03080100 (2) u
CITY OF CUPERTINO `"` 1 '
BUILDING DIVISION PERMIT CONTRAGTC7R TNTQIiMAT7( µ
BUILDING ADDRESS: JON R CRASE CONSTRUCTION I F""'03080100
224PE MC: C�T-RT-T-AN RD
OWNER'S NAME: 164 GILMAN AVE PERMITISSUEDATE
(408) 370-1485 SANITARY NO. CONTROL NO.
NE:
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEOCH
!00 LICENSED CONTRACTOR'S DECLARATION
im C 1 hereby affirm Nm 1 am lian.¢d under pmviaions of Chapl 9(commencing lob Descrip[ionFI ,�ryy �� .
-Zw with Scction]000)nf Divisian3ofthc Businca,anbPm ss' tlm limns is A
jE2Zin full force and m. KITCH. REMODEL
Licens ms LI<.N h)®t� a rx003
�^ Canlraat., KI 4 L
HITECTS DEC RATION
1 understand my plans shall he used os pu lie rands
a u p'
G� Licensed Pmfesshrml BUILDING
S OWNER-BUILDER DECLARATION
a8 1 hereby affirm that 1 am exempt from the Contractor's License Law far the
n o following reason.(Section 7031.5,Business and Prorassions Code:Any city or county
<m� which rcyuirm a permit to construct,alter,improve,demolish,or repair any structure
di i
prior In iu issoanee,also requires the applicant for such Permit to life a signed statement
_sa that he is licensed pursuant totheprovisions ofthe Contractor's LiecnseLaw(Chapter 9 Sq. Ft.Floor Area Valuation
ut-� (commencing wi th Seeti .7")mr Division 3nr the Business and Pmfassium Certain,
s, Net he is exempt therefrom and Ne basis for Be alleged Exemption.Any i mati, or 35705051
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
not mom Nan Gvc hundred dollars(5500).
I,m owner of the pmpeny,or my employees with wages as their sole compensation,
Will do the work,and Ne starting,is not intended or offered for salt(Sec.1044,Business 01 — FOUNDAU' Qkbd Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of 102 — PIERS
property who builds or improves thereon,and who does such workhimself or through his
own employees,provided that such impmvemems are not intended or offered for rate.If, 103 — UFER
however,the building or improvement is smtl within one year of completion,the owner
builder will have the burden of proving that he did not build or improve for purpose of 104 - REBAR
salt.).
ol,as owner of the property,am exclusively contracting with licensed contractors to 105 — ANCHOR BOLTS
comsoucl thepprjdctEbac.]B44,Bro,messand Profession,Code:)The Coavacwr's LI. 106 — SEWER & WATER
cense Law dors not apply to an Owner of property who Wilds or improve,themen,and 202 — UNDERFLOOR PLUMBING
who contracts for such projects with a contractor(s)licensed pursuant m the Contractors
Lime Law.ns203 — UNDERFLOOR MECHANICAL
❑l am exempt under See. ,B&PC for this reason
204 — UNDERFLOOR FRAME
Owner Dam WORKER'S COMPENSATION DECLARATION 205 — UNDERFLOOR INSULATION
I hereby affirm under penalty of perjury one of the following declarations: 301 — ROUGH PLUMBING
❑ IhamamdwwmaiaminaCenmeamorcomscmtouiNinsnmrorwarkcrhComPcn- 302 — TUB & OR SHOWER
sation,m provided for by Section 3100 of lie Labor Code,for Ne perfmmancc of the 303 — ROUGH MECHANICAL
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance.as required by Section 304 — ROUGH ELECTRICAL
370oofmc tabor Code,for Ne per(ormandcof Be work rorwhich this permRis Issued. 305 — FRAME
My Worker's m0ren boot insurance carrier and Policy number are: _ 306 — HOLDOWNS
Cartier. 1 A ��+1 Policy No.:D 0 ✓S
CERTIFICATE OF EXEMPTION FROM WORKERS' Z_�yyr 3O7 — INSULATION
COMPENSATION INSURANCE 308 — SHEETROC'IK
(This section need nor be completed it the fermi(is for one hundred dollars(S I m) 309 — EXTERIOR LATH
nr less.)
