050201600C
z.
w
W
ow
U<
C
U F
UA
CITY OF CUPERTINOws>rtix,-,.'sFz'4�'',"
`?
BUILDING DIVISION PERMaC
1N(TRACT09 INFORM ON
T AaIS✓3�„".. ✓k, a ., .L9ti Y^4'H ebr ,kyr ,
BUILDING ADDRESS:
L0629 RO=r�UFR AV
CELTIC CONSTRUCTION
PERM'rN�5020160
OWNER'S NAME:
PERMIT ISSUE DATE
JOHN & SHARON
ONE:
SANITARY NCONTROL NO.
(408)973-1224
ARCHITECYENGINEER: -
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that I am licensed under previsions of Chapter 9 (commencing
with Sced.. 7") ofDi,i,i.O3 of tie East. and Professium Code. and my license is
I. fail Face And efect.
BATHRM REMODEL
License Clue a
Dew Computer
ARCHrMCTS DECLARATION
I understand my plans shall W =ties public ..and.J
a[/
j
as.
Licensed Prof c..banal
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt (rare the Conuactofs License Law for be
\�
(allowing mason. (Section 7101.5, Busineu and Professions Code: Any city or roomy
which requires a permit to construct. aloe; improve, demolish, or repair any structure
prior In its issuance. also requires IW applicant for such permit to rile a signed statement
Sq. Ft. Floor Area
Valuation
that la, is liccmed p.nor .A, to the provision of de Contractors Liwnse Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Busiwss and Professions Code) or
that W is exempt therefrom and IK bub for the alleged exemption. Any violation of
3 5!ffTQQffae10 0
Occupancy Type
Section 7031.5 by any applicant far a permit subjects the applicant m a civil pena3ty of
nm mom Nan five hundred dollars ($5007.
❑ I, As Owner of IW properly, or my employees with wages u their sale compensation.
Required Inspections
e
wYl do thework, and the sauclum is natinwnded oroQered Aussie (Sec. 7D44, Business
and Professions Code: The Cormsemrs License Law docs not apply w in owner of
- q p
properly, who Wildsor improves lhemen, and who doessuch wmkhimshlfar through his
Own employees, provided Ihmauch improvements, am not intended oraRened for sale. IL
however, the building or Improvement la sold within one year of cempledan. Ne awn o.
buildcr will have IW burden of proving that he did not Wild w improve for purpose of
sale.).
❑ 1, as owner of ted properly, am uclusively contracting with licensed mmnato s to
construct the project (Sec. 70". Business and professions Cade:) The Conuactrai U.
cense law does not apply to an owns, of property who Wilde or improve{ Merton, and
who contracts far such projee wldl a eamractar(a) licensed punaam m led Cmlwaelara
Lw nth Law.
'
❑ 1 em ex t oder ea. . B @ P C for b moon
caner uBL Date
WORKER' OM 'NSATION DECLARATION
1 hereby alRr a under penalty of perjury one of tie following declan0ons:
❑ Iban and will maintains CeNOmre ofComeen w self-insurefmWorkNeCompen-
snion, As provided for by Section 3700 of the labor Code, for the performance of IW
work for which this permit is loud.
1 have and will maintain Workers Compensation Insurance, u required by Section
3700 of the I ohm Code, for the performance of the work for which this permit is issued.
My Workers Compensation Introns artier and Policy num Wr am:
Cartier. Policy No.:
CERTIFICATE OF EXEM PT10N FROM WORKERS'
COMPENSATION INSURANCE
(Thb section wed notal conpleed if the permits for one hundred dollen ($100)
ar less.)
1 cemfy that in the par Mean of tie work or which this permit is Ivued, I shall not
employ any person in anyA(uWCr m�^ bee me subject to be Worksri Compensadon
Laws of California. Detc lllill// -1494
Applicant
NOTICE TO APPLICANT: IL after making this Certificate of Eace,ption, you should
become subject he the Worker's Compensation provisions of the Letter Cade, ynu must
' (aMwith comply with such provisions or It permit shall W deemed revoked.
3
CONSTRUCTION.issLENDINGAGENCY
1herebyichI that there Isocd(S.C. i3 mercy for the performma of
,Cm.
' the work fur which Nis permit is issued (Sec. 3097, Civ. C.)
