01030087 CITYOFCUPERTINO
ou HOLDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMITNO.
10104 CRESCENT RD 01030087
OWNER'S NAME' - • � APPLICATION SOB,DATE
VIF_IRA DAV'ID . R AND ELEANOR P T 03/15/2001
'PHONE: Y - SANITARY NO. CONTROL NO.
t.
0z z ARCHITEFI—NGINEEIYALED , BUILDING PERMIT INFO
0
BLD I..LF:Cf/ Pl-wr. M
LICENSED A S PION
zS I hereby abut that Iain Iiceo Nudder pmvixions of Cnun(er 9(connntcdng Job Description
Fc,, with Serino 7000)of Division Jar,hcBusinewind professions Cadc,md my license -
�x "in fallferon::°def```t' Bll� /: ' `bEMOLITION ,APPROX. 1'30 SOFT, OF EXIS
ffiLiranaa cmaa111. 1 ��
s L vs D'te ARCHITECT'S DECLA�rR-A'I'ION, ROOF REPAIR / BRACING-
vs
�O J I understand my plans shall be used as public records
O Lns
iceed Prolis.innal
H 1
OWNER BUILDER DECLARATION
i 1 herah,taffintral that 1 am exempt froon he Count Exalt Law far the
t z Q •
following .Saint 7031,5 Bacolon,, ad P .Code Any city or county
rr55gO
which evolution,"it parnal. .t t,aduar,inopove'deI'.h p o,lot return
n.3� Pr nr to it,ioualce.alxarayaresmam raa
eappl. ther Iran,11, a dar
file signed ` `e
ata,he islicensed pan..,it,the provida.mlContractor.,LicameLaw(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business and Professions Code)
or that he is exempt donefron:md the basis far,he alleged exemption.Any violation
of Scei r 7133)S by arty r,,,+an for apron..xnhlccm Iha af,branl to a r'wil perally
Irma,/^}arc,manreehundred dollaras500). - APN Number - Occupanol'ET'0M
f sown`of the pmpenR a,my ctnNayees with wages s,han sale compensation,
will do thework,- and ilia surcommis not o,a l l or offeredfor salf,(See.7044, -
11 nProfr.xl n C Ito'TI C:n. t ,Licemel Ipplytoan -32E170�(3?egKifed Inspections
w f p putt Wn h ild. ' tp w'es the d who J h ak himself ,
or through his two modulates.mo ht chp vem , , mended ar
offered toe sule.If,however,rhe building or tmpmvememis sold within one year of
nImpletion,ata mora,-baJder will have burden of pmvdng Jlm he Ad no,build or' NO ASSIGNED INSPECTIONS
q,rov£Por purpose.1 ;,It.) I - '
01,as on net of the hopcny.am exclusively connecting wait licensed aimucton to . -
cnnswn the prmju, c.7(441,Businoss vnd Pndcs.inrss CtdcO The Contrdemds
License Lnw Anes no,nppl rof pro who buil ds for Imp,
ves,hercoa,.
anA who emm�mm f r I pr jets with u mmmct...6) IiariseJ puranun. nI the '
Can,mnars hiccns .0 . -
❑la pt nn rsc ❑ I'C thrifts nv,on
Oslo
l R i SAl'ION I) CLAK I'I(1N� .
Ihereby affirm under penalty of perjury one or the fallowing declarations: ,
t ❑ 1 hove mal ,It md`cartoon a Ccnif:cam of Cordon, m self-inmrc Cor Wo, the
Compenxntlmt, he work
h J for by s farmit 1700L.f ,he I,ubor Crude, for dhc
Ixrformance nl.he work tato which this pcnnit is is.ncd.
❑1 have and will mainmin Worker's Compans:nion Insurance,as recruited by Section
3700 of,ho Labor CoAu,,.in,he performance of he work to,wh'ah.his permi,is -
issued.My Worker's Comllunsmlon Insurance carrier and Policy number am: -, -
Cartier. - Policy Nn.:
cER nFICATION Op EXEMPTION FROM WORKERS' '
COMPENSA'1'IDN INSURANCE(Thi,section need not to completed if the permit is for auto hundred dollars
g 100)or to
1le.ity Jett In dm an forntmmu of the work or whlci,this permit is issued,I _
shall not employ any post In any manner so as to hurthe cancer it,,be Workers '
Comparoad oa'lawe of California.Dae -
Applicant
NOTICE T(1 APPLICANT:If,,free narking this Cer ihcme of lixemp,inn,you.hnulJ '
became subject it)the Workers Compannation phooske s of.he l.:mar Carla,you rens,
O O Pon oei,h c hply with.such provi.inns or this permit shell be Jcemed rcooked.
HCONST RUCTION LENDING AGENCY
I hereby ulfirnt,hatthe,,is a con.tmmima ImAing agency for the pe hadmarce
at he work lit,which this pem,n is issued(Sec:71197,Civ.C.)
