00050097 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS; PERMIT NO.
'i0465 MADRONE T3/LT61 00050097
OWNER'S NAME: APPLICATION SUB DATE
THE O 'BRIEN GROUP 05/16/2000
PHONE: SANITARY NO, CONTROL NO.
O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w{{- BLDG ELECT PLUMB MECH
Ll O LJ I_1
LICENSED CONTRACTOR'S DECLARATION
0 5 y' I hereby firm that 1 am licensed under Job Description
OZ o ya provisions of Chapter (commencing
ry�w is in Seais..0):,rD;visimr 3 aflh<Busi:tcssana Pmroodonv Collation my license 3362 LIVING SPACE 681 GARAGE
e,lem
is
in full forte and effect. r
ce w U License Class Lic.N
t�r 3 a Dat`-ARCHITECT'S DECLARATION
h o-'so
O g 1 understand my plans shall be used as public records
�Y
p O Licensed Professional
o� OWNER-BUILDER DECLARATION
w= 1 hereby affirm that I am ex<mpr from the Contractor's License Law for the
?O
following mason. Business and Professions de:Any city or county
which qesa,Smuttoonstrut It p demolish, repairY wnun,, � $
3357
2-1
.pro or s n .11.pauum,N ppl onfor such pemuuo fl a signed tmm
h .
m rw licensed u rt N p, m. fN t t i License W ons Cuar9 F,t�p r Valuation
or he ing;wnh Seuon)Ossa)of Division 3ofthe Business and Professions Any
ns Code? 1`i, `1,34�6UU pl�.0 ./,.) l..gJt ]
or tent he is 31.5 b zany applicant dm anit the hairs far the alleged exemption.Any l Pennon
-of Section)03 n iv a u edolfor a Permit subieos the applicant to a civil Penalty Occupancy Type
,or nor mom than five nanarea aanars(ssan). 101 APN IAp{t�t�bATI ON I ,`..•r r�t.
❑I,as owner ar the property,or my employees with wages as their sole compensation.
"will dohework,and the structure Is notintended'or offered for sale(S,,-7044. Re Ins `
Budbass and Professions Cade:The Contractor's License Law does not apply to an 103 - Required UFER 9 Inspections .
owner mpropeaty Who builds of nommes thereon and who dos such work himself
or through his own a pl yees provided that such improvements am not'intended or 104 - REBAR
_._.__ - .. .......__ . .... . .. ...._ .it _ ... ._ __...
n d f 1 booklet.then have
the
mpruvemem Id -'ih tie year of r.;\ -
complaion,the owner-builder wdl have Nc hrden of proving that he did not'build or 105 - ANCHOR BOLTS ' ' `�
improve for purpose ofsale.), 106 - - SEWER & WATER
0Los fN<pmpeny I .'elycontracting withlicensed contractors 107 - POOL%BONDING
constructp p , tf5 )ton B ❑e f. ns Code)ThC tmrpon, t-, I•.
,
License Ww docs not apply n,an owner of progeny who builds or improves Hereon 202 - UNDERFLOOR PLUMBING '
.: _.and who contracts.for_such pmisets with a contmcmns).hrensed pursuam.m the .._..._ ... ..
r Contractors License Law
., "_...2.03 .._._UNDERFLOOR-.MECHANICAL. _.._._.....__. ._
❑lam exempt under Sec. ;0&PCfor this reason 204 - UNDERFLOOR' 'FRAME"'0
- _= ower pwe' 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
301 - ROUGH PLUMBING
.. IM1ereby offirm under Penalty of perjury t ore of the following declarations. 302 - TUB & OR SHOWER
° 1 Wife and will 'amin'dCenfic m of Conant m self rmure for Worker's
i•
Compensation, as provided f by Sect 3700 f the Labor Code for the
Pwerfnwnceofthe wrkfor nchhis permliii -
d. 304 3 03 - ROUGH MECHANICAL
ROUGH ELECTRICAL
°I Inas aird will maintain Worker'i Compensation lnsurdriee,as lequired by Sminn 305 - FRAME
3ii7 for the -'f o work for'which this .it s
a
My wok C open. tiIncarrierand Pol rn rola m. 306 - HOLDOWNS
30
.
cane -ra Y i!'>i�c'PolicyNo. i.., ,112- %- FINSUliATION;
m. )CERTIFICATION OEEXEMMION FROM WORKERS' ' '3OB - SHEETROCK ..
