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021200801-O, 0 u ,ca= F- n0 �LLQ soy 6to FZ� 65� r z z� a� d Q UO QU U F0. Iti y WA CITY OF CUPERTINO r "" fit, - Jam- F CONTRACTORINFORMATION:' BUILDING DIVISION PERMIT HUILDING ADDRESS: PERMIT NO 20324 GILLICK WY NEWS NAME: APPLICATION SUB DATE HIRAI FRED M AND DONNA R 12/19/2002 PIIONE : SANITARY NO CONTROL NO, ARCHITECT' /ENGINHER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 LICENSED CONTRACTOR'S DP:CLARA'I'[ON Job DeSGfI I hereby aflirm that 1 am licensed under provisions of Chapter 9 (commencing 10 with Section 70f1(I) of Division 3 of the Business and Protections Code, and my license is mmllPa. ad effect. STROAGE SHED (140 SQ.FT.) MAR 1 4 2003 License Class Lic.N Date Contractor ARCHITECT'S DECLARATION I understand my Plans shall he used as public records BUILDING Licensed Professional OWNER - BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law fin the following reason. (Section 7031.5, Business and Professions Come: Any city or county which requires a permit to construct. alter. improve, demolish, or mpair any structure prior at its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the contractors Lice no, Law (Chapter 9 Sq. Ft. Floor Area $4H'00tion (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for be alleged exemption. Any violation of anC Oeen T Occupancy YP C Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars (S500). 1. a owner of the property, or my employees with wages as their sole compensation, tat equlred Inspections will do the work, and the swaum is not intended or offered for sale (Sec. 7W, Business and Professions Code: The Contractors License Law does not apply to an owner of 102 - PIERS property who builds or improves thereon. and who does such work himselfor through his ownemployas, provided that such improvements am not intended predicted forsme .It. 103 — UFER however, me building or improvement is sold within one year of completion, the owner 10 4 - REBAR builder will have the bard.. of proving that he did not build or improve for purpose of .sale')' 105 - ANCHOR BOLTS I, as owner of the property, am exclusively comracsing with licensed contractors m 10 6 - SEWER & WATER construct project (Sec. 7()aa, Business and Professions Conk:) The Contractor( Li cease law does not apply to an owner of property who Wilds or improves theeon ,and. 202 — UNDERFLOOR PLUMBING CramLLaw, for sorb projects with ecomranor (s)narsee pursuant comsncmr'e 203 — UNDERFLOOR MECHANICAL ❑lam ex ,,, der Sce. �• B &PCforda ream, 2001, 204 - UNDERFLOOR FRAME /�i /fL - am �1 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARA 301 - ROUGH PLUMBING I hereby afpmt under Penalty ofP erjury one ofthe owing declarations: 302 — TUB & OR SHOWER ❑Ihavc and maintain Certificate of Cono,nlmself -insure for Worker's Cnmhem sation, at provided for by Section 3780 of the labor Cole, for the performance of the 303 — ROUGH MECHANICAL work far which this permit is issued. 304 - ROUGH ELECTRICAL ❑ 1 have and will maintain Wnrkcr's Compensation Insurance, as required by Section 3 0 5 - FRAME 3701 of the labor Code, for me performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy rum her am: 306 — HOLDOWNS carrier: Policy No.: 307 - INSULATION CERTIFICATE OF 308 - SHEETROCK Cruesecrom retract becompleadiftheparmitisforanc hundmJdollars ($100) 309 - EXTERIOR LATH Tits`) 310 - INTERIOR LATH 1 certify Nat in the performance of Elie work for which this permit is issued, l shall not 311 - SCRATCH COAT cmployiny person in any manners satWCCw,� jecun the Workers' Compensation Cali4srlsja,Dmty��Yl �4 313 501 - ROOF NAIL - FINAL ELECTRICAL ENERGY Appica Applicant YY'4}��L. P E TO APPLICANT: II: alter making this cam of Exemption, t ,nnaw u hens scojenm the provisions , lsuch himmunithoneria, hallwheonedrCUJe,youmuat fnnM1wiN comply with such provisions ar this Permit snail M Jc.m.J revoked. 