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03010133 CITY OF CUPERTINO BUILDING DIVISION PERMI C,ONTRACTOR,INFORMAT BUILOING ADDRESS: PERMIT NO. 10889 BARRANCA D W NER'S NAME: APPLICATION SUB DATE UEBEL JOACHIM J AND UTE D 01/23/2003 PHONE: SANITARY NO. CONTROLNO. ARCHRE MNGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH �Op CON11"RACTOWS DECLARATION I hereby affirm IMI1 am licensed under previsions of Chapter Y(commencing Job Description with Senion )of Division 3o(Ne Businesgend Professions Code,end my license is z2Min roll fo dcffece _ LVT/r?/�/ TERMITE REPAIR/FUNGUS DAMAGE 3 License less ENI;, Du — Conuxlor d� ARCHffECI'S D ATION !� 1 unaenuad my piens shall he used u PPl is tecords ,V< v �oy5 Licensed Pmfcssional OWNER-BUILDER DECLARATION < H O� <f 1 herby affirm that 1 am1. exempt fain the Contractor's Co License law for the \V OO followingtenon. amens ]onstru Business and improve, denoos Code:Any city or county $fLi which requires a pnmic re conawct,alter,improve,dcmmnh,or repair any hoormm t- �^ ded heor its issuance,saidatm inquires the applicant for such permit to fileasigned suumem $7g��t10❑ Nac he is littnxd pursuanuo the previsions of Ne Conmcurs License law(Chapxr9 Sq. F[. Floor Area e W_ he axe pt Saaon]Ondth Division]them Budcinor dPmfa,ions Code)or u — Nu he n exempt m,apps and the bun for the alleged a log,,.Any violation of Sidon than five toy applicant roe a permit subjects the applicanuo a civil penalty of net more than Bve nanama amen(slot). 32AWR PU Occupancy Type ❑6o sownerk.the the gract emyemntendedwithwagesutheirwle compensation, will Pr the work.and Ne ah Con is not,Lt.. .Law dosed Out apply ¢an Bulinus oma Professions Code;The Convenor,License law does not apply u an owner of 10 2 - PIERS equtred Inspections Ownpropertycom who builds or improves thereon,and who areuuch work himsal(or through his however.the Wilding or ded progn each Imps sold wtsanmyear not f d or completion, forthe saleownIt,er. Wilder 103 — UFER however.the building or den of einem is rid within one year o improve for Ne owncn builder will have Ne burden of paving Nat he did not build or improm for puryose of 104 — REBAR „le.). 105 - ANCHOR BOLTS ❑k n owner of the property,am exclusively t and comrncting with 3The,Contractor's m 10 6 - SEWER & WATER consima th project(Sec.70u,Business and Rofaulom Code)The Conuxmh Li. cane law noes not aPPIY m.n Owner of Properly who bands or improves themon,and. 202 - UNDERFLOOR PLUMBING who contracts for such pmjecu with a cognmicr(s)licensed pursuant to the Contractors License Law. 203 - UNDERFLOOR MECHANICAL ❑ 1 sm exempt under Sec. ,B&P C for this ream 204 - UNDERFLOOR FRAME OwnG1 Dam 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING I hereby affirm ander Family of perjury one of the following aeclmdmu: 302 — TUB & OR SHOWER C I have and will maintain a Certificate of C.naeal m self-iuum for Wohers Compere sation,or provided for by Section 3100 of the Labor Code,for tae performance of the 303 - ROUGH MECHANICAL woh for which Nis permit Is issued. 304 - ROUGH ELECTRICAL ❑I have and will maintain Workers Compensation Insurance, h requited by Section 305 — FRAME 5]00 of the Labor Coae,for No performan of the work for which this permit is laved. My Workers Compensation lnsu rand Policy number am: ,Q�g 306 — HOLDOWNS Carrier: 1t V VEOF . Policy No.:Lit IJ?1-7-V 307 - INSULATION CERTIFI COMPENSATIOTE OF N]INSURANCEON MOM ORKERS' 308 — SHEETROCK Or Thissetionneed not hecomputed itthe,permit isfor one hundred dollars(Sta) 309 - EXTERIOR LATH I conif) 310 - INTERIOR LATH employ that in the performance of IM work for which this permit is Wued,l shall not 311 - SCRATCH COAT employ any person in any mennerx u m become subject to the Woheri Compensation Laws of Celifomie.Data Applicant313 - ROOF NAIL NOTICE TO APPLICANT.If,after making this Cenificate of Exemption,you should 501 - FINAL ELECTRICAL ENERGY become subject to he Worker's Compensation provisions of the labor Code,you muse O7 502 - FINAL PLUMBING ENERGY O forthwith comply with such provisions or this permit shall be deemed revered. X70 CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY tom — IMmby alrum that ft.I.aconswcdon lending agency for tho Pommancemf 504 - FINAL BUILDING ENERGY Lri the work for which Ni,permit is issued(Sec.309],Civ,C.) req Lender's Name 505 - FINAL ELECTRICAL ] anaer,Ada—.. z 506 - GAS TEST U O 1 certify that 1 have read this appticatwo and tum that the be.information Is 507 - FINAL PLUMBING O !