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03080052O fn a `O V 4 z z CITY OF CUPERTINO 11. ^� ' � = �' �^` " 4 ` "j' BUILDING DIVISION PERMITCONTRACTO. R,. IvNFORMATIQN BUILDING ADDRESS: 20400 ERMff N003O8OO52 """03080052 ER'S NAME: BTA (BERG FAMILY) PERMIT ISSUE DATE pts SANITARY O. CONTROL N0. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description o p rm et I am Bombed under provisions car Chapter 9 (commencing I hereby a1BNlice who Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. TI--DEMO INTER. WALL & License Club. Lic.g Dam contractor INSTALL WOOD INTER. CURB �1��■ ARCHITECTS DECLARATION Pro �® I undma aid my plans shall be usW as public rocnrds SEP 1 4 2003 Licensed Professional OWNER—BUILDER DECLARATION 1 berehy. Slim I a1. eBusin from the adllacloia License Law for the " 711715,Businessand Pmfcle ins Code: Any city or county fallowing reason. on f which requires permit alcor, i car repair any arumam permit re enres h Permit t t for such oapionsor far ouchpermit mice signed atamment n the pdmtosl issued.,atmrequites provisionsof the Contractor'sLicenseTaw 9 that heislicensed pu.tant to No Sq. Ft. Floor Area 0 of Division positions Cnde) or (commencing with Section 7000) car Division J of the cure end cgW m. Any Ont he l exempt dtemlrom and Ne bus (m the alleged eampti.n. Any violation of ,�W�...,..{, 3 11 2UtTt(;rO 0 Occupancy Type _. . Section 7031.5 by any applicant for a permitSuLj"t, the applicant to a civil penaty, of - not more Nan Ow hundred doll. (3500). 0 1. as owner of de prepeny, in my employes with wash as their cele compensation, Required Inspections will do the work, and the structure Is not intended m or ebad rural. (Sec. 7016, Business and Praressions Cade: no Conuaerses Licence Law dos not apply to an owner of property whobuilds orimprovex d¢mommal who doesauch work himsedor thmuloh his 101 — FOUNDATION own employees, provided that Such ideprowmanl aat not intended or.Irered for able. If. 102 — PIERS however, rite building or Improvement is sold within one year or completion, the Owner- builder will have the hurden of proving that he did not Wild or Impmw for purpose of 103 — UFER ale')' 104 — REBAR las owner of the property, am exclusively contracting with licensed contractors to a IrectNeprojm(Sec.70+4,BusinessandPm(evsion,Code:)TheConvaetor'sLi- 105 — ANCHOR BOLTS. cease law dao not apply to ren owner of pmpeny who Milds or improwa Orman, and 106 — SEWER & WATER who eorVSl for such projects wash a earaaton(Q Iieented pursuant in NC Commocuse, Lima. Law. 202 — UNDERFLOOR PLUMBING O lam exet�n�/f undd�er Scc. B k PyC for this moon 203 — UNDERFLOOR MECHANICAL 1 WORKERS COMPENSATION DEC fa ION 204 - UNDERFLOOR FRAME Ib.mby afind under penalty of perjury ane of the fallowing daelarstions 205 — UNDERFLOOR INSULATION . (3 [haw and will maintain acemBeate of Consent m..lalnaure for Worker's Connote- 301 — ROUGH PLUMBING scion, a provided for by Section 37W of de labor Cade, for las performance of de 3 02 — TUB & OR SHOWER work for which this Pamir is issued. 303 — ROUGH MECHANICAL ' O 1 hale and will maintain Worker's Compensation Insurance, as required by Section 3700.1' 0. Labor Coda, for de, performance ofand workrarwhich Ibis permit itiaued. 304 — ROUGH ELECTRICAL My Worker'. Compersuim Insurance carrier and Policy number m 3 05 — FRAME Conten Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 306 — HOLDOWNS COMPENSATION INSURANCE 307 — INSULATION (Thi routine teed nota completed if Permit l fm arc hundred dollars(3 lum 308 — SHEETROCK or loss.) 309 EXTERIOR LATH I certify last in dte performance N the work far which Nis permit l issued. I shall nm - employ any person in any mannerm as to became subject to to W.rken' Compensation 310 — INTERIOR LATH Laws f Lawsor c.Bromi.. Wm' nt Appl 311 — 313 — SCRATCH COAT ROOF NAI L NOTICE TO APPLICANT: If, after making this ConiOnm or EscmPtion, you should become subject to thc Worker's Compensation previsions of are Labor Cook. you must rarthwiNcomply with such provision.mIbis Permit shall xdeemed ranked. 