00070070 CITY
1
BUILDING DIVISIONNo CONTRACTOR INFORMATION:
_ PERMIT ,
BUILDINGAI BARDEN (BATE DRIVE KBOL METAL PERMIT NO.
0007907e—
OWNXR'SNA .. ! THO 3505 KIFER RB APPLICATIO. RD —
'HONE: (408) 245—F559:7 SANITARY NO, CONTROL NO.
('vob 973-9/y 9
MOO ARCHITLC MNGINEER: _ - BUILDING PERMIT INFO
z W _ BLDG ELECT• PLUMB NIECE
Ni Cl t-1 CI LJ .
Z m 3 LICENSED CONTRACrOR-S DECLARATION
o i y e here,',farm dont 1 am 11arn+rd under nrwi,l,m trelmimrr v taummoalog 141 . X 441 PHI 1lf rL�Ef1pER
Pao'. with Section 7100)of Division 3 of the Businessland Professions Codr.train,license
i.in full force and eRca 6• '
cinest License Clas: �� Lic.0 a �s o
3
RU
t Dale Contmem�LL O ARCHITECTS DECLARAGON
I undersand my plain shall Ne used h.publicrecords
00Z(ti1Z�P1(
,0 Lica, ad Pmbsinnal
OWNER-BUILDER DECLARATION
I hereby,gra that I am exempt from the Camra"Coo License taw for the
C or a following main.,(Section 7031.5.linsimr,land se.demolish.
in Any city arm one
ts-o which requires u permit nm con.mmn,over,improve,demolish,ur repair any awemrt '
a3. P^t he is
slcensed pursuarcyuiree the applicant fur Commmah mi License
Low,(Chapter
statement
mmneirear,.mpumcammtnepnwo,mantrnecnmmemra randP_i.cs,mrs ode) Sq. FL Floor Area Vah
a,that a it a win,Semon intron)of Division 3 tmhe Busioe.c,and Professions Cade)
or thin he is exempt,any applicant
p li and the basis ram Ne subjects
th J emmpnt to Any violation
of Section 7031.5 by my handed
dollars
for a permit aobjens the applicant¢m a civil penalty
,rote more ninon ear mtmrea a,uar.ta5an APKWnnli. LAO Occupancy Typo:.
❑I.us owner or the properly,or my employees with wages re. sole compensation,
will do the work,and the steams,is not intended or offered to,sale(See.TNT
Brom...and Profession.Code:not Commm o,',uaam+c Luw dues rte may ton„ '101 — F �j a petitions .
owner of proper,Who builds or improves thereon,and who does such work himself 102. — PIER -
or through his own employees.pno drd thin such impmamenm are not intended or
offered for sale.If,however,the building or improvement is sold within one year(if 103 — UFER
completion,the owner-builder will hive the burden of proving that he did not buil)or
improve mrpurlm,eofmle). 104 — REBAR .
❑L as owner of pm try,am exclusively contracting with licensed c,mraamry m 105
m — ANCHOR BOLTS
m abort the pn,jac,(See.7044.Barrels ,ad Pmlmsinne C'%1,:)C'%1,:)The Counter106 — SEWER A WATER '
License Law does no,apply an owner of pmpc^y who bond,,,, th
r improves ereon.
