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04110133 1 CITY OF CUPERTINO BUILDING DIVISION PERI& ®NTRACTnR INF®RM,ION 4 - N.A x"rzs bt�a.F.u.spffi;;;:ey4t„s;? rouxx<e^3 -..�iata�.a BUILDING ADDRESS: PERMITN'0 4 1101 3 3 10581 CASTINE AV OWNER'S NAME: PERMITLSSUEDATE KANNE LLC 11/22/2004 TONG: SANITARY NO. CONTROL N0. ARCHITECT/ENGINEER: _ BUILDING PERMIT INTO BLDG ELECT 'PLUMB MECH C7 I� auk LICENSED CONTRACTOR'S DECLARATION °p JobDescri ti{I'n���p <�F I hereby affirm that l am licensed under provisions of Chapter 9(commencing p �" Ada . �b with Section)DnU)nf Division JoftM Businc end Profcsnum Code.and mylittnu is � mmllr... acrreat DEMO (E) POOL �z License Class Lic.g . =p Dam Contractor Z� ARCHITECTS DECLARATION • N /cl �rsOr 1 understand my plans shall W used as public records N T IJ 5 `LLu Licensed Pndcssional �f a pB yy�,,, °g OWNER-BUILDER DECLARATION t 1�ft fl p •,{ t(7� y Lhcmhy affirm slim 1 am exempt from the Contractors License Law for the 1lSrl����J<D ICpli9Nn BgUUON� O° following motion.(Section II01.5,Business and Professium Code:Any city nr county C I., m which round.a ycrmit to cnmtrucs.arm,,improve.dcmnlLsh,m repair any strucmrc '2 Fib prior to its issuance,also mquims the applicant for such permit to rile a signed statement 2�° that he is licensed pursuanuo the inwiliuns of the Contractor's License Law(Charter 9 Sq. Ft. Floor Area Valuation be (commencing with Section 7")of Division of the Business and Professions Code)or ' y Nat he is exempt therefrom and the basis for Ne alleged exemption.Any violation of Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of0t O Occupancy Type - not more than five hundred dollars(5500). ❑I,as owner of the property,or my employe"with wages as their sole comp Semon, will do to work,and the Someone is not intended or offered for Sale(Sec.1064,Business and Professions Code:The Connector's Lienee Law does not apply to an owner of Required Inspections property who buildsor improv"thereon:andwhodoes such work himself orthmugh his Own employees,provided that such improvements arc not inm Wed oroffced for sale.If. how er,the building or improvement is sold within am year of completion,the owner- builder will have the burden or proving that he did nos Wild or improve for purpose of sale.). �{1,as owner of the property,am exclusively contracting wit licensed contractors to v constmet the project(Sec.7W.Business and Professions Codc:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improv"Braman.and who contracts for such p x rets with a canwanins)licensed 1.11mum to the comseamr's .. Lice se Law. Sam❑1 exempt under Sec. ,t .B&P C rot this Season rte 1�}c�( - ENSA ION DE � i( ,L V�OR 'SGCOMPENSATION DECLARAT N I hereby affirm under penalty or p"jury one of the loll wing deelemtiov: - 1 haw and will maintain a Cenifeate of Consent to scl f-insum for Worker's Compcn- on,u provided for by Section 3100 of the Labor Code,for the performance of slit work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,u required by Section 37W of the labor Code,for the pedmmanee of the work for which this permit is issued. My Worker's Compensation Insurance tamer and Policy number ate: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu""ion need notbreompleted Bthe fermis is forme hundred dollars($lip) of less.) 1 unify Nat in the pedmmanee of the work for which this permit is issued.I shall not employ any person in any manner u az 10 become Subject o the WorkersCompensation Laws or California.Date Applicant NOTICE TO APPLICANT:IL after making this Ccnificale of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must .J O forthwith comply with such provisions or this permit shall he deemed evoked. z CONSTRUCTION LENDING AGENCY (r I hereby affirm that there is a construction lending agency for the performance of - a> the work for which this permit is issued(Sec.3891,Civ.C.) Is-1 tenders Name 6.n Lender's Address D U 0 1 certify that 1 have mad this application and sure Nat the about information is u,- Contact,l