Landers None
/
Add
1< aerress
')
I certify that 1 haw mad This application and sow Nal the above sus minting is
1 and county aminawes and ante taws w
carteeL slime to comply with all any
r upon{
aoand hereby mthodaemoses. fives of this airy to enter upon led
/
above-mentioned property for manifdan purposes.
aboven{cationed
(WC) agree m taw, indemnify and keep harmless Ci., of Cupertino against
4 w
0 Ilabilhles,judgmcnut,ca andexpenses which msy in anyway arnw against aid City
a
J
x In consequ Of the lin soli of this permit.
of
i APPLI UNDERS NDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SO Q
u cra s s
Re -roofs
Type of Roof
Signature orApidicardlContramor Data
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant ar fawn Wilding occupanuwm ar handle hwardou material
as dcOwd by he Cupertino Municipal Code, Chapter 9.12. and the Health tad Safety
Code. Section 25532(a)7 �(
All roofs shall be inspected prior to any roofing material being installed.
❑Yes Ona
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 ha'urdnus air contaminants As darned by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes CYrvu -
1 ham mad the hamrdom materials requiremena under Chapter 695 ofthe Califnr-
, 25533 and 25534. I mularmnd that ifthe Wilding
At. H lth@S clyCode. SLtpn'.'�
does Iwo III Wm •oh my responsibility w notify Nc awupwt of the
mqulm c whic musoWasuraceofa CertiOawar
Signature of Applicant Date
All roof coverings to be Class "B" or better
Ownertarauthorizedegcnp Data
a
6 0
CITY OF CUPERTINO
*em 1 of 1 PERMIT RECEIPT
•
FEE ID
BPERMFEE
BPFIXTURE
BPLANCHK
BPVENT
BREMVENFAN
BENERGY
BREMVENSYS
PPLBG
BSEISMICRE
ELECTRIC
EPERMITFEE
MPERMFEE
MPERMITFEE
PPERMITFEE
Sec: Twp: Rng: Sub: Blk: Lot:
APN : 35910052.00
DATE ISSUED.......: 02/24/2005
RECEIPT #.........: 28702
REFERENCE ID # ...: 05020160
SITE ADDRESS .....
SUBDIVISION ......
CITY .............:
IMPACT AREA ......
OWNER .......'.....:
ADDRESS ..........:
CITY/STATE/ZIP ...
20629 RODRIGUES AV
CUPERTINO
OPERATOR: conniew
COPY # : 3
JOHN & SHARON NIEDERMAIER
CUPERTINO CA, 95014-2964
RECEIVED FROM ....: CELTIC CONSTRUCTION
CONTRACTOR .......: O'DWYER, AUGUSTINE PAUL LIC # 15503
COMPANY ..........: CELTIC CONSTRUCTION
ADDRESS ..........: 1094 HUNTERSTON PL
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
TELEPHONE ........: (408)973-1224
ll l�vi
VALUATION
UNITS
PERMIT FEE
UNITS
NO UNITS
PERMIT FEE
NO UNITS
SQUARE FEET
VALUATION
SQUARE FEET
FLAT RATE
SQUARE FEET
FLAT RATE
FLAT RATE
TOTAL PERMIT
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT
0
QUANTITY
20,000.00
3.00
277.56
1.00
1.00
277.56
1.00
80.00
20,000.00
80.00
1.00
80.00
1.00
1.00
------------
1010.94
1010.94
AMOUNT PD -TO -DT THIS REC
277.56
0.00
277.56
27.00
0.00
27.00
370.40
0.00
370.40
10.79
0.00
10.79
45.39
0.00
45.39
133.23
0.00
133.23
10.26
0.00
10.26
6.40
0.00
6.40
2.00
0.00
2.00
6.40
0.00
6.40
38.37
0.00
38.37
6.40
0.00
6.40
38.37
0.00
38.37
38.37
0:00
38.37
---------- ----------
1010.94
----------
0.00
1010.94
NUMBER
------------------
5434
NEW BAL
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
- l�l�F•
• CUPERTINO
17,
46 CITY OF CUPERTIN# 0 S-' _z o 16o
PERMIT APPLICATION FORM
APN # 5 4 100 s z
Date: —2
Building Address:I Mailing Address (if different from building address):
da9
.2o od&, u� eevae.
Owner's Name:
k,✓ 4AitoN A)t%ealdiw2ine.