501 — FINAL ELECTRICAL ENERGY CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY I hcmhy affirm las, Ne.la.comuuctina leading agency far Ne Performance, of 503 — FINAL MECHANICAL ENERGY Bit .,it far which this permit is Wood (Sit. 7097, Civ. C.) Iandres Name 504 — 505 — FINAL BUILDING ENERGY FINAL ELECTRICAL Lr's Addmas ende 1 certify Na I haw read Nis applimien and mm that the .bow information is cancel. I alone to simply with all city and county onfinances and sum laws existing be 506 — GAS TEST building construetion, and hereby amhmiw representatives of Nis city to enter upon the FIN PLUMBI G shove-montiuned property for lmpection purposes. (We)agree to saw, led ... try and keep harmless the City of Caperton !Sxmu08 FIN IIabllldu,judlomcn0. costs and expenses which may in any way aeon against aid City 5 in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 NG Date . S RC GU TIONS. z% Re-roofs 514 Type of Roof NAL PUBLIC WORKS ignaru of ApplianUComramr Data HAZARDOUS MATERIALS DISCLOSURE Will Ne applicant or future building Occupant nom m handle hramous material as dcfined by the Culenino Municipal Code. Chapter 9. 12, and the Health and Safety secdne2ss7aa)7 ❑Ya {AN. All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which roll haatdme, air mrannum nu as defined by Bob Bay Area Air Quality Management all new materials for inspection. uic17 Oyu KNu to aw mad are hasnNus macriels requirements under Chapter6.95of the Califon nice Hcmlth!¢ Safety Coda, Soc me, 25505.25573 and 25531.1 committed that it the building debt not surreally haw a tetmm, that it is my responsibility or notify the occupant of the mq.i men whit nun Its I 'ortoissuanccor.CartiOcrOccupanc. ��7 Signature of Applicant Date ` All roof coverings to be Class "B" or better ner of authorised agent Date 2 C CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING, ADDRESS: 20400 MARTAN-1 A14 """003080052 OWNER'S NAME: SIEZA (BERC",_FhMTT.V1 PERMTWUEDATE Q 0 -7 0 0 PHONE: SANITARY N0. _60NTROI, NO. ARCHITECTIENGINFFR: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLAP ATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force License Classand effect. — Lic. # TI --DEMO INTER. WALL Date Contractor INSTALL WOOD INTER. CURB 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 Law for the following reason, (Section 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure Sq, Ft, Floor Area Valua%%5 0 0 prior to its issuance, also requires the applicant for such permit to file asigned statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and ft basis for the alleged exemption. Any violation of 3 IWIM41*110 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 doll= ($500). 0 1, as owner of the property, or my employees with wages as their sole compensation, Required Inspections will do the work, and the structure 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, andwho does such work himself or through his 101 - FOUNDATION own employees, provided that such improvements are not intended 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 - UFER sale.). 