502 - FINAL PLUMBING ENERGY 503 - FINAL MECHANICAL ENERGY CONSTRUCTION LENDING AGENCY I hereby M. that there is a contraction lending agency for Performance of 504 - FINAL BUILDING ENERGY the work for which this permit is issued (Sec. 3097, Co, CJ Iandtrt Name 505 506 - FINAL ELECTRICAL - GAS TEST Leader's Address I certify Nat 1 have read this application and ionic that the above information is correct. I agree to comply with all city and county ordinances and state laws palming to building contraction, and hereby aathonx representatives of this city to enter ulam the 507 5 - FINAL PLUMBING FINAL MECHANICAL above mentioned property for inspection purposes. 0 9 FIN (We) agree m save, indemnify and kith harmless the City of Cupertino against liabilities, judgments,cosu end expenses which may in any way accrue against aid City 5 N G in consequence of the graining of this permit. APPLICANT UNDERSTANDS AND NULL COMPLY WITH ALL NON -POINT Issued by51 WORKS Date / SOUR EGULATIONS 4N.r�F /9�0 Re -roofs Type of Roof aii� Signaturcol'ApplicaradCommuctor HAZARDOUS MATERIALS DISCLOSURE Date Will me applicantorfuture building rompam moreor handle hwsraft smemtlil as definer by the Cupertino Municipal Code, Chapter 9.G, and she Health and Safety 'the, QYes 25532(41 All roofs shall be inspected to any roofing material being installed. (N]r� prior 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 emit ha solo is air contaminants as refined by the Buy Area Air Quality Management all new materials for inspection. District/ )6No ❑YCs 1 have mad the hvaNnusmaleriali nequiremenu under Chapter 6.95 of the Cali for- nisllcalth& Safcty Cm )c.Ssr:6ons25915,25533ud2553J. l unJcrsund lhv iflM holding duns not currently have a tenant. that it is my responsibility to noddy me, necup rm of the hmhmust rome, r m examnce of a certificate of sea an ' Signature of Applicant Date ��mamemen DJ/.� /.� f ! �i iAf -x All roof coverings to be Class "B" or better Ow e, oramlimieedag,a Dale O oC Z hoc ac's P aZu tY H:)v zbnn'Z a��5u i C) W, W 3LLf t—�o< Hy ce I; W_ppC aX °m li W "a rz> AFC s 0� ro i W� a UC wE 0� U10 CITE' OF CUPERTIN® .;. BUILDING DIVISION �r I+ �y 7�T, i ��7 l �� FIGliu �� 7 a_` BUILDING ADDRESS: PERMIT NO. 20324 GILLICK WY 02120 80 OWNER'S NAME: APPLICATION SUB DATE HIRAI FRED M AND DONNA R 12/19/2002 PHONE: SANITARY NO. CONTROL NO. ARCHITECTfHNGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full forge and effect. STROAGE SHED (14 0 SQ FT ) License Class Lic. # . . Dale Contractor ARCHnBCPS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER - BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement Sq. Ft. Floor Area 4 Vifttion that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 $ (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of RiMbeY Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, — equired Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business Code: The Contractor's License Law does and Professions not apply to an owner of 102 - PIERS property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, 103 — I JFER however, the building or improvement is sold within one year of completion, the owner- 104 — RE BAR builder will have the burden of proving that he did not build or improve for purpose of sale')' 105 - ANCHOR BOLTS I, as owner of the property, am exclusively contracting with licensed contractors to 106 — SEWER & �ATER conswct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and 202 — UNDERFLOOR PLUMBING who contracts forsuch projects with a contractor(s) licensed pursuant to the Contractor's 203 - UNDERFLOOR MECHANICAL License Law. ❑ 1 am ex t under Sec. , B & PC for this reaso l�wr�e�� d�i( Date B 204 - 205 — UNDERFLOOR FRAME UNDERFLOOR INSULATION ✓'�, WORKER'S COMPENSATION DECLARA 301 — ROUGH PLUMBING 1 hereby affirm under penalty of perjury one of the owing declarations: 302 — TUB & OR SHOWER ❑ I have and will maintain a Certificate of Consent toself -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 304 — ROUGH ELECTRICAL ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 305 — FRAME 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: 306 — HOLDOWNS Carrier: Policy No.: 307 — INSULATION CERTIFICATE OF EXEMPTION FROM WORKERS' 308 SHEETROCK COMPENSATION INSURANCE — (This section need notbecompleted ifLhe permitis foronchundred dollars ($100) 309 - EXTERIOR LATH orless.) 