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03080133io'2 �F �tE fa: >dc 0t �aC <$E u—o .2> oI zC u7 a UC U( L"E 0 ( Fg U OF CUPER'1'INO - BUILDING DIVISION PERMIT �kCtONTRACTOR INFORMATION `::: FCITY DIN ODRESS: `41 LOVELACE CONST. PERMIT NO 03080133 N1l;;T2QUS; DR. :R'S NAME: 10144 CAMINO VISTA DR. PERMIT ISSUE DAM 5 ryE: (408)255-4923 SANITARY 0. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing . with Section'IIXMq of Division 3 of the Business and Professions Code, and my license is in fullforceanderree'. lass ADD 260 SQ.FT./REMODEL MASTER BATH/ License ClLk. x Dam Contractor WALK IN DINING RM POP -OUT ARC TS DECLARATION ! I Nana shall the W used as records PI NA LE D understand ter gunge LMcnmJ Professional DECLARATIONthe Oat I FEB 1 2 2004 am exempt from Law for 1 hreaso affirm that I am exempt from the reasons o e: Any c reasons Code: Any city lir county i ng reason. my Rnnstr Business and improve. de lir any structure a rcmtit us consouct, alms. imrrnve, which erten t whim tits a u,air isu h wmaitu fleas License Lwdsmmmem ! triton its issuance, grsuant to to theisionsof the Contractor's that Sq. Ft. Floor Area �P��p�� 6YYg�LA�000 mencingwitrursuanuotheofDiviomofththeBuaccs.i ndPrortaw(Chepmry 0ls r the tar withtherefrom Anynvi Code) (cat basis excerp f the alleged ed. tion Nat he is exempt thcmfrom and the basis far Ne alleged cxcmpuon. Any violation of he is seem id the 32WOT,1,4�gr00 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than fin hundred da1Un 4500). . ❑ I, u owner of the progeny, or my employees with wages as their sole compensation, Required Inspections will do the work, and the awaurc is not Intended or offered for sale (See. 70a . Business and Professions Cock: TW Contractor License Law apes not apply m an owwr of 101 — FOUNDATION property who builds or improv thefeon, and who does such work himself or through his own employees, provided that such improvements arc not intended or offered for seer. If. 102 — PIERS however, the 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 improve for purpose of 103 - UFER tele')' 104 - REBAR ❑ 1, as or, of the propcnY, on eaelnsively contracting with licensed eonsacmrs m construct the Pmjcct(See 70,4d, Business and Professions Code:) no Contractor's Li- 105 — ANCHOR BOLTS. ants taw does not apply soon owner of property who builds or improves daemon. sand. 106 — SEWER & WATER who eonuacus for such pmjecu with a contncsor(s) licensed pursuant to the COn1OCmrs License law. 202 - UNDERFLOOR PLUMBING I am exempt under Sec. ,BkP for mi moon �/%7✓/%y 9NS'%�DIOPV 203 — UNDERFLOOR MECHANICAL /r— WOR R'S 0 PENSaT NDE ATIOI 204 - UNDERFLOOR FRAME hereby afrsrm under penalty or Ncjm, of a following eeelaraaions: 205 - UNDERFLOOR INSULATION an and win maintain a Certificate of Consenfto self-insum ter Workm'scumpea- 301 — ROUGH PLUMBING m provided for by Section 37W of the labor Codc, for the ollarma= of the 3 02 - TUB & OR SHOWER orwhichthispermitisisau<d. I 303 - ROUGH MECHANICAL ave and will maintain Workers Compensation Insurance, u required by Section rthelaborCow. foruW performance of the work ter which this Permit is Issued.304 — ROUGH ELECTRICAL orker. Comlensadon Insurance emits and Policy number ase: 305 — FRAME r: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 306 — HOLDOWN`S COMPENSATION INSURANCE 307 - INSULATION (This anedon wed not Weomplemdtithe Permit is for one hundred doB,n($10r) 308 — SHEETROCK orless) 309 - EXTERIOR LATH 1 certify Nat in the pe,formanec of the work for wM1ich suis permit is issued. I shall not employ any any manwrmu f !ga t eworkers'[omrcnsauon ". 310 — INTERIOR LATH laws ofear0 ADDlicant 311 - 313 - SCRATCH COAT ROOF NAIL f N ICE TO AP LI CANT: if.ayo m unssnisCcmreamo tempuon,you should oma subject to the Worker'ss,C mpcnsetion provisions of the Labor Codc, you mull C onbwithwmrtywimsuch rmvistom.1hisPermit sha0bedecmedoevoked. 