Q Lender's Nnme
a
Lattice's Address c a
V O 1 can 11y that I boa read,bis application and state that above mantra tion is .
w (~ correct.1 truce b comply with all city and cou onlinmcaa and sole laws micron,
OV in building commotion.and hereby had tep•,enmu'a,of this,only manor upon
>„ gam, he abave.rnenammb�mpery for i, ran paBalsea.
F.. 1 (We)agree to save,indecom nil keep harm less the C of Ch 'a
against
it rA liuhilitie,.judgmrnb, rvo,and pun •s which may In wuyaccrue nguilts,said
City In conscyucnce or ate gran Ig oft Lpermit
APPLICANT UNDERSTAN AND ILLC WITN ALL NON.POINT
soulxCE RecuLAno s. Issued by: Date
i mntarc el Ap,, I' nrmm�r mato Re-roofs. .
! .ARDOUS MA ALS OISCLOSURli
Will
ll the vppllmm n throw building occupant score or handle hazardous material 'type of Roof
as dc0ned by the Cupertino Municipal Code,Chapter 9.12,and the Health and safety
Code,Section 15532m)?
13Yes I El No
All roofs shall be inspected'prior to any,roofing material being installed.
Will the apprcammfuture nuildingnacupun,use cynip...ant a,device,which - If a roof is installed without first obtaining an ins ection, 1 agree to reove
mi,hazardous me comemimms as derided by the Bay Area Air Quality Munugement g p a g
m
�rnotion all'new materials for inspection. Applicant understands and will comply with
❑Ye, ❑rvn' all non-point source regulations.
I have read the ha,ardnox.n: `rialsquitemenm antler C r fi 95 of the
Cali hand-Health&Sardy Code.Sc,ions 2505,2553 and 2. .I unMn,md,eat
:robe building docs not currently ht emmnan thus i,is my nsibili,ymnmily the -
occupant or the co uaemmn,whi tants. r.prior m" c of a Crr,raa:m of
pmcY.
Signature of Applicant Date
fnararnpma,ized - - - -urea All roof coverings to be Class "B"or,better '
OFFICE
CITY OF CUPERTINO- - -
BUn.mrvG DIVISION. PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO, .e
OWNER'S" .. - AI'FLICATIO A
PHONE: ENN f , tlff! , - SANITARY - fl.
ad,p ARCHTECDENGINEER: - - HUILDING PfiRMI'1'INFO
�'w F BLDG ELECT PLUMR MECH
Z N z LICENSED CONTRACTOR's DECLARAI ION - Jph Description
O '
z_G I h by Il L that licensed nJe p ' ns of Chapter)f inn a cin, _ „ p
z; wtlSection]000),1D W 3 Afthe Bo :,add P fe - Code arduc,tire nse
,
s 1111 ra.nlet - r e cl'taa UC x
" um Li .nrar.mr DIVIDE ROOM , INTO 2 ROOMS,
o
ARC]B IbCT'S DECLARATION
L` I unducannA my Alun%shall be aced ns Public records
to p O Licensed I'ndosaianul
OW'NIE-BUILDER DECLARATION '
<to I herchy allinn that I.am exempt from,he Contractor's License Law lin the
following reason;l l,,flm 9071.5.Business aad'Pmfessloas Cnde:Any city or county ,
e, s F O which"most permit to con.ormel,aper,Improve,demolish,to repair any smortdrc
prior to its ,ako requiresthe applicant for such permit file a signed summer, '
=�
Oat he is helmetedpar. t to the proviumnsoftheContractor License La (Chapter 9 Sq.'Ft.'.FloorArea Valuation
(commencing with Sect 7TAn f Division 3 of the Business dl efeWom Cude) S r
I,,that he is exempt therefrom and he basis Formal alleged exemption.Any violation
of Section 7031.5 by any,applicant for a permit subjecrs the applicant m a civil penalty
of mare than five handred dollars($500). - APN Number OccujmqTpe
01,as owner(if[lie Property,or my employees with wages as their sole camparra ion.
will do,he work.and,he strucwre is not intended or offered for sale(Sec.90,44. -
Bmivess and Problems Coda:T1w Crawl License Law does not apply m as Wquired Inspections .
owner of property Who builds or improves thereon,and who Jae%such work himself
nr through his..It empinyaes.provided that such improvements arena,intended ar
offered for tube.Ir,however,me bui]aiag ar impmvammt is,old within one year of .101FOUNDATION . `
completion,tire ovanar-bddder will have me burden of pm4ing that he hid no,b,@dor .
d,prove car pam'sse oc:de), 't 102 - PIERS - t
rLasowneru,men(Sol.7,nmBrune,,aemmrofessiwithl ,:)TheC....mdram 103 — WFER
cnnahuct tthew prnimt(Sol.]f14y Busincs.trod elF,who
Codo:)The Ca, lienor,
License l.:,wdoe,inn n such a.,os arlha diviywhanonoc oil mprmcsmmemn 1.04 — REBAR
mm who er,tttrmrx for snob pt»jro,a with a o6mn,e,m(x)neen,ed pnrsuam to dn' 105 — ANCHOR BOLTS
G,nunnot"y Licctfsc Less. '
❑Inn,e.emplunderSee.. � R&PC For Ihis mm"n " 106 - SEWER •R WATER
Owner WORKE:R'S COMPENSATION DECLARATION 20c — UNDERFLOOR PLUMBING
Ihlmhy uffnn under penalty ofpcjf,one of,he following dalamtion.c, 203 —" UNDERFLOOR MECHANICAL '• .
