06010011CITY OF CUPERTINO
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�CONTRACrOR�TNF4RIVIAT10
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
(179.0 rlJT.T;F.RTLqON DR
s
PERMIT N0. o 6010011
OWNER'S NAME:
PERMITISUB DATE
LINDA & HARVEY ZIFF
01/03/2006
NE:
SANITARY NO. CONTROL NO,
ARCHITECTIENGINEER:
BUILDING PERMITINFO
BLDG ELER PLUMB MECH
O O
p LICENSED CONTRACTOR'S DECLARATION
Job Description
I luxury affirm that I am licensed under provision of Chapter 9 (commencing
with Smtion 7(a)(1) Of Division Jordi Business Profc,sh Code.eMmylicensu is
Ca A� q a��
Lm,O.fall ma and tt L
CHANGE tv/0 tffnlltt"—�`"' lfr7r�—C
:uanacl.ef'`olb�ue.«]
Dam. Contractor
CONTRACTOR: G STEPHENS 1 '�{,(I0j'\��i `ji.y
ARCHPIECTS DECLARATION
I understand my plans shall he died as public records
^� 2006
V
Licensed Rafeaional
OWNER -BUILDER DECLARATION
12. w for
p i Ig (Sfm exempt from Ile Conlracmr'a License law
•
masa n. (Suction ]
yO mem . on 1. Buslneu antl tape Crile: my
ca mmetur
5 t
IL Willes
whicfolloh requires remit eonaWel, elect. w, de Or mash any
nniu ep
Maar
I
mme. also re plic
tsnua
prior at its iensedpursuant to usstate hperr Ott
the applicant oaf Counrcrmrs Licenso rile a
such statement
< he cansedrums.mtothepmvialao a Lawdsummenl
_..
Sq. Ft. Floor Area ahi'a[i
e
(tita, Othe ftheBuarmraluenm�w(Cmprer9
commencing r Business and Prafas vl Crede) of
$ (commas exempth Sectihcmf 7
— that r exempt the al eged
and the aper for the alleged exemption. Any violation of
and basis f
Saco or
sat..ticamvehundrddollalicant mr501)). adbjeeause .ppla.nla,aWlpn.urar
my appy
APN Number
Occupancy Ty�
rest mart dian taw hundred sono, ($SW).
37534022.00
❑ 1, asowner of tie properly, m my cmpluy ns with wage so tier soleampenution.
a n Pr th �nd.. and the he Corer not s Licem , a w does,
rat apply owner
and of
Code: The Contrator, Lienee Law daus rot apply ll an owner of
Required Inspections
ywhioW
propertywho
propertywho doesouchwork his
Own employee, croffrperthrough
semmuarenot IemadWmpleno.orcul tor axle. If.
,proorimprowuh Improvements
a,proWdad
due r.
however, Ne building or Improvement a said within on year of completion. tlu
prawmnt Is
builder w10 law the burden of proving Nbo at did build ld improv purpose of
bfor puose of
per.).
❑ 1, u owner of the Properly. em exclusively contracting with licensed conuacmra to
construct the project (Sec. 7011, Business and Pmfesiaus Code:) The Contractor's U.
cera law does not apply to an owner of property who builds or Improves diction. and
who contracts for such projects with a conwctor(s) licensed pursuant m die Contractor.
Lkxac law.
❑ 1 am exempt under Sec. . B k P C for this recon
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hemby affirm under penalty of perjury am of the following declarations:
I ham am will maintain eCenifiam or Covent m self -imam for Worker's Compen.
nation, as pmvldad for by Section 7700 of the tabor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Wof es L'ompensallon IRWlmee, a required by Section
7700of Ne labor Code, for the performance of the work for which Nr permits island.