actor,Bud in the perfmrmenec of the work for which this permit is Issued,1 shall nal 310 — INTERIOR LATH
empmyiny fiction imanymaancr an asmiaecome subject to the Workers'Compensation 311 — SCRATCH COAT
Laws of California.Data
Applicant 313 — ROOF NAIL
NOTIC E TO APPLICANT:If,after making this Certificate of&rmn prion,yen should 501 — FINAL ELECTRICAL ENERGY
become subject to the Worker's Com pcnsntion provisions of the Labor CnJe,you must
3zForthwith enropy with such provisions orthis Permit ahanthe deemed ravoked. 502 — FINAL PLUMBING ENERGY
zO CONSTRUCTI ON LEND ING AGENCY 503 - FINAL MECHANICAL ENERGY
F. .. I hereby affirm Nat Ncrcis a construction lending agency for the performance of 504 — FINAL BUILDING ENERGY
x > Ncworkrwhichthis pertnitisiaucd(Scc.lfri],Civ.C.7 505 — FINAL ELECTRICAL
W Q Lender'sder'sNName
] z mderaAddrea 506 — GAS TEST
U O I certify Nat I have mad Nis application and sort(hal Nc above information is 507 — FINAL PLUMBING
W comet,I agree to comply with all city and county ordinances and state laws relating to
OU building mnmm�ion,anJhcrcbycuthorixercprescnmtivcsufthis city mcmcrupnnlhc FIN MECHAN CAL
O W anovwmconnoadpropand for iby additio mposs.
(We)agree to ave,indemnify and keep harmless the City of Cupertino against 0 9 FIN
o-F.t h liabiliries,judgmentt costs and expenses which may in any way accrue against said City of the granting of this permit. 5 NG
in
U APPLICANT eUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 C WORKS Date
URCE GU 0
910 Re-roofs
SignawrcafIic=11acmr - Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof .
Will the Cucsnt or!Muni building i ode,Chapter
9.12,urc handle Health andations material ,
az deRncd by the Cupertino Municipal Cotic.Chapter 9.11,end the Health and Safety
Code,Section 25532(aR All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant nr fu ser aJding aecapaml are,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Cook hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Dfaricil
oyes
1 have mad the haMous materials requirement,under .Chapter 6.95 of Ne Califon
ria HcaIN&Safety Code,Sections 23305,25533 and 35534.1 understand Nat if the Wilding
does not currently have a tenant,Not it is my responsibility m nobly theoccupantof Ne
regoirannum hoc IpdorluissuanccofaCcnill x, IOap up Y. Signature of Applicant Date
Ott Ila 46
wmer ar as rued,sent Date All roof coverings to be Class"B" or better
Di
JON R.CRA8HCONSTRUCTION,INC. Clan, reS� e °�
184 01LMAN AVENUE
CAMPBELL,CA 85008 X495 t'teCk" Lk
(408)370-1485 Gr��=41ro!CIS
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Joseph's Woodworking CRASE SCOTT CUPERTINO l Roorplan
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etwne:46w79-wu Fm:4eaM?Q33 Room 1 CNrt t Daft:AV 11.2D03 I Scale: 114"=1'
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.ION R.CRAB@ CONSTRUCTION, INC. �
184 OILMAN AVENUE
CAMPBELL,CA 95006
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Jose h's Woodworking CRASE SCOTT CUPERiTNO '( Elevation - Wall 1�
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164 GILMAN AVENUE
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Joseph's Woodworking CRASS SCO1T CUPERTINO Elevation - Wall 2 0
be ns-�o]3 F.::406-379-7033 -- Room 1 cue oxe-An If.xw 1 Scale: 1/4"=I'
AY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEIZTINO
APN # TJ- 7 d Date: �G9103
Building Address: Mailing Address (if different from building address):
L 2 4 5 Ndc C(e
Owner's Name: Pho e#:
(MLQ 13X1.1 Cmc 4)D 259-(05
Contractor: License#:
,z fC63 1- CAA9F- COM7 (1K- B Gl15417
Contact: � /� Phone�2M) 37o-t4e6 Cupertino Business License#:
1 11b l coq-, Fax:(4Of5) 3-10-oISS
Building Permit Info:
Bldg Lld�PElect Plumb IR Mech
Job Description:
Residential K �Cl 2e3.a0DcZ Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Proje Occupancy Group:
��
Type of Construction: Please check this box if the project is a
second-story addition: ❑
Quanti Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1 M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V<= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A 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
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