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02100172 CITY OF CUPERTINO BUILDING DIVISION PE s T 'CONTRACTORdNFOR BUIEDI<`6ej3kE5lgfYANNISPORT DR CRW INDUSTRIES PER MIT NO 2100172 owANDERSON STEVEN J 1157 DELL AVE . APPLICATIIDO"P6ZL4.TR 2002 All ONE: %(408) 378-2477 SANITARY NO./ / CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECN �00 LICENSED CONTRACTOR'S DECLARATION hhD O O O Ihereby amrmthat Iamlicensed under provisions orChapter 9(commencing REMODEL BATHRMTpRI' D with Section 7000).f Division 3 of Ne Bose ssand Professions C e,and my license is FEZ inful1.1g,, a ,cy Z ZOY�— License Cl V oZ—� Dam �''—e f'y — APiCHITECT'S DEILARATION A="16aatG s G w U I sugerstand^Y Plans x1,11 Ic usctl m public reemds L. a dmSPmfcssnnal DEt, 1 2 2002 OWNER-BUILDER DECLARATION <x 1 herebyaR by rm Nun at I exemm pt from the Comcots License law for the $85000 W�xdp0 following moon.(Scetun]OS LS.Business and Professions Code:Any city mcounty BUILDING $ which mequires a Permit n OF WOucL improve, alter, demolish.or repair any structure Fiy poor to its issuance,also requires the applicant for such permit to file a signed summcnt Y G Nat he is licensedpursuanttothcprovisionsoftheContractorsLicenselaw(Chapter9 35545Bt4IF76eBAfh@ Valuation w�S (commencing with Section 7100)of Qivision 3 of the Businesa and Professions Code)or y — that he is exempt therefrom and the'balia for the alleged exemption.Any violation of section 7031.5 by any applicant fora permit subjects the applicant to a civil Penalty of not more Nan five hundred dollars(5500). PN N Occupancy Type 102 - PIERS ❑1.o ownerof the pmpeny,re is emnloyeu with wageazthey anile compfusine , will do the work,dna the structure is Out intended or offered!resale(Sec.](40,Business 3:83 UPER and Professore Curie:The eommeor'a Licnve law does not apply n an owner of 104 - REBAR Required Inspections property who builds or improves thereon,and who doessuch work himselforthrough his own employers,provided that such Improvements are not intended°rorteree fursale.If. 105 — ANCHOR BOLTS however.the building or improvement at sold within one year of completion,the owner - Wilderwinhavetheburdenofpovingthathedmnorwilaorimproveforparp°se°f 106 — SEWER & WATER side.). 202 - UNDERFLOOR PLUMBING ❑I,as owner of the property,am eschi ively contracting with licensed contracnrs to 203 - UNDERFLOOR MECHANICAL construct the project(Sec.7004,Bvinco and Professors Coact The Con✓acmrs Li. cense law does not pply in an owner or ymperty who wilds Or impmves thereon,and 204 — UNDERFLOOR FRAME who contracts Lace for such pmjecuwith aconvacmr(s)1i¢,sed pursuant to the Contnnm's License Law. 205 - UNDERFLOOR INSULATION w h ❑ 1....mptumWersee ,B&PC for thisreazon 301 - ROUGH PLUMBING OwnerDate302 - TUB & OR SHOWER WORKER'S COMPENSATION DECLARATION40 303 - ROUGH MECHANICAL I hereby affirm unser penalty Of perjury one of the following declarations: O l have and will maintain ACeirdiicaw of Cover,mself-insure for Workeh Compcn- 304 — ROUGH ELECTRICAL sation,az provided for by section 3700 of the Labor Code.for the performance of the 305 - FRAME work for which this permit is issued. 306 - HOEDOWNS ❑1 have and will maintain Worker's Compensation Insurance,az required by Section 307 — INSULATION 3700 of the labor Code,for the performarm cruise work fo hien this permit is issued. Mykcr'sCO—m-pensatiOnlnsunntt�carnera°na`yPObc-y berare: 78 308 - SHEETROCK r1�$ 309 - EXTERIOR LATH GERTIFl COMPENSATION INSURANC310 — INTERIOR LATH or (This section need nut be completed it do,pemmn is for one hundred dollars IS 100) 311 — SCRATCH COAT Iclea,l 313 - ROOF NAIL employthatinthc in any foomamrsoas work to subject to Permit is issued.Ishtllnot 501 - FINAL ELECTRICAL ENERGY employ any person in any mannerm az n become