agree to comply with all city and county anfinances and state laws mlating to OWilding conxwnion,and hereby authorim representatives or Nis city to chief upon lite U &dove-mentioned properly for Inspection purrases. IL (We)agree to save,indemnify and keep harmless the City or Cupertino against by liabilides.judgments.costs and expenses which may in any way accme against said City V z APPLICANTUNDERSTANDS Cof OC groaning LAND WILL COMPLY WITH ALL NON-POINT Issued by:his Permit. Dale �( / SOURCE REGULATIONS. -) < (( Z ,Re-roofs Sight eornpp1iwmV n ed, - m ♦{ ARDOUS MATERIALS DISCLOSURE / Type of Roof Will the applicant or future building occupant store or handle hadNous material as refined by the Cupenino Municipal Code,Chapter 9.12,and the Health and Safety Code,Sccfion oy;25532(a)l \J- All roofs shall be inspected prior to any roofing material being installed. N. Willma apNfuture or turre building eeaapant ase quipme,ordcvia:which If a roof is installed without first obtaining an inspection,I agree to remove fit haiardous air cmerainah6 as defined by the Bay Area Air Quality Management all new materials for inspection. lett Oyer, Hitvc adthchmar nusmamrialsmquimm nuundcrChapmrb.95ofthcCalifor- niaHcalth&SafctyCo ,Sc..25505,25533and25534.1understandthuifslit Iuilding does Trot currently haw a tenant.Nat it is my resPernlhllity m notify the occupant of Oc requirements which most he met Her to issuance of a Ccnfcaue of Occup ar' Signature of Applicant Date �.� (/ LL - All roof coverings to be Class "B"or better Otvncr ton tharircJ gent Dam CITY OF CUPERTINO �em l of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp : Rng: Sub: Blk: Lot : APN . . . . . . . . : 32644033 . 00 DATE ISSUED. . . . . . . : 11/22/2004 RECEIPT # . . . . . . . . . 27833 REFERENCE ID # . . . : 04110133 SITE ADDRESS . . . . . : 10581 CASTINE AV SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER KANNE LLC ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95015-0712 RECEIVED FROM . . . . : JOSHI ANNE CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , TELEPHONE . . . . . . . . : EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL - -------- ---------- --- ---------- - --------- - - - - ---------- - BPERMFEE VALUATION 3 , 000 . 00 83 . 16 0 . 00 83 . 16 0 . 00 BPLANCHK PERMIT FEE 83 . 16 110 . 98 0 . 00 110 . 98 0 . 00 BSEISMICRE VALUATION 2 , 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00 ----- ----- ---------- --- -- - - -- - ------- - - - TOTAL PERMIT 194 . 64 0 . 00 194 . 64 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER - - --------------- ------------ - - - ---------- -- - - - CHECK 194 . 64 6916 TOTAL RECEIPT 194 . 64 VOICE ID DESCRIPTION VOICE ID DESCRIPTION --------- ___ ___-------__---------------- 704 DEMO • �(titoL.i 5{� Imo' SGL 1 ENC = Jr i M I � r POO! I' I � � sritil eve TT` 'I CEI V v M ON= MTH NOV � 2 4 TH .fXfY OH q0�QiD AND tDINA BY: Wt TVc plan b specifications MUST. DA kit wa ne job a alltimesand ft is urt, � cop avatut to make an hon es or, alterations ran some without wr tzer (ermission from the building Dept., C D Cupertino, Phe stamping of this Ian and specifications !HALL NOT be held Jo permit or,to be aC #pproval of the violation of any pmmijana �f anv City Ordmanc� oc kala Lars. CITY OF CUPERTI T DEMO OF CUPERTINO PERMIT APPLICATION FORM APN# � Date:2 � - y- y- -� 33 Building Address: toS� I cPtS-rI Al v� Owner's Name: Kky` SSL LLC Phone#: kvS(j Nj ) o R -X33 Contrac'or: J f (-14J\-A 6-/ec—w, - License#: Q - S axj Contact: ��5}{) A ,mF Phone#: 7 Applicant/Contractor: T054 1 k /lJAJE Building Permit Info: L �I L !N G� W I T-1 k S o )L Bldg Elect Plumb ech Job Description: Residential: Qoo i II_L I N �� o Sq.Ft. Floor Area: $/Sq.Ft.` Architect/Engineer: Valuation: Type of Construction: Occ pancy Gr Qty. if AFOpiable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILIDNG BSEISMICOM Seismic Commercial BUILIDNG BSEISMICRE Seismic Residential BUILIDNG BPLANCHK. Plan Check Fee BUII.IDNG BUSLIC Business License BUILIDNG