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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 _.. ._ .....