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04020110n I N Z;: 3�u +oG Km W� F� fF n� CITY OF CUPERTINO BUILDING DIVISION PERM*�'CONTRACTORI.INFORM 5 i o 0 ?I Qlender's Q F" U Is7 �„�+^�'",..y;,x JN BUILDINGADDRESS: 1A qTqAr)C)Wlz1II 1N VANNI BROTHERS CONSTRUCTIO ERMrrNO04020110 ER'S NAME: PERMIT ISSUE DATE PHONE: SANITARY NO. CONTROL NO. ARCHITEC rENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O O LICENSEDCONTRd SDEsionof JO under provision ofChapterCode. Y (commencing 1 hereby affirm Nat I am underhap ��® nd10) of Division 3 of the Business and PrOGssinns Code. and my license is fthe Hu infull to= Licenlse Choat, d e(f� Lt.,# KITCHEN REMODEL Date Contractor ARCHITECTS MAR d� ZUU4 1 utmersunJ my plans a1W I he used u public records L T Licensed OWNER -BUILDER DECLARATION affix BUILDING 1 hereby .(firm 1 .Bumpe the Comoro License law for tK s an o on Business and inns Code: Any city m county meson. (Sante TOILS. ressu L wffinhire t. w. de requires a Permit cnnsbucL alter, impmw, dcmoRN, or mash any tatemum priort its re prior m its issuance, raalso, mq. lin the applicant for such permit W files signed statement that cwitpYRYanitolh)ofDivinnOfof Sq. Ft. Floor Area Valuation ft usinesandPromshoChapter ome)9 (commencing;ompthSection]000) of Divuionlnf theeged Business and An,A of Nm he u es.mpt tmefrom and anis for the .puled exemption. Any violation of to, l tion or decdan m3LS by airydred lana for a pcnnit subjects dm applicant m • civil penalty of 3 6 gI$et0 0 Occupancy T not molt Nan five hundred dollars ($500). P y type 0 1, u owner of the pmpeny, or my employees with w9M u their sale mmpenmtiw, will do the work and the structure u not intended methanol formic(Sm.]044, BWines and Profession Code Ins, Contractor's License Law don not appy m an owner of Required Inspections Property who builds or improve thereon, and who doessueh work himself or through his own employees. provided that such improvements am notimeMd nofremd for sale. If. however, the building Or improvement is sold within oro year o(completion. the owner - builder will have the bumm of proving dtat k did am build or improve for purpose of sale.). I, n owner of Inc Property. am eclUmwly contracting wit licensed conimsma W onsoact the project (Sec. 7844. Business and Pro(easions Code) The Consmrofs Li- cense law dao not apply W in owner of propeny who builds or impmws thereon, and who contracts for such projects with a eomnimtor(s) licensed pursuant the Conuxtr's License law. 0 1 am c ntler Sec_ . B & P C far tis anon Dala 2-/ O l W, RKER'9yCOMP SATION DECIARATIONN-) I hereby aRtm under penalty of perjury one of the following declaruiotu ❑ [haw and will maintain a Certificate of Comenua self-insumforWorkerYCompen- sadon, u provided for by Section 3100 of the labor Code, for the performance of the work for which this permit is issued. 0 1 have and will maintain Worker's Compensation Insurance, as required by Section 3]00 of the labor Calc, for the performance of the work for which this pcmtit is issued My Worker's Compensation Insurance carrier and Polity numher are: Cartier. Policy No.: CERTIFICATE OF EKEMP ION FROM WORKERS' COMPENSATION INSURANCE (Thu scctim need nolbeeomdcuml If the permit is forom hundred dollan($100) m lea) 1 eerily Nal in the penfomm�n of th. work for which this Permit u issued, I shall not employ any person in any mmner an sa to became subject to the Workers' Compensation Laws of California. Dale Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption. you should become subject W the Worker's Compensation provisions of tM labor Code you mum forthwith comply wit such provisions or tis permit shall M (caned mvnkcd. CONSTRUCTION LENDING AGENCY hereby mmms that them u a construction lending agency rat the performanmof ' the work fm which this permit is issued (Sm. 3097, Civ. C.) Name Lctder's Add sa I certify that 1 haw mad this application and sate that the .hove information is correct. 