03060155 CITY OF CUPERTINO x''.'_- t<s ;•,=c:r✓ : e-e'�-<-•- "thy lt`-"•a' ; �'
BUILDING DIVISION PERMIT CONTRAWTOWINFORMATION
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BUILDING ADDRESS: PERMIT ND03060155
OWNER'S NAME: - PERMIT ISSUE DATE
E: - SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MRCH
(� � (�
300 LICENSED CONIRAC(OR'S DECLARATION
aC I hereby afOrm that 1 am lire ed aver provision,or chapter 9 anmmeneing Job Description
n<i with Section 7001 DiAxlon 3orthc Busi an Mofcssiom Code.mdmylicto.r.
i q< Imm�rnWinder L e� � �g. REPLACE WINDOWS & SIDING
= Licenac c.n - /� q
t� D¢ — Contractor CONTRACTOR: VIPLEX INDUSTRITONALF:ql
CHITECFSISCLARATION
1 undcratand my plans shall be metas public recnNs
%n LicensedProfassional JUL 14 2003
3 OWNER-BUILDER DECLARATION
F I hereby affirm that I am exempt from dm COntracmrs License law(or the BUILDING CDC fullowingaason.(Section 7131.5,Business and PmfcsxinnsCode:Any CityorCounty UILDIfiICa
$ which rcyvirca a pc.It to cnn
nstru ,niter,imm
prove,dcnlLh,or repair any avocture
B
u�
prior its its ismance,also requires the applicant for such permit to file a signed statement
G that he is licensed pursmmtothe provisionsOfthe Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valua,�ipryg92
N$ (commencing with Section 7")at Division 3 of the Business and Professions Code)or
that he i,exempt therefrom and the basis(a,flue alleged exemption.Any violation of
N
Section 7031.5 by any applicant for a permit subjects she applicant o a civil penalty of 3 A8II 2JDo,l6er 0 0 Occupancy Type
not more Nan fin hundred dollars(S50B).
0 I,as owner of the pmpenY•or my employees wish wage as their sole compensation,
will do the words.and she slnnurc is not intended ormnarcd for,ala(Sec.7061,Business Required Inspections
and Profession,Cade:The Contactors License Law don net apply to an owner of 101 FOUNDATION p
propeny who build,or improves sherec nand who da,suchwork himself omh eugh his
own employccs,provided that such improvements are not intended aroRered raises.If, 102 — PIERS
however,the building or improvement it mid within one year of completion,the owner.
builder will have the burden of proving that he did not build or improve for pure.of 103 - UFER
sale')' 104 - REBAR
❑1,as owner or the propeny,am exclusively contacting with licensed ansmactan to 1O5 — ANCHOR BOLTS
aowct the pmject(Sec.70x6,Business and Professions Code)The Contractor's Li.
mom Law does not apply to an owner of propeny who builds or improv maroon,and, 10 6 — SEWER & WATER
who contracts for such projects with a eontracmr(s)licensed pursuant to the Contractors -
LieeveLaw. 202 - UNDERFLOOR PLUMBING
❑I errs exempt under See. ,B&PC par this rcuon 203 - UNDERFLOOR MECHANICAL
Owner Data 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
I hereby tlflrm under penalty of perjury one of the fallowing declarations: 205 — UNDERFLOOR INSULATION
t, have andwill maintain aCerificareofConsent totelf-insuresurworkersCompere, 301 — ROUGH PLUMBING
Cation,as provided for by Section 3700 of the Tabor Code.for the performance of the 3 02 — TUB & OR SHOWER
work for which thisxmitisissued. 303 - ROUGH MECHANICAL
❑1 have and will maintain Workers Compensation Insurance,as required by Section
3700 of the tabor Code,for the performance of the wort for which this permit i issued. - 304 - 'ROUGH ELECTRICAL
My Worker's Compensation losunnm artier and P/o�yby ronstae/r,a ; 305 — FRAME
Cklp�r.2Grvl1 (� IftS �olfJwo.:.L-gl—L11—L�J�-}
N CERTIFICATEOF EXEMPI'I0 FROMWORKERS' 30E — HOLDOWNS
COMPENSATION INSURANCE 307 - INSULATION
(Thisseedmi eadnatbecompletcdifthepermit1,foranchuidmddollan(glrll) 308 - SHEETROCK
Ilea,.) 309 - EXTERIOR LATH
employ
Nat I.she pmnmmance of the wort for which this permit I.issued,I,hall not
Law iffany pormnmany manncrmumhecomc subject to workcn'Compensation 310 - INTERIOR LATH
Lawsca Ctlifomla.Onc 311 - SCRATCH COAT
App)36
NOTICE TO APPLICANT:If,after making this Ccnincate of Exemption,you should 313 - ROOF NAIL
become subject to the Worker'sCompensation provisions of the tato Cndo,you must
oZ
forthwith Comply with such previsioMorthis Permit shanbeaaemedrevoked. 501 - FINAL ELECTRICAL ENERGY
z CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
F .N 1hereby affirm that thcreI..crstructimleadingagencymrllmpormrmammf 503 - FINAL MECHANICAL ENERGY
C > ho Lands' mrwhimNi,permbisivmd(sec.3097.Cir.C.) 504 - FINAL BUILDING ENERGY
It] Q Lands' Name
j z L nder'sAdd , 505 - FINAL ELECTRICAL
U 0 1 cenifY that I have rad this apphadnn and ante that the also.!or ums.Ran I. 5 0 6 - GAS TEST
E~ correct.l agree m comply with all city and county ordinances and State laws tainting in
0506
U building consbuction,and hereby authorise representatives of Nis city to enter upon she — FIN PLUMB G i
abovcmentianed property for inspection purposes.