+ cored I agrtt to comply with all city and county ordinances and sum laws telling to CrJ^ building construction,and hereby auffinde,mpersentatims of this city to enter Orion the 5 FINAL MECHANICAL W above-mentioned propcny for Inspection purposes. O9 FIN L (We)agora m save,indemnify and keep homeless the City of Cupertino against [q liabilities,judgments.costs and as,.which may in any way tame against said City 5 N G V 7 in consequence oflM granting of this permit r7 APPLICANT UNDERSTAN S ANO WILL COMPLY WITH ALL NON-POINT Issued by5 1 WORKS Date SOuRCE REGULATIONS. Signature pp icmtl R nor Data Re-roofs HAZARDOUS MATERIALS DISCLOSUg l Type Of ROOF Willy the applicant or future building e,Chapter emm omen handle Mwth and u defined Second. the 32(a)?no Municipal Code,Chapmr 9.11,end she Health and Sa(cty • Code.S Nen25s72(MP ❑Yes ❑No All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove .Unit hazardous it contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? C]Yes 0 N I have mad the hazardous materials mquiremenu under chapter 6.95 of the Califon- am Health&Safety Cade,Sectiuna 255115.1557]and 25534.1 uncer and NN ifdm building dote not eurtently ham a tenenk Nat is is my responsihillty b tify tae acupent of Ne n requimments which muss he met Met In issuance,of a Ccrdfreeo (Occu eery. Signaturebf Applicant Date - OW All roof coverings to be Class "B" or better Owncror,uh.h.dagcm DOW r CITY OF CUPERTINO • CITY of PERMIT APPLICATION FORM • CUPEf�TINO APN# r Date: 0 -3 A Z3 Building Address- In Pq,2 r Cu 2rtiu Owner's ame: Phone#: Contractor• License#: M c Contact Phone#- Applicant/Contractor: Fax # jJob ' ing Pennit In o: d Elect Plumb Mech scription: 1—urj d.u-s r,�a"^dc_ sidential: Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: jj 6o uc 8 g s �x Architect/Engineer: Valuation: Type of Construction: Occupancy Gr uanti Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances 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 BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BNEWMULTI New Multi-family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM I New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING I of 3 WOOD DESTROYING PESTS AND ORGANISMS INSPECTION REPORT This Is an Inspection report only -not a Notice of Completion. CORRECTED REPORT ADDRESS OF PROPERTY INSPECTED BUILDING NO. STREET CITY ZIP COUNTY DATE OF NUMBER OF CODE INSPECTION PAGE9 10889 ARRANCA DRIVE CUPERTINO 95014 43 1/16/03 13 SUNRAY TERMITE CONTROL A1Rx stamp here on Board copy only 125 SO. CAPITOL AVENUE A LICENSED PEST CONTROL SAN JOSE, CA 957 27 OPERATOR IS AN EXPERT IN HIS FIELD. ANY QUESTIONS • RELATIVE TO THIS REPORT 1408) 258-0927 FAX#: 258-3308 srtermite@aol.com SHOULD BE REFERRED TO HI REGISTRATION# PR 0502 REPORT# 234452-P jSTAMP# ESCROW# 35362702 ORDERED 9Y: WISTER CHU C_OLDWELL BANKER 10105 S. DE ANZA BLVD. CUPERTINO, CA 95014 252-1133 REPORT SENT TO: JIM NAPPO, ` ALAIN PINEL 167 S. SAN ANTONIO ROAD LOS ALTOS, CA 94022 (850) 941-11 PROPERTY OWNER: UNKNOWN C/O AGENT PARTY IN INTEREST:STEWART TITLE, 10125 S. DE ANZA BLVD„ CUPERTINO, CA 95014 SUSAN 257-2850 ORIGINAL REPORT IXI LIMITED REPORT I I SUPPLEMENTAL REPORT I I• REINSPECTION REPORT 1 I• 'ORIGINAL STAMP# DATE 1 N F S D F O D E F C S GENERAL DESCRIPTION: TWOSTORY SINGLE FAMILY D N O U U R U T A A A E X H PWI A T R T V N H M R U O STUCCO AND WOOD EXT C T T w G E P T L W. C I H E O U R w H T U S E SEMI-VACANT g a w n D S w D W Y D S R S P A O O D 0 G 8 V L B C N E E R D T D A E E EA , L T S A R 0 E 0 D M K. INSPECTION TAO POSTED: SUBSTRUCTURE AREA E E P N M R P R C E 6 O' S t2STALL HER INSPECTION TAGS: COMBAT TERMITE DATED 118/03 A D .C__T—�— Y E M T E R T WILD A V S U N I T S T L E .