+ COMPENSATION INSURANCE
309c-A=..;'EXTERIOR -LATH' _. _...•...
(Thu secuoo used i h mplc. d if the pemrt s f M1 r died dollars _ - --
IS 100)oneas) 310 - INTERIOR LATH
""'31T "- "SCRATCH ;.COAT"
`5 I n fy that in the pert mote fth kfor h It -3 4is-ed 1 ,.
h II t m,l y any p any mann as to becom object to the Worker,'t 313 - ROOF NAI L '
Co ,point on La-.of C I font Date '
.:Appl m _ .. ._. ._. -3-Lb--- 'EXT SHEAR---
f NOTICE TO APPLICANT`If,afte,makingth
' C_nif tfE
Pti ' y should
OC 'beasubject1 he Workers Compensation t P Labs Code,you nner __. 501 FINAL. ELECTRICA-L ENERGY
z ..7onh N plyNhp n.am p tshall
Wd d retaken. 502--- -FINAL- PLUMBING- ENERGY .
.
—
''.CONSTRUCUON LENDING AGENCY
1 h T 3
p:, `°r 'If" ' 503 - FINAL MECHANICAL .ENERGY;
by' enn that a onarvn o lending gag y f N pnwnc<
ofth rkfo hichln permit 'swd(sc,3n9) c<. _. - FINAL-BUILDING-ENERGY
Name
Name
.. r c) eno.. 504FINA . .... _.... . ...,.__.. ..
Y(we .AId _s 505 - FINAL ELECTRICAL
V'C 506 - GAS TEST
,�... Gen fy thin I hove r<ad @'s apPl' ton and state Nut th above intormauon is
i QE: .correct.I agree to complywith all cdy.and county ordinances and state laws relating 507 - F I NAL PLUMBING
:V 10 buildingcaarsarucfiandh reby'auth t representatives of this city to enter upon
w ane bo dnnpap pct>(r spe<u p war. 508 - FINAL MECHANICAL
[r 4 (W Y you msam,findeproffyond keep harmless the City ofCu,parfino against
Vj liabilities.judgment,ct d cxKnses which oray'nany way accrac againstsaid 509 - FINAL GRADE
C„) Z City y ce r f thegranting of thisPermit
^ �APP LICA.NT1INDERSTANDSINDWILL COMPLY WITH ALLNONPOINT
' lO - NA ING
SOURCE REGULATIONS - Issued _ Date
Sig t m rA,licardContmnor... . - - 'Dam Re
' -roo.1s,16 -. FINAL BUILDING
HAZARDOUS'MATLRIALS DISCLOSURE
rr cot ml t .dcf1n.. Ib r tphanB„�>Ah[(doa
te Type
'� ' R • PLYW, .00D_.NAIL-WOIN<aPP t rlowmWlJln mha ttore or handle
'os fin 6 the CL enmo M ,aI Code,Co 9.12, d theHealth a astir
Code Section 25532( 1 603' x „[_ROOF"BATTENS
E3 Yes, N - -
r All.roc$;Olal6beR( PPtecTNridtRQ@RW&hg.mater-ial�.b�•e...i:.n
g ins"t-
alled.
_
._.,--
` W II theppb nt future Wilding p nt equipment d es which If a an inspection;'I'd oree'to`remove
.ean Quality anas rma,
Districts all new, materials:forinspectionApplicant understands andwillcomplyw.ith .
°Ye °N,' all non-point source regulations
1
have lead,she h d m <
-it
ter I. - y' r u'under Chapter 695 ml the
CilifomHealth&5 f ty Code Section 25505 25533:rod 25534 1 understand Na
ii building lines nous tly have o tenant,e,prior my stacomsibility trimadyCertificate
the
'oec pat f sh rtquia t. h ch muss bf t p miss ante of Ccnifi v of
Occ p cy �� - i
,. ... _ SignamrepfApplicant. .. . . ...... ._ _...... .. Date _
td'
All roof covertn s to be Class "B" or better '.Owe uthonzN ag tit' ,': .. `• :. iDare g .. ,.
•
-,.,. .OFFICE._.. . . .... . . - .. . . ._ .. _.
