06010177 CITY OF CUPERTINO #
BUILDING DIVISION PERNUT CONT Cio-A I1�TFQR 'I ATIONa x;
BUILDING ADDRESS: AMERICAN BRANDS CONSTRUCTIMMITNO06010177
21442 ELM CT
OWNER'S NAME: PERMITISSUEDATE
ft MCHALE RESIDENCE 1145 HAWKS HILL-ROAD 03/06/2006
111ME: SANITARY NO. CONTROL NO.
(408) 210-4945
ARCHITECDENGINEER: BUILDING PERMITINFO
BOEO PLO MECH
O
3oj LICENSED CONTRACTOR'S DECLARATION Job D85CTIP[lOn
vd 6 1 bereby"not Nns at 1 are licensed under prevision of Chapter 9(commencing
with Section TOM)of Division 3 of the,Business and Protessiona Code.W my license is
n in fall force aadcfract. PATIO ENCLOSED ON SLAB AT REAR OF SFDWL
?�Z License Ius U'.N
q Dam — — Comoo,var
7W ARCHITECTS DECLARATION
U I undersand my plans shall be used u public mcar is
g C Licensed Professional
q OatNET-BUILDER DECLARATION
9 M I berehy ilium that 1 am eaempt from Ute Canons Cm Liccoe Law for the
p o following mason.(Section 71D 15,B. Itm. and edooli Co dc:Any city of county
$(r which inquires n permit re consumer.dor.imp...dPermit,fie a sig any talcownt $132909
_ Sec privaits issued issuance,also requites the probdons of for the Contractor's
fdpuLvdatsument
Z�y< that heiall¢ved pursuant of Division
nl theeummr'andPom TawsCode)9 Sq.F[. Floor Area Valuation
C$ drat he s exempt
Section and
of D alis f r of the ejd Business and m.An al Code)of
BB Ihet he is e¢mpt Uwn(rom and Um basis for the alleged eacmpUon.Any vlolaUon a(
Section 703 LS by arty Applicant for a permit ubjects the applicant to a civil penalty Of Occupancy Type
Am come than Bw hundred do1Ws($SW3
0 1,u Mae,of the properly,or my employees with"gas as their sole compensation.
will do Use work and tia svuc5oe Is not intended oroResad for Ask(See.7044,Bud.
and Professions Code:The Carmines Limme law does not apply to an ownm of Required Inspections
propenywbe buildsorImproves Us..andwhodoesouchworklumna!terthrough his
Own employees,provided that such improvements are AN inmmded oroRered forule.IL
however,the building As Improvement Is sold within we year o(compledon.the owner. -
builder will law the pudan of proving that he did not build m improve for purpose of
sok.).
0 1.As owner of the property,am exclusively contracting with licensed mnuatmn to
cm atmct the projas(Sec.7044.Business and Professions Cade:)The Contractor's Li.
cause law does not apply to an owner of propenywhe builds or improves merean.and,
who convects for such projects with Acommmods)licensed pursuant m da Camomiles
Lkene law. ,
❑I ore eacmpt under S. .B At P C fns this moon
Owvr Dam
WORKER'S COMPENSATION DECLARATION
19 I hereby avian under penalty of perjury am of the following declarations:
O l ban and will maintain aCeNRcale of Covent to self-Inure(a WorkeeaCompen-
sslion,As provided for by Section 3700 of Ne 141mr Code.for the penitent at the
work for which thea permit is issued.
0 1 have and will maintain Workers Compensation Insurance,As required by Section
3700 of the labor Code.for the performance of the work forwhich this permit Is issued.