0 1 have and win maintain a Cedhcam of Convent to self-imam for Wodcle 204 — UNDERFLOOR FRAME
Compensatmm as powided for by Seenon 37M of the I.anar,Cede, for ,he 205 — UNDERFLOOR INSULATION '
performance of the and,rnr which,his rem n I,issued.
0 l have and will mairadd Worker''a Comsum
pensation lnnee,.,required by Section 301 - ROUGH PLUMBING
79011 of the Labor Cal far he performance of,he work for which,his recall,is
ed. 30e^ — TUB & OR SHOWER
issuAly Worker's Couple
ntion Insurance artier and Policy number are:
Cartier. Policybm. 303 — ROUGH MECHANICAL
CIiRi'IFICA'1'ION OF EXEMPTION FROM WORKERS' 304 ,— ROUGH ELECTRICAL .
COMPENSATION INSURANCE -
(Thissection need put be completed r ile permit is for one hundred dollars 305 •— FRAME ' '
olf(Borle".) 306' —.' HOLDOWNS ' '
1 miry drt the rate k r h r' 307 INSULATION
Shull , II y y p r t ry n n t h p` rkc 1
Cm1 r tl w: t Il Dt 308 — SHEETROCK
App1 c t
Npllu IDnlll A 11, k dt cA1t rE pt y hold 309 — EXTERIOR LATH '
nevi Ii tt dew k c I -t room,of I M e 1
O od,wm canpp villi Ip vro .
n orm.reman shml bed mdm—ked. m'a - 31.0 — .INTERIOR LATH e • '
^ ~ CONSTRUCIION LENDING AGENCY
311-- - SCRATCH COAT '
rF1r ? 1 herby.flim,that is a comame,ion lending agency for he Perforator - —
f the work for which this permit is issued(Sal.30G.Cir.C.) 313 ROOF NAIL
LaillAdre 501 — FINAL ELECTRICAL ENERGY
Z) z 1<nJer's AJJrtax
U OIcertify that I have mad this application and%methat the Oil informa ,nis 502 — FINAL PLUMBING ENERGY
E nimca.1 upase m comply with all ally and aunty aNironces and xmte lawms relining 503 FINAL MECHANICAL ENERGY
(� m building aaof,his nsnnelon,and herchy Infertile representatives city R, at,,upon
>r fi7 ,he dove.mentioned propcny for inspection purposes. _ —
E a (we)agreetosave,indemnify and keep hamtles,the City ofcapemmmagainot
504 FINAL BUILDING ENERGY
A lion mica,judgments,costs and expense,which may in an,way aeccae against said 505 — F I L ELECTRICAL
U'Z City in consequence of the granting of,his Penni,. �� J�
APPLICANT UNDERSTANDS AND'WILL COMPLY WITH ALL NON-POINT• ✓
SOURCE REGULATIONS. Issued by: 506 —L ST Date
Signature d Apphcam/Contructor - Date Re-roofs ':
I IKI.ARDGUS MATERIALS DISCLOSURE - r]Q18 — FINAL MECHANICAL_
- Will the applioa It as kande building ooivpem dare or hassle haenmona tnaerial 'Type of Roof' .
asdermad by the enpcdno Mmmcf,:d Code,Chapter 9.12r'ond the Dealt and satoty 509 FINAL GRADE
Codes Section 2557$"° r - „ /l.
OYca I ❑Nm IrAll roofs shall` t6specEd iNF -toRhp&lbliiWfmaterial being installed. _
wu1 the nppuenn,or r,dt�ro ndildms n«spam nae etinlptnant m:aeviee,,wlatth If a roof is ins611dd with6ul IfLPALpbfa2hHlg Ef%inls�QftWfi, 1 agree to remove
emit hasmdousnir,contvninuntsusdefined by the Bay Acta Air Quality Munagenmot '
of+meta all new materials for inspection. Applicant understands and will comply with
El yes 11 No allnon-point;source regulations.
1 have read the hamNous - s myu ourran s under Chapter 6.95 ,1 the _
California lfel SRIF C,de, actions 5505 'and 25534,1 understand that r
if,he building does nolo Indy ave ate am i,is mycesponsibilitymnmifylhe '
occupant al,hc reyuin ;m.a Is ick mus, e,pnono isstCont of +
oeeapana)'' - Date
Signature of Applicant
Camaro Id gen. - ,e All roof coverings to he Class"B" or better