- A s 8203 BSTRUCTURE AREA SEE ITEMS 1A THRU 1H BELOW X X X X SHOWER -UNDATIAPPRUVMV 4. PORCHES. , WwgI BELOW 1N CO DANCE WI THE CITY X 5: VENTILATI CII CODES D ORDINR U 14 B..ABUTMENTS -11 7.ATTIC SPACES SEE ITEMS 7A AND 78 BELOW IATF X B.GARAGES SEE ITEMS SA THRU BD BELOW X X 9.DECKS -PATIOS SEE ITEM 9A BELOW X 10. OTHER -INTERIOR SEE ITEMS 10A THRU 101 BELOW" " X X X 11.OTHER-EXTERIOR SEE ITEMS 11A THRU 11K BELOW -9— X X •X DIAGRAM,AND EXPLANATION OF FINDIN (. I ,rgOoht)id llmltddlto DUt0191br Mffictures shown on diagram) tllo building Dept., City of Cupertino. The stamping of this held plan and specifications yam— 1 L NOT h held tt p, arp t9 is an prove) of the vloleti�)R"91 an��l Ovlelons of any lA lllull......I 19 11E 101 11F 110 r 11H 10 1D 1D 1D - 11K 11A IE 1H 1H IH 1D 1D 10A 10B 100 11J 10C 10D 1A 7A 10 11n 11B -, 111 11A 1D 7B - - 1OF 1H 1D 11A SA 1D 10E 11A 'i" 1H 10 1H 10 • 8A 10 1D 1D IC 1F tOH 1C 1H 1D BC BD 9A Be 11C V u . 119 a FRONT-DIAGRAM NOT TO SCALE Inspected by PHIL PERCY License fi OPR 9666 Signature NOTE:Questions or problems concerning the above report should be directed to the manager of this company Unresolved questions or problems with a-, cas performed may be directed to the Structural Peet Control Board at(213)897-7838, 1416) 667-9114,or(9161263-2533. re entitled to obtain copies of all reports and co lotion notices on this property riled with the Board during the g receading two.years upon payments 0 02.00 gearch fee to: Structural Past Control Board, 1422 Howe Ave., to 3, Sacramento, California 96826.328 , . 43M41 IRev.9/91) FFHE OF STANDARD INSPECTION REPORT OF THE PROPERTY LOCATED AT: 10889 Barranca Drive Cupertino 95014 BLDG. NO. STREET CITY ZIP CODE 1/16/03 234452-P STAMP NO. DATE OF INSPECTION CO. REPORT NO. . 1P. NOTE: Minor and/or superficial damage was noted to .the wood members of the subarea. After the chemical treatment and/or the infestation or infection is eliminated, no other recommendation involving the minor/superficial damage will be required as this condition affects appearance only. INFORMATION 1G. Drywood termite pellets were found in the area (s) indicated on the diagram. RECOMMENDATION: Remove and/or cover the accessible drywood termite pellets. NOTE: It is possible. for old pellets to sift down and to become visible in previously infested areas due to normal movement and vibration of a structure. our bid is for removing and/or covering the pellets on a .one-time basis. • SECTION I - - 1H. Surface fungus and excessive moisture was found in the subarea. This condition has lead to a fungus infection to the subfloor wood members . When the subarea soil becomes very .wet/damp condensation will form on the wood member of the subarea. This condition is a contributing factor to the fungus infection mentioned elsewhere in this report . RECOMMENDATION: Cover the subarea soil with visqueen plastic at the front- and rear of this structure as necessary to aid in preventing r fungus infection to the subarea wood members . SECTION I PORCHES - STEPS 4A. Sections of the side wood porch have been structurally damaged by fungus activity, as indicated on the diagram. RECOMMENDATION: Remove & replace the damaged wood members as necessary. ' NOTE: This bid does not ' include painting or refinishing. NOTE: If damage, infection and/or infestation is revealed beyond the visible damage, a supplemental report will be issued outlining any further findings and recommendations and a bid, will be issued if ' • applicable . SECTION IECEIVE JAN 2 3 2003 SUBMITTAL BY: #1 17 1.