S 3850 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUP(?R'I'INO BU I LIHNG-ELECIRICA], TERMU NO.
BUILDING DIVISION APPLICNI' ON/PERMIT PLUMBING-MECHANICAL S 3 8 5 0
BUILDING I'ItOJECI'IDENTIFICATION BUILDINOAOIJIt I?SS: SANITARY NO. APPLICATION SUIih11Tl'A I.LATE
{OZZS !l 8L4 +• 2,-9
OWNS 'S NAME,: PHONE ll 'IItACI(I)II J NAME LIC NO,
NIC CONTI3
IHI'ECIIiN IINEER LICNO: AODItHS.4 ❑
In u� ob Zoo' 5r p Lairw, t'V2ww C 7
CONTACT PHONE: G`� a('. 3 BUILDING PERMIT INFO
ih GQ (Sla) 35312�3$ 2- �- Cil
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
LICENSED CONIRACTOR'I DECLAN11 ION Q'ry.. ELFCTAICPERMIT FEE
1 berehy nlFrm mm 1 am Fiametl nrmnr prnvi�i..na.,r ennpter Inmeneilts JOB DESCRIPTION
WoZ with Secnian]f00)nf Dlvisinn3aftbe Busmenante PndesviansCode.and mylicrmcis R SI ENTIAI;
Woo O I'IikA11T ISSUANCi3
F Iy_ t full force and effect. N'L ❑KITCHEN REMODEL
.'U�' Licence Gloss Lica
6 U ,\PPLIANCEC-RESIDiiNTIAh ❑ADDITION El PLUMBING RG-PIPE
yG i Date [nnlma,,r
p-pw ARCHITECTS DIiCLAkA'I'ION PANfIS - ❑MULTI-UNIT ❑MODCICATIO
Z O w Z I understand my plans shall he mscd as public Iremds MODIFICATION
Oz in, UPTO 20()AMPS ❑l.. ERIOR ❑CHIMNEYREPAIR
FL t:W Licensed Prnf—ionvl 201-100AMPS IMPROVEMENT i]SWIMMING TOOLS
r,y=�
OWNER BUILDER DECLARATION OVER I(NM)AMPS ❑BATF(REMODEUREPAIR (]DEMOLITION
< 1 hereby affirm thin 1 nm exempt fmnr the Continentals License Law fur the
3 ia.FU- imbruing...,(Section 7031.5.Business and Profcrions Core:Any city or,only SIGNS ELECTRICAL ❑OTHER
r� which requites a permit In nm%Imeh almc'mprove.demolish,or repair any annO re
Fori< a m .its immense,al-wr iresthe applicant fmwch pmmit to File asignecomontem S19iCIALCIRNIT/MISC.
E V}2 that he is licensed a romir m the provisions of the Cnmra.r's Licerne law(Chapter 9
��<0 (commenamg wan sermon 71N0lrnnweirntJ ohne nusinea arm rrnreaairnF crdc)or TISMr.nusrl:R ORPOLE nest. COMMERCIAL'
d d po C that he is exempt therefrom and the basis for the alleged exemption.Any,olatirVt of ❑NEW BLDG/ADDITION ❑DEMOLITION
X,,U, Seainn]OJLS by any applicant Rn upemtif wbjccruhc applicannnaclvil penulryn POWER DEVICES (] .NAMf ❑FOODSERVICE:
not more than five hundred dollars(S50% PROVEMENT
F M El Lm owner of the property,or my employees with rages as theirsolecomP<nniI SWIMMING POOL HLECI'RIC SFO
will loth .mi,andthesounurc is not intended or uttered farsale(See.Z781usin THBR
i3 m real Podemions Code:The Comment..License law done not apply to an owner n OttPETS-$lVl'I CIiP_S_TN_I'URES
progeny who build%or imps %thereon,and who does such work himself or rhnugh
his own employees,providedthatsuch imponemems are not intended or offered for I!W RE. )ENUAI.ELECIR SQ FT.
sale.If,however,the building or improvement iesnld whim one yearefcntnpl rion.0u, SQ.IT.FLOOR AREA $ISQ.FT..
