01090019 OF CUPERTINO
CI BUILDING DIVIISSIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10330 COLBY AV 01090019
OWNER'S NAME: APPLICATION SUB DATE
OU
IENDLER LAWRENCE AND SMADAR 09/05/2001
1 HONE SANITARY NO. CONTROL NO.
O O ARCHITEC IINGINEER: BUILDING PERMIT INFO
�( BLDG ELECT PLUMB MECH
1 -1 CJ, L_j L i .
S v i LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm tom I am liacnzed under provisions of CM1apmr ,9(commencing P
yt, with Section Not of Division3of,heHusinessandProfessionsCode.andmylicense ADD 622 SQ. FT.
m M_ is in full force and effect.
:mac< Dole Class Lic.p ������®
O ac r- Date Contractor
j u O o, ARCHITECT'S DECLARATION
a 1 understand my plans shall be used as public retards
Licensed Professional APR 1 4 2003
a. OWNER-BUILDER DECLARATION
a 1 hereby affirm that 1 ran station,from the Conuxtor's License Law for the
h?Q following main.(SemionTH31.5.Business and Professions Cade:Any city or county �UI L7!'I V-u
E O which requires a perand to construct,alter.improve,demolish,or repair any structure
a 3'-` -Fria t t Is y the applicant forvuch permit to fl 'g d statement
_ _,
_..
an,
thmh sl«nwith .uon7006)the ion3oComr«toesL N 1nsChar9 1 I f �3�10 `1.V'Jbrfarba- .. t;
(tom cog with Section xiianfhe tomadvoaBgedai dProhssoiCak) Valuation
or Nat he rs exempt therefrom and he basis for the alleged exnapt on.Any violation
-Of not mom
vanyapplicantrorapermitmbjems the applicant toocivil Penalty
ofTot mare Non Bvehmred y,or my
remploye 10 -PN " Occupancy Type
❑I,as downer of me and
the s ru my employees with rages offered
their sr s compensation,
will na the work:'ond lite structure C not intended License
Lar.doe sOut airily U4,
Bml'owner ofpro Preany Who builds Calc:The Contractor's Land w row tl su not apply m un 10 3 - UFER Required Inspections'•
own
r or property woo oeeor improves at such,and who does such work intended
or
orthrough ti plye p ddmt .L,improvements. _ t odeagr 104 - REBAR
'nrr ar sale.-� If, � de hand ns v ria la within one year or -._ ..... . ..—..._ ..._... -..._ . ._ _........
inmpletion the owner bu Ider will have the burden affronting that he did not build or 105 - ANCHOR BOLTS 'sz ' •• - -•
mprove fn"hipat sale.). 106 - SEWER & WATER
_._ _.
'.ml '-' --... ...
I e tnneapety y t- . g `mile:d nnoaemtrtn - 202 UNDERFLOOR PLUMBING f�
construct the project(ace T(W4 Business and Profcsi arm Cade)The Contractor s � '`
LicenseLowd«a not apply loan ownernfpm,artyumbuildsorimproves thereon, 203 - UNDERFLOOR MECHANICAf '
and who contracts,for h projects with a emnosaon s),I tensed pursuant to the. .. ._.._. _..
Comment,,License L
204._..._'UNDERFDOOR FRAME.. _.. ....-.
: ? ❑Iameemptnner5«. '',9&Pcfor Niareamn 205 - UNDERFLOOR' INSUfATION
her -O 3 01 - ROUGH PLUMBING
1 R' ATION ECLARATIO
Ihereby affirm under,an ally of perjury mai othe following davlameona: 302 - TUB & OR SHOWER
• 303 _ ROUGH MECHANICAL
C I naoe and win maintain n'cennmecti er37W of to self-insureLaborfor worker's 304 ROUGH ELECTRICAL
0 1 ha a and as-provides for by section Sine of he Labor carie, for the
arrarmancic of the work ta,which his permit is issued. 3 05 — FRAME,
_ ❑I have and wilPmuiniain Workd:s Coinpcnsation Insurance,as required by scctioa 3 0 6 - HOEDOWNS
:. '..