CI'1•Y OF CUPF RTINO
ISUD.DING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: - - PERMITNO, -
OWNER'S N1h0465 MADRONE .CT -3/LT61 APPLICAT10y>(!q gTg097
PHONE: THE O*BRIF—N GROUP SANI'T'ARY W5!16 AANTIjQIiNO. -
CO0 ARCHI LECr/RNGINEER: ' BUILDING PERMIT INFO
H.)G FLEET PLUMB MECII _
t-Cy
❑FF I ICI NSED CONTRACrOR S DI CLARAHON ) -
n
O< C lhn.by ff nmml an,licensed add,,
t P of Chapter)1 license
-- '
F t isini IO' nnlnfthe Business annProfession,Co e m
Cod,anYl c „ .
I, 11 force
and Ifecl
Class Lit,#
au�u Dal ARCA TTCr S DECLARATION w "
t ogor
luaden,taadmypun,shit Is,a,ala,Publicmr,a 33E LIV NG . , A E; 681GARAGE
ams
e
r. ,Licensed roof fccsinnal `, ♦ '
that'OWI a -BUILDER DECLARATION ConT10N
I ma...affirm on 70 ate exempt ftom the CocoCo License Law rnr the ..
t C fnunwi nilrears(Section]031.5,9nsincsx mnemeProfessions ielCode:Anyc11y or county -
i x O poor l rnluircs u permit m crnswcl,aIle:impm.e,dnnellsh,or rcpair any structure
sa $ he I l.':u' I In 'rN,..murr sen Pcnmu file B d.t mm1 .
mall 1 Jp . ion 0 P unrlife doorijT 1- . L m .9. Floor Area - Valuation .
or her a ng x%70 Section an a of Ire basis
3 of ou Brij nes,and Professl 'ale)
or Thal he is 31.5 b Iherctrom and fireor awls Int the subjects
the cxempnt to A rviolat lty
of Section7031.5five
Ydmedol for apermit nubjens me applicant Lir n'il pen:Jp ' l
of na mare man five hnmbed ennna csstgl)- _ PN Number O T e '
Sg�"i2iYp
' Ol.n,owner ofthe�rmpeny,nrmY employees with wtq;rS its the' nils eompmisminn; _
will do me work,and the diacritic is not
intended or offiere for sale see.Inkell -
,k Intros,,and 1 refine onx Code:The Con¢mmr s License die,I o apply In to 34260025. OIR�q°tied Inspections
owner of pmpeny Who builds or improves thereon.and w dm%suc work himself
or through his own cn pl Y provided that such 1 pr inLs are n I Intended or }
offered for sale If,ho 'hefunding p m i IJ lh one year of = ��IFS II�n �e
rapmt nl,me nw corn llr ulmeu n d r tvitgthtl r nIbaflor •101'S — FOWNDRTION uv L�_.1� .
hap
f p rNse nf,aid.) - -
.p1 r Imep pent' - in8 'thlcemedeom cmrs, - 102 — PIERS- - MAY 2 1 2001 ^
rot Imeporco(See ln44.Rls',eslld nres,n Code)Tire Con eI 103 — UFER
License Law doe,nil apply Ir an owner pmpuny ,,lwilds m i prvve.the nn,
end h t:It,, h, rj"I"wld 0,etnrlx) p atlt [or 104 - REBRR - ;, - •-
Cnntmq License fm 105 — ANCHOR BOLTS BUILDING
❑m x nI -sera � n err td re.,. t
Owner. Dale 106 • SEWER 8-'WATER
WOR SEWS COMPENSATION DLCLARAT1
2202 — ' UNDERFLOOR PLUMBING
. affird underh,of Perjury one(if the rnu ingde lm t .203 _ UNDERFLOOR MECHANICAL_
❑ 1 h and will maintain Certificate' f Consent m elf mutt f Wrde's
Cr p nsttrl.-a, pr..'ded for cry Serif.... 3700 rI Jl L l r Code. r me 204 UNDERFLOOR FRAME, _
0.Ihavaneenrmewnrkfnrwhicntni,pmiti,i„ned 205 — UNDERFLOOR INSULATION
❑.