• Continued on page 6 F DPAGE OF STANDARD INSPECTION REPORT OF THE PROPERTY LOCATED ATs 10,889 Barranca Drive Cupertino 95014 BLDG. NO. STREET CITY ZIP CODE 1/16/03 234452-P STAMP NO. DATE OF INSPECTION CO. REPORT NO. 8C. Evidence of drywood (Kalotermes) termites was noted in the wood framing as indicated on the diagram. This infestation appears to extend into the inaccessible wall area. RECOMMENDATION: Seal up and fumigate this structure with a lethal gas in compliance with the manufacturer' s instructions to control drywood (Kalotermes) termites. Remove seals and air out this structure ready for reoccupancy. Fumigation cannot begin in inclement weather. In the case of rain and/or strong winds, this job may have to be postponed to a later date . NOTE: There will be preparation work that must be completed prior to the performance of the structural fumigation. The preparation work is the responsibility of the homeowner. If interested, you can contact a preparation company which specializes in this service (like Prep. Solutions ® 639-9490) . The cost to complete the preparation work varies for each particular structure depending on the amount of required work. • SECTION I -- 8D. Drywood termite pellets were found in the area (s) indicated on the diagram. RECOMMENDATION: Remove and/or cover the accessible drywood termite pellets . NOTE: It is possible for old pellets to sift down and to become visible in previously infested areas due to normal movement and vibration of a structure . our bid is for removing and/or covering the pellets on a one-time basis . SECTION I DECKS - PATIOS 9A. Sections of the second story balcony(( (deckinng, joislft", facia and railing) have been structurally damaged by fungus activity as indicated on the diagram. RECOMMENDATION: Remove, replace and reinforce the damaged wood members as necessary. NOTE: This bid does not include painting or refinishing. NOTE: If damage, infection and/or infestation is revealed beyond the • visible damage, a supplemental report will be issued outlining any further findings and recommendations and a bid will be issued if applicSECTION able . � JAN 2 8 2003 ,. S(1 . . BM1TTgL Continued on page 8 IFEDGE OF STANDARD INSPECTION REPORT OF THE PROPERTY LOCATED AT: 10889 Barranca Drive Cupertino 95014 BLDG. NO. STREET CITY ZIP CODE 1/16/03 234452-P STAMP NO. DATE OF INSPECTION CO. REPORT NO. OTHER - INTERIOR %OA. Fungus (dry-rot) damage was found to the wood members beneath .the ceramic tiles of the hall bath bath floor indicated on the diagram. The damaged wood cannot be removed and replaced without disturbing the ceramic floor tiles . RECOMMENDATION: Remove all of the ceramic tiles of the bathroom floor to expose the damaged wood members for replacement . Remove and replace all of the damage wood members as necessary. Chemically treat the exposed wood members for the control of fungus per the manufacturer' s instructions . Install new ceramic tiles of standard grade set in mortar over the complete bathroom floor. Reset the existing toilet on a new wax ring properly bolted to the floor. NOTE: A diligent and thorough inspection was performed; however, we cannot open enclosed areae without the owner' s permission. Therefore, if, during the process of work, damage is found to extend into areas not visible during our original inspection, a supplemental report will be issued to the owner and/or agent outlining the additional damage and required additional fees . NOTE: If ceramic tile wainscoating is present and becomes damaged during the process of repairs it will not be repaired as part of this contract . A supplemental report will be issued. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AGENT TO CALL WITH MATERIAL SELECTION: Dal Ceramic Tile 2549 Zanker Rd. San Jose, CA 95131 Phone : (408) 435-1566 Hours : Mon - Fri 7 : 30 AM - 4PM SECTION I 10B. The bath sink cabinet will need to be removed in order to perform the required repairs as outlined in this area. We RECOMMENDATION: Reinstall the •vanity ke Xio'ns t �J� he related repairs .NOTE: No plumbing modifications and/oo plumbing are included in this estimate . If any modare found to be necessary, a supplemental report will be issued. SECTION 1 iOC. There is fungus damaged subflooring in the hall bath extending beneath and/or behind the bathtub. RECOMMENDATION: Remove the complete tub surround, waincoating and the bathtub. Remove and replace the fungus damaged subflooring as necessary. Supply and install a new bathtub. Instal moisture-resistant sheetrock through out the ��431011'ka m. Install new ceramic tile set in motar. Shee ockof k it be rough .taped only. Final finishing, texturing, sea inglA4>Si9iA0qan /or painting will not be performed as part of this contract/agre ment . - • Owner and/or intrested parties ,should contact Wspecial' arrange for these services : NOTE: Estimate.. doi Jude floor or wall repairs outside shower area, i .e : the "wa 1 or: tile bath floor coverings . NOTE: NEW CERAMIC TILE )STALL TO EXTEND APPROX. 5 ' ABOVE THE TUB . THE WAINSCOATING NOT BE REINSTALL AS PART OF THIS AGREEMENT. THE OWNER WILL NEED TO V THE WALLS .TEXTURED AND PAINTED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • AGENT TO CALL WITH MATERIAL SELECTION: Dal Ceramic Tile 2549 Zanker Rd. San Jose, CA 95131 Phone: (408) 435-1566 Hours : Mon - Fri 7 : 30 AM - 4PM SECTION I r ED PAGE OF STANDARD INSPECTION REPORT OF THE PROPERTY LOCATED ATt 10889 Barranca Drive Cupertino 95014 BLDG. NO. STREET CITY ZIP CODE 1/16/03 234452-P STAMP NO. DATE OF INSPECTION CO. REPORT NO. '11F. Cracks were noted at the exterior stucco at various areas . No outward indications of infestations or infections were noted. RECOMMENDATION: We suggest that parties of interest seal, paint and maintain these areas as part of normal exterior maintenance . SECTION II 11G. Cracks were noted at the exterior stucco at various areas . No outward indications of infestations or infections were noted. RECOMMENDATION: We suggest that parties of interest seal, paint and maintain these areas as part of normal exterior maintenance. SECTION II 11H. The exterior wood members are weathering, collecting algae and/or paint is peeling insome areas . RECOMMENDATION: The owner should maintain all exterior wood, keeping it well sealed and/or painted during the course of routine general home • maintenance to minimize future decay in these areas . SECTION II / RA -Ffr.- -AA. < III . There is fungus damage in the wood member (s) located at the overhang for the roof indicated on the diagram. RECOMMENDATION: Remove the roof .Covering if necessary to expose the damaged wood members . Remove, replace and/or reinforce the damaged wood members as necessary. NOTE: This bid does not include painting. NOTE: If damage, infection and/orinfestation is revealed beyond the visible damage, a supplemental repo outlining any further findings and recommendationrgNr%�OP�03 i be issued if applicable . NOTE: If applicable, it may be necessa roo covering and/or rain gutters to facilitate these _.__._NOTE: Our cost quotation does not incl = t=.w-, roof . . covering or rain gutter repair or reinstallation. The owner is directed to contact a licensed roofing/rain gutter contractor to make any necessary repairs to the roof covering and rain gutter system after all necessary wood replacement is completed. SECTION I �J. The roof covering will be diet �ngoUrse of the wood replacement recommended inthi a gutters may be removed to facilitate the necessarywoo acement . Our bid does not include any roof covering repair or replacement . Our bid does not include reinstallation of rain gutters . RECOMMENDATION: The owner should engage the services of a licensed roofing/rain gutter contractor to. make• any necessary roof covering repairs or replacements and to reinstall any rain gutters as applicable after all necessary wood repair/replacement is done . SECTION II' SUBMITTgL 11K. The stucco extends below the ti�rior grade," level and conceals the foundation. It is possible r subterranean Oermites to enter a structure between the foundation and the stuoco siding. No representation can be made regarding the presence or absence of any possible concealed infestations. Periodic inspection advised. • INFORMATION See work authorization for cost breakdown CITY OF CUPERTINO fad aRn BUILDING DIVISION PERMIT �j,,CONTRACTOR INFORMATIONV BUILDING AUDHISS: PERMIT N0. 