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02050016ai �a �v OZ= a'F ,pi %doa WLLLL a566� t� Ix at a3 L I G UPERTONNO B BUILDING PERMIT CONTRACTOR INFORMATION: [BUILDINGADDRESS: PERMIT NO9160 ANNE LANE RONALD B. WALKER 02050016 'S NAME: APPLICATION SUB DATE QALD B. WALKER 05/02/2002 SANITARY NO. CONTROL NO. RCHU ECTAENGINEER; BUILDING PERMIT INFO BLDG ELECT PLUMB .MECH ii I_7 F IL"J lul i LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 on licensed under i i of Chapter (commencing 70 )Of Division 3oftneBusiness�iProfe,amn,Code GARAGE/ASSESORY J Description P J `ithSection .add mylicense in four aercea. r s fie® Lee CI ur.x�� (1504 S FT Q y ARCHITECT'S DECLARATION RAY 1 12004 g 1 understand my plans shall he used an public mossids OLicensed Professional P., OWNER-BUILDERassort BUILDING 1. 1 hereby affirm that 1 exempt mthe ContractorLicense Law for the the Cessions ,„V, BUILDING 1. s an a Billowing teas,.. (Srebro ]on Business and Professions Code: Any city o tr stcounty O which requirt a perosit to conztmct, cher, imprn c demolish, or .,.it any structure, es .,prior W its issuance, also requues the applicant for such Proust to file a signed statement. — that h"slicensed pursud)h p is;onsoftheContracw/s License Law (Chpt 9 k-- gitn Section 7000)fDivision 3 of the Bladnesmnnd Professions Code) S i;r\°d°�:, "q• Area F[nnn Valuation 3.Floor ° nr that he 11 exempt m rearm aid the bass far the alleged enc njt me. Any violation - l of Saturn 7G31.5 by any applicant for a permit subjects the applicant to a civil pcna¢y- 7ni:.5.1.i�4.• nn ofnmmorcmanevehundreddonars(s5oo). APN Number '+ Occupancy Type Cl 1, as tome, Of the propcny. ur my employees wi th wages as their sole coinpensmiom _ will do thework:'and the structure is nm intended or offered for sale (Sec: 70J4: Business and Professions Corse The Contractor's License Law das not apply In an 102 - PIERS Required Inspections owner of property Wha builds or improves meteor, and who das such work himself or through his own employer. provided that nimprovementst intended or 103 - prc d f'-- ale Ir however the building ' -p T s sold within one f build or ... .... _ 10 4 -UFER _ ... __._..._.. _ .. .. _............ . ...... _. _ _ - - REBAR .. •. . . caitiff, t on me owner ba mc, w u have me burden at mat he did not Poing t improve for purpose of salc.r. 105 - ANCHOR BOLTS or.. gwi ... - .. . as owner of the property, on ¢relatively comrvcun with licensed canvaaors to 106 - SEWER &_ WATER..-_..._... ratedthe does ect not 100 murders, and Professions Code 9The vContractor's License Law does nm apply m owner of propertyearn who solids improves thereon, 202 - UNDERFLOOR PLUMBING " ro 7 and who.co Liam forsuch.projams wimn.a comractogzl licensed pursuant m me se - contractorruansclaw, - "203 -- UNDERFLOOR-MECHANICAL--- ❑Iana pato Sec. BkPCto, this rcuon AJI_e, N Date ' - 204 205 - UNDERFLOOR)IFRAME''-l' RKF WORKER'S CO\IPE ATION DECLARATION - UNDERFLOOR INSULATION 301 - ROUGH PLUMBING I hi offirmunder Penalty orpe,j.,one ofhefollowing deelar�dnn,; 302 - TUB & OR SHOWER PI�0I have and will maintain a certificate or Canamm to self -insure for Worker. Compensation, as, provided for by Section 3700 of the Labor Code, for the 303 - ROUGH MECHANICAL perroi,m,nee of the rorwnirn rose pe„nh is i..nra. 304 - ROUGH ELECTRICAL ❑ 1 have and will maimaln Worker. Cmnprms,im, ]asamnrr, ai reyahee by section 3 0 5 - FRAME n(n of me LaMrr CMe, for the performance of the -work for which this permit i. s und'My Worker's Compensation Insurance carrier and Policy number arc: 3 0 6 - HOEDOWNS re i ^!.r'S=•'vol o ... _..._.. 307, ,... ChRTIFICATION OF E%E ROM WORKERS'l .. 3 8- '-r'-SRHE`ETROC+K4, .., COMPENSAT O' URANCE'--'Z' aw—EXTERTOR--IiATH---- (This section need not be completed if the Perot is for one funded dollars (s00) or le.) 310 I - - INTERIOR LATH - i ry r at p r tin k n n th, p� 't .. ea. l C. ' :I C t e a n Workers rfi.Apq 31 -1 ----SCRATCH 313 COAT- - . - ROOF NAIL �t IC�SI NO'11Q'ET }qk 501..