05070082 CITY OF CU13F.R'I'INO � 3e 5`�.ig��w ' �'°�' � �
BUILDING DIVISION PER f C®lVTitA.C-*TCiRINFORMATION sew,
PERMIT NCO 5070082
BUILDING ADDRESS: '
35 DEODARA DR
PERMIT ISSUE DATE
'R'S NAME:
onr
GERLACK RICHARD Z TRUSTEE 07 13 2CON
SANITARY NO. CONTROL NO.
PHONE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
_00 LICENSEDCONI7tACTOR'SDECLARATION Job Description
F❑ I hereby affirm that 1 am licensed under provisions of Chapter 9(nwmencing
UZ with Section T(MRO or Division 3 or the Businev and Profession,Code.end my license is
in ranmteeand affect. REMODEL MSTR BATH, REPL. SHOWER, FAN, VANITY
C-� Dmax Class L1nv FLOORING NEW LIGHTING FIXTURES
g—O Da¢ ConlDECL
Fp
ARCHITECTS DECLARATION
C� I understand my plans sM1all M used as public records
JyU
30G Licensed Professional
`mg OWNER-BUILDER
ronto RATION
aa' 1 Wren,
reaso .(Ste Nat 1 1. exempt from the Crsions hi License Law(or the
x no following reason.permit
t 7031.5.Business and improve,
de of Code:Any city os counry
K m which rets u a a permit reconstruct,a11ar,imprnvc,do permit
t or mama any structure
Pdormincensed pursuant
to the
lhoapplicaut forsuch Cmanormiuoile a ense Law(Cha mcnt ValuaO(5h000
that he is licensed Pursvam to the pmvisiou of the Comraaur's License law(Chapter Sq.Ft. Floor Area
x'$ (commencing with Semon]")of Division 3 nrlhe Busines and Professions Code)or
that be u exempt Nemfrom and the basis for she alleged exemption.Any violation of
Sectioa 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom than five hundred dollar,($513(7. 316 3 0 0 4 5 . 0 0
❑L u owner of the pmpcny,ar is cmplees with wages az their(See
eons.Business
will pr Ne workprofitable.
Code:
no Cumunal intended License
Law dos arde Out apply to an owner
RC uired Inspections
and property
%n obis builds
of imprints
Cs dreamt.Liaise law dos not apply lf rt ownu of /� 777777 f
ownenywyees,provided
suchimprandwho are not
himsdfar ed for ugh slehis FIN �/\\ 11 E p
oweve,oyecs,ping or iphercrem is soldmsarene intendedor mllefed the ower- FINALEU
Wild,,a the building or den of pmenl is sold within one year or completion,for purpose
mwnco-
builder will have 0e burden of proving Nat he did nor build or improve for puryoa of -
k' t.rn 29 2005
1.as owner of the property.am exclusively contracting with licensed mnvacmm to SEP .
to Duct the pmjem(Sec.7014,Business and Professions Codc:)no Conwxtor's Li.
who not
such apply mts owner ormair (adlice Wilds nimprnvc,flWConuared, ����®���
who contracts do for such projects with aco(povi r(s)licensed porn mepor Na Coocam.and
License Law. ,B k P C fora This reason
ore cacmpt upder Scc. artha in
tier Date
•{WORKER'S COMPENSATION DLCI.ARATION
1 hereby affirm under penalty of perjury one of the following decluations:
❑1 have and will mainuin a Ccnifinw mfConsery toself-insure for Workx,sCompcn-
aation,az provided for by Section 3700 of the labor Code,for the peffmmana of the
work Tor which Nis permit is issued.
1 ban and will maintain Wofkcr's Compensation Insurance,u mquire0 by Section
3700 of the labor Code,for Ne performance of Ne work for which this peroul is issued.
My Workels Compansadon Insurance carrier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
trials section treed not W complewd if the Permit is formic hundred dollars($100)
mlcss.)
- 1 unify that in the performance of the work for which this Permit is issuoil l shall raw
mploy any person in any manner so I.beemme,ubjml of .Worker,Compensation
Laws of Calirom' I.