310 — INTERIOR LATH 1 certify that in the performance of the work for which this permit is issued, I shall net 311 — SCRATCH COAT employ any person in any manncry!i to es9tl} Wject to the Workers Compensation f �Y�(1�1� Law so(Califorry {any 313 — 501 - ROOF NAIL FINAL ELECTRICAL ENERGY Applicant J E TO APPLICANT: If, after making this Certificate of Exemption, you should beccuft subject to the Worker's Compensation provisions of the Labor Code, you must 502 - FINAL PLUMBING ENERGY forthwith comply with such provisions or this permit shall be deemed revoked. > 503 — FINAL MECHANICAL ENERGY CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the Performance of 504 - FINAL BUILDING ENERGY the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name 505 — FINAL ELECTRICAL Lenders Address 1 certify that 1 have read this application and state that the above information is " correct. I agree to comply with all city and county ordinances and state laws relating to " the 506 — 507 — 5 GAS TEST FINAL PLUMBING - FINAL MECHANICAL building construction. and hereby authorize representatives of this city to enter upon above - mentioned property for inspection purposes. 09 FIN (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way scene against said City 5 / f N Win consequence of the granting of this permit. APPLICANT UNDERSTANDS AND SKILL COMPLY WITH ALL NON -POINT Issued by? 1 - RKS Date SOUR . EGUULATIONS— f Re -roofs Type Roof Signature of Applicant/Contraclor Date HAZARDOUS MATERIALS DISCLOSURE of Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety Code, Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes Q►Jo 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 emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 'JNo ❑Yes 1 have read the baiardous materials require ments under Chapter 6.95 of the Califor- nia Hcalth & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a tenant, that it is my responsibility m nodfy the occupant of the hic-authorized h must M mesuance of a Ccnificate of Occupancy Signature of Applicant Date �� fD /��d All roof coverings to be Class "B" or better o � ohreyuiremen CITY OF 1[ 1liR1V ET APPLECATIO V FORM CUPERTINO 0) _12- cro v APN # Fee ID Fee Description Date: 19 Buil Address: BAPPLOTHER Other Appliances Owner's Name: Phone #: Contractor: BCONSTAX License M Contact: BCONSTAXBQ Phone #: Applicant/Contractor: BCONSTAXH Fax M % l.Z BCONSTAXR Constax — Resi/Mobile Building Permit Info: BELEC1000 Bldg Elect Plumb Mech Job Description: / Residential: S1Vy' e / S /uw Commercial: Sq.Ft. Floor Area: BELEC200 $ /Sq.Ft.: d B EN ERGY Energy BUR LDING BENERGYADD iz Architect/Engineer: Valuation Type of Construction: BMITIGATC Occup Group: won-/ 6 -,1,& cax C&t a BMITIGATR ' Quantity Fee ID Fee Description ]Fee Group BAPPLOTHER Other Appliances 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 B EN ERGY Energy BUR LDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation 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 BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING 1 of 3 IN3 S� j ITq ACCORDANV WITH THE CITY 09 CUPERTINO WA-AND-MIDINANCE9 This set Of Pi and S�pe �clf li cation 7skll �U �S�, Of be kept OrPMe �ijabat aii times and it is un lawful to make any c"langes or a)LeTafiuw� on same without vvitten pe;m,s,-icn fror,-. the building Dept., C-'ty cof t:nr,. The stamping of this p :.nd pl---,J!icati;;n, SHALL N j i be tied t:� to b!,, a. approval of the viola! ' r ic, ' oi pt-ovision If anv City 0-d.nance or stale Law, N -- - -- - -- - -- �,l��i Li NE!, H7 73 A lku o p � ao _�2 �� Yc� 0 0 oc o nit - f 9 .z- '-. £s € xx »k O %f,- H N' HMM; vma WI 0 Milk 5 — g =go E 04 2 r zozza aos 88a -t H ia s. G 12 9z I F Z Mw Us' T 4 s 11 4 Z: 9W ...4, faa4 jo a a E& is Na PH H Hi 22 z ff F� 15_ vma WI 0 Milk 5 — g =go E 04 2 r zozza aos 88a -t H ia s. G 12 9z I F Z Mw 3 E 4 s 4 Z: faa4 jo a F Z Mw 0 S Ox J 4 s faa4 jo a a E& 22 z ff F� 15_ Z