37W of the Labor Cole,for the,a'rfarm rn mof&work for which this permit is
issdw:My workers Compenaation lnzara«eearaerand Pohcy.,ombiorac: 307 - INSULATION
cam k n ". s.GS,i Por yt 308 :-,('SHEEZROCK
t'CERTIFICATION OFEXEMPTION FROM WORKERS i ' '" I 3 0 9 ' - 'EXTERIOR LATH
COMPENSATIONINSURANCE'a
3I
0'V 'INTERIOR`LATH __...._.
.,:u (Th c'toa nem noi rte mmpletnd nhe,armit's fur one hundre0 dollars ,) .
15100)nr lean) _ 311 - SCRATCH COAT ,
.; . I tploylify annm pair. _ nnh rkr _n hN ,a raaaaal 31.3.'.'_`. ROOF._.NATL " -. ._ ,�5.� .-
mahall t urLawsf bepmesubjectioneworkq 501 FINAL ELECTRIlCAl ENERGY
Com,a sauon Laws of C 1 Tem a Date'' '
Aphasia - - - — - - -502------FINAL-PLUMBING-'ENERGY
_- - . _._ .
NOTICE TO APPLICANT If,aft making CertificatefFx pion y -'- -
berr n object to the W kc C should
ZZ i ve:t p .nnaonneLabocm ys�nwm 503 - FINAL MECHANICAL ENERGY f't'
O fonhwthi»mplywith mac hp...Win nsor'his terrain shod]ISO d mrevoked. 504 -.--- FINAL-BUILDING .ENERGY-..._..._._.... ._.._ .. _
'CONSTRUCTION LENDING AGENCY
- 505 - FINAL ELECTRICAL,,
1 h by e"nn th t them a c t o lending .C.) f the performance' I.
�.Q Lame nkr -hmnm permoaiaaam(s' 3H9'/c cd __ _506_.___ GAS -TEST__... . ..
d- Lenders Name "- �� -"- + "-�+-�
UC Lenge Aaarea ., .' -...., .,-,.... 507 - FINAL PLUMBING. . : ..-. ._.
1 nrythat Iho mad this application and state that the abovemformaion is 508 — FINAL MECHANICAL
coirea1 agree to,comply N II city ane county ordinances d stat laws relating 509 - FINAL GRADE
0:V m bmdmg consouction:and hereby authosim mpresdnmtives of this city to upon
y,yfa. b riproperty de Acro 510 - FINAL PLANNING
>I Pa (W) B ed indemnify ilkeep h mes.,,NeCty ofCupenia agLinm
(n B°bin judgments, rt and xpe a`a which y y way gain, 514 - FINAL P IC WORKS
Uz City I equenee of tit 'gra t g D thi.,a t - '
hPPLICANTUN ERSTAND$AM1D WI I OMPLY W'I'TH ALLNONPOINT'" �� O
50' ec'REau��irwns - '.�� 'r Issued by: Date
041 'A
nm f lean unt'�" ' '�., `�t. •, '•' Re-roofs
PP "—
' ser ea by,tn�a,an Municipal Ca cl°'ap;;t9 a,`a nin Hh"'°'althons a reg 1 -Type of Roof... -
HAYARDOUS MATERIALS DISCLOSURE
W ll thea rc t f tore bu ld'n a
asy _ - .. ,,_ - _ _
CodeSecton255i21o1s f I El @ lst I � ,1i r. 1 - _
" oY '11, y..' " All roofsshall_be respected poor to-any roofing matena] being-installed.
t n q p t x wnt�h If a roof Is installed'without first obtaining an inspection :I'agree to remove
tit do contaminants d�f tlby the ByA- Ar Quality Ma-g'm<m _
XN all new materials for inspection Y
P
Applicant understands and will comply with _
4 all non-point source regulations - . '
iluive ond.the h d anals
gmrcmcnm d2 ,Chapter 695 id the
ifthe Tit Hdoesnealth As tourolely Cay.Seeta Lamenns 505al it
ydsponsi Tt tonond that
deco building
o!Nc res not currently have a mtun4 Nat it is my-mpgnsibility to notify the - " - - - - - --- _ ____ ___- _-.,.___
requirements which must he nor prior m issuance o(a Certificate of
.W quircm
Occupancy:'.
-oZ - .. - _Applicant Date
Signature of A li
. n=m agent '. ' Dine ., All roof coverings to be Class "B"or better
woe t o
OFFICE _.. ._ .....
