02080117 CITY
I BUILDINGDIIVISSIIONNO PEOIT CONTRACTOR INFO TION:
BUILDING ADDRESS: PERMIT NO,
20595 MAPLETREE PL (LOT48) GB GROUP 02080117
OWNER'S NAME: APPLICATION SUB DATE
CUPERTINO COUNTRY WOOD HOA 8921 MURRAY AVE 08/21/2002
�). I,PHONE. (800) 653-7172 SANITARY NO. CONTROL NO.
s
04 ARCHITECf/ENGINEER: g BUILDING PERM UIM
BLDG ELECT' PLUMB MECH
6
f._ U L_I L.J
rF^O se ZjH LICENSED CONTRACTORDECIArtwnON
0 Job Description
Z-° Thereby.ffNalicensed provisions mme
ofen.p�ar9(enncing REPLACE POOL FENCE
<P<.''t. with Section 7000) f D ysion 3 of the Business and Profession,Code,ane my licene �..'NALE®
y Y f•Ji ccnttl f y;enQ eRdII. 2 p
;fir AUG 2 2 2002
cr'e . no
I under ❑my plan.,Lan Ise aee as publi records
.E o o Li"ebud professional
a� OWNER-BUILDER DECLARATION BUILDING
f Is '9--' 1 hacby all that 1 am exempt from NCorm
actor's Concrola
r's License w for than
I'?a followingrc n.(Section 703 L5.Business end Profusion Cade:MY cit,or county C 12 5
uo Y
F° which residues s pcmut m construct.ever,improve,demolish.or repair any sanctum
�p3m .prior s00
on uuame,also q Ne pplicem(w such permitan fileesigned mterbtent - .... .. . ,
Wth{yB.nsed pinsJan�b Je Pim tsiom of the Conaxanfs liccne law(Chapter9 ]!}t �I•�a I a Valuation
(tvrmnerrcmg
with
Section]000)oroivinon Sof she Bustne{sand ptofsmion Calc) ( f f'', i �Z+.--]s� "sS' a t:�1�t Iti�1'
or I he n ecempi Nertffom anA Ne buts rob Ne JleglA d<mpfoo.Any violation
of Session]031.5 iv any hundred
eft for a permit subj.ss Nc applicant an a civil penalty ,,,,.st,,,,�
of lot more thur Time hadrcd donors as00). 101A��Gt7YV'UATION Occupancy Type
01.n owner,of dye property,as my employ.,with wages as their in compensation,
will do don work.and the structure is not intended or offered for sale(Sec.7044, 1 O 3 — UFER Required Inspections
'Buswd
sis aProfessions Code:The Combatant's Line.Law does trot apply an an q p
owner of property Who Wilds or improves thereon,and who does such work himself 104 - REBAR
or through his own employees.provided Nat such imProvemenu art not intended or
offend for We.If,howevea the building or improvement is,old within one Year of - - '-- . . _. __ . ._... ... .._
completion,thi owner-Wilda will have the Wbden of proving that he did trot Wild or 105 — ANCHOR BOLTS
impromefmp.rpo,e.ixale.). 106 — SEWER & WATER
1.as Danser ofP x-r:.am .....Y.. .....8..._. ............ ..... _ _-. ,2.02.. _...UNDERFLOOR- PLUMBING --
0 -
n exclusive) contracting with licensed contractors to '
="
construct Ne project(s..]ora.Baines,arca Profession Code)The Coanaaa a 2 0 3 — UNDERFLOOR MECHANICAL "
License law does not apply m an owner of progeny who Wilds or improves thereon,
L.
_.and who eamruu.for.suc,Pmjecu,wlN a cremations)Bcaa e.pursaant.m Ne _.. .204 -UNDERFLOOR-FRAME- --
Contractors License Law. .
0 l am exempt under Sec ' .B&PC for thisrwon 205 — UNDERFLOORS INSULATION
0", Date 301 — ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
lMby.Mm,undcrpenahyorpjary.oneofNefollwingd«lara6ons: 303 _ ROUGH MECHANICAL
0 I have and will maintain .certificate of Consent an self.imme for Worker, 304 ROUGH ELECTRICAL
Compensation, as provided for by Section 3700 of the labor Cade, for the
performance of the work for which this permit is issued. 305 — FRAME
01 have ad will maintain worker's Compensation Insurance,u required by Section 306 — HOLDOWNS
37M of the lobar Cade,for the perfmmance of the work for which this permit is - INSULATION
issued.M W ds Co0TIP"timn luuru¢e Gun.ad Polky /� :•s .3 O 7 — s {+
.. C EXEMPTION
IR I/20 I 3010 $SN+TETROCK - :•-•. ._ ...