have and will maintain Wiukei s Compe;f din Insurance,as requited by Section
•
3200 of the Labor codefor he parinntmon,.of tee hind for which mix period Ix 301 — ROUGH PLUMBING
and.My Worker's Compensation beard nce carrierund Policy number are:
302 — TUB d- OR SHOWER
Carrier _ Policy N.,
CERrmICrnON DF EX17MrrION FROM WORKERS' ' 303 - -ROUGH MECHANICAL
COMPENSATION INSURANCE 304 — ROUGH ELECTRICAL
(This return Ideal n I he c plead f the pcmli,Id f hundred dollars •^
fs100) Is., 305 — FRAME
I rendr Inaln,n tnlmewrkarwl1enln 306 — HOL''DOWNS - w
r 'p 'nn p 'tteWoee l • 307 -' INSULRTIONI
C u t employ anyd Y n t become,subject ni Nc Workers' '
Cn I I Laws ofC 11 '.U'
App1 ' 308 — SHEETROCK
NOU CE IO AIPIICANF It. II ak ,[III, Earen"firar, should -
rz bee a bj tt to x kr c pe. tionpn%oI1 LbrrCale> sl .• 309 '--'- EXTERIOR LATH
o CIrrO '0 IIr 'nl hl mi,, t hall he hadioned ne,oked, ' 310 - INTERIOR LATH
CONS IRUCIION LENDINGld, CY
,ac 311 — SCRATCH COAT . 1
a > 1 hereby hi ra t th IA t 1097 nil aged Y far the pednm ce .
nr lh took for which Ih,pe l t s duct lSe. l09),Civ C.)
0. o Lender',Name 313”— 'ROOF NAIL
� z 111l Addre 501 — FINAL ELECTRICAL ENERGY
v C I lelfil"hadln .1 pity
t Ltt lo-lln t i tnl s 502 FINAL PLUMBING ENERGY
correct I.,me r pt' he 11<1, and ry M i lir ane t l,1 mining
Q O lel Id e t etc d1 hereby ,, I pivw IDI. lyt ter pin I
he bo mentionedp penyf tn.pen prry_ves. 503 — FINAL MECHANICAL ENERGY
[fir ClWi
(We)airmemsave. ryand keep l -d .rthe City fCP fi ,aginst -
LIC liah'lit . )dbnntr, tam peq.ed hlchny .any y _ g_inv,aid 504 — FINAL. . BUILDING ENERGY
Clly I.........come of the granting n1 this permit. Issued J
SOUBCAREGULATIONS.RTANDS AND WILL COMPLY WITH ALL NON POINT dby. 505 — FINAL ELECTRICAL Date '
'sigmm�rt of nPPlicent/Cnntnmmr 11 •, Data Re-roofs n n .
HAZARDOUS MATERIALS DISCLOSURE 507 — FINAL PLUMBING'
Will lle,appbemo(it it"
ore beeehigaccopam,lm<nrinmdlcnnrmmlrlotoeml Type ofRoo€S08' FINAL MECHANICAL
m defined by the Cupertino Municipal Cale,Cmiapr 9.12,and me Health and Safe,
Cock,Scotia 115532(a)! - pR _
0i" 0N All roofs sh inspeeti •tpa F)fin material being installed.
Will the applicant or ludire building occupant use equipment ordwices which �yj$gy, ��� ��',
If a roof is il'.y11hd`witEi dD� �Sy�ywy�I IM15�s ection I agree to remove
ea it bunminux tircnnunfinanls us defmcd by the lay Arlin Air Quelity M:mngenmm '••b p ,
Dislricl' I all new.mater` A0for-inFp;Wh, 19101 kaItQ'nktf#Rr hM and will comply with
OYe' ON.
':ill non-poinGQece,-regQIDOgns.PLYW00Di NAIL_
I have read be haLudle,mmtrimis rngairetneolt order Cnaiver 6.v5 or me 603 ROOF BATTENS
California Hmolth.R Smer,Come,Seeions 25505.25533 and 25534.1 understandlhal
Ifmehadoingdoesuolcunotltlyhavearodrt.ImpiromYrcdpnesimhlymomifYthe
604 — 'ROOF IN—PROGRESS
reprisal of the rcquio norms which must he met prior to issuance of a Ccnifcate of `
Occupancy. .
' - Signature.9f Applicant Date '
Dane,to amhuri,<dvgcm Date - All roof coverings to be Class-"B" or better
OFFICE - - ,