1 qme to comply with all city and c..my on inances and sum laws miming W Wilding construction, and hereby mdurie repmmittlives of this city to enter upon the shave -mentioned property for inpeetlon puM=& (We) agree to saw. indemnify and keep barmlera the City of Cupertino against liabilities, judgmcns, casts and expense which may in my way accrue against said City in camexpuence of the graming of t his Permit. APPLICANT UNDER UNDERSTANDS WILL COMPLY WITH All. NON-POINTL7 Issued by: Date SOURCE GULA ONS. G� Re -roofs nazur. of Applicaate RDDOUOD HAZARDOUS HAZAS MATERIALS DISCLOSURE Type of Roof wll the applicant or (uwre building acupam atom or handle havardous material fined by the Cupertino Municipal Code. Chapter 9.12, and the Hcaldt and Safe deSafety we. Sc zss25532H)'Yrs �4a p res All roofs shall be inspected prior to any roofing material being installed. Will thea applicant or future building Occupant use a or which pP sArea If a roof is installed without first obtainingan inspection, I agree to remove emit ha'rardnua air contaminants as defined by to Bay Arca Air Quality Maescmrnt Mara D1111110 all new materials for inspection. P ❑tea No 1 have mad dm lu and o rnmertihn:loo menu un ic, Chmme,6.95 orae Califor- maHealt&SafeyCoce. Sections 25505.25533 md25534. 1 undersand dinauthc Wilding Joe not currently naw a meant, that it u my maponsibility, m notify the occupant of the m9.imswhich =nor or to ism,mm of a Cetdream or Oc era Signature of Applicant Date All roof coverings to be Class "B" or better ow .r or ..tart ea ogee m FROM Vanni Brothers Construction PHONE 1,110 : 408 253 7 -7 / FEB. 09 "004 09:54PH P1 / lo�Cl��'slt •!3 j., ; -f'u r N : h $. /.a:-./, vim'-' 1_i-'�� __ i+-� � -"� 'Z i�� vicar • `'J UE...Z Z. I� .I . sLtd hI ,,)A LIAYCS �5., \,li3�. P11Jb9 .... I(20 q 7 2004 plus �o .. . U . �N V , IN CCORD NCE THE OF CUP RT D A ORD: DATF. SIGNc`l uSt v i ati. is en V on sari 1prLto i Y-1, n rn� i Ire 6: 1 - _�.. the oml:'fro "wi ,4o+ A i ,� U% The,Stel ipi1� o*. thie plan_ �\ Ou lu SHALNOT be held `i�d, nu of Irl UP ter. epRwt ,r.!.the ::a8d;. r.'.oM' S�fOVf ±: of GrdiWvliLe*oj''ShAv Law. — \5 Vanni Brothers Construction PHONE NO. 409 253 7028 0 a 3s ..�p lam. FEB. 09 2004 09:52PM P1 �O/Y T./ 41 elf, . ! � 0.T y k, AF ; Pftovf- Itl PCCOAI4CE Vil" TME ' OH SM CODES P',0.OP01ii? COPERTIN RD .: �Srt.. - ....... - �, ' : it�es'c�h h n'c s ' �.>: 1 {lsun� � pw'i�,5�e.cssFcC_e1C ;�EGutbduJ. il .n+wu,l iii .111'1 CrUJISipR° _ Ga - CITY OF •CUPERTINO 4PITY OF CUPERTINO PERMIT APPLICATION FORM o 6 o ( (,O APN # 0 / Z -2-� o Fee Description Date: BAPPLOTHER Other Appliances MECHANICAL � 00 Building Address: BUILDING Mailing Address (if different from building address): Owner's Name: MECHANICAL BBOILER2 Phone #: T-) ltzly\-ID BBOILER3 Boiler> 500K to IM Btu 0-01� Contractor: 1 MECHANICAL License #: Boiler> 1.75MBtu MECHANICAL BCONSTAX Construction Tax Contact: Phone: 4 -bb- --k53 -7 028 Cupertino Business License#: BCONSTAXBQ Fax: BUILDING BCONSTAXH Building Permit Info: BUILDING BCONSTAXR Constax - Resi/Mobile BUILDING BELEC1000 Bld Elect 4!!�— Plumb's Mech Jo escription: ELECTRICAL BELEC200 Residential ❑ N Q Commercial ❑ Sq.Ft. Floor Area: BUILDING BENERGYADD $/Sq.Ft.: Cost of Project: BINVESTIGA Investigation fee Occupancy Group: BMITIGATC I Comm. Housing Mit. Fee BUILDING Type of Construction: Please check this box if a project is a second-sto addition: ❑ 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> 1.75MBtu 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 > 1006A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC I Comm. Housing Mit. Fee BUILDING 1 of 3 /1 �� ","®ravu CITY OF CUPEII;TINO ATY OF CUPERTINO PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group M BNUCOME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME inspection Overtime BUILDING BPBACKFLOW Atmos heric Vacuum PLUMBING BPCESSPOOL Cesspool 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 rinklerBackflo 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 cfrn 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 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 BREMPOWER Power Device/Apparatus ELECTRICAL 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 Sips, Marquee ELECTRICAL 2 of 3 Z` CITY OF CUPEkTINO VITY OF CUPERTINO 0 PERMIT APPLICATION FORM Quanti Fee ID Fee Description Fee Group 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 Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Power ELECTRICAL BTEMPPERM -Temporary Tem ora Bld Permit BUILDING BTEMPSVCS Tem Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electricals foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG PlumbingFees foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 0 • •