10889 BARRANCA DR 03010133 NCR's NAME: APPLICATION SUB DATE UEBEL JOACHIM J AND UTE D 01/23 2003 ONE: SANITARY NO, CONTROL NO. AHCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Op LICENSED CONTRACTORS DECLARATION ee C I M1creM1 affirm Ihm 1 am licensed aide, previsions 9f Chapter J(commencing Job Description with Scminn Xq of Divisinn3nf NC Bustncs and Pmfcssinns Cndc,end myliccnse is infnnto' tdcncct TERMITE REPAIR/FUNGUS DAMAGE 0wzoq4 Lfacnac mss ��,�a „��® ; D le Cnnuacmr e�l �yt- ARCHIIECT'SD is ATION KK a e 1 understand my plana shall he used as mcmda .j o Licensed Professional MAR 17 2003 5 OWNER-BUILDER DECLARATION sp I hereby affirm that I am exempt from the Cunlracmea License law for the to 00 following cartoon.(Section a ma 7031.5. ar, Business and Professions Cole:Any city or county ��'�Dlrx.� s g� which requires permit to cnnst ,al ,improve,demolish.or repair any someonery Z< prior m its issuance,also requires the applicant for such Permit file a signed statement pis �sthat he is licensed formation the previsions of the Contractor's License Lw(Chapar 9 Sq. Ft. Floor Area $7YOGation c�o (commencing with Section 7000)of Division 3 ofthe Business and Professions Crust)or yr;$ Nat he Is exempt dominant and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fora permit subjects the applicant o a civil penalty of Occupancy Type not mom Nen Eve hundred Jolla.($500). I,as owner of the Properly army employee,with wages as thew sole compensation, will do the work.and the structure is not intended or offered for sate(Sm.7044,Business FOUn— and Professions Code:The Cont.cmrs License Law does not apply m an owner of 102 - PIERS equtred Inspections property who huildsor improves thereon,and who does such work hurselforthrough his own employees,provided that such improvements are not intended oroaered for mle.If, 103 — UFER however,the building or improvement is within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of 104 — REBAR asle' 105 - ANCHOR BOLTS C]1.as owner of the property,am exclusively contracting wife licensed contractors to 106 - SEWER & WATER construct the project(Sec.7044.Business and Professions Code:)The Convector's Li. renselawdoesnotapplytoanOwnerofpropertywhoWildsorimproveamereon,and. 202 - UNDERFLOOR PLUMBING who contracts for such projects with a coneractor(s)licensed pursuant e Conricmr'a License law. m N 203 - UNDERFLOOR MECHANICAL ❑ I am exempt under Sec. .B&P C for this reason 204 - UNDERFLOOR FRAME We, Data 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING I hereby alfrm under Penalty of perjury one of the following declarations 302 — TUB & OR SHOWER 1-11 haus and will maintain aCer ificate of Consent to self-insure for Worker's C9mem p anion,as provided for by Section 3700 of the labor Code,for the performance of the 303 - ROUGH MECHANICAL work for which this Permit is aaucd. 304 - ROUGH ELECTRICAL ❑ 1 have and will maintain Worker's Compensation Insurance,as required by Section 305 - FRAME 3700 of the Patin,Code,for the performanc op f the work for which this Permit is issued. My Worker's Compcnsatinn lnmm rand ule,num berarc: 306 — HOLDOWNS Carrier: t C v(� PolicyNo.:l 1 ' 307 - INSULATION CERTIFI ATEOPE MOTION COMPENSATION INSURANCEORKERS 308 - SHEETROCK (This sectum.ced not he completed if da Permit is tonne hundred do)l..Di 1491) 309 - EXTERIOR LATH offers') 310 - INTERIOR LATH I certify fen in the performance of the work for which this permit is issued.)shall not 311 - SCRATCH COAT employ any person in any manner an as to become subject m the Workers'Compensnion Laws of California.Data 313 - ROOF NAIL NOTICE TO APPLICANT.If,after making this Certifies¢el Exemption,you should 501 - FINAL ELECTRICAL ENERGY become subject o the Workers Compensation