` RTfFICATION OFpolicy woR' Keas• 309 EXTEFf$OR ''LATH
�u �Z RIOR LATH-
miiss��nor tac'templetdifthe permit i, .1 one� donor, 311 - SCRATCH COAT
(,loo)err lea.)
1 certify that in the performance of the work for which this permi,is issue.1313 — ROOF NAIL -
shal mot employ any person in any manner so as to become subject to the Workers 501 - FINAL ELECTRICAL; ENERGY
Compensation Laws of California.Da¢
.Applicant 502 — FINAL PLUMBING ENERGY
NOTICE TO APPLICANT:IC after making this Certificate of Exemption:you should 503 - FINAL MECHANICAL ENERGY
become subject to the Workers Compensation provision of the LaWf Code.you must
O forthwith comply with such provisions or this permit shall bedeemed Invoked, 504 — FINAL BUILDING ENERGY
CONSTRUCTION LENDING AGENCY. 505 - FINAL ELECTRICAL
_e4 . 1 nertbr off.that there is issued(Sec.309],Civ.C.)construction leading agency for the performance 506 - GAS TEST
of the wak for which this perrrtit is
w p Leder,Name -. .... . _ . 507 - FINAL -PLUMBING
Lender's Address -
1 Gasify Jut 1 have read this application and suite that than above information is 5 0 FINAL MECHANI CAL
W 0 -correct.I agree to comply with all city and county ordinances and state laws relating 5 9 - I NAL G E
O V .to Wilding construction,and hereby authorize representatives ofthis city to enter upon 5 0 — INA NG
r� the above-mentioned property for inspection purposes..
0. (We)agreetosave.indemnify and keep hortnlesstheCity ofCupertino against 51 — INAL RKS
re liabilities,judgments,ensu and expenses which may in any way aceme against said
V-^ City in ten c sof N< ming of Nis blot
AP LIfm
C ERST )S WI C IP Y WITH ALL ONP lNr Issued b Date
U TIO Y<
ignaturc of Applicant/Conhactor are Re-roofs
a- HAZARDOUS MATERIALS DISCLOSURE..
- ill the applicant or future Wilding oc"mpont store w hurdle huibdws material Type of Roof _ -- -- -- -- -- -
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety . .
Cede, ctio 255321i1'
O .. ''.Otho •.s::.;..1 ;. j r" ' - t . ' ` `t: i `.s•� art ,. ,r
. - . . All roofs shall be inspected prior.to,any roofing material being.installed. .. .
Wlthe applicant or future building aocupin,use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air cmruimimnu as defend by On Bay Area Air Quality Managemcm
onion"? all new materials for inspection. Applicant understands and will comply with
OYcs 0No all non-point source regulations.
I have read the huallous maarials requirementsunderuer Chapter 6.95 of the
California Health&Safety Carle.Sections 25505.25533 and 25534.1 understand thi, _
31hWa'd« ot curmndy have a ten t,that' is mY nsponsibilit,a notify thethe ufrtme 'chmusttedissuance of Cmi cafeof he Signature of Applicant Date
f 07iAll roof coverin s to be Class "B"or better
uthdaN agent tie g
.. . .
- • - - OFFICE - „
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*CITY OF CUPERTIN(I&
CUPEI�r PERMIT APPLICATION FORM
1WPN# 3 Z 3 A4 02- S Date: q / ;/OZ
Building Address: Z 0-5-7s, ¢ Y
CLJ O E(ZI i N o CD U nT-P-V1,t,0o b LUrvl M v✓) AR-t L-07 g
Owner's Name: ' Phone#:
vpe" ncD COUy1 Ytv00.d )AC)A 737-Tf95
'Contractor: License #:
TJE 63 GRovP 0T-Er&Pc 7.59 ZO5
Contact: Phone#:
E7 W -(EZ�� Z/�17 ,OS i
Applicant/Contractor: Fax #:
i g Permit Info:
Bld Elect Plumb Mech
Description: `` &r C C
Residential: - t"- (,l "d 6 K T t 2w. PodC } Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation: 11
l Zl �i7 Z i7U
Type of Constructi n: Occupancy Group:
J G N T" k-')n Cj n
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX hid/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax-Resi/Mobile BUILDING
BELEC1000 Elec 600V <= IOOOA ELECTRICAL
BELEC1001 Elec 600V> IOOOA ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
• BENERGY Energy BUILDING
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
�I $7 