501 - FINAL ELECTRICAL ENERGY 502 - FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY I hereby affirm that mere its construction lending ageuy for the performance of 503 _ FINAL MECHANICAL ENERGY the work for which thsPermit Isiuwd(Sec.J097,CmC.) j LanderbName 504 - 505 - FINAL BUILDING ENERGY FINAL ELECTRICAL Lenders Add. P entity Nes I have read this application and sum that me above oformadiun is 506 - GAS TEST correct. l agree to comply with all city and county ordinances and sum laws mixing m building construction. and hereby authorise represenuti.es of his city to cruet upon de FIN PLUMB I G a aWvcmcmiuned property for insrcmion purposes. save, indemnify and keep hanlcss the City of Cupertino against (We) agree m m 08 FI L 4 0 lobilluu,judgments, costs and caPenms which may in any way aceta, against mid City 5 ily( r in camegwnec of the Starting of this Permit. ' APPLIC NDERSTANDS D WE COMPLY WITH ALL NON.POINr Issued by:5 ING Dat SO R ULAT S. 514 NAL PUBLIC WORKS Re -roofs Type of Roof g urc rfAPPli< HA ARDOUS MATERIALS DISCLOSURE Dam Will the plicam or niter, building wcupam store or handle haaarduus material defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety . Secuon 25532(a)? � All roofs shall be inspected prior to any roofing material sing installed. ❑ Yu If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant lir future building wcupam use equipment or devices which it haeardnm air contaminants u dcrined by the Bay Arca Air Quality Management all new materials for inspection. District? _ p va DO - 1 have real me haaarduus materials requirements under Co pmr6.95 of the Cxlifor. ria Healdth Safety Calc.Sauum 255115.35573 and 2557d.1 unMrsund thridthe Wilding it. ntly ha a mnan4 til ism rrspomibiloy m only rte wcupam or me ads wm= atWm ormi ane ora c= am or z3��3 Signature of Applicant Date All roof coverings to be Class "B" or better o ter oreumodv d Date C- fY OF CUPERTINO CUPERTINO PERMIT APPLICATION FORM o 3,, S' 6 /B APN # 37-6 - oz- -o2-5-- I Date: 3 Building Address: 7 7 1 V1 �i ?,-5 C- L;. Mailing Address (if different from building address): Owner's Name. Phone #: Contractor: -- r� IAJC License #:1g, _35 - Contact: Phone( - Contact:b.1 ,14e") —7,5-5- Fax: Cupertino Business License#: Fi LIE, Building Permit fnfo: Bldg n-' Elect Plumb 0-' Mech job Description: woa- e4W14vAv-k Residential 6JD"1d.1A& ou j Z60Commercial El r— Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: :> an `Ompancy Group: Type of Construction: Please check this box if the project is a second -story addition: 13 1 of 3 e3 u Fee Descr!pq!��. RAPPLOTHER 3 Other )liances MECHANICAL Bldg Permit sq. foot BUILDING Boiler <= 100,000 Btu MECHANICAL I3o11er>100Kto500KBtu MECHANICAL Boiler> 500K to I M Btu MECHANICAL II Boiler > IM to 1.75 M Btu Boiler > 1.75M Btu MECHANICAL Construction Tax OHM • Q1 Elec 600V <-- 1 OOOA ELECTRICA Elec 600V > I OOOA ELECTRICAL Elec Svcs 600V <-- 200A ELECTRICAL Energy lamp] Energy Ad Multi P21 Mmi"'Lvm", Investigation fee BMITIGATC Comm. Housing Mit. Fee 1 of 3 e3 u CITY OF CUPERTINO BUILDING DIVISIONPERMIT BUILDING ADDRESS:0 22141 LOVELACE CONST. 13 3 PER" "0 3 0 E3 OWNEWSNA-ME: GRAT4AM (TPOW-W. W TP. AND DQR.Y 10144 CAMINO C VISTA DR. PERMI'17ISSUPDATS Q o 1,) r, /,) n r) i PHONE: {408)255-4923 SANITARY NO. NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 1) (commencing with Section 7000) of Division 3 or the Business and Professions Code, and my license is in full forand effect. celass Lic. ADD 260 SQ.FT./REMODEL MASTER BATH/ License C Date Contractor WALK IN DINING RM POP -OUT ARCHITECTS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Low for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, immove, demolish, or repair any structure prior to its issuance, also requires the applicant Far such permit to files signedsirucencru that he is licensed pursuant to the provisions of the Contractor's License Law (Chaptcr9 Sq Ft. Floor Area Val .