02090191 Ask
CITY OF CUPERTINO
BUILDING DIVISION p IT -CONTRACTOR TLV F0 ,ATJON.
BuILI)OQA 9ESJUDY AVE. STANLEY CONSTRUCTION PERMITN®2090191
OwW(FHAEL 6c LISA WARREN 852 JORDAN AVE APPLICAT1W)"51N 2002
ONE: .(650) 969-1962 SANITARY NO./ CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O O
�woo LICENSED CONTRACTOR'SDECLARATION ��ii pp
�2 Sectiohereby n
affirmthatder REMOVE EXISTI]J(!P ffVinRUCTURE
G< with Scetion]IIW)nf Division Sof NC Business and Professions Code,and my livens is
< in full farce and affect.
8�_ License Clues LIC.N 0=0NALIE
IEl3
F 4;o Date Contractor �Y�V`II Qaa Das
ARCHITECTS DECLARATION
a<to
i�u1 underwdd my plans shall he used as public records
LLot Licensed Professional
APR 1 4 2003
oi5 OWNER-BUILDER DECLARATION
aa <P 1 hereby affirm that T am exempt from the Contractors License law for the $5000
ad 00 following reason.(Section 7031.5.Business and Professions CaBUILDING
lc Any city or county
rog l which requires a permit cowmen
u,cowe ,eller.improve,demolish,nr repair any structure
rzr prior m its issuance,also requires the applicant for such permit 4o file a signed tutamen
�0 that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 3Sg5IDa(lo1i@AI@fl Valuation
A,
1p (commencing with Section 7OXgof Division 3 of Ne Business and Professions Cade)or
i 3$ Thal he is exempt therefrom and the'-0asis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for i permit subjeess Ne applicant to a civil penalty of
as roma m.n fie hundred dollar,(ssln). Ai ON S Occupancy Type
-
El I,as owner orthe property.or my employees with wages as their sole compcnsadon.
will do the work,and the svuctum is not intended ororfered forsale(Sec.7044,Business
and Professions Code:Te Contractors License Law does not apply to an owner of Required Inspections
progeny who Wilds orimprom defend.and whodressuch work himselforthrough his
own employees,provided Nat such improvements an,not intended oroffered tarsale.If.
however,Ne Wilding or improvement is sold within one year of completion•the owner-
W ilder will haw the burden of proving Nat he did not Wild or improve for purpose of
5 1,as Owner of due progeny,am exclusively contracting with licensed contractors to
construct the project(Sce.7040,Business and Professions Code:)The Contractors Li-
cense Law does not apply to an owner of property who Wilds or improves better,and
who Wouta for such projects with a contanor(s)licensed pursuant in the Contactors
fc Law
O eexempt under Sec. '�C ,B&PC for this mason
-�� � Dade a 0
W R' COMP SATION DEC ON
Ihembyaffirmunderpenaltyofpeduryoneo efollowingdeclaratiou:
1 haw and will mainuin.Cenifcate of Consenuo self-insure for Worker's Compote
.Milan,As provided for by Section 3700 of the Labor Code,for the performance of the
walk for which this permit is issued.
D 1 have and will maintain Workers Compensation Insurance,0 required by Section
3700 of the LaW i-Coule,for Ne pciformmce of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This mesion need at M completed if de permit is for one hundred dollars IS lacy
nr lcssJ
I cartery Nal in the perfo race"f Ne work for which thin permit is issued,I shall not
employ.,pennni Otter so asu bow me suit 't m the Workers'Compensation
Laws of California. �_+ Zs J22
p 'cam�- //in/ ""'-7
ICE TO APPLICANT:If,after making Nis Ccnificam of Eacmplion,yov shoulJ
come subject to dm Worker's Com formation previsions of the Labor Cork,you must
Dz forthwith comply with such provisions or this remail shall W deemed revoked.