My Wnrkees CompensWm Insurance amm and Policy number are: -
Carrier: ST'A><t—e C�wi'( Policy No.;7/3 G '?—Zvuy
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
MIS 4a71m need n otbecompked If tis permit m farm to n lredcalbus($100)
to less)
1 cereif-v Nat In the performanc of Ibe woh tar which this permit is issued.l Nall not
emplay any person in any manner an As to become subject to the Workcm'Compensadm
Laws of Califorela.Data
Applicant
NOTICE TO APPLICANT:If.alter meting this cumnuaa of Exemption,you should
became suNcer to me Worker's Compensation provisions of the labor Code,you must
.J O
Eforthwith comply with such provisions m this permit shall be deemed..sed.
ZM CONSTRUCTION LENDING AGENCY
I hemby alum mat inert is a conservation lending agency for the perpmraunceuf
tha wars k for which this Perth Is issued(see.3097,Civ.C.)
It1 Q Lmdm'a Name
.7 z I4ndees Address
U Q 1 certify that 1 Mn read this application rend stam that da above information is
UI coven,I&gree to comply wilh'dl city and county odiwmes and sato m"relating to
Q building consuualon,and hereby authorize inpreen2liM of this city as enter upon the
W shove-mentioned property fm inspection purposes.
LL (We)agree to ave,indemnify and keep humless the City Of Cupertino against
y liabilities.judgments.casts and expenses which may In my my accuse against said City
U 7 In consequence of the grunting of this permit
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE LATONS. /�➢ 3/6/06
�J Re-roofs
Sigmuwe afAppllaHAZARDO Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or(alum Wilding eecupsuumin or handk h amaterial
dennW by the Cupertino Municipal Code.Cbspmr 9.17,W Ute Health
and
nd Safely
Code,SecDYcf 25537(a)7 All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant use equipment ordcviccs which If a roof is installed without first obtaining an inspection,I agree to remove
colt ha'rutlam air conumiaa is As declined by me,Bay Am Alt Quality Management all new materials for inspection.
Diavicl7 /
r`1 Yea �qa .
I have mW the haradnus materials requitemems underchapser 6,95 of the Cables.
me Health&Safely Code,Sections 25505,75533 and 25534.1 undersand mu if Um building
does out currently have a mann that it b my responsibility m notify B<Occupant of me
requlrtmyyyy��bice mull met p�oyys cp or a Certificate ofOccupancy. Signature Of Applicant Date
3/6106 All roof coverings to be Class"B"or better
Owner or outhod.d agent Dem
CITY OF CUPERTINOr ' " " . . . - -
BUILDENGDtVIStON PERM 'CQNTRACTORINFORMATT N;
B3H4'2" iM CTJAMES & SHIYI MACHA PERM No 02050140
Ou3 m ":& SHIYI MACHALE APM72YYnT62
PHONE: SANITARY NO, CONTROL NO.
y O C ARCHITE=NG NEER: BUB.DWG PERMIT WFO
z n BLDG ELECT PLUMB MECH
<y EO E'-1 L_7
;Sy i LICENSED CONTRACTOR'S DECLARATION
Ho Ihereby aarmmet lamlicensed under proviaionsofChapter 9(comarmning REPLACE COUNTERIobI'Befficl�VRCITCHEN/BATHRM
mFw with Section]o00)or Division 3 of,hc Business and Professions Code.and my l union
a Iis in full force and effect.
O c< License Clan Lic,a
F• DateContractor
1 r`rn ARCH ITECrS DECLARATION
i O 1 uMcrstand my plans shall be used as public records g7` vQ/
1 d v O Uc<nud Prefcnsonal v
/jam C�
u ore a OWNER-BUILDER DECLARATION
1 hereby.Rent that I em.Benne from the Contractors Co License Law for the
following mason.(Schon 7031.5.Business alter and ver de o demolish.