uta runt contracts for such projects with a romoc,orts)licensed pursuant m the 202 — UNDERFLOOR PLUMBING
.ad%he c nor License Low, -
❑Immmemptam@rSec. ,BN,PClot this maama 203 — UNDERFLOOR MECHANICAL
Owner Data
137MWORKER'S COMPBNSAnON DICLARATION ' 204 — UNDERFLOOR 'FRAME
Ihereby afntmunder Woolly of aropayone pthe following declaration.: 205 — UNDERFLOOR INSULATION
1 have and will mmntan n Cenmamr of Courant to +eleie,ore u r Wmkcr'+ 301 — ROUGH PLUMBING
ompensation, as pmvidcd for by Section 3701 of the Labor Code, for the n
erformance ohne work ter which this permit is i...ea, 302 — TUB & OR SHOWER
111 1,,m adwill,uaimainwoker'.Cnmpctaniomlttsmmance.asmgmredbySectim1 303 — ROUGH MECHANICAL
or the labor Calc,for the performance of the work tar which this permit is ''04 — ROUGH ELECTRICAL
ssweri My Worker's Compensation In,umnce carrier a�nd P/ol�icy number am .•rarrier: /Y'4/C C PtlicY No: —IRA 0$ 9—G 305 — FRAME
CERTIFICATION OP EXEMI"DON FROM WORKERS' 310E — HOLDOWNS
COMPENSATION INSURANCE
(This.rnionnrednetheconplmedit he perm it ismroehundreddollars ' 307 — INSULATION
SIONorl=ss.) 308 — SHEETROCK
I artery dm,in int padbrmamru,f me work ram which ids permit is lsared'1 309 — EXTERIOR LATH .
shall not employ Laws
fmrwnon unY mom,cr so azvy n'n m the he Wnrkus�
Contention..nitIawsol 02nN_.at=0 wrD7a�, G [a 31.0 — INTERIOR LATH
Not ICE TO APPLICAN'1:It,a(teemaking this Ce,diticatc of lismmption.you should 311 — . SCRATCH COAT
o 2 become subject mine W'orker's Compensation provision,of the Labor Gavle,you mins,
mnhwith comply with such provisions this permit shall be thermalrevoked. 31 3 — ROOF NAIL
F, 4 CONSTRUCr1ONLENDINGAGENCY 501 — FINAL ELECTRICAL ENERGY
CS I hereby aRn,mat,here is u conservation lending agency for the performance
if 502 — FINAL PLUMBING ENERGY
Q Leon=e's Name
5 z Londa•„Address 503 — FINAL MECHANICAL ENERGY
O 1 certify that 1 have read this application and state that theabove information is 504 — FINAL BUILDING ENERGY
w F' cnrtea.I apron to a,n,p1,with all cry mal'cam'onlinnnm,and atria laws rrwtfny
o
to building dra%araction.and thereby of hir cqu,enuctipart 505 — FINAL ELECTRICAL
>, fil the shove-mentioned property for impemion parpnves. Stab — CAS TEST
I•y py (We)ug,oemsave,indemnlfyud nkeephunilcssthe Cityofpe
Curinoageinst ,•
Z) liu alibis,jmgnmcal,calls and r.pen.es which may in any why accrue agin.t aid 507 — FINAL PLUMBING
U Z City in consequence or ther
e gming of this Penna.
APPLICANT UNDERSTANDS DWIL OMPLYWITHALLN POINT ^6�
SOURCE REGULATIQNS �/�f .mss aG Issued by: 508 — 1`-1L MECHANICALDate
Signal..;Ap I � ' DateRe-roofs `
09 - FINAL GRADE
HAZARDOUS MATERIALS DISCLOSURE 510 — FINAL PLANNING
Will nmrnppnmoommne h,coding«rnpnm ammtrnnmllabnaantos,mm:,,raa1 Type of Roof
as defined by the Coleman Municipal Cale,Chapter 9.12,uad,he Health and Surety 51,4 — FINAL PUBLIC WORKS
Cale,Section 25532(4)?
0tCa A. All roofs shall be.inspected prior to any roofing material.being installed.
Will the...hear ,,mire banner,unse,antn.a equipment or device,which If a roof is installed without first obtaining an inspection, I agree to remove
mit hmardoon air comuminan,.as defined by,he Hay Arco Air Quality Mmmgcarcne
khi'oves Nt all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
I have read the hazanlous materials requimm=ms under Chapter 6.95 of the
Califomia Health&Surety Code,Section,25503,25533 and 25534.1 anderstmul the, '
Bibb building does not currently hose a m,mm,that a is my te,,undluli,y nm amity the
occopam of the req iremems all t be met prior to i.a....c of a Certificate of
Occupancy.