(We)agree to ave,indemnify and keep harmless the City or Cupertino against 08 FI AL
FN liabilitinjudgments.costs and expenses which may In any way accrue against saidCity 5
U z in consequence Of she granting of this permit.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 ING Date
SOURC EGULATION .
'�-cP Re-roofs
stations Of Applica Contractor rte
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building uccupanutore or handle hazardous material
as defined by Ne Cupanino Municipal Cade,Chapter 9.13,and the Has1N and Safety
was etian zsslz(a)+
❑Yu p�pl 'u All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or(future buildingmcupent use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hazardous air contaminants as dcfncd by the Bay Area Air Quality Management all new materials for inspection.
iatricl?
❑Yca 1�4a
I have revI the l o,arNms mmerials requirements under Chapter 6.95 of the Cali rnr,
ilia Health&Safety Cents,Savona 75505,25533 and 2553,.1 undcratand and if tM building
duo not correctly haw a mnant,Nn it u my responsibility to notify No Occup tint of the
require tswhich mus m pour m issuenm of a Cerditaus of acupurcy Signature of Applicant - Date
acser inn oris. agent Daa
t-0 All roof coverings to be Class "B" or better
CITY OF CUPEI2'I'INO """""`r '� t«"^� 'Y' ➢ �' ` ' �`
BUILDING QlvislQN PERMIT • CONT=RACTnR`INFORMATI(�`m
CT .b:.R a�f< .?.a ➢'I^QS `.:
BUILDING ADDRESS: PERMIT NO.03060155 3060155
OWNER'S NAME: PERMIT ISSUE DATE
AN LAWRENCE K AND CANDY L
E:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELELT PLUMB MECH
0 0 0 0
Inc, LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am liecnud under provisions ofChaptcr 9(commencing Job Description
With seeann ir>ro) roi.iaion3nrme nasi ....gTjrssioMCMU.andin rcenxis
nfullfo�a�nder I.LianseGl'Sk o e.a •'� REPLACE WINDOWS & SIDING JUL 1
,mac Dam Contractor - CONTRACTOR: VIPLEX INDUSTRIES 7 ZOOS
RED A CIVTECf,TTS17�LARATION
y I understand my plans shall Wuses it records
e Licensed Professional
BUILDING
9OWN[R-BUILOGR DECLARATION
2<S I hereby atbrm Nu I am exempt from Ne Contractor's License Law for 1M
p o following mason.(Section 7031.5,Business and Prorcssiom COJC:Any city or county
<m wt ich requites a pcmtit to consumer,alter,improve,demolish.or repair any structure
"' prior to its issuance,also requires the applicant for such Permit o file a signed statement
gg
that Ix,is licensed pUrmant 10 flue provisions or he Cimarractor's License Law(Chapter 9 Sq.Ft. Floor Area Valua, I`F392
t�S (commencing with Section 7000)of Division 3 of the Business and Profnssiom Code)or
Oat he is exempt therefrom and he baso for be alleged exemption.Any violation of
.action 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of 3 gFI1Md16e[0 0 Occupancy Type
not more than five hundred dollars(S50r.
O 1,as Owner of the property.or my employees with wage;as their Iola mmpcnmlion.
will do the work.and the structure is not intended or offered but sale(Sec.70N4,Business
and Professions Crede:Tho Contractors License Law does nal apply m m owner of Required Inspections
pmpenywho builds orimvrowshrmoo.andwho does.achwork Ir seBorthroughhis 101 - FOUNDATION
own employees.provided that such improvements are not intended or offered for sale.If, 102 — PIERS
however,the building or improvement is sold within one year of complcuon,he owner-
builder will have the Wrdcn of proving Wat he did not Wild or improve for purpose of 103 - UFER
sale')' 104 - REBAR
❑1.as owner of he proper,am esclusirc ly conuaeting with licensed conoaetom m
construct the project(See.704E,Business and Profcssons CWEj The Conmemr's Li. 105 — ANCHOR BOLTS
cease law does not apply to in owner of proper,who wilds or improves thereon.and 106 — SEWER & WATER
who Late.Law.for Bach pmjccuwith acommaorta)Ifunscdparsaam mBe Convacmra' 202 — UNDERFLOOR PLUMBING
❑I am exempt Undat Sec. .B h P C for this=on 203 — UNDERFLOOR MECHANICAL
Owner D11e 204 — UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLA0.ATION
I hereby affirm under Penalty or perjury one of me following declot.don:: 205 — UNDERFLOOR INSULATION
I haw and MI maintain aCenlrcamofcoosemmself-boom ror Worker's Compen. 301 - ROUGH PLUMBING
aation,a<providedfor bySection 37Mofthe LSWrCnde,for mePerformance ofine 302 - TUB & OR SHOWER
work for which his pant it is issued.
