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03090031 CTY OF CUPEW11NO '"� `'°+'a 'F`;• ^` �I? ' ' BUILDING DIVISION PERMIT CONTRACTORANF,ORMATION zc flUILDING ADDRESS: PERMIT NO. O3090031 .R' NAME: PERMITLSSUEDATE NE: SANITARY 904. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECr PLUMB MECH .00 LICENSED CONTRACTOR'S DECLARATION E u F I hereby affirm that I am licensed under provisions of Chapter v(commencing Job Description with Section 7M)).fDivision 3ofine Busumax and Professions Code,and my license is ' s in full forte and effect. ;q= LieenseClasa Loc.a ADDITION-FINALS ONLY �9�� ARCHITEC on D Da TSDEtarCLARATION SEE. ORIG PERMIT 00110131 £w`u 1understandmyp[,.,hallwuedAsPublic.,raw FOR ALL OTHER INSPECTIONS . e o Livened Pn,feAxiana, SEP 0 5 2003 OWNER BUILDER DECLARATION A 2 1 hereby affirm that I am exempt from the Contractor's License Law far the OD following mason.(Section 7031.5,Business and Professions Cade:Any city or county BUA1 n�prG R� which requires a permit us construct,alter,improve,demolish,or repair any structure ILDING rM '!zj• from or is issuance,also requires the applicant for such permit m file a signed,odannom < that he is licensed pursuant nthe pmvisionsofthe Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation C�C (commencing wi If Section 7000)of Division 3 of the Business and Profeuinns Cole)or $ but he is exempt therefrom and the basis for the.11A,ed exemption,Any violation of Section 7831.5 by any applicantfor a permit subjects the applicant o acivil penally of APN Number Occupancy Type not mom man five hundred dollars($500). ' - ❑ 1,As owner of the property,or my employees with wages As their sale compensation, 342 15049 . 00 will do the work,and the swembe is not intended or offered for sale(Sec 7044,Busiraes and Professions Code:The Contractor's License law does not apply to an owner of Required Inspections - property who builds or improves rhemon,and who does such work hiensalfor through his own employees,provided that such improvements are not maended or offered formic,If. 101 — 'FOUNDATIONhowever,the building or improvement is mid within one year orcompletion,the owner builder will bars the burden of proving drat be did not Wild or Improve for purpose of 102 - PIERS Aide ❑1.as owner of the property,am exclusively contracting wish licensed contractors to 103 UFER construct she pmject(Sec.7044.Business and Prefesteas Code)The Contracmrs Li. 1 04. — REBAR cake taw does not apply to an owner ofpmpety who Wilds or improves human,And 105 ANCHOR BOLTS who coA a,fiat ch projeam with a contractors)limned pursuant to she Conuactor's — Cen"Iaw' 106 - SEWER & WATER lamexcmpsun is. B A,P C for this mason �W(6.3 202 _- UNDERFLOOR PLUMBING WORKER'S COMPENSATION DECLAR,01IONB 203 `:UNDERFLOOR .MECHANICAL the yaffrm under penalty of perjury one of the following declarations: 204 — UNDERFLOOR FRAME I have end will maintain a eerdimak of consent to adf-asum bar Worker'sCompen- 205 - UNDERFLOOR INSULATION sation,as provided for by Section 37th of the labor Code.for she pkrforroana of on, 3 01 ROUGH PLUMBING work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance,As required by Section 302 - TUB & .OR SHOWER 37110 of thelaborCode,for the Performance of the work for which this permit I.issued. 