Code Any city or county c\ $3000
Y�O which in iasis a p<mut to uires the
ober,improve,h pero sh,or repair ed structure
a. L maor to theis lssunm P also rtquhe thropplicant for such perure Licfoe ssiaw(Chaemem
(commerming it pursoam tothe p f Divindf ter Convenors License Lew(Chaper9 �n] ,hR! _ - - - - -
(commnecisexem tdieSectraforma)pfhebasis oof rtthelegedexandProfusionsCody Valuation
or Sect he is exempt any pli and the basis for the alleged uempnad Any violation
of a., an]0han v any hundred
anrror,a pemduubjats the applicant to°civil Penalty PN
of ndt marc than Br<nunarw emha Issop). � Occupancy Type
01,as owner of the pmpeny,Lir my employees with wages az melr sale compensation, 102 — PIERS
will do the work,and be structure is not intended or offeree for sale(sec.]DM,
Business and Pmfeuions Cade:The Contmcwr's License law does not apply to an Required Inspections
owner of pmpeny Who builds or improves thereon,and who docs such work himself 104 - REBAR
or mrdugh his own employees.pmvided that such improvements arc not intended or
offered for ale:If,however:she baading or improvement is sold withim'ona yev of 105 — ANCHOR BOLTS-
completion,the owner-builder will have the burden of proving Thal he did not build co
improve for purpose ofs,l°.). 106 - SEWER & WATER
171:as owner or mepmxny,on exclusively contracting with license daonva)ton To 202 - UNDERFLOOR PLUMBING . -
ean,dan the Project(See.loan,Business aad Proportions Cade:)Thr Contractors 203 - UNDERFLOOR MECHANICAL
License Law does not apply to an owner of property who builds or improves thereon,
.. aad who contacts for such projects with a common fa)Humane pm ent.w me - 204. —. .UNDERFLOOR FRAME
Commander License law. ...- .....-
❑lamexemptadec5ee. ,B&PC for this mason 205 - UNDERFLOOR, :INSULATION
>�na, ( —} %oJ 301 - ROUGH PLUMBING
ORKER' COMPS
ATION DECLARATION 3O2 — TUB & OR SHOWER
Ihereby affirm under Penalty ofperjury one ofthe following deelaation,: 303 - ROUGH MECHANICAL
o I have and will maintain a Cemlficme of Consent to:elf-ince, far Wmkm, 304 - ROUGH ELECTRICAL
'i Compensation, as provided for by section 3700 of me labor Cade. for the 305 — FRAME
Performance of me work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section 3 OG — HOLDOWNS
3700 of the Labor Code,for the performance of the work for which this permit is 3 07 - INSULATION
. Compensation lnsuarmecarrier and Policy number am: 308- .— SHEETROCK
issued. y orkers
ammir PaMP`F1O 309, ,:,EXT;ERIOR LATH
CERTIFICATION OF E%EMPTION FROM WORKERS', - ,, -
.. ... comrE.usnnorvINSURANCE.' INTERIOR..LATH
rrnh rection nail not be completed innr permit it far an<wnar<a dollars 311 - SCRATCH COAT '
fsloo>ane,.) 313 - , ROOF NAIL
Curdirertple many person iror,L,n<emor of so srk mrwhim this perme;a is:Zo. 501 - FINAL ELECTRICAL ENERGY
rM1all not employ any person in m ,�Qbec 1 t to t Worlers'
nt���arppppppn awsdfC�hramie. I"°� —°� � y 502 - FINAL PLUMBING ENERGY
APpliranU�Sl
NOTIC OAPPLICANICtieftcrmaktn therm manOrExemption.youshould 503 - FINAL MECHANICAL ENERGY
0
become subjectto use Workersns
compeation provision of the Libor Code,youmust 504 - FINAL BUILDING ENERGY
0 forthwith comply with such previsions or this permit shall be,dremcd revoked.
, CONSTRUCTION LENDING AGENCY
505 - FINAL ELECTRICAL
C Ihembyaffrmmvtthereisaconswctionleading agency for meperformanec 506 - GAS TEST
of the work far which mis permit is issued(Sc.3097,Civ.C.)
