02060044 CITY OF CUPERTINO
BUILDING DIVISION PERMiIa CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10399 MERRIMAN RD TOM SLEE 02060044
OWNER'S NAME: APPLICATION SUB DATE
TOM SLEE 06/10/2002
PHONE: SANITARY NO. CONTROL NO.
fo,+OO ARCHITECT'ENGINEER: BUILDING PERMIT INFO
E DG ELECT PLUMB MECH
uso
S?y LJ CJ l-J
z LICENSED CONTRACTOR'S DECLARATION `
Ihereby0b.f dratI.3ofhe dunderv.it Pr.na,fentolde9tammeneme Job e�cript6
°_�w with seam,7ufx»nr Diviamn3nnhe endmea,ane Profeaamna chile.ana nlr license DECK ADDITION ! ba
ams,, is m mu e,me and effect. e�'�O 2�Q^
ec N u Lignac Class Lic.x CC
Date Contractor
'u.0 .t; ARCHITECT'S DECLARATION '�
g I understand my plans shat)be used as public recmd,
r
w n o O Licensee Professional
OWNER-BUILDER DECLARATION
ti M 1 hereby affirm that I am exempt focus the Cmummumr's License Law gorilla
H?afollowing reason.(Section 7031.5.Business and Professions CoAny city or county
I x O which asciona Cone:Any
to comuna,alar.int uo,o.demolish,or refolu any structure $2500
ce
ou3--.prior toils issuance.also requires Ne applicant for such permitro 6l...ignWstemoen
e ,
,na,hliii,liansed putooant to Bi provisions of the Conlrsc,ofs License Law(Chapter 9gL F C• ea Valuation
(commenting with Slaion.70011)of Division 3 o the Buximi agd fsef9ssions Cade) ccl\,d'i34 �: JNl:�lA:��{")''"
or,hai he is exempt thekfrom and the basis for the allpg(d exemiumb.Any violation
of Section 703 IS by any applicant for a permit subjects the applicant to a civil penalty mber ,
of act mmethan five hundred aot.(SSW). 101APN- VbftATION IPn ., r'•:: Occupancy Type
O1.as owner of the property.or my employees with wages as their sole compensation,
-
will do the work.and the structure is not intended or offered for sale(Sec.7014. - ..___ Required Inspections!,
Bminae and Ptmfessions Code.Toe Commemr's License law does not apply Int an 10 3 - UFER e 9 p
owner of property Who builds or improves thereon,and who does such work himself
or through n'. ply provided that such improvem<ms are not intended _.. ._-_.. 104...-._.REBAR. _ . _.._
m I Is sold within'one _.....O-_ ..
-,offered for -If,now the will base
a provemenye or
on:pleuo, me owner nu leerwu Haut me baN<n ml prow mg mm he did not build., 105 - ANCHOR BOLTS •
improvaforpum1fC0f'`al`) 106 - SEWER & WATER
- DMBING _
01' nnaproa r mm f g inf . v 1 train 202 - UNERFLOOR PLUMBING 11 '
construct to project(See.7064 Business . d 0 d Professions ons CoTn Contractor
L cert a La d s not apply to an owner of property who buil) or improves thereon. 203 - UNDERFLOOR MECHANICAL;
Y - and who contracts.fur.such.projects-witha.contralacol)licensed.pursuant,o me. _ -..- ._._-. - ....... ..___--
Contractors cane,law. . . - - 204- - 'UNDERFLOOR FRAME:
-" lumen undc -' " .BkPCfonhisreaon R 'IN
205 - UNDERFLOO SULATION
Go OF TON 301 - ROUGH PLUMBING
PENSATION DE ION
IherebyarrnnonderPenalty ofp<rjnryone onnefunowingdecimations:
302 - TUB & OR SHOWER
303 - ROUGH MECHANICAL
l ❑ I hive ana warmaintain 6'c die<at<nrenn m m gar-macre rot wprkera 304 - ROUGH ELECTRICAL
Compensation. a provided roe by Section 3700 of ,he labor Code, for the
performance nrthe work for is is mid v<rlliy is lagged. 3 0 5 - FRAME
❑1 have unit will as
Worker's Compensatimi Insurance,as required by Section 306 - HOLDOWNS
- s y penia performance of the work for which this Permit is
Labor k 'Cade f the
issued Worker's Compensation l anrana carrier and Policy number are 307 INSULATION ._.,,,,,,..•,,.: .-e11J,.-,.. ,.._ . .,....-.M.... ..
cJ�, :t y'.�;. 1� -, PourN . .., 308; r`. SHEETROCK Q.)•4`y —': •1'fr., 1
r tCHRTIPICAI ION OF EXEMPTION FROM WORKERS, - �, �. s 1
COMPENSATION INSURANCE 1",,;�''' 1 309 'EXTERIOR"liATH
.. _ .-_._ __ .. ..�._.__—_-ft-I � .... .. _.. __. ..