99-builder
,ih�tlet will have the burden of proving that he did not build or improve for par- 2 P-6
1)0, Sir) S
(jyY wnerofthe P o,q aex
nt exclusively countering with licensed c......mry m '10 :(_ '01 3 � s
wet the projnm(Sec.7044,B- ,rad professimu Cad.B'Ihe Contractors Li-
"me La, nmapplym an 11 ,,1 moperty who build%,,,improves thereon,and QTY, 'LUMDINC PERMIT FIiH Y� �a
whoeontr't u�pmjemswltb ucnmmch'dsl tic• e,I punrwm,,the Commit-,
License Lm PERMIT ISSUANCEI um ewer Pr de R h P C En this ream
AUIER-GRAIN A,VENT-WATI!R BEA) VALUATION
Ox'ner Dae _
KI!R'S CO S, JO' !CLARAIIOI BACK FLOW FRO[LCI.DEVICE O O
1 trembly afOmt ander penuhy -pep ante I'd
i the following Jeclaallum
haveradwillmuintuiauCeamdct afCunsennnself-insumfnr WnrAer's CnmPct- DRAINS-FLOOR.ROOP,ARHA,COND. STORIP.S TYPE
CONS'fRUCTION
lop nation..provided E,.by S...no J7r f the LaborCada,far the Pcifort a rr of the
work for which this Pettit is issunl. PIX'f DRpS-vER TRAP
i] 1 have and will mainmin Worker'.,Compensation huurance,m reLpLard by Section
370 of the lath...Code,fort he pc rfoonanecnl'Inc work in,shwh0ti,permit i,issued, GAS-EA.SYSTEM-I INC.40I1I'LF.T9 D OCCGROUP AIN
My Worker's Cnlnpensellon li,mam a comer mad policy nw the,are:
Carrier: Polley No.: GAS-IIA.SYS HIM OVER 4(EA)
CERIIIICATL OF EXI7M FI'IIIN Pit(1M WORKERS'
CONIII17NSA'1'ION INSURANCE GIt P.ASEIINDIIS'I'In.WASTE IN'I ERCEP OR
BUILDING DIVISION PIES
(Th.. r J rb plt Irl 1 it 1 IJIlurn(510111 GREASEIRAP
,ale ) PLANC PGE s 3/
1 ndy tri "'he perfunt,un,co[the sold,rahidh111 .I is killed,I shall 4l:Whlt-SANITARY S'IOIth11?A.210I'I'.
nrlu pl ya y ne Y I tasu
SO 1x U hjca r 11 W A Col P' �, Oro r E,
C loon I sCm
oflloPato WA'I'I14 I WATER W/VIN'('/FlAHC'I'It
� O Appl n GIA NG 1'LE
y NGI'ICE'10 APPLICANT'.11,Irl, rising ads Cenifinllcof l!xunpli..n,you sbmdrl WA'IEIt SYS'I limit RHAI'ING INN
hemntr subjecl.lhe Worker's C....I",a nen Prnvisinna aI ILe IaiFol'Cndc,Yon Iuusl
W fonhwitn comply w'nhsuchpovi,llasa'this sunlit shill be Jecmhl rm'okIllWA'IY,It SERVICE
Q
CONS(Inv, oho LENDING AGENCY NEW ItE,VIDEN'I'IAI,PIAIB. SQ.IT. PA
VQ konwynflirnM:u..iti isaurd So, 30lending ngrnry firnnepcf rnninceof Da liu'ciplM
W (—.I he work Nenchich rola Prrmif la innnl[Sea.3119],CIv.C,
ULender's Name ,% �JT r
Lancer's Address AI
y I certify Int 1 have aid this uPPlinnion unA avec Ihul the above Immnn:riolr is a BUILDING
IH+ tz1 arorm I mire,,,.comply wish all Illy and a,1 1,onli im,c,and xlnlc law,'c a h"o, QT'y. MEC(IANUAU PERMIT FEE
UZ bmIdingcrnstnlctioo,und her cry umhnrile reprsenunivew of this city toenter upon rile SEISMICF r
abave-menlinnal pmpeny far inspeclinn Pmpnxes.
(W' to sure,indenmlfyuntlkeephsuntic t •CItyofCtpaninoagabtsl PIiRMI'I'ISSUANCE ELECT ,FE1i f'� Z Q
also` cwaand expmtwswhichenvy' woyall nea&lints raid Cil AI:ILItOHADII'IY)MIiCIL ZO 2
Vue ce of the 6ranl ing of Ibis pennll PLUMBI PEE
APPL AN UNDE.RSTANDS AND VILL UM Y WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,1X10 CEM(
SOUR ERE IN
h1ECHANI L1131i
iii� AIR I IANDLINGUNI'I(OVER IQOIIDCFNp CONSTRUCTION'IAX
wmreof ApplicaWConlor IAnc IpKHAUSI'l OODAODUCTJ HOUSING MITIGATION PP.E
HAP.ARDOUS ?IIIA1 S I CI.OSIRRH
Will the applicom or fuulre hui Ail wr i aore m'handle limanfous nuacrial IIEA'I ING UNI'I'(TO I00,(0)BTU) 12, to
as defined by the Cupertino Municipal C c.Chapmr 9J 2,anal the licalth nnJ Safety
Cade.Senion 25532(..)? TWA'IING UNIT(OVER 100,00f BTU)
❑Yes ❑Nr VHNFI F,AT10N FAN(SINGLE REM D) PAID
- Nthe applicant ansae im device,which Dole Be t p f
S
na>atinuair u,mamimans as refined by the Bay Area Air Quallp.Managcnunt
BOILER-COMP(JI{I'(1R 100.000 B'N7
lint?
