00080191 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:00080191
10146 CARMEN RD CUPERTINO CA 95014(357 09 061)
14510 BIG BASIN WAY
SARATOGA,CA 95070
OWNER'S NAME: SIMMS JOHN A AND HELEN DATE ISSUED:08/25/2000
OWNER'S PHONE: PHONE NO:None
IL 1. I I , t: II_S BUILDING PERMIT INFO:
License Class CONTRACTOR-GENERAL Lic.#
Contractor Date 03/31/2006 _BLDG _ELECT _PLUMB
MECH_RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION: (4;47
GRANNY UNIT 640 LIVING SP,400 GARAGE
I hereby affirm under penalty of perjury one of the following two declarations: 8/21/03 REOPENED PER GREG. ` `/
1. I have and will maintain a certificate of consent to self-insure for Worker's / �� �
Compensation,as provided for by Section 3700 of the Labor Code,for the •
performance of the work for which this permit is issued. `
2. I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$71830.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 357 09 061
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date Issued by:Legacy
Date:08/25/2000
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date Professional
—' Bu LDING DIVISION 'V PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS:
OWNER'S
PHONE:
NO.
SUB
R O O ARCl4Vn.Illon"I nda" 1mvu
IIITIiCI'/IiNGINIiIiR: BLDG ELECT PLUMB MliCll
W
Z
u u o
yah
Z8 N ZLICENSED CONTRACTORS DECLARATION - lob Description
Z : 1 hereby aMrn, that I am licensed under provisions of Chapter 9 (commencing
_ with Sectom700) fDsi,ion 3nf the Business and Professions Code, and my license _
f i is in full force and elft
o Li"""clax g 5 ZG Z GRANNY UNIT 640 LIVING SPI 400 GARAGE
3 � N Eme �- Cnmmunr
ARCHITECrer IIECLAic 1
O g I Lindeman my plans shall tx used as public records
�aI
ad i a OLicensed Professional "
a.
OWNER- F ELL A
=' 1 herthy-affirm that 1 N ,at or's t,al a or The '
C Z folloom, reaxen. (Section ]0 , Basinuxs P sxi Code y y a nuns
❑ which oxmim, n parmit m co mel, alter. Ise demi 'h vl y.
i3m primod its issuance. also requi c:mt fir ch per nsig It men, _
,),at be is licensed pnnaantte, soft tmet Live a (C let [- Floor Area Valuation
(commencing with Section ](g of Di,i,iI,n miand Rafe on ale)
or that be is exempt Ihertfrom in 0e iasis are eanption. tion
of Section 7031.5 by any appli ubjwe c plie I a v Ivil �pnaahy
of more than five hundred 1. APN Number Occup nc O
Cl L as owner of the property, or my employees with wages as their stile compensation,
will do the work, and the structure is not intended or muffed for sale (See. 7144. _.r
Raaatu and Ptofesslom Code. The Cmmanm'a License Law does not up,), to as Required Inspections
owner of prnpcny Who builds or improve., thereon, and who docs such work himself
or through his own cmpinyi<s, provided that such improvemenu oat no, intended or
o0ered for sale. IL ev
hower, the building of improvememis sold within one year of 101 — FOUNDATION
completion , ,rte owner -builder will have the Barden of pmving that he did not build Lir
imp ravc for peEme of site.). I.02 — PIERS
❑ Las owner or the pnopcny, am exclusively contracting with lieensed contractors to 103 — UFE R -
construct the project (sec. 71H4, Business and Professions Cade:) The Contractor's 104 — REBA R
License Law does not apply to an owner of propcny who builds oro
r impves,hereon,
and whe commcu for such pri with a centrricam ) licensed pursuant to the 105 —ANCHOR BOLTS
Contmnors License Law.
❑ I am exempt under Sec. .B& P C for this reaxon 1.06 — SEWER &. WATER
Owner Date 202 — UNDERFLOOR PLUMBING
WORKER'S COMPENSATION DECLARATION
hereby annnnnderpnwlynfperja nnenrn,elamwingdeemI m, 203 — UNDERFLOOR MECHANICAL
i
cnmpe6havnsaae and will muinuin a Cenilicme of Consent m self -insure for Worker's 204 — UNDERFLOOR FRAME
nn, ro provided for by section 37M of the Labor Core, for the 205 — UNDERFLOOR INSULATION
performance of the work for which this permit is issued.