- FINAL ELECTRICAL ENERGY-...._.. Q t yth Cnlcte tee pt myou:hould Monne uspect Idthe Workers CompensationforYnnsofth Lohni-Caleroumust 502 _. - FINAL PLUMBING ENERGY' ' j F.r imcomplywim,achpEmvi,inn. or his permIt .hill Fe deemed re,nked. 503 ”- FINAL MECHANICAL ENERGY 1 • nCONSTRLaoNIENDINOAGENCY ' 1 harm that pe ci't t ling agency for the performancerhu 504 - FINAL BUILDING ENERGY work far which permit i. issued (se. 3d9zv. ac.) 505 - FINAL ELECTRICAL ' L i Lenders Name Lc d .Addres 506 ...... _._- - GAS TEST Icattily tatIhave read this appiiafn and word that the n information i, 507 - FINAL PLUMBING correct 1 Ogren to comply with all city and county ordinances and. tat laws relating to buildinecomm ¢tion and hereby authorize representatives 508 - FINAL MECHANICAL or this city m enter upon the b e n t aed p p oy r inspect n P mire.. 509 - FINAL GRADE agr<crosafo.rodemnifyandkrcphsrmlcdmhcCityidCnpIagao;falnm habinagme .. n,ta a e.p<,nx, wnien main awseer a again. sera J1.11car gonni,pmit Ta I DWILLCOMPLYWITH L s. T ;c ., Q� 510 514 Issuedlily: b - FINALctyTONteomeg ING F) F A WORKSTUN> Date t mre of t e Reproofs ' HAZA DOU HAZARDOUS h1dingsa LSDISCorharr as defineilldnapplicant " Cea^o future bat ng tae panteon2,berme histamiHealth an Safeal P Pat Cod Charter 9 1 tl m< Health and Sat ty Cn le S 2511,0) ❑ ye, a PI✓su l V-� _. Type of Roof_. ._ _...._. _".__ ..... ..,-. _.. ... . - - - - -• ...,.. . : , All (prior to Will the applicant future building p ntuseequipment devices which turn a cam m, nr aefnm by mh Bay AmmA c I lyManzg atg roofs shall be inspected any roofing material being installed lled'without first obtaining an ins ection-, I agree to'remove- p c"' '0Yes �(N s for inspection. Applicant understands and will comply with I 1 h e J the h z dos materials requirements and Chart 6.95 of me Cal' Health & Sat ry Cele S chow 25505 25533and 25534. I d nand mm If, 'Id' doc,not ort tiv h' cut<n v th t t'. t rep mnatify the =tureof ce re ulations. .blit 66 u : nt of a gnirem lu which mon be met t izmae prim or a Ccnificate of � U C/ licant Da I or mo ted ^gent All roof coverings to be Class`B" or better OFFICE - - - - .- ❑ d' art O FCF Fl¢.Z[ti pyFa 6 �- tn3a.� �Y. aha Caa Ira Z 1d 01 L: a3°- L CrrY OF NO BUILDING DIVISION, pERB CONTRACTOR INFORM, )N: BUILDING ADDRESS: PERMIT NO. - 19160 ANNE LANE RONALD B. WALKER 02050016 OWNER'S NAME: APPLICATION SUB DATE RONALD B. WALKER 05/02/2002 PHONE: "'- SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 1-7 CJ r t LJ LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under c visions of Chapter 9 (commencing with Section 70 0) of Division 3 of the Business Professions Code, and my license is inrullrndeffect. GARAGE /AS SE S ORY BLD . ��NV�La Lice se CI Lic. X1504 SQ. FT. ? Contract ./ ARCHCTECT'S DEC ARATIDN I � r4l,Y 112004 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION BUILDING I hereby affirm [hat l am exemptfromCrthe Can Law License w Cor the following reason. (Section 7031.5. Business and Professions Cade: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any suucmte. . prior to its issuance, also requires the applicant for such pernsitto file asigned statement 41 00000 - - 'C1 S Ft,. x °FOD •urea-•, • •.. � ? I,., tq' r � - 4.p i , 3 Valuation that heir licensed pursuant t0.the provisions of the Contractor's License Law (Chapter 9 (comtne isine with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation _ y .` ;07niq 00 of Section 703 L5 by any applicant for a permit subjects the applicant to a civil penalty of not more than Five hundred dollars. ($500). APN Number - Occupancy Type ❑ I, as owner of the property. of My employees with wages ns their sole compensation, •will do the work.' and the structure is not intended or offered for sale (Sec: 7044, 'Business and Professions Cade. The Contractors License Law does not apply in an Required Inspections 102 — PIERS ' owner of property Who builds or improves Chevron, and who does such work himself 1 0 — LIFER or through his own employees. provided that such improvements are not intended Or Offer*d foi sale, If, however, the buRding or improvement is sold within one year of _ _ -� '• ` -� - " - - - -'"' 10 4 — REBAR ' completion, rhe owner -builder will have the burden of proving that he did not build or improve for purpose of sale.), 105 — ANCHOR BOLT'S r as owner of the property, am exclusively contracting with licensed contractors to 106 — SEWER & " WATER ' construct me project (See. 7044. Business and Professions Code:) The Contractor's License Law does not apply to an owner of property who builds or improves thereon, 202 — UNDERFLOOR PLUMBING and,who.contracts for such. projects with a contractors) licensed pursuant to the -- 203 — UNDERFLOOR -MECHANICAL - - -� Contractors License Law. ❑fume prat [Sec. ,B&PCfor this reason 204 — UNDERFLOOR'FRAME ' �uyter 'A%• A� Date y' WORKER'S COMPEAr ATION DECLARATION 205 — UNDERFLOOR INSULATION ✓� 301 — ROUGH PLUMBING I hereby affirm under penalty of perjury one of the following declarations: 302 _ TUB & OR SHOWER ❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker's 303 — ROUGH MECHANICAL Compensation, as provided for by Section 3700 or the Labor Code, for the performance or the work for which this permit is issued. 