❑1 have and will maintain Workees Compensation Insurance.u required by section 303 - ROUGH MECHANICAL
3700 or he labor Codc.for m. terfmmance or the work for which this Pomo is booed.
304 - ROUGH ELECTRICAL
My Worker's Compensation Insurance carrier and Po'cy number
umbeam: "� 305 — FRAME
ccA 1 2E'Ej N �/JS CQall v: 7Oy j-2,i-5 L} 306 - HOEDOWNS
CERTIFICATE OF E%EMPr10 FROM WORKERS'
COMPENSATION INSURANCE 307 - INSULATION
trntaleedonneed am w completed if(be pemtit is permit,Wadreddouars(SIM) 30$ — SHEETROCK
4Mrs.)
1 Santry that in he Performance or me work for which this permll is issued.I Shan not 309 — EXTERIOR LATH
employ any person in any comber SO as or become subject o the Walacts Compensation 310 — INTERIOR LATH
Laws of California.DateApplicant 311 — SCRATCH COAT
NOTICE TO APPLICANT:If.army making this Ccniric.w of Eacmprion.you Should 313 - ROOF NAIL
become subject to the Worker's
Compensation provisions of the Labor Code,you must
p Z rorthwRhcomply with such provisions orthis p,Mol shall wdecmadrevoked. 501 — FINAL ELECTRICAL ENERGY
?2
CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY
[-. .. Ihereby affirm hat here is a construction lending agency In,On perfurmriesof 503 — FINAL MECHANICAL ENERGY
C4 > We urwhich this permitisissued(See.3097,Civ.C.)Name 504 - FINAL BUILDING ENERGY
lt7 Q Under's Addh
a2 Lnder;Addro 505 — FINAL ELECTRICAL
U O 1 sentry hat I have read thin application and sum that me above inrormalion is 506 - GAS TEST
pFcmrcct.1 agree 10 comply with all city and county On inane.and aura laws ml.ung m
U buildingconswetion,and hereby authorise mprescnmamsor this city to enter upon the — FIN PLUMB G
above-mentioned property for inSPCCsion PurPOSo.
fir-' G (We)agree to Save,indemnify and keep harmless the City of Cupertino against O$ F I AL t
rA
liabilities judgments.costs and expenses which may in any way accrue against mid City 5
U Z in consequence of the granting of th is perm it.
ar APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 MWING Date
SOURC� EGULATION\+j�
11 Re-roofs
ignarumcfApplicaContractor am
AZARDOUS MATERIALS DISCLOSURE Type of Roof
Will he applicant or rumre building Occupant store or handle ha mous material
as defined by the Cupertino Municipal,Code,Chapter 9.12.and the Health and Safety
Cole.Section 25532(x)7
❑Yu All roofs shall be inspected prior to any roofing material being installed.
t�fNu
Will the applicamor future building occupant use equipment ordeviss which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants az defined by Be Bay Arca Air Quality Management all new materials for inspection.
dict?
El Yes rYC`R'
1 have mad the hmaNtms materials nequimments under Chapter 6.95 of the Carrot-
or.Health gt Secty Code,Secuuns 25505.25533 and 25534.1 undcrstmd hu if he wilding
does not comen try have a tenant,that it is my respomiality IS notify the Occupant of me
nequi¢mr B which mus wm l prior to suanw ora Cereficam or Occupancy. Signature Of Applicant Date
S ' -o
rte maamoriz agent Date - All roof coverings to be Class"B" or better
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CUP TYOF O PERMIT APPLICATION FORM
-3 J Z o 3 6 Dater
Building Address:
L-�R CuE TrNn
Owner's Name: Phone#:
L /twRcrscc HIJ 4o$ - 913 - ya-a�
Contractor: License #:
Vi ?0--X 1/JDUSTR(F-S 5807 ( 8
Contact: Cupertino Business License#:
uilding ermit Info: Fy ACC 120 CJ S
Sr �rfv
Bldg Elect ❑ Plumb ❑ Mech ❑
J ascription:
Residential Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Occupancy Grou
,
Type of Construction:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILER1 Boiler<= 100,000 Btu MECHANICAL
r BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 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 Elec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
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