W p Land<rrNime 507 - FINAL PLUMBING
wp Z L<aaerrertifyr 508 - FINAL MECHANICAL
Q Ecd Ico'mr,TO lhave reidiad appfi<atmnana.rtnematmeabove mmrmaan"ir 509 - FINAL GRADE
. built.1 agree to comply win all city and county ordinance and state law,relating
V tabuilding mnswniom.andherebyaumorize,repiesemativesbfThis city wenter up°n 510 - FINAL PLANNING
),a W the above-mentioned property for inspection purposes.
.Fw gL We)agree toreve.mdeddifyand keep harmlessthe City ofCupeT,mmagainst 514 - FINAL PUBLIC WORKS
rn liabilities,judgments,costs and expenses which may in any way accrue against said
U i City in consequence of the granting of this Femur. �
APPLICANT UNDERSTANDS AND WILL COMPLY WITH L ON-POINT,
I URC GULATIONS. Issued by: V(/
-a; Date
igna,ar A_Applmanu dmmrwr Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will The applicant orfrom holding occupant rtdreorhardlehazuNononcerial Type of Roof
as dcfinrd by the Cartoon Municipal Cod,.Chapter 9.12,and be Health and Safety
Code.Section 23532arr '
Ely<s' tyQ No I s
f\b All roofs shall be inspected prior to any roofing,material being installed.
Will us applicant or fumrc 'Idicg occupant use equipment or devices which If a roof is installed without fust obtaining an inspectiofi, I agree to remove
emithaardous air romaminants u t d by me Bay Area Air Quality Management Dirdirn all new materials for inspection. Applicant understands and will comply with
L ❑Yes o
I I have read The
all non-point source regulations.
Catf°rmas Health&Safety Code.Setions 255materials 05 25533 and 25534.1 undeau"dapter 6 95 ithat
if Ne building does not currently have a tenant,mat it is my responsibility,to notify the
occupant of the requirement which must be mon prior w i on of a Certificate of
OceuPmcy,
_a Signature of Applicant Date
" °umdn ea rag°"' Date All roof coverings to be Class "B" or better
' OFFICE
Sn CITY OF CUPERTINO *
CITY OF PERMIT APPLICATION FORINT
CUPEkTINO
APN# 6 O Date:
- a
Building Address: _ qq
L � � ( m LtTU�t T
Owner's Name: Phone #:
h I I Mac,ha 42, a5 —Zktd
Contractor: License #:
Contact: Phone #:
Applicant/Contraptor: Fax #:
uild Permit Info:
Bld Elect Plumb Mech
escription: /� 1 e-oan4-e„
Residential: (k, 7 61A w -&f, Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation:
Type of Construction: Occupancy roup:
Quantity Fee ID Fee Description
Fee Grou
APTFEE EACH STORY OVER 3
HOTELFEE EACH STORY OVER 3
OFFICEFEE EACH STORY OVER 3
BAPPLOTHER Other Lkppliances MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXB Con. Tax for B 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 h; estiation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BNEWMULTI New Multi-family Res ELECTRICAL
Iof3
271. 56
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T
PRIM-
002
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CD -- --- -----
APPROVED
--------IN-ACCORDANCE-WITH THE-CITY-OA- --- - - ----- - - ----- -- --- - - ._ . _ . ._.
CUPERTINO
--------IN ACCORDANCE-WITHTHE-CITY-OH--
CUPERTINO CODES AN ORDINANCES
DATE_
-- -SIGNED-- --- --- - - -- ---- - -- -- -- - — ---- - --- -- - — - - - -
T
IGNED—
This set of plans and specifications MUST
-be kept on-the job atall-fimas-and it is uni-
lawful to make any changes or alterations
On same without-writtun Permission from
the building Dept., City of Cupertino.
The stamping of this p;.n and specifications
SHALL NOT be heid to Peimit or to be al
-.approval.of-th_-_,vio!ati5n-of-nny -provis'wn
Of any City Ordinance or State Law.