OF CUPERTINO
CI BUILDING DIVIISSIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10330 COLBY AV 01090019
OWNER'S NAME: APPLICATION SUB DATE
OU
IENDLER LAWRENCE AND SMADAR 09/05/2001
1 HONE SANITARY NO. CONTROL NO.
O O ARCHITEC IINGINEER: BUILDING PERMIT INFO
�( BLDG ELECT PLUMB MECH
1 -1 CJ, L_j L i .
S v i LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm tom I am liacnzed under provisions of CM1apmr ,9(commencing P
yt, with Section Not of Division3of,heHusinessandProfessionsCode.andmylicense ADD 622 SQ. FT.
m M_ is in full force and effect.
:mac< Dole Class Lic.p ������®
O ac r- Date Contractor
j u O o, ARCHITECT'S DECLARATION
a 1 understand my plans shall be used as public retards
Licensed Professional APR 1 4 2003
a. OWNER-BUILDER DECLARATION
a 1 hereby affirm that 1 ran station,from the Conuxtor's License Law for the
h?Q following main.(SemionTH31.5.Business and Professions Cade:Any city or county �UI L7!'I V-u
E O which requires a perand to construct,alter.improve,demolish,or repair any structure
a 3'-` -Fria t t Is y the applicant forvuch permit to fl 'g d statement
_ _,
_..
an,
thmh sl«nwith .uon7006)the ion3oComr«toesL N 1nsChar9 1 I f �3�10 `1.V'Jbrfarba- .. t;
(tom cog with Section xiianfhe tomadvoaBgedai dProhssoiCak) Valuation
or Nat he rs exempt therefrom and he basis for the alleged exnapt on.Any violation
-Of not mom
vanyapplicantrorapermitmbjems the applicant toocivil Penalty
ofTot mare Non Bvehmred y,or my
remploye 10 -PN " Occupancy Type
❑I,as downer of me and
the s ru my employees with rages offered
their sr s compensation,
will na the work:'ond lite structure C not intended License
Lar.doe sOut airily U4,
Bml'owner ofpro Preany Who builds Calc:The Contractor's Land w row tl su not apply m un 10 3 - UFER Required Inspections'•
own
r or property woo oeeor improves at such,and who does such work intended
or
orthrough ti plye p ddmt .L,improvements. _ t odeagr 104 - REBAR
'nrr ar sale.-� If, � de hand ns v ria la within one year or -._ ..... . ..—..._ ..._... -..._ . ._ _........
inmpletion the owner bu Ider will have the burden affronting that he did not build or 105 - ANCHOR BOLTS 'sz ' •• - -•
mprove fn"hipat sale.). 106 - SEWER & WATER
_._ _.
'.ml '-' --... ...
I e tnneapety y t- . g `mile:d nnoaemtrtn - 202 UNDERFLOOR PLUMBING f�
construct the project(ace T(W4 Business and Profcsi arm Cade)The Contractor s � '`
LicenseLowd«a not apply loan ownernfpm,artyumbuildsorimproves thereon, 203 - UNDERFLOOR MECHANICAf '
and who contracts,for h projects with a emnosaon s),I tensed pursuant to the. .. ._.._. _..
Comment,,License L
204._..._'UNDERFDOOR FRAME.. _.. ....-.
: ? ❑Iameemptnner5«. '',9&Pcfor Niareamn 205 - UNDERFLOOR' INSUfATION
her -O 3 01 - ROUGH PLUMBING
1 R' ATION ECLARATIO
Ihereby affirm under,an ally of perjury mai othe following davlameona: 302 - TUB & OR SHOWER
• 303 _ ROUGH MECHANICAL
C I naoe and win maintain n'cennmecti er37W of to self-insureLaborfor worker's 304 ROUGH ELECTRICAL
0 1 ha a and as-provides for by section Sine of he Labor carie, for the
arrarmancic of the work ta,which his permit is issued. 3 05 — FRAME,
_ ❑I have and wilPmuiniain Workd:s Coinpcnsation Insurance,as required by scctioa 3 0 6 - HOEDOWNS
:. '..