Phone #: 5 3 - 026
Contr ctor:
License #: 65 7F/4
MECHANICAL
BBOILER2
Contact:Phone: 9 —
Cupertino Business License#:
/ D 1 pW& Fax: 7- o4s
Boiler > 500K to I M Btu
Building Permit Info:
Bid ld`p Elect [P' Plumb 0�' Mech C`l�
Job Description: /
Ram. A/
Residential �' Commercial ❑
Sq.Ft. Floor Area: S T
$/Sq.Ft.:
Cost of Project:
Occupancy Group:
Type of Construction:
Please check this box if the project is a
BCONSTAX
second-storyEladdition:
�
Project Size: Standard & Large ❑ Major ❑
BCONSTAXBQ
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 I M 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/Quasi
BUILDING
BCONSTAXBQ
Con. Tax for BQ Zone
BUILDING
BCONSTAXH
Hotel and Motel
BUILDING
BCONSTAXR
Constax — Resi/Mobile
BUILDING
BELEC1000
Elec 600V <= IOOOA
ELECTRICAL
BELEC1001
Elec 600V > 1000A
ELECTRICAL
BELEC200
Elec Svcs 600V <= 200A
ELECTRICAL
BENERGY
Energy
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
BINVESTIGA
Investigation fee
BUILDING
�t 2,ff7oZ
Iof3 -116)/". ��
T x I y �y''\�e'�h'kF��1..Y k'y 5���r C,r�x�k: 4wi4�vw �F '!�X�b�Sll� . }fin � �✓ �u Y ids � +
Assessor's Parcel Number: 3 ( /0 ^ ��
Name of owner. do" t Shgne P4 N 'e di-ewo., nz
Project address. p%6AIod�j de hyeonfu e
Contact person. Phone. 40�4- 473 ' VD -It
Fax, !,#'r 973 402d5
Net square footage of lot.
Existing
Square footage: First floor:
Second floor:
Garage:
TOTAL:
Proposed
• Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y� N
Is privacy protection planting required for the project? Y
On what floor(s) is work being done? 61e9- �00/–
Brief description �
ption of work. aq!. , .et �%A c OAI
cj1"f
Nage T%fief S�>+u c
AdA 0coe 2, � • f .
Code editions: 2001 CBC
2001 CPC
Effective.1 I/1/02
(Y - N)2001 CFC (Y - N)2001 CMC
(Y - N)2001 NEC (Y - N)
OFFICE COPY
Plan Review Process Work Book Page -8-Revised 4/28/04
(Z'- M
MECETVED
FFR 2 4 2005
II'��� `��' TEfiCO• ;�
o,
To air.
)(001 (4)
AV
�e (Al) cASICIf t
sslf�foAs � s33
IS 4� !,F � O' O L,'N6✓
I
FRI,CEI . 2 4 26(�i/IFr
— ,a,,g. ,g,g
Z;7- ?05�FA A414 eOOA4
D '
'01.2 4
J
N)
PRO me
��fico
j 7weS
Ta oar,
ssrfr�s �' � s33
Pw
/� a
, toy 2-(0
6es,
Ciba::
DPOOM E ON
�
J , 1���geIQD
15'�
j00
=EEEO�
D
z
z o
E4
ow
U0
0 E
�a
�z
CITY OF CUPERTINOr
- *vis ', � «' "_' �'' ` "'"" �`'''
RATION -s
BUILDING DIVISION PERMIT
aCON-4T'RACTOkINFIO
BUILDING ADDRESS:
9.0r9c) ROT) TrTTPq AV
CELTIC CONSTRUCTION
PE`Mr`N005020160'
NER'S NAME:
FERMiT ISSUE DATE
JOHN & SHARON
NE:
SANITARY NO. CONTROL NO.
(408)973-1224
ARCHIIECf/ENGINEER:
BUILDING PERMIT INFO
BLDG�p PLUMS MOECH
LICENSED CON7RACIUR'SDECons of CON
1 krtby "no Net 1 am licensed under S DMILA of Chapter 9 (commencing
Ar
p
Job Description 1111 a��
with Section 7000) ofDivW.n 3 of the B.M ... nM Profeeaiu.. Code, and my lbeenu is
y,
in full fomeand crfe<4
BATHRM REMODEL
LLlc.a
Lima. Class
Dam Contractor
ARCHITECTS DECLARATION
kc tel
1 unlsrganJ my pkv shall k used As public recorN
Licensed Professional
DECLARATION
Oat
I hereby assn that 11..Bump' from the Contractors n law far tk
I .. exempt from
Code; A c
rcsmn. (Sutiun 71D1.5, Bushot, end uv Any city or [aunty
whichfollowire ve, de h.o
which mash any structuummem
permit to cnvlmeL alter, Improve, lsermitt
iresW11
file
pilar m.l issuance, aten m in the tbe applicant fordw suchCon panni' m Ole se Law mtemanl
its 1
that nfUmContractoriLhenufaw(Clspmr9
Sq. Ft. Floor Area
Valuation
(commencing with Section sand of 3 of the Business and Cols) or
witpuemanttotkofDivisio
on.fAny vi
that he 4 emmp'tterefram and the bask far the alleged eump'la. Any violation of
aisxe basis f eg
3 51;8 cr0 0
Occupancy Type
Secdon 7031.5 by any applicant far a permit subjects the applicant M a civil penalty of
not mom than five hundred dollars ($500).