303 - ROUGH MECHANICAL My Worker's Cnmpensaiise Insurance carrier and Policy number am: 304 — ROUGH ELECTRICAL Cartier: Policy No.: - CERTIFICATEOFEXEMPTION FROM WORKERS' 305 — FRAME COMPENSATION INSURANCE 306 - HOLDOWNS (This actton need not becomplead if do permit is for one hundred do)].1$100) 307 - INSULATION (It Icas) 1 anify Out in the perform...of the.,it for which this permlt is issued.I shall nut 3 08 - SHEETROCK employ any person in any manner an as to become subject to tbe Workers'Compensadon 309 — EXTERIOR LATH ' Law.of California.Data Applicant 310 - INTERIOR LATH NOTICE TO APPLICANT,If,after making this Ccnificate of Exemption,you should 311 - SCRATCH COAT become subject to the Worker's Compensation provisions of the Labor Code,you must Zforthwith comply with such provisions air this permit shall W deemed revoked. � 313 - ROOF NAIL zp CONSTRUCTION LENDING AGENCY 501 - FINAL ELECTRICAL ENERGY ^ (hereby aurum that there is a construction lending agency(or dre Performance of 502 - FINAL PLUMBING ENERGY x> disc work for which this posit is issued(See 3M.Civ.C.) landar'. 3. Lender'.AAddddo ss 503 FINAL MECHANICAL ENERGY Y re :) z504 - FINAL BUILDING ENERGY 1 certify Nat 1 have read this appliewit fob suit that the a Wve information is 3s L. come,.I agree to comply with all city and county ordinances and stale laws mlming 10 505 - FINAL ELECTRICAL building construction,and hereby authorinrepresentativesorthis city toenter upon the GAS EST o-m VV ahavcntimed property for inspection purposes. ti y W.)agme to Anne,indemnify and keep harmless the City of Cupertino against 07 F I V) Ilabilisies,judgmen6,Costsandexpenseswhichmayinanywaysee=againstmidCity 5 ICAL JZ been equc`n..ccofmcgrantingofmi rmit. APP owl UND;RSTANOswILL COMPLY WITH ALL NON-POINT Issued by:5 Date s uac Reese 1 Ns. Q/.,/ 510 NAL PLANNING 1`11r1]_ Re-roofs 4 - FINAL PUBLIC WORKS S' mos ApplicaHAZARDO Data HAZARDOUS MATERIALS DISCLOSURE Type of Robb Will me applicant or Twort building a Chat erre or handle hmardous materiel az dcOncd by the Cupertino Municipel,Code,Chapter 9.12,and the Iicalth enJ Safety Section 35532(a)7 All roofs shall be inspected prior to any roofing material being installed.❑Yea 6No Will the applicant or future buildingoaupanl use equipmcntordevices which If a roof is installed without first obtaining an inspection,I agree to remove emit hamsdnes air contaminants a dc6ned by me Bay Area Air Quality Management all new materials for inspection. District? ❑Yes VN. 1 have mad the handithismau:rialsmquimmenu under Chapter 6.95 of the Caliror> nia Hcalthdr SafctyCWc.Secuons25505,25533and25534.lundcmmndthetifhe Wilding teas nor elobbdyhaw tenant,Nat it s my msp uihility to nnuly the mcupmt of dm mquimm nL which mus b et prior im.Aaccoh CanBcateofacuPab Signature of Applicant Date 0 r nuthorirsdAgenl f Daw All roof coverings to be Class "B"or better CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT OPERATOR: suem COPY # 2 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34215049.00 DATE ISSUED. . . . . . . : 09/04/2003 RECEIPT #. . . . . . . . . : 23014 REFERENCE ID # . . . : 03090031 SITE ADDRESS . . . . . : 22707 VOSS AV SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : URAUCHI KEITH M AND PAMELA W ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2673 RECEIVED FROM . . . . : PAM UPAUCHI CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , � TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 0.00 177.00 0. 