ApPlicam C¢ ,
NOTICEIb A :Ir,miser r&kiOg dos Cisions f the
E aboron,you should
Wcomc h comp y tic Worker's Comms or IJ on Permit
funs of dw Imed i cope,you mon
.Jz forthwith comply With such previsions or this permiuhall bedccmcD revoked.
Z O CONSTRUCTION LENDING AGENCY
�-. 1 hereby affirm that there is a consvvainn lending agency for the performance of
G4 7 the work for which his permit is issued(Sec.3091.Civ.C.)
Lendarf Name -
G Lender's Address
U Q I ecnify that 1 have read this application and state that the above information is
U.t" correct.1 agree to comply with all city and county ordinances and sum laws relating to
V building construction,
to save.
Inde nify andlau harmless the
this city uric upon the
r W above-mentioned property for rnspechon purposes.
HW
(We)agreeIre save,indcapifyandhich hay in anthe Cityof Cupertino
against
� liabillrics,judgmcnts,ensu and expenses which may in any way accmc against said City ,
U Z inconsequence Of the granting of this parmil. Date
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE RE N .
/2,70,,05 Re-roofs
Signature A p' nt/Contmclor Dow
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
4koWill the applicant or future Wilding occupant store or handle hawdous material
Defined by the Cupertino Municipal Cade.Chapter 9.11,and the HcaWr and Safety
de.Section 255320)? All roofs shall be inspected prior to any roofing material being installed.
❑Ycs )No
Will the applicant or future building occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
emit ha'nrdnus air contaminants az dc0 tied by the Bay Area Air Qual lly Management all new materials for inspection.
District?
❑Ycsu
1 have mad the hvmdnus materials requirements under Chapwr6.95 if the Califor
iia Health A Safely Code,Seances 25505.25533 and 25534.1 understand that if the building
does nor currently have a tenant that it is my responsibility to notify tho occupant Of the
myuiremh rest clpncemracerdncaworacaner. SignatureofApplicant - Date
//6f �� 7 3 w�-�$ All roof coverings to be Class"B" or better
a. Data
1 •
IRECEIVED
JUL 1 3 2005
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`MEN
CITY OF
CUPEkTINO
Assessor's Parcel Number:
Name of owner.
Project address.
Contact person.
Phone. �LO �J� 253-SSS
Fax.
Net square footage of lot.
Existin Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y N
Is privacy protection planting required for the project? Y N
On what floor(s) is work being done?
Brief description of work. \LQ111,1AeA-
Code editions: 2001 CBC (Y -N)2001CFC (Y - N)2001CMC (Y- N)
2001 CPC (Y - N)2001 NEC (Y - N)
Effective 11/1/02 d-c,,6
Plan Review Process Work Book Page-8-Revised 4/28/04
050'1V� g2
CITY OF CUPERTINO•
CITY
® CUPEf�TT INO PERMIT APPLICATION FORM
APN # 3 /w/ a O Q L) l O Date:
Building Address: J Mailing Address (if different from building address):
/0 S-3,3- -jCoDRRA -30ZiOC— cc.LPL 2TrX00 e 'FS-0 1(/
Owner's Name: Phone#: , /off �s3 S SS6
R1c4AILo GE2CRGk Y
Contractor: License #:
N'tilKC w'?t,G — SMNft_T e4dwEs 6y7b9 '7
ntact: Phone: /Vg -73 -91x3 Cupertino Business License#:
ffICH111/Z E/e,46J<
46J Fax: Yat -773-831491
Building Permit Info: RsynoneL- yA(aSjtR tJ/17Ftj &,� aca
Ju-C�,P-•-a.e. c�z,r,_._t,, J,,,_t,.e...cz v-✓w �-o-.+,,.,�C._ ne.w R�t.A..n..S�udtus>✓
BldgElElect ® d Plumb L^1Q S Mech Ln 9
Job Description:
Residential ® Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.: Sd S fi
Q
Cost of Project: D O D. Occupancy Group:
� bo g
Type of Construction: Please check this box if the project is a
UN
second-story addition: ❑
Project Size: -Standard ® Large ❑ Major ❑ --- ---
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILERS Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax —Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elee 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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