0 I, u mm of tk property w mY mployeu with veru u Usk mle emmpensadon.
Required Inspections
will do the work, and thestructure is not Intended maRered follow (Sao. 7041, Business
And Platy e. u Cade: The CoduactoA Lice= Low daes tot apply to an owner of
progeny who Wilds o tmprow thereon. end who does such work himself or through him
own employees. provided thmmuch improvemenu ace not Intended ooRereE for sale, If.
however. the building or improvement is mid witain arc year of completed, the owner-
"
builder will have the burden of proving that k did not Mid at improve for purpose of
sale.).'
0 1, as owner of the property, am exclusively contracting with licensed cemmelors to
construct the project (Sec. 7004, Business and Profusion Cade:) The Convector's LI -
cove Law deal not apply to an owner of property who builds or hapoom woman. and,
who comacu for such pmjec with aconuactor(O licensed pursuant in them, Contractor's
License Lew. n
olamamu t ndu ee ,BhPCfor srtemn
nor Due O
WORKER' OMFINSATION DECLARATION
'
I hereby offing under penalty of perjury oto of tk following declare tons:
❑ I hem and will mainuln a CenlRvm of Consent to ulf-ivum far Worker's Compco-
action, as provided for by Section 3700 of the labor Code. for the performance of the
work for which this permit is Issued.
0 1 have and will maintain Workers Commnsadon ivunnce, u squired by Section
3700 of the labor Cols, for the performance of the work for which Nis permit is issued.
My Workers Compensation Wallace Artier and Policy number ace:
Carrier. Policy No.:
CERTIFICATE OF EKEM PDON FROM WORKERS'
COMPENSATION INSURANCE
(Ihk section need not he completed if the permit is forarc hundred dollars (g10U)
or los.)
1 certify that in the ptrm�yy��a of Nr. work or which this permit is issued. I shall net
employ any person in my,dknrkrmrswbm An nbjectin thewokerr Compensation
Laws of Califoron. Dam'I, _� gssLiy�
ft
Applicant NN
'
NOTICE TO APPLICANT: If, after making this Certificate or Exemption, you should
became object to the Worker, compnW tan Provisions of the Later Cols, you mug
forthwith comply with such provisions As Nis permit shall be deemed mated.
CONSTRUCTION LENDING AGENCY
1 bemby affirm that there Is • construction lending agency for the perro mence or
the work fm which this permit k Wood (Sm. 3097, Civ. C.)
Lentleh Name
Lender's Address
1 comfy that I bows mad this pplicmlon and sum thn the above Information is
Z��5
eortect.l agree to comply with all city and county ordinances and sate hoc, relating to
building construction, and hereby mthorin mpmaemmives of this city to enter upon the
above-mentioned property for inspection purposes
(We) agree to cave. indemnify and keep krmless the City of Cupcnido steins'
IhblliUesjutlrmenu,c and'a". which mryin anYwYamue gelM said City
In eonseq of they Ing of permit.
APPLI UNDER NDS AND WILL COMPLY WI711 ALL NON -POINT
Issued by: Date
SO GgLA�I Q
u a�aS D s
ns/LA
Re -roofs
Type of Roof
Slgneturc or Appliun ...rota. Dam
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant at future building occupant tram or handle hanrdav material
Am, defined by the Cupertino Municipal Coda, Chapter 9.12, and the Health and Safety
,
ode, Section 25532p)?
All roofs shall be inspected prior to any roofing material being installed.
❑Yu Lj�Lo
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building maupent tau equipment or devices which
emit haurdnu aircanuminanv as lsancd by the Bay Area Air Quality MmaCemcm
all new materials for inspection.
District?
0Yes ptwu
I have rad the hmeNnusmaurialsmqulremcnu under Chapter 6.95ef the Califoo-
nlulkallh&S cty Cade. Sec 25505,25533 and 25534, 1 undemond that film Wilding
does not dy have a tens L that I. is my mspomihility m notify tk wcupmt of thc
squire, whim mug e. prior aIasuance or a Certificate or (kup�i�;
Signature of Applicant Date
OC roam
All roof coverings to be Class "B" or better
ow�.erl.rmm.nved arenP