301 — ROUGH PLUMPING
❑ 1 have and will Code.
Worker's fo mance f t Insurance, its required by erection
3nIB of the LaM,r code. rnr me pema,m:mat nr me work for which mi.x peseta n 31712 — TUB &� OR SHOWER
xsaedMywmkerxCnmpemahnnIm,mineI,carrieri IPo1eynamheram: 303 — ROUGH MECHANICAL
Curzier: CER' I'IIICATIONor: r aHTTONFROMWORKERS' 304 — ROUGH ELECTRICAL_
COMPENSATION INSURANCE. 305 — FRAME
(This section need not he completed if the permi, is for one hundred dollars 306 — HOLDOWNS
WWII
1 cenh'yy tluu In the PerHmmnna of uhc work for which ,his panni, is isxueA. I 307 — INSULATION i
shall not emplay any persnt in any inion m1,r� ,ggsuhjeat m the Worker.,' 306 — SHEETROCH
Compensation l� fCalifix Date _S 2-
Apphcan,�_. 309 — EXTERIOR LATH
NOTICE TO AI KLAN .I. raterIB this Cenlficute of Exemption, you should
Zbecame subject it) the Warkera Compensation provisions ra of the LabCode, you must 310 — INTERIOR LATH
0 4
C forthwith comply with such provisions (it this permit shall he deemed revoked.
VI CONSTRUCTION LENDING AGENCY ' 311 — SCRATCH COAT
"" I hereby affirm thin there isaho,mrurni lending agency ronhe perfonnano, 313 — ROOF NAIL_,
of the work for which Ibis permit Ir issued ISec. 3097, Civ. C.)
y p Lender's Name 501 — FINAL ELECTRICAL ENERGY
p Z Lender's Address
v o 1ccndythat Ihave need this application andxumthat the abneinformmionis 502 — FINAL., PLUMBING ENERGY
La, F correct. lagrtetocomply with .IIcity andcounty nrdioarm,andnmclawsrelating 503 — FINAL MECHANICAL ENERGY
V m bulldingcnnswnion, and hereby authoiu represenutives or,his city to enter upon
the alki,wa,en,ioned property for inspeent n purposes. 504 FINIAL BUILDING ENERGY
�.I p, (We)agree it) save, indemnify and keep hdrmltss the city it capenino again„ 505 — FINAL ELECTRICAL
Gr h liabilities, judgments, costs and expenses which may in any wary acerae against said
V APPLIconsequence ANTUNDER UNDERhe STANDS AND
of this penmt. —
SOURCEREGULERSTANOSANDWILLCOMPLYWITHALI.NON POI 506 — GA$T ((RRY 'L_� �•-fj
SOURCE REGULATION Issued by: — Fix At pilli — Date
s,8n�r oiRpltfa4nocontraamn fate Re -root's 508 — FINAL_ MECHANICAL_
• HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or finare bdltling ticeup:mt stone or handle halardommacrial Type of Roof' 509 — FINAL GRADE
x defined by the Cupertino Mond Cude, Chapter 9.12; and tbu 11.10, unit Safety
,code, sectio, 255321sT' 5.10 IN I_ PLAT L NG
Yes All roofs shall b este 3 a I m• mg installed.
Will the applicant or future Witdtng mcupam use equipment or devices which If a roof is insta (thou $$$ 1�gnly4}[1IQQq 1]jr�'1's agree to remove
emit hazardous, air mmandiants as defined by the Bay Area Air Quality Ma"agennrnt n t1, s/Cj j] PfyIQ In g
District all new material Hns e A pp Ic nr���QQQ❑❑❑QQQeeerStTIIQQQs and will comply with
°Ye` o all non -point scififf3egulaEUROF BATTENS
I have read Ilse hamrdnus mmetial.s requlm,"ems under Chapter 6.95 of the 604 '- ROOF I N -PROGRESS
Cslinuma Health & Safety Cade. Section., 25505, 25533 end 25534. 1 understand Bon
if the building does not currently have a tenant, that it is my mspunsibility to Italy the
ca cont of the ra uiremems which must be met prior to issuance of a Certifcme of
C"uuma`y. Signature of Applicant Date
owneraramhon ed agent " ` Date All roof coverings to be Class "B" or better