❑Yn C]No BOILER-COMP(OVER IX.00)131 U)
��••••��
he hasaNnus mnteriet mquiremenB under Chapter fi AIR CONDITIONER
OS..f the Cilli- nV ISSUANCE DATEE��� �C
forma alth Safety Crile,Stations 25505 ..U and 255]4.[understand That if the NEW RESIDENTIAL.MIiCH, SQ.Fir
building v
re curreelyameat Iran, it isl yrt'P,nsibility to notify tire ore pant �YV
of the terra which st :?4,,I a ncenf a Cenificam..f 0,., nty.
wneror aulbeiWOagan Date T AI. /
_ f ISSUED BY
OFFICE �I
' . � � I! . ' �:. 4 � ', � � ♦ w , sola • �1'� � ��
C-S
Crt uNGDIiRON®
DIVISION 'CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10303 S BLANEY AV EXTERIOR SOLUTIONS 01070135
OWNER'S NAME: APPLICATION SUB DATE
HAGGARD SABINA ET AL 1771 SMITH AVE 07/26/2001
PHONE:
(408) 358-1233 SANITARY NO. CONTROL NO.
p ARCHITECTIEN'GINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
H« LJ C_J 1� LJ
= LICENSED CONTRACTOR'S DECLARATION non
p 1 hereby 4afrm that I am licensed under provisions of Chapter9 Job Description
P
F= m isthScction 7000)ofDivisiun3oftheBusinessandProfessionsCWcandmylicense REROOF.
¢ is in full force and Tec
�� Lieen.eelas.- �� Lie.» 3 REMOVE SHAKE . INSTALL 30LB. FELT &
X o a u Date '�.-2 e,_ r.„ cnmmct°r HEAVEY DEDAR SHAKE.
w 3"y ARCHITECT'S DECLAR
ter
a ter I understand my plans shall be used as public records
d
ac.25 po 0 Licensed Pmfessional
ce OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt frothe Contractor's License Law for Ne
F Z< from the
reas m.(Scelma 7(31.5,Business and Professions Code:Any city or county,
Cwhich requires a permit to construct.alter,impro e,demolish,or repair any itrunure »
i3__pri t it issuance,alsothe applicant for such pm't to fleasigned statement
that he,is licensed put to the provisions of theContractors LiL (Chapter 9 , Sq. Ft Floor Area , r , '` 1'i.i $200b'�tiation
( ningw'thSection 7000)of Isl nS of the BusinessdPivio,ions Code) -t♦ ^, d..n. ..'rt 'sy-:
or that he is exempt iheretrrnit and the buss for the alleged exemption.Any violation "
--"f Section 7031.5 by any applicant for a permit subjects the applicant too civil penalty
:nf net more then eve handled dollars(s500). 3 6 An hmWb Occupancy Type
01 of the property,or myemployees 'th ag as their sole compensation,
w Il.din the work,'-and the stionctum is not intended of offered for sale(Sce,70414,
'13tifiness'lord'Pitifiessions Code The Commi License Law,does not apply to an 305 - FRAME Required Inspectibns .; :,.:.
owner f
" property Who pro a th -and who nn wi'nk :ar
or throughhis ow employees.provided that such improvements tire tended o .._.... ___...3_.0._7_..- INSULATION_U._L._ATION
�oRrcd'fale If,hicth building pr ment la Mn on __
_ _.__.. .._._.
ye f 601 - ROOF TEAR OFF Ya,''I r, * T' `
completion,the own c bt ilder will Tuve the book"of praying that he did not build on i -"
improve for Purpose of sate.). 602 - ROOF PLYWOOD NAIL
-- -
❑l n pope ty ..In Ir. f i g- mi' a �t:ai to 603_.=._ROOF-BATTENS
t tin prove ns .7(4W BusinessaP r,ann Coale:)Tn cnmrmt a 604 - ROOF IN-PROGRESS i' LI `I''
law ense Liw does not apply to an owner of property who builds or improves thereon. s`
_and who contracte.for such.Pmjcets..with a.wnmeconvO licensed pamvamrt.m.tM. _ .__.. ._.,..___.._.............._....... _..__..___._. .} ____.
'- ------
C,
cl r. L¢ense La - .___.._ ..__-._... _ .__._..__...
'
El al '1<ei:rr_ '
mpt undo Sec r"' B&PCa this renson i(+ �,- 17[j(m
Owa e r `d to
WORRLR S COMPENSATION DECIARA7ION
I he by a(firm ader'rIry ofpeDu y e f the.follming arbitrations_
❑ Ihae anda11 mmm Ctrate fC dt-the,-t n, Ca Wkeree
❑I h and w II to n W k CS t 3700 f tM Wb Cod ( the
'01hav the Labn'Cnifir hcthi r'sCm t n,;.