37W of the Labor Cole,for the,a'rfarm rn mof&work for which this permit is
issdw:My workers Compenaation lnzara«eearaerand Pohcy.,ombiorac: 307 - INSULATION
cam k n ". s.GS,i Por yt 308 :-,('SHEEZROCK
t'CERTIFICATION OFEXEMPTION FROM WORKERS i ' '" I 3 0 9 ' - 'EXTERIOR LATH
COMPENSATIONINSURANCE'a
3I
0'V 'INTERIOR`LATH __...._.
.,:u (Th c'toa nem noi rte mmpletnd nhe,armit's fur one hundre0 dollars ,) .
15100)nr lean) _ 311 - SCRATCH COAT ,
.; . I tploylify annm pair. _ nnh rkr _n hN ,a raaaaal 31.3.'.'_`. ROOF._.NATL " -. ._ ,�5.� .-
mahall t urLawsf bepmesubjectioneworkq 501 FINAL ELECTRIlCAl ENERGY
Com,a sauon Laws of C 1 Tem a Date'' '
Aphasia - - - — - - -502------FINAL-PLUMBING-'ENERGY
_- - . _._ .
NOTICE TO APPLICANT If,aft making CertificatefFx pion y -'- -
berr n object to the W kc C should
ZZ i ve:t p .nnaonneLabocm ys�nwm 503 - FINAL MECHANICAL ENERGY f't'
O fonhwthi»mplywith mac hp...Win nsor'his terrain shod]ISO d mrevoked. 504 -.--- FINAL-BUILDING .ENERGY-..._..._._.... ._.._ .. _
'CONSTRUCTION LENDING AGENCY
- 505 - FINAL ELECTRICAL,,
1 h by e"nn th t them a c t o lending .C.) f the performance' I.
�.Q Lame nkr -hmnm permoaiaaam(s' 3H9'/c cd __ _506_.___ GAS -TEST__... . ..
d- Lenders Name "- �� -"- + "-�+-�
UC Lenge Aaarea ., .' -...., .,-,.... 507 - FINAL PLUMBING. . : ..-. ._.
1 nrythat Iho mad this application and state that the abovemformaion is 508 — FINAL MECHANICAL
coirea1 agree to,comply N II city ane county ordinances d stat laws relating 509 - FINAL GRADE
0:V m bmdmg consouction:and hereby authosim mpresdnmtives of this city to upon
y,yfa. b riproperty de Acro 510 - FINAL PLANNING
>I Pa (W) B ed indemnify ilkeep h mes.,,NeCty ofCupenia agLinm
(n B°bin judgments, rt and xpe a`a which y y way gain, 514 - FINAL P IC WORKS
Uz City I equenee of tit 'gra t g D thi.,a t - '
hPPLICANTUN ERSTAND$AM1D WI I OMPLY W'I'TH ALLNONPOINT'" �� O
50' ec'REau��irwns - '.�� 'r Issued by: Date
041 'A
nm f lean unt'�" ' '�., `�t. •, '•' Re-roofs
PP "—
' ser ea by,tn�a,an Municipal Ca cl°'ap;;t9 a,`a nin Hh"'°'althons a reg 1 -Type of Roof... -
HAYARDOUS MATERIALS DISCLOSURE
W ll thea rc t f tore bu ld'n a
asy _ - .. ,,_ - _ _
CodeSecton255i21o1s f I El @ lst I � ,1i r. 1 - _
" oY '11, y..' " All roofsshall_be respected poor to-any roofing matena] being-installed.
t n q p t x wnt�h If a roof Is installed'without first obtaining an inspection :I'agree to remove
tit do contaminants d�f tlby the ByA- Ar Quality Ma-g'm<m _
XN all new materials for inspection Y
P
Applicant understands and will comply with _
4 all non-point source regulations - . '
iluive ond.the h d anals
gmrcmcnm d2 ,Chapter 695 id the
ifthe Tit Hdoesnealth As tourolely Cay.Seeta Lamenns 505al it
ydsponsi Tt tonond that
deco building
o!Nc res not currently have a mtun4 Nat it is my-mpgnsibility to notify the - " - - - - - --- _ ____ ___- _-.,.___
requirements which must he nor prior m issuance o(a Certificate of
.W quircm
Occupancy:'.
-oZ - .. - _Applicant Date
Signature of A li
. n=m agent '. ' Dine ., All roof coverings to be Class "B"or better
woe t o
OFFICE _.. ._ .....