104 - REBAR &owner of the; property, am exclusively contracting with licensed contractors to O -Ii. - et the project (Sec. 7044. Business; and Professions Code:) The Contractor's Lt. 105 - ANCHOR BOLTS. cense Law does not apply to an owner of property who builds or improves thereon, and - SEWER & WATER .he contracts for such projects with a contractors) licensed pursuant to the Contractor's106 License Law. 202 - UNDERFLOOR PLUMBING [:3 1 am exem t rider Sec B & P C for this reason wrtzx:za�� )_7 203 - UNDERFLOOR MECHANICAL Z. f WORKEWS COMPENSATION DECL-Aly ON 204 - UNDERFLOOR FRAME I hereby affirm under penalty of pedury one of the following declarations: 205 - UNDERFLOOR INSULATION 0 [have and will maintain a Certificate of Consent to self -insure for Wortter'sCompen- 301 - ROUGH PLUMBING satkin, 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 Worker's Compensation Insurance carrier and Policy number arc: 305 - FRAME Carrier. Policy No.; — CERTIFICATE OF EXEMPTION FROM WORKERS' 306 - HOLDOWNS COMPENSATION INSURANCE 307 - INSULATION abis section need not be completed it the permit is faronc hundred dollars ($ 100) 308 - SHEETROCK or less.) I certify that in the perfunriance of the work for which this permit is I issued, I shall not 309 s EXTERIOR LATH employ any person in any manner so as to become subject to the Workers' Compensation 310 INTERIOR LATH Laws of California. Date Applicant — 311 313 SCRATCH COAT ROOFNAIL NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such previsions or this permit shall be deemed revoked. 501 FINAL ELECTRICAL ENERGY i CONSTRUCTION LENDING AGENCY 502 FINAL PLUMBING ENERGY I 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 (Set- 3M7, civ. C.) Lender's Name 504 505 FINAL BUILDING ENERGY FINAL ELECTRICAL Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to 506 GAS TEST building construction, and hereby authorize representatives of this city to enter upon the F I Nla PLUM13ING above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against 8 I—IL — - FIN liabilities, judgments, costs and expenses which may in any way acme against said City in consequence of the granting of this permit.53 1 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by:5 NG Date RC GUL TIONS. tZ ff Re -roofs 514 Type of Roof -f-F.-INAL PUBLIC WORKS o9ignatuirol'ApplicautlCoMmlor . Data HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. Ll yes If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? M Yes AN. I have mad the hamnious materials requirements under Chapter 6.95 of the Califer- me Hcalth&SainlyCode, Sections 25505,25533 and 25534.1 understand thatif the building does not currently have a tenant, that it is my responsibility to notify the occupant of the w must.ch e =ssuancc of a CcroficatmjRf� �DCP7. requSignature of Applicant Date z7o K27/ All roof coverings to be Class "B" or better 5,0n'er or anD ac CUPEkTINO OF O APN # Description r. 1 Date: '.511 ,403 Building Address. Mailing Address (if different from building address): Owner's Name: v1q ✓ Phone #: Contractor: MECHANICAL License #: Contact: 1(14 4;�axpFax: Phone: /t/ Cupertino Business License#: Pe it Info: rBldg Elect Plumb Elech quhpd-cription: Residential ❑ 1.75M Btu l if y// y — I .1)gQ Commercial Sq.Ft. Floor Area: Construction Tax $/Sq.Ft.: Cost of Project: Occupancy Group: 5 / Zs Type of Construction: Please check this box if the project is a second -story addition: ❑ 1 of 3 Description r. 1 BAPPLOTHER MECHANICAL Bldg Permit foot BBC loiler <-- 100,000 Btu MECHANICAL i i 1 Boiler > 500K to 1M Btu MECHANICAL Boiler > 1M to 1.75 M Btu 1�111141ilvvvllBoiler> 1.75M Btu MECHANICAL Construction Tax Hotel and Motel MEN=431 #f1 111' RICAL 1iElec Svcs 600V11 ,ELECTRICAL Enqff Add Multi BUILDING Investigation fee, i BMITIGATC 1 of 3 CITY OF CUPERTI?, J PERMIT APPLICATION FORM on Fee Description BREMRELOCA Relocation of Hood I�Tair/Alter Heating V NJ 6 W" Remodel Res �k ppliance TV Rmdl Sips Add Brxnch ELECTRICAL WON, Remodel Signs, Marquee Sim Theatrical Li Fix ELECTRJCAL Vent Fan Single Duct Specific Plan r�rScb BSEISMICO Seismic Commercial 1133 1 Seismic Fee Res—_ �WRIU 1001011 �WUIRNIC ILI Swimming Pool -took Temporary BldgTennit II BTEMP T��m Dist_Svcs • _p Business License �UWAWARvjqftvr�� sq'foot —Electrical Elec Permit Issuance I F1 for -n Mechanical sq. foot T" "N IN MPERMITFEE 11MMUMIUMISIM UN lq� PI ing Fee. sq floot ��00010 MEMIN Addressch e on