!This sauon need nn,he cnmpiaad.r mearm tis for one humdmd aonam 3 l 0,' ' INT'EP I OR LATH
T$IWnrlless a _ 311 - SCRATCH COAT
_" ' Icn7ym5mthar ter kr a<tt-tnp= 't � .�<dI 313- ROOF NAIL -}: - ,-- _
{hallo t pl yany,ar n nee Zln_ Wnrkem 501 - FINAL ELECTRICAL ENERGY
Cnm nsJll Ola n Ca
502 ---- FINAL PLUMBING--ENERGY--
z
LUMBING ENERGY - -
OICL TO AYI'LI A ing th s C ri f m of Exemption,you should s
bl ttto thew ekr cnmansst p nrme labor Inde.you mag, 503 FINAL MECHANICAL ENERGY
z lorthwiln comply with such provisions or Iter arms shall h gamed masked. -
. . - -504 -- FINAL -BUILDI-NG --ENERGY--,'-,:-
�.y d:'CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
" ' 1 hereby affirm that mw
ere is a consctios lending agency for the performance
GFC > nr.n<wurkmrwnichmiap<rmi,iaia:umfs<c.3897.cv.c.) '.:,:,....:y. . _ _.506 GAS TEST-- - - ...-- ---
y.G LLndds Name--...: . _. ... _. _... ._ ......:..... . .. ._. __
D•Z Lenderanddreaa 507 - FINAL PLUMBINGI. ,1,
U-0trytnmin ' read this rte statemom a <mmrmadania 508 - FINAL MECHANICAL
.. ial, correct.lae to comply m d aq cand,mmaynodraroo,ord,notic laws relaling 509 - FINAL GRADE
Q-V to building construcdnNand hereby umhodae representatives of this city nl enter open
heap,we-memmgedpooperq for inspection purposes., 510 - FINAL PLANNING
Is,. (Wo)agree uI save,mdemmfy and keep harmless the City of Cupertino against
F to liabuid<a,pdgmenam costs and axpamsa which may to any way nccma ggamst said 514 - FINAL WORKS
U Z On in cnnscqu•llec of the coming of this'armi,. • r`
^-' APPLICANT I,DF.RS" 'ANDWILL COMPLY WITH' .LNON, OIN Is$Uedb Date
SOURCE EG 4llt S.` y'
signmme ofA ¢anJCnnmctor Re-roofs
. I HAZARDOUS MATERIALS DISCLOSURE
W'll alle.ppl,cramorfultme dildingmcc pant store or handle havNous malo' I Type of Roof.,
•.def adb theCupertinoM 'CPal Cad Chapter 912.adth Health and Safety, )
Cade Salim2553'_(0) 1 - f• sSo.. 1 •`• a I ,ifi't ° ! ice tis,i' '
oy<a 1.",I
All roofs be-mspected.prwr to any.roofing.material being installed.-
'Will the applicant or future building occupant use equipment odevices which If a roof is installed without first obtaining an inspection;I agree to remove
cern humorous a r aonmmimants as defined by the Bay Area A r Quality Management'
D;awn all new materials for inspection. Applicant understands and.will comply with _.
❑Ye:•. 9Z.''° - ' all non-point source regulations, . ,
I hale lead the hazardous mmerials requirements under Chapter 6.95 of the
r .
,up o
Cali(omia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that
-if the ln:ildlne does not currently have a tenmt;dant i,is my respnnsihilily to notify the -
_o' t fm 4 t, h, esp' rto ice. a of a Certificate of -
°"°vat`y `Signature of Applicant Date
_!I -
own r nmhne,eq.Ige Dgf�— All roof coverings to be Class "B" or better
z..,
.... - .OFFICE ... . .. -
CITY OF CUPERTINO - s ' f^' r
BUILDING DIVISION PERMIA "CONTRACTOR INFORMAT*.-
BUILDING ADDRESS: PERMIT NO.
10399 MERRIMAN RD +TOM SLEE 02060044
OWNER'S NAME: APPLICATION SUB DATE
TOM SLEE 06/10/2002
HONE: SANITARY NO. CONTROL NO.
Qec00 ARCHITECrENGWEER: BUILDING PERMIT INFO
— BLDG ELECT PLUMB MECH
a i h-W
�NLICENSED
•S m K 1 hefcby affirm the laCONT'RACTOR'S
OM d under provisions
DE o s of Chaap cr 9(commencing Job Description
1y_u�s with Section 7000)of Division 3 ofthe Business and ProfiessionsCode.andmirliceave DECK ADDITION
f y f< Licime ll force and eeect
i ec ec a License ClassLic.N
o a D Date Convector
i :o t; ARCHITECT'S DECLARATION r
:uLn
1 undersand my plans shall be used as public records J U L i 7 2002
3 E o O Licensed Professional
OWNER-BUILDER DECLARATION
u� 1 hereby affirm that 1 am exempt from the Contractor's Lee=Law for the BUILDING
L7 K< following reason.(Section 7031.5,Business and Professions Code:Any city or county' $2500
s O which requires a quirepermit to comsua
v ,alter,improve,demolish, m
or repay any saurc
X.3°—°"Imam to ire issuance sto requires the applicem fureach Namur to file a signed saterient
Nat hs iglianxdpufstmm sy the pmnstons of Jrc Conuactofa Lioarselsw(Chapu9 c1,H, F r•5^�'y.,e Valuation
(comm encing with Section 7000)of Division 3 of the Busineq mq Pmf�ss' ns Cade) ] ',•34`G 2. O'•��.;V V�
or mei he is exempt mercfmm ant me basis for me alleged I Fpoh.My violation
of Section 7031.5 by any applican for a permit subjects the applicant to a civil penalty �.l mTnbb����
of not more than five hundred dollars(SSW). 101'p-' VMffiATION Occupancy Type
O I,d owns of the and
th. ,m my employee win wages offend their sole le(Sm.ution,
'-will ne the wmk.'nnd the ode;T e is ont imendcd or enLaw for sale(Sec.70aa, - '- - - -- --
ow02
nerof
end profession Cade:The Connmcmro License Lew dose not apply m an 10 