'Z O CONSTRUCTION LENDING AGENCY
(-+ I hereby affirm that there is a construction lending ageay lot the Performanceor
a dm work for which this permit is imucd(See.YN7,Civ.CJ
IL)Q lender's Name as
LL Landers Add.0
V 0 1 certify that I have read this application and Su¢that to W.information is
DrU eormingconagree lo comply herebyth llilyanJ countyOrdinancesOr and Cum laws cater
upon ria 0 U buildingconstruction.pro and hereby archon mmprescnutiry of this city to cnmr upon ds
aevemenlidncdprogeny fon inspection par,mxswhich m.
H 0.i
Wo)agree to an.indemnify and keep harmless the City of Cupertino against
fq incoisegjnceoftheeoeuand expenses which may in any wayaccrue against said City
V z m APPLICANT
LIC NT of the granting of this permit. /
~ SOURCE bE UL TION ANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date
et [Applies Contactor Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding Occupant store or handle hazardous material
As derided by the Cupertino Municipal Code.Charter 9.12.and de Health and Safety
Cade,Section 25532(a)]
❑Yea /No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or town,building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
it hazardous air contaminants As defined by the Bay Area Air Quality Management all new materials for inspection.
District? ./
Dyes s Irl Nu
I have mad the hazard"..mat 111 requirements drNx CWp.,&95afthcCalifon-
maHealth&Safety Code,Sccuou 2505.25533 and 255}1.l undersand that iflM Wilding
does not currently haw
a Imam•tht it is my respouibility a ratify ch Occupant of the
requirements a troupemel prior in issuance ofa Ccnifrcate cry
��,,��An Signature of Applicant Date
a
Owner ,athot c ascot Date All roof coverings to be Class "B"or better
0
CITY OF CUPERTINO So2, 670171
Z 6 �f o / 71
DEMO L
CUPERTINO PERMIT APPLICATION FORM
APN# ?75 Og D Date: n_ /
Building Address: 6 U
/0.279 Jur( �✓� . C' r�ii�o .
Owner's Name: Phone#:
d�ichoe -� LiSQ G�arr�� 408-- 255-1319
Contractor: License#:
.�fi1fv
r , n
Contact: Phone#:
Applicant/Contractor:
Building Permit Info:
Bldg E$ Elect YES ZZoV,1�, 3oa Plumb Ara►3-E Mech A1D fJ6
Job Description: KEAI n Ex(5-fiNG 54 0P STtZvC-TUQE
Residential: X Commercial:
Sq.Ft. Floor) S,F, $/Sq.Ft.: #!S/S F.
Architect/Engineer: M0 krE Valuation:
Type of Construction: woo D FF(rME. V40P S1D(N Occupancy Group:
R5P KA LT RooF ubN-ocGv P(e l'(
Qty. if
A licnBSEISMICOM
ID Fee Description Fee Group
BldgPermit Fees BUILIDNG
Seismic Commercial BUILIDNG
Bldg Permit Fees BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG
�7Ja7
# ` "' 7 .
Al4i-
in
Ts
September 24, 2002
To:
Building Department, City of Cupertino IRFTVFD
From: SEP 3 0 2002
Mike and Lisa Warren BY:
In order to get a Demolition Permit for our existing shop building, we have been
asked to provide signed statements from our adjacent neighbors stating that they
have no issues with the demolition and removal of the building.
As homeowners at 10293 Judy Avenue, Cupertino, we have no objections to the
removal of the 20 year old shop structure that is situated on Mike and Lisa
Warren's property at 10279 Judy Avenue, Cupertino.
nama�, (Tln P r I , �t signa date _
name w signature date
As homeowners at 10265 Judy Avenue, Cupertino, we have no objections to the
removal of the 20 year old shop structure that is situated on Mike and Lisa
Warren's property at 10279 Judy Avenue, Cupertino.
kU
""J
name _V 1 n )12 EVZ
� signature ^ � � date
Iir 1C Q.A,�nfs ��4ti Y--v .�ZA J Q
na signature - — date `-