previsions of the Labor Cole,you must 502 - FINAL PLUMBING ENERGY z forthwith comply with such provisions or this permit shal l he deemed revoked. zo 503 - FINAL MECHANICAL ENERGY CONSTRUCTION LENDING AGENCY [.n Ihereby affirm Out there is a construction lending agency for the performanccol 504 - FINAL BUILDING ENERGY �„� the work uJ 505 - FINAL ELECTRICAL 0 Lenders Name W Z enderaAddmas 506 - GAS TEST U 0 1 ccnify Nat 1 have read this application and mile that the above information is 507 - FINAL PLUMBING P correct.I agree m Comply with all city and county ordinances and state lawsrelning to Q building constmetion,and hereby authorimrepmsenedivesofthis city mcmerOnto the 5 FINAL MECHANICAL Wah9vc-mentioneJ properly for inspection purposes. O9 FIN (We)agree to save,indemnify and keep harmless the City of Cupertino against yliabilities,judgments,costs and expenses which may in any way accroeagainst mid City 5 NW U 7 in consequence of the grnting of this permit.APPLICANT UNDERSTAN S AND WILL COMPLY WITH ALL NON-POINT Issued by51RKS Dale SCE REGULATIONS. Re-roofs Signamre am,pliesmucimumm, Dam BAZARDOUS MATERIALS DISCLOSU Type of Roof Will the applicant or future Wilding aca,.,...or handle hvalloua maledal as defined by the Capetian Municipal Code,Chapter 9.12,and the Health and Safety mk.Section zss3z1.19 All roofs shall be inspected prior to any roofing material being installed. ❑Yes ONO Will the ePPlicam m future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove emit hazardous it contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District! Cl Yes 0 N 1 have read the hamnlous materials reyufmments under Chapter 95 of the Califon nia Ilcalth&Safely Gale,Sections 255115,25533 and 25534.1 understand that if the building does not currently hove a tenant,that it is my responsibility to til,the cecupanl of die requirements which must be met prior i issuance of a Ccnidea fachy as Signature of Applicant Date owncnv amnorived escm 2 ry� All roof coverings to be Class "B" or better CITY OF CUPERTINO '•,. '* � BUILDING DIVISION PERMIT '�CONTRACTO"RMATION BUI ES R T NA & SCOTT BREHMER PERMTrN92110103 1T@A4E:& SCOTT BREHMER APPLICATT11g fI1r3T 2002 ONE: SANITARY NO. CONTROL NO. ARCHITEC IENGINFER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH �00 LICENSED CONTRACTOR'S DECLARATION a uF�,j I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing REVISION--ROOF�°b Description ��25 wish Section 7004)of Division 3 of lire Business and Professions Cole,and my license is mow mmuforce and effect. IN HOUSE USE ONLY, NO NEW PERMIT ISSUED oygz ate echo Lk.g De F, DatContractor ORIG. #02070067 $$$6 W ARCHITECTS DECLARATION 1 unticcslnnJ my plans shall he used as public records Licensed Professional a/\ FhO OWNER-BUILDERDECLARATION \ C� I hereby affirm that 1 am exemptexempt from the Contractor's License Law for she C� Mw 00 following reason.(Section7031.5,Business and Professions Code:Any city or county aat2 which requires a remit to conswct,alter,improve,death ish,nr repair any mtuctorc Fa< prior to its issuance,also requires the applicant for such Permit to file a signed statement Riothat he is licensed pursCommon'sano she provisions of the Common's Liccnsc Low(Chapter 9 Sq. Ft. Floor Area 29@Qatlon y $ (commencing with Section 700(8 of Division 3 of the Business and Professions Codi that he u exempt tMmfrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects he applicant a civil penally ofXPR Occupancy Type not more Nan five hundred dollars(5500). ❑Luowncr oftM pmpcny,or my tmplOyees wish wages as Neu role c9mpcnsation. willdeIMwads,andtheswctumisnotin¢ndedorof(tredforsale(g .7W,Businm and Professions Code:lire Convectors License Lew does not apply to an owner of 102 - PIERS equired Inspections property who build,or improves thercon,and whodoes such work himselfor through his ownemployccs,provided that such improvements arc nnlintandedoroRered Usage.If. 103 — UFER however.the buildingor improvement is sold within one year ofcompletion.Ne owner- 104 — REBAR builder will have the burden of proving that M did not Mild or improve for purpose of sale.). 