304 — ROUGH ELECTRICAL ❑ 1 have and wilhmaiMain Worker's Compensation Insurance, as required by Section 305 — FRAME 3700 of the Labor Code, for the performance of the work for which thispermit is 3 0 6 — HOEDOWNS is ued. My Worker's Compensation Insurance carrier and Policy number are: -sort' .3 0 7.... "'INSULATION OM WORKERS'. CERTIFICATION OFEX�.MRANCE r :3 0 8:- COMPENSA ' 0 9 • _-=EXTERhOR LATH - �.... .... __......: _.._ _.. .. (This section need not be completed if the permit is for one hundred dollars 310 — INTERIOR LATH I (5100) or less.) n yt 3 11--- -SCRATCH' COAT' - - I certify t in die perfotman of the w rk o hi It llys permu is issued, 1 shall not empl any a -on • nnerso a 1 the Workers' 313 — ROOF NAIL• AP ficnsati ws fc jr to - 7. ?.p tic nt_ - ..-- - 11 N T L a ter r k ng this Cenif cafe oy Exemption, you should 501. -- FINAL ELECTRICAL ENERGY_ . — _. 5 Q FINAL PLUMBING ENERGY bee a b cer tothe R'arke{s Cor:rperuation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. _ 503 — FINAL ME CHAN I CAL_ . ENERGY CONSTRUCTION LENDING AGENCY 504 — FINAL BUILDING ENERGY .. ' I hereby affirm that [here is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ Ca 505 — FINAL ELECTRICAL ame - - -- - - Lender's Name- Lender's Address - tender's _ 5 0 6 - GAS TEST- �. .• J - 507 — FINAL PLUMBING I certify that I have read this application and state thul Elia ubove information is correct I agree to comply with all,city and county ordinauce_s and state laws relating 508 — FINAL ME CHANI CAL to building construction, and hereby authorize mpmseatatives of this city to enter upon the above-mentioned property for inspcolna purposes. ( )agree to cava, indemnify and keep harmless the City of Cupertino agai ast 509 — FINAL GRADE ► 510 — FINAL ING lia4iliti ., udgme s. ores and expenses which may in any way acc a again .said City i' nscqucu a ills g tln- of [his permit. A, P AST L'. T D tiF7LL CONIPLY'.Y[TH L - N 0 • T 514 F; F A WORKS Issued by Date ig attire f)f - ' icaar/Cnnttactof a Re -roofs HAZARDOUS MATERIALS DISCLOSUR %LLII the applicant of future building occupant store or handle hazardous material Type of Roof.. • - as defined by the Cupertino Mty�rc'pal Cade, Chapter 9.12, and the Health and Safety Code, Section 25532(ay! I V .. `C7 Yes c _ All roofs shall be inspected prior, to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as ec'ned by the Bay Arra Air Quality Management District? ❑Yes N° If a Too 's installed without first obtaining an inspection, I agree to remove all news aterials for inspection. Applicant understands and will comply with I have read the hazardous materials requirements under Chapter 6.95 of the all non -'(s ce re uIations. . ; r' Cali a iia Health & Safety Code, Sections 25505, 35533 and 25534. 1 understand Thar if r c uildin does not currently bave a tenant. that it is repo sibilit), to notify the i' - "- t issuar a of a Certificate ofc cc u' ante h�IqLnra!p "mustr pantylgnAture of Applicant Daw or tho izedagenate All roof coverings to be Class "B" or better 0F'F:;0E CITY OF CUPEkT[NO CITY OF CUPERTINO PERMIT APPLICATION FORM o L 6S'I;r-'' /� APN #-375- 0 7" 012—Date: D Build' ,A ddress: rTl 0 Owner'rozy a��� Phone#:� ,, - 9� - 75 o I Contractor:f_ ' f� License #: Cont o� -c-r Phone #: / 6 -7,3-59of App 'cant/Contractor: �� Fax f :v J _ 0 3 �10p Buildi g ermit Info: r Bldg ( Elect PIumb Mech 3 Job scription- 1;5esi GGUQ �,55�5orj Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: chitectlEnen er: h S 'Valuation: Type of Construction: Occupancy G oup: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BB0IL•ER1 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/Quasi BUILDING BCONSTAXB 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 BrWESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING 1 of 3