My worlu(o Cam pe tion insunne nine and Policy number me:
C.rmr-:C Ir I Polley No.:
CERTIMCATE OF E7 PrION FROM WORK
COMPENSATION INSURANCE
'
(Tins section heed nutboeompleed if the Knuth rroronchundreddnitan(SI00)
or lctx)
I modify Not in the performance of the work for which this permll is Issued. l shall not
employ any person in my manner an is an became subject to the Workcn' Compsam adon
Lew, or California. Dam
Applicant
NOTICE TO APPLICANT. If. &Aur making this Cenifieam of Exemption, you should
WOne a subject to the Worker's Compensation provisions of the Labor Com, you most
7 forthwith comply with such provisions or this remit shall be dcemed invoked.
CONSTRUCTION LENDING AGENCY
1
I hereby affirm that Otani is a commuctinn lending agency for Nu performance of
the wart for which this permit Is issued (Sac. 3097• Civ. C.)
lander, Nlmd
.
Lender's Add.
1 aNfy that l haw read this application tow funs that tbo ,rove informadun is
'I coned. 1 agree m comply will all city Ind county ondinsm s and some law, mlating In
building construction. and hereby authorize mpnixnmiwo of this city to enter upon die
1] above-mentioned property fa iapection purposes.
L. (We) agree to saw. indemnify and keep hnmles the City of Cupertino against
O liabilides judgments, coats and expenses which may In my way accrue agalosuNd City
in consequence gran
of the ting of this Plank.
APPLICANT UNDERSTANDS AND WILL CO PLY'PITH ALL NON -POINT
/
Issued by: Date
SO ULATIONS. 3.�
Re -roofs 1-2aL�.b�t
Type of Roof
Sign rADpbcanVCantrxetor , Dam
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building Occupant nom or handle hsardou, material
as tleRnod by the CupeNno Municipal Code, Chapter 9.17. and the Health and Safety
Oft. Scctim 255324)7
❑rpe @rl�
All roofs shall be inspected prior to an roofing material being installed.
Pe P Y g g
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipment or devices which
it hunrdaus air contaminants a dcrincd by die Bay Area Air Quality Management
all new materials for inspection.
Diatrict7
0Yes fasts'--
Ihave mad the hsadaw materials requirements under Chapter 6.95ofthe Califm-
M.ImoW@Sall C Sa9aus255a5,2577ud S .lurdcmtat Jm ftecholding
data nal cu y I cent. h i y res icy m ratify the amupam of am
regaire w hustWoe per and per cmf mofacuPmey._
+pato
Signature of Applicant Date
All roof coverings to be Class "B" or better
O
oudiorifedegenI
G�
8
Ic
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
/072-0 �klbe�"6,, WDr.
PERMIT #
b 661 Oa//
OWNER'S NAME: ,c "�arve Z.
PHONE # C —
GENERAL CONTRACTOR 6foAFAX
#
I am not using any subcontractors:
Signator Date
Please check applicable subcontractors and complete a following information
60
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
—in
l—um bg
tee cn�S rA55mC
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ Contractor Signature
Date
amm,
CUPEkTINO
MW
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
PERMIT APPLICATION FORM
APN #
3s_3 oz --L,
Bldg. Permit Fees
Date:
I- -
Building Address:
10720
GasPi ing System Fee
PLUMBING
,Own �j! Name: J)
/�ina<<i, qnA f/ltr✓C/
2�
PLUMBING
Phone #: p
1/0 / %3-"%873
Contrac or: l
' Sf
Phone: pg
�/
License #: a
Contact:
Phone:
Main Water Service
Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect ❑
-,O� ate- CQ--Qz
Plumb
Job De ion:
BPSEWAGE
Sewage Disposal
Resi ential 117f Commercial ❑
Cost of Project
m� J .
BUSLIC
Qty. if
Annlicable Fee ID
Fee Descrintion
Fee Groun
BPERMFEE
Bldg. Permit Fees
BUILDING
BPGAS
GasPi ing System Fee
PLUMBING
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BPREPIPE
Re i e of Fixtures
PLUMBING
BPFIXTURE
Pbl . Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BUSLIC
Business License
BUILDING