105 - ANCHOR BOLTS 01.as Owner of the property.am exclusively convecting with licensed contractors to 106 - SEWER & WATER construct an,project(Sec.7044,Budinea and Professions Code:)The Contractor',Li- ecram Law does not apply to an masher of parciperty who hi or improws themon,and 202 — UNDERFLOOR PLUMBING who contracts for such projects with a contrennr(O licensed pursuanuo the Corommonrs License Law. 203 - UNDERFLOOR MECHANICAL ❑ I am exempt under Sec. ,B&P C((ir this resson 204 - UNDERFLOOR FRAME net Dale 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING I hereby alBmt under penalty of perjury one of the following declarations: 302 — TUB & OR SHOWER ❑l hawand will maintain a CeniRcale n(Consenoto self-insum for Wotker'sCompen. 303 — ROUGH MECHANICAL sation,as provided for by Section 3700 of the Iator Code,for Ne performance of the work for which this permit is issued. 304 — ROUGH ELECTRICAL ❑ I have and will maintain Workers Compensation Insurance,as required by Section 305 — FRAME 3711)of the Lebo,Cole,for Ne Performance of the work for which this permit is issued. My Worlo is Compensation Insurance canierand Policy number are: 306 — HOLDOWNS Cattier: Policy No.: 307 - INSULATION CERTIFICATE COMP COMPENSATION RAANCEMPTION MOMEORKERS' 308 - SHEETROCK (This section need not he completed if the permit isforonc hundred cottos(Slpp 309 - EXTERIOR LATH nr less.) 310 - INTERIOR LATH I ccnify that in the perlinmancc of the work for which this permil is issued,1 shall not 311 - SCRATCH COAT employ any Person in any manner so as to become subject to the Workers'Compensation Laws of C9Rnrtta.Date 313 - ROOF NAIL Applicant NOTICE TO APPLICANT:If.after making this Ccnifcate of Excmpsion,you shrwlJ 501 - FINAL ELECTRICAL ENERGY become subject to One Worker's Compensation provisions of Ne laIWr Code,you must 502 - FINAL PLUMBING ENERGY ,Z fnnhwiN comply with such provisions or this permit shall he deemed evoked. C 503 - FINAL MECHANICAL ENERGY CONSTRUCTION LENDING AGENCY Ir `z) Iherehyallirmchatthereisaconstmcdonlendingagencyforther.'rormanccof 504 - FINAL BUILDING ENERGY x the wenkfnrWhich this permit isissued(See.3097.Co,C.) 505 - FINAL ELECTRICAL W Ca LendersNamc 506 - GAS TEST C Lender's Address U 0 1 ccnify that 1 have mad this application and sum that the iWoe information is 507 - F I NAL PLUMBING W h correct.I agree to comply with all city and county ordinances and oak laws rchting to 0 U buil dingconswction.andherehyauthonn:rcpresentativesofthiscitytoenterupnnthe 5 FINAL MECHANICAL W ,love mentioned property for inspection purposes. 09 — FIN GRADE G (We)agree it)save.indemnify and keep harmless the the City of Cuperlinn against y liabilities,judgments,costs and expenses which may in any way accrue against said City 5 N G U Z in consequence or the granting of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by`. 1 WORKS Date SOURCE REGULATIONS. Re-roofs Signnum of ApplicaHAZA DO Data HAZARDOUS future MATE RIALS DISCLOSURE Type of Roof Will the applicant nt fMuni building Occupant amre or handle Health material 's defined by the Cupeninn Municipal CnJe,Chapter 9.12,and the Ncallh unJ Safely e.Section 25532(ap All roofs shall be inspected prior to any roofing material being installed. ❑Yes ON. Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hezaNnus air amwminants az defined by the Bey Arca Air QualityManagementall new materials for inspection. District? ❑Yes ❑Nu 1 have mad the hvallous materials requirements under Chapter 6.95 of the Califor- nia Hcaldt&Safety Galc,Scvkms 25515,25533 and 25534.1 understand that if the building does not currently have a Imam,that it is my responsibility to notify Ihe occupant of the requirements which must he met poor to issuance of a Cciificaue ofOcupancy. Signature of Applicant Date Owner comshorded agent Date All roof coverings to be Class "B"or better