Compensation. asp r by
M at
pe w
it vil.
na AL V/SirN�- P N l "L .7G d by Seen pen t 1 ens req
y pc once of the d rk f nowhich thisPerot '
r Compensation t In ur e r orf Pat y b rc
C Gq'CERTIPICATION OF EXEMPTION FROM WORKERS'„�7�w f=• - 'r..f l �i ”
. I 1 , . .. :
COMPENSATION-NSU ANCE ..,. ____... _..._..___.._ __.. _.....,_— ___t_.,_ _-......___ ._._....._._.... - _...__.
R
;: 1 (Th dsediurin door be c°mladf the . :
p Permit is for ore handled dollars
(3100)orless) i
->s\ 1 t fth t Y In the eR P Rhe w"k f th h ch Pcrmii a i d.tl """:` - "- '_' _' •.-,
'hilla t y y pe y inn m bbedm Object to the Workers
Cro '
C pe tm Laws of Cal f m .Dote
Applicant
. :.. ..:.
.NOTICE TOAPPLICANT:If,after making'hit C....a, fE Exemption,you should most li .• . .
neem blest tri thewith
WorkersC p ton pro .ll e -eLaborCode you must
Q O forthwith comply With such provisions or this permit shall he deemed revoked
Vi i f CONSTRUCTION LENDING AGENCY '..I-•�
F""' I�pDss"tOZ of th wlik fby "
this there- ' o leading
' Y f i„th "p i_rfas r e
which N Permit issued(Sec.i09 .Civ.C.)
LiadlLkde Address
.. .,_., -n-
._ _,,li "I.,i . )
..".._.
V-� 1 rify that lh erellthis application and state that above information iso
c'o 1I gee m,comply ith-all,city d county dna" and slate laws relating
Q U to fin g nstruct n d h reby hathcat2e_reposeiluntliOi Of this ity t°emer upon
'me above-oventionedppetyf P t pulp: _ ..
44 ly fwe) gee i° de fy and keep harmless.theC ty of Curtains,against:
F'W Ileb I nes judgments. is and expens hmh,may In any way accrue against said
V•,Z Ctyy ev sequenfbef th gr to 'fkhl - "
^ APP[IC UNDERSTANDS AhD WILL COMPLY WITH ALL'N2 WONTei' Issued by: Date
sol vcnvtD 7 6•
$gn to fApit ca uC to Date Re-roofs
RI
- HAZARDOUS MATEALS DISC-.OSURE
Will m ppli ant mi future building pant store or h dl hoi)us material _ ,_.Type of Roof :.: ... ... ...._. .._..
�ha defined by the Cupert Mlp1code Chapter912, ad the H .Health and c i , 1J1 ••,, .,I v; . .I
Code S t 925532(a) ,.,
oYe,
. . _.: _. .All.roofs shall be.mspectedprior_to.any_roofing.matenal_being.installed
f , 5 scant r future b In a p t eq it an device, heM1
If a roof is mstalled'without first obtaining an inspection I ngree'•to remove
O4 ❑Y of adefinedby th Bay Area AQIty Mag m
s:s Yn of fP
ri
t ,., all new materials for,inspecuon Applicant understands and will comply with _
I nage read i Nnall non-pain[source reg`ulations,,,,
1 P ' .
✓.
the h Ls x 't Is y -' e u nil Ch Pt 6.95:.f th .
C I f H lin&Surety
Code,
S i 25505 25533 ad 25534 1 understand thin _
if the build d t rr ml ti l tit ih t it Y p bilty t, ffy the, -__..._. .. _ ._... _._.. ,.....
e Y lac. 1 , `�- ZG.--a�),.
Oce a c -o: f Cert f to of
oke v c ea a eaJ.t s which must rte IP r!, Signature of Applicant _ :. Date
Blip/. �• 26 _. . _._ _._. . _ .._o _ ._. ._.
O e r thorax
g u to All roof coverings to be Class B"orbetter
. . .: OFFICE _ .___
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
142 Telephone: (408)777-3228
a
ICITY OF Fax: (408)777-3333
CUPEPTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the reroofing is
completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City the following steps are required.
1) Preinspection and/or tear off approval.
2) In progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,will
require the removal of all new material down to the sheathing so that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of 1/" per foot slope and demonstrate that
there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: #44;iAo
Address: / 0 3 0 3 S �cqK ti
Reroofing Company Name: > fin SoG�J4o 2s
Applicants Signature: /� ��;'r Date:
Joe Antonucci
(Chief Building Official).
6/25/01