00 177.00 0.00 BPLANCHK PERMIT FEE 1.00 150.45 0.00 150.45 0.00 BENERGY PERMIT FEE 1.00 53.10 0.00 53 .10 0.00 BSEISMICRE VALUATION 0.00 1.20 0.00 1.20 0.00 PPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00 EPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00 MPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00 __________ __________ __________ ---------- TOTAL PERMIT 488.31 0.00 488.31 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ -_--___-_-_-______ CHECK 488 .31 6453 TOTAL RECEIPT 488.31 t INVOICE INV INVOICE I OICE INVOICE INVOICE . INVOICE INVOICE INVOICE CITY OF CUPERTINO Vo ERMIT INVOICE OPERATOR: christya � /J 7 . 04Sec: Twp: Rn. . Sub: 342 Lot: /• /'� A APN . . . . . . . . : 34215049.00 NVOICE DATE. . . . . . : 0,�9/03 2003 �/ ) FERENCE ID # 000110131 _`� lV ✓ TE ADDRESS . . . . . : 22707.VOSS AV � ll SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO /JV IMPACT AREA . . . . . . . O OWNER . . . . . . . . . . . . : URAUCHI KEITH M AND PAMELA W ADDRESS . CITY/STATE/ZIP . CUPERTINO CA, 95014-2673 i " rl CONTRACTOR . . . . . . . : LIC # a 9 / COMPANY . . . . . . . . . . . DC ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . TELEPHONE . . . . . . . . .. ORGYDESCRIPTION ACCT NUM CHK TOTAL FEE PD TO DATE BAL DUE ----------------- ------------ --- ---------- ---------- ---------- 4119 A' 53.10 53.10 0.00 ORGY 4119 , BLDG PERMIT FEES 4116 P 177.00 177.00 0. 00 PLAN CHECK FEE 4111 A 150.45 150.45 0. 00 SEISMIC FEE RES 2013 - P 1.20 1.20 0.00 . BUSINESS LICENSE 4063 A 90. 00 90. 00 0.00 ELEC PERMIT ISSUANCE 4117 P . 35.52 35.52 0.00 MECH PERMIT ISSUANCE 4117 P 35.52, 35.52 0. 00 PLUMBNG PERMIT ISSUE 4117 P 35;52 35.52 0. 00 578 .31 578 .31 0.00 VOICE ID DESCRIPTION VOICE IDPTION I/6 --- __ p 101 FOUNDATION 102 PIERS 700, 3` 103 UFER 104 REBAR 105 ANCHOR BOLTS 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL 204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION 301 ROUGH PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL �'" 304 ROUGH ELECTRICAL 305 FRAME 306 HOLDOWNS 307 INSULATION 308, _ SHEETROCK 309 EXTERIOR LATH ; 310 INTERIOR LATH 311 SCRATCH COAT 313 ROOF NAIL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY 5 FINAL ELECTRICAL 506 GAS TEST 7 FINAL PLUMBING 508 FINAL MECHANICAL 09 FINAL GRADE 510 'FINAL PLANNING 514 FINAL PUBLIC WORKS ' CITY OF CUPERTINO� BUILDING DIVISION PERMIT CONTRACTOR INFORMAT ON: a BUILDING ADiiRESS i1 PERMIT NO. y .,271:17 )ti;tC^;!5 AV tSt rlu;.: OWNER'S NAME:' APPLICATION SUB LAW lffllis.! HONE: s SANITARY NO. CONTROL NORCHITECTILNGINL'ER: PHONI'n BUILDING PERMIT INFO PLUMBC 11 L 1 CI'fOARRANGE[NSPCC"PIONNSI'IiC'1'IONS DA'I'li INSI'CC. JOB Ul?SCRIPf10N a i CALL T77-7228 MONDAY-Il21DAY 24 HOURS RESIDENTIAL: S i FOUNDATION/PIERS/H.D.S. BEFORE REQUIRED INSPECTION.JOB ADDRESS ❑ SF L ❑ KITCHEN REMODEL z o AND PERMIT#ARE NEEDED WHEN PHONING- DIT10N ❑PLUMBING RE-PIPE F-sy BEER GROUND ❑ ULTI-UNP[' ❑STRUCTURAL ou PAD/SCT BACK-CERT - ra.Z RESIDENTIAL_COMMERCIAL_OTHER MODIFICATION 3 u,t� GARAGE SLABS/PREGUNITE f{AZARDOIhS FIRE AREA ❑ INTERIOR ❑CHIMNEY REPAIR 20 g POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED IMPROVEMENT ❑ SWIMMING POOLS <E UNDCRGROUN D/SLAB ❑ YES. If 111ndersland 111.1111 Clic Amo l'o,cnhl +,u ❑ BATH REMODEL/RCPAIR❑ DEMOLITION p O )'es. y yulmJ. ❑ OTHER ^_ PLUMBING ❑ NO Initial LC.B.O.