-;,t* SO -40 0 0 (commencing with Sccfion70W)ofDivision 3 of the Busimessand Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of 3 2VbT"§qr0 0 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). [] L as owner of the property, or my employees with wages as their sole compensation, Re�uircd Inspections will do the work, and the stractum is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his 101 - FOUNDAT ON own tomployces, provided that such improvements are not imendod or offered for sale. If, 102 - PIERS however, the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or improve for purpose of 103 - OF ER sale.). 104 - REBAA 0 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) The Contractors Li- 105 - ANCHOR BOLTS. cerise Law does not apply to an owner of property who builds or improves thereon, and . 106 - SEWER & WATER ,he contracts for such projects with a contractor(s) licensed pursuant to the Contractors Pas W, 202 - UNDERFLOOR PLUMBING I am exampt under Sec. & P C for thi reason Owner Dat WOR WERs 1COMPENS NDEC Tto 203 - 204 - UNDERFLOOR MECHANICAL UNDERFLOOR FRAME I hereby affirm under penalty of perjury on of 0 following declarations: 205 - UNDERFLOOR INSULATION C] I have and will maintain a Certificate of Consent to self -insure for WxrkcesCcnxrpcn- 301 - ROUGH PLUMBING salon, as provided for by Section 3700 of the Labor Code, for the performance of the 302 - TUB & OR SHOWER work for which this permit is issued. 303 - ROUGH MECHANICAL 0 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 304 - ROUGH ELECTRICAL My Workers Compensation Insurance carrier and Policy number are: 305 - FRAME Carrier., Policy No.: CERTIFICATE OF ExEmpnoN FROM WORKERS' 306 - HOLDOWNS COMPENSATION INSURANCE 307 - INSULATION (This section need not be completed it the permit is rot one hundred dollars ($100) 308 - SHEETROCK oric.,m) 309 EXTERIOR LATH I certify that in the performance of the work for which this permit is issued, I shall not employany rmymarmoraan�� ftreCompensiumn 0 _ Laws of Ca If ypn) Applicant- 310 311 INTERIOR LATH SCRATCH COAT one subject to the Worker's ompensation provisions or the Labor Code, you must � N TICE TO APAICANT: IrTr iswinrihis CierwifIcirgr xamption,youshould u an, 313 ROOF NAIL ,ihwith comply with such provisions or this permit shall be deemed revoked. 501 - FINAL ELECTRICAL ENERGY CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY I hereby affirm that them is a construction lending agency for the performance of 503 - FINAL MECHANICAL ENERGY the work for which this permit is issued (See, 3097, Civ. C.) Lender's Name, 504 - FINAL BUILDING ENERGY Lenders Address 505 - FINAL ELECTRICAL I certify that I have read this application and state that the above information is 506 - GAS TEST correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the FIN PLUMB I',',TG above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, in way said City 08 FI VL 1 -C -AL ri judgments, costs and expenses which may any accrue against Asn in consequence of the granting of this permit. S' P?LIC ER rANDS,5ND WS COMPLY WITH ALL NON -POINT A _A=-�INC 5 issued by:5 G Dat V so 11p, UL is, _� A� I , * Re -roofs 514 _Y—��ZNAL Type of Roof PUBLIC WORKS g turcofApplic iiicuir Data A-Io�of_ H ARDOUS MATERIALS DISCLOSURE Will the plicamor future building occupant store or handle hazardous material Will as defined by the Cupertino MunicipalCode, Chapter 9.12, and the Health and Safety Code, Section 25532(a)f All roofs shall be inspected prior to any roofing material eing installed. 0yes If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant = equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. 0yes r&,/ I have read the baaardous materials requirements order Chapter 6.95 of the Califor. nia Healon & Safety Code, Sections 25505.25533 and 25534.1 understand that I f the building does e fly he a tenant, tit ism in responsibility to orally the occupant of the 0 es n nos which at r o J an of aCc f ancy. i I ms which at b t Ice c Signature of Applicant Date All roof coverings to be Class "B" or better 0 mer (it authoriz a t Date