county K m which requires a permit to construct,alter,improve,demolish,or repair any structure yZi prior In its issuance,also requires the applicant for such permit to flit a signed statement _ Sp That he is licensed pursuanuo the provisions or the Contractor's Licenu Uiv(Chapter 9 Sq.FL Floor Area Valuation - I-$ (commencing with Section TgNd of Division 3 of the Business and Professions Code)or y Net he Is exempt therefrom and the buts for the alleged exemption.Any violation of ' Section 7031.5 by any applicant for a permit subjects be applicant to a civil penalty of 3 7i� 12`I)I&terO O Occupancy not mmethanfivehundred delta.(f503). p y Type ❑1,u owner of the property,or my employees with wages as their axle compensation, will do the work,and the swcmre is not intended or offered for sale(Sec.7044,Business and Professions Cade:The Contractor's License Law does not apply to an owner of Required Inspections property who builds or improms thereon,and who does such work himself or through his own employees,provided Not such improvements are not intended or offered for sale.If. howaver,the building or improvement is gold within one year of completion,the owned builder will have the burden of proving Net he did not build or improve for purpose of ' sale. L eg owner of Ric property,am exclusively contracting with licensed contractors to conslmct the project(Sec.7Ddd,Business and Professions Code:)The Conh-acto's Li. acme law docs,not apply to an owner of property who builds or improves daemon,and - who contracts for such projects with a contraaor(s)licensed pursuant to the Convector's License Law. ❑1 em exempt under C. ,B&P C for this rcuon Dam O O A ION DECLARA Ihereby affirm on rpenalty or perjury one of Ne following declarations; . 1 have and will maintain a Ceni6eam of Consent to self-insure for Workers Compen- sation.u provided for by Section 3700 of the Labor Code,for me performance of the work for which this permit is issued. ❑1 have end will maintain Worker's Compensation Inaumnce,u required by Section 3700 of NC labor Code,for Ne wdormmce of Ne work for which this permit is issued My Workers Compensationlnsumnana erand Pulicynumberam: Cartier. Policy No.;__ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE INis acmi.nneed not to completed ifthe permit is(L hundred d.11va($IDB) - - orlcga.) - I cenify that in the performance of the work far which this Permit is issued,l sholl Lou employ any person in any manner sag u to WCOnle subject to the Workers'Compcmation Laws of California.Dale Applicant NOTICE TO APPLICANT:if.after making this Ccuifinm of Exemption,you should become subject to the Worker's Compensation provisions of the Ichor Caade,you must .J,O forthwith comply with such previsions or his permiuhall he deemed revoked. - LZa y CONSTRUCTION LENDING AGENCY (~ I hereby affirm Nat there is a construction lending agency for the performance of CL > be work for which this permit is issued(Sce.3097,CO.C.) W� Q Lender's Name a z Lender's Address O Q 1 certify that 1 have read this application and sum that the above information is ty F+ correct.l agree to comply with all city and county ordinances and Stam laws Misting to _ QU building conswction,and hereby autharie representatives of this city to enter upon the 6i ahovcros,judgedproperty costs (an i expenses purposes. (We)agree to aave,indemnify and keep harmless the City of Cupcnion against eF'rh liabilities enceofthe granting Of this whichmay in any way accrue against Said City V z APPLICANTeUND RSTANDSt&No W t COMPLY WITH ALL NON-POINT Issued by: Date SOURCE R AF- Re-roofs 07 6SIPattlfre of ,Iusd o error Dat. HA RDOUS MATERIALS DISCLOSURE Type of Roof Will Ne applicant or future building Occupant store or handle havudous mammal as,deflacd by Ne Cupenum Municipal Code.Chapter 9.12,and the Health and Safely I ,sc❑cdon zssu(ar. All roofs shall be inspected prior to any roofing material being installed. Yim Nu Will the applicant or future building occupant use inuipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove haramous air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection. ict? YeS I have mad one hamming materials mquiremcnts under Chapter 6.95 of the Cab or- calN6SafetyCadc,S uou8585,25533md25534.1understood Netifthe building not cunen I haw a maga.Nm his my ma nsdaluy m notify the Occupant of Ne rements which bat esu or cenirssm.'0"'Ponc. � Signature of Applicant Date 4. own ra NmOedage Dam All roof coverings to be Class "B"or better