� ..-- '�3/ 0 Signature of Applicant Date
orunr 4m,racdrgrn, Date All roof coverings to be Class "B” or better
OFFICE
CITY OF CUPERTINO � "t"�'�"'x^� �+�� '�� � `�`-•"` del
BUILDING DIVISION PERMIT CONTRA. -TOR INk50'RMATIO,N ;
BUILDING ADDRESS: _ KOOL METAL PERMIT NO.
OWNER'S NAME: 3505 KIFER RD PERMIT Ls A
SLRR Tun
E: (408) 245-6597 SANITARYN 2 2 F01901 NO.
ARCHTIEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
300 LICENSED CONTRACTOR'S DECLARATION
1 hereby of on,that I am licensed under provisions of Chapter 9(commencing Job Description
with Sudo.7000)ofDiA.Im,Sof the Business end Pmfcuiom Cock,anti my lkcnac is
In full fora and.dACL
Deane clue Lo.« 14 ' X 44 ' PATIO COVER
i Dem ConT'S ractor
DEC
As hall use DECLARATION mcamb
1 1 understand my plate shall W used n public rtardr
J U
r i)
Licensed Poncuinnal
r OWNER-BUILDER DECe Cont,ON t•! YA/
1 hereby meam .(Sete that 1 oro exempt from dm CnntrumrA e:A License Lew for the d�
00 followinguiresa permit
7ostr Buainrusedwa.damns Co de:Any city at county
b$ which requires•issuance.also re C.mWet,titer,impmro,demolish,or septlr any structure
printpursuant
antto resMA theapplicantor for achpermil l0 file a Limas,Law atammcm g
22FF< Ihalunmem mW pSend..mlMpmvisi,mo 3 thea B.aneuljvcnmlaw(Chapter Sq.F[. Floor Area
60
their
exempt
hheefrom and of basison3 nflWeged exemption.
Anyona I.tf.of Y
$ S e do k 31.5 b therefrom and the burs for be cts ed eumant 1.Any l pennon of
Section Man
by anyapplicantdoll fora permit subjects Ne Applicant m a civil penalty of 3 AL811 N9119ler 0 0 Occupancy Type
not mom Nan tiro hundred dollen(f50D).
❑I,a nwar of tha pmpcny.m my employM W[Lh wgu u dmlrsolo mmm=tion,
will do the work and the structure is not intended molfen,d mrsam(Sec.7044.Busious 101 - FOUND � dInspections
And PmferAians Code:Tru Contractors License Law does not apply to an owner of
property who build..,bar.thercon.and who docimchwmkhrmulfmthmugh his 102 - PIERS
own employees,provided Net such lmprnaomenu An nothmaniad cruQered for We if, lO3 — UFER
however,Ne building or improvement Is sold within one year of completion,The owner-
builder .will have the burden of proving that he did not Wild or lmpmro for purpose of 104 - REBAR
sale.).