subject the Wortrri Compensation laws mrc.liromi,.Dam ApplicantApplicant502 - . FINAL PLUMBING ENERGY NOTICE TO APPLICANT.If.after making this Cenificam Of Exemption,you should 503 - FINAL MECHANICAL ENERGY become subject to the Workers Comp,madion provisions of the Labor Codc,you must zz. forthwith Comply With such Provisions orthis Permit sha0wdeemedrevoked, 504 - FINAL BUILDING ENERGY h CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL F Ihereby a�irmOat door isaconswnionlending agency for doPerformanttof 506 - GAS TEST LendcrsAame IY the wvrtfor which this Permit isissued(Sec.309].Civ.CJ 507 - FINAL PLUMBING a q a Z L naersnearess 508 - FINAL MECHANICAL U O 1 certify that 1 have mad this application and slate that the above information is 509 - FINAL GRADE is, F COMM I agree m comply with all city and county ordinances and state laws relating to 0 U building construction,and fameby authorise neproematives of this city w,Ow,.,n she 5 FINAL PLANNING U.1 awvcmemionedPmpcnntsand specamswhichmaon purposes, S 4 - FIN F q (We)agree to save,indemnify and keep harmless the City of Cupenino against C.aC7(IC W/ W RKS y liabilmim.rieofdo,c rartiq,of this csoiichmayin any wayaecroe agaiwaia City U z mconsegmcee of the granting of this permit. ^ APPLICANT'LINDERST AND WILL COMPLY WITH ALL ON-POINT Issued by: Date SOURCER U ION s ppl,ean✓ ommolon �- 1 Z`✓-oZ Re-roofs �_✓ ON MATERIALS DISCLOSURE Dam Type of Roof Will the applicant or future builtling ottupam score or handle havardov mamnal U defined by the Cupertino Municipal Code,Chapter 9.12,and Om Health and Safety COac.Se dion y.23532(a)7 All roofs shall be inspected prior to an roofing material bei, �Y" B't`'° P P Y g g installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit har olous air conuminanu defined by the Bay Area Air Quality Management Oi...ictl all new materials for inspection. 0 Yes1. 1 have real the havafdnus mammals requirements under Chapter 6.95ofthc Califor- nia Health&Safety COdc,S°niona 5505,25533 ana25530.I understood Narifthe building does of ett rcntly h a WooL Nat it is my responsibility to notify Iw attupant of tan re mmenlswhi tau he a prior in issuance of a Certifiggle of ancyf 1� Signature ofApplicant Date our aehonrcdagent Date All roof coverings to be Class "B"or better r p ( � CITY OF CUPERTINO Z CUPEI�T CITY INT PERMIT APPLICATION FOR �/ 7 APN# Date: Building Address: I. CoY6&)k)1-5 XbR Owner's Name: Phone#: L5 /---L.c d- a04�3 7Gn/- 3 989 Contractor: License #: CIO •'2dL45 /ii-5 Cont a t: Phone#: A--,e '�a - , / 7(9i - 3v3� Applicant/ContraFt Fax #: Permit Inf . Id E X Plumb X ech Job esc l:::: n: esidential: o i 1: Sq.Ft. Floor Area: $/Sq.Ft.: Arc utect/Engineer: Valuation: O—Db Type Construction: �1= Occupancy oup: VK l Quanti Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/OfflComm/ uasi BUILDING BCONSTAXB Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax —Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD -Energy Add Multi BUILDING BINVESTIGA Investi ation fee BUILDING BMITIGATC Comm. Housin Mit. Fee BUILDING BMITIGATR Res. Housin Mit Fee BUILDING BMNEWMULTI New MultiFamilyRes MECHANICAL BNEWMULTI New Muulti-famil Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING 1 of 3 4- is l IN IhO&V'r ex rH� rZ A4 4 IN mrIPVATEF `WIT H-T4E C4TY--G6­ )Aft ED , This set'.. pans anan _jq!e_aL@jLhMQS_aqd It is U11 4 lawful to ma!,,e any changes or alterations oFtiw without -vTi4eq-Mmission-ftrom By the building Dept., City of Cupertino. The st MDI be held to permit or to be 30 Ipproval of the violation d'any -It any-City —--------- ------------------- ---------- - 2, CUPERTINO VD7341,11D 9RD1Nj1?4C C DATE 111,is set be kept OCT 2 4 2002 lawful tr JIS 1P but"I SHALL NOT rt In —jj)PTMrL)l L5v v -- .If Any Cov 0 r OW 11dI/