# $$ao ELECTRICAL COMMERCIAL, PLUMBING a 3 4)O POUR I'LGDIi 11 N'I'II,ABOVIi IL\S BEENSIGNED EXISTING ROOF COVERING ❑ NEW BLDG/ADDITION ❑ D17MOLITION PLUMBIDING MECHANICAL Number of existing coverings ❑ TENANT ❑ FOODSERVICE IMPROVEMENT ELECTRICAL To he cinicoed To he emined ❑ OTHER FRAMING VENTS INSULATION PLACE NO SUBFLOOR UNTIL ABOVE IIAS BEEN SIGNED TYPE OF ROOF COVERING ROOF SHEATH/DIAPHRAM EXISTING: PROPOSED: PLUMBING ❑ Built-Up Roof ❑ Built-Up Roof TUBS&SHOWER PAN ❑ Asphalt Shingles ❑ Asphalt Shingles MECHANICAL Is, ❑ Wood Shakes ❑ Wood Shakes ELECTRICAUPOOL BOND ❑ Wood Shingles ❑ Wood Shingles RAMING/STAIRS/E.EGRESS ❑ Olher(Spccify) ❑ Othcr(Specify) NSIJI,A'fION/VENTILATION r Provide[C.13 0.Repan No. COVER NO WORK 4JNPIL ABOVE HAS I 'EN SIGNED Provide Mfgr.Installation Specs. EXTERIAL SHEAR/HOLD DOWN ZA- Ne INTERIOR SHEARIHOLD DOWN SH PET'ROC K/S3113PTROCK SHEAR INSPECTION SPECIAL $PECTION REQUIRED ❑ DATE INSP EXTERIOR LATH/W-SCREED SHOWER LATH NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED SCRATCH COAT J SEWFt/WATERG TEMPORARYAPPROVALS OCCUPANCY `AAW ��p �7r� FINALS' �"•- `^' � Z PLANNING 777-3308 ZO GAS TEST O GRADE(P.W.777-3354) W FIRE ZHANDICAP U O ELEC'T'RICAL OU PLUMBING y MECHANICAL ENERGY U zVISUAL FINAL ONLY BUILDING OCCl1PAKCY OF 13UILDING IS NOT PERMITTED ON']11.BUILDING FINAL IS SIGNED BY BUILDING 'SPT:C OR. CERTIFICATE OF OCCUPANCY❑ PRE-INSPECTION. PLYWOOD; IN-PROGRESS INSP. DATE INSP. DATE INSP. DATE TEAR OFF INSPECTION: BATTENS: FINAL: INSP._ DATE INSP. DATE INSP. DATE NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION APPLICANTS POSTING COPY CITY OF CUPERTINO OF PERMIT APPLICATION FORM D �j3a9 d� CUPERTINO APN# ''2., � I� Date: 2 Building Addroca�Owner's Name: Phone #>Q x'PA� Ll 19l Contractor: License#: Contact: Cupertino Business License#: Building Permit Info: Bld Elect ❑ Plumb ❑ Mech ❑ Job escri tion: Residential ❑ Co Sq.Ft. Floor Area: $/ q.Ft.: Cost of Project: Occupancy Group: _^7 Type of Construction: 7 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> 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 1 of 3 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 BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric 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 rick er/Backflo PLUMBING BPSTORM Stonn/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 BREMFLKT Lighting Fixtures ELECTRICAL BREMFURN Relocation ofFumace 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 2 of 3 ,ii gvvvs . CITY OF CUPERTINO CUPE(�TINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group 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 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 Insection 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 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 BUII.DING 3 of 3