0 1,as our of the pmperly,am exclusively contracting with licensed convenors to 105 - ANCHOR BOLTS
construct to project(Sec.70".Business and Prefessiaes Cade)The Convactm's U. 106 - SEWER & WATER
come Law dace not apply to an owns of property who Wilds or improves themon,and, ZOZ - UNDERFLOOR PLUMBING
who contracts for such projects with auonvactor(s)licensed pursuant to the Contractor's
License Law. 203 - UNDERFLOOR MECHANICAL
m
0 1 aexempt under Sec. .B&P C for this reason
204 - UNDERFLOOR FRAME
O nu WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
1 hereby strum under penalty of perjury arc of the following decimations: 301 — ROUGH PLUMBING
❑Iharo and will meinWnaCeNBcamof Conummuv-loom fmworkerACompem 302 - TUB & OR SHOWER
aadon,
As provided for by Section 3700 of Ne Labor Code.for the perf atom.of the 303 - ROUGH MECHANICAL
work for which this permit Is Issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Seaton 304 - ROUGH ELECTRICAL
37M of Me Leber Code,for the pcdormana at Me work for which this Moral Is leamd. 305 - FRAME
My Workers Compenadon huunme carrier And Polity number art: 306 — HOLDOWNS
CArtier. PolicCERTIFICATE OF EKEMPIIONTFROM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
lea,)(tele Auction need not N completed if the permllk for we hundred dollars($lad) 309 - EXTERIOR LATH
m
I candy that in the performance of the work for which`thir permit is issued.I shall not 310 INTERIOR LATH -- - - -- - -- - - -
• employ any pcaon In any manner an u in become subject to Me Wodams Compcnsadon 311 - SCRATCH COAT
Iawaf Ctlifomo.Date
Applicant 313 - ROOF NAIL
NOTICE after TO APPLICANT: making this Ccoom;of ofExemption,LIsede.ynushould 501 - FINAL ELECTRICAL ENERGY
bttome AUM1Jem m Nc Worker's Compensation Ittovisiona of Nc labor Cnde,you muse
7� forthwith compty with.uch pmvidom nnhis permitmall W deemed evoked. 502 - FINAL PLUMBING ENERGY
z� CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
Ihen,by.fr,.Net Nen,is construction lending gency far the performance of 504 - FINAL BUILDING ENERGY
Y' the work for which this pencil is laved(Sec.3097,Co..C.)
:uq LendcraName 505 - FINAL ELECTRICAL
�z Londor.Add., 506 - GAS TEST
J Q 1«rtify that I have mad this application and sate NAt Ne above Inf so n.a.n is
i correct.1 Ume to comply with all city and county ordinanas and sok lows relmng to 507 - FINAL PLUMBING
�U building construction,and hereby authorise represenlatims of this city to enter upon the FIN MEC CAL
N a Aboro-menden d property for impeNoses.
on purp
(We)Ague a sea,indemnify and kap harmless Me City of Cupertino against 0 9 F I
r y IobiliUu,Judgmenu.costs and expenses..bleb may In my way ettrue against said City
L)Z iu consequence of Ne granting of this permit. 5 NG
�••� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 C WMORKS Date
SOURCE REGULATIONS,
Re-roofs 516 NAL BUILDING
Signature of Applicsry mlrumr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or(court Wilding oaupmel a.er handle hatanioas mamdsl
As defend by the Cupertino Municipal Code.Chapter 9.1],and Ne Health And Safety
Cade.Section 25532(4)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes ON.
Will the applicant r future building occupant me equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
smll tavuduue air conominanu An defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes ON.
I hart read Ne huiNour memriAlsmquimmcnu under Chapmr6.95 of the Celifno-
.I.HcalN&Safety Cade,Sections 25505.25533 And 25534.1 mtkamnd that lithe Wilding
docs not currently have a knam,Nat It o my responsibility to sadly tic met sat of the
mquiremenn which must be met prior to issuance of ecnifcae of occupancy. Signature Of Applicant Date
Owner or aulhon.el Agent Dam All roof coverings to be Class"B"or better
•
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efv4/
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��. pt.
dog
• HousE
APPROVED D
IN MWRDANCE WITH THE CITY Ot JUL 13 2000
CUPWINO CODES AND ORDINANCES
DATE D_y
SIGNED
This set of pans and specdt cations MUST
be kept on the job at a.! times and it is urlL &A9 A(rE
lawful to make any ceanges or alterations
on same without wikon pe.mission from
the building Oopt., Crty of Cupertino.
The stamping of the p an >nd specifications
SHALL NOT be hid io pe.mit y r be s an
OFM
���?pproval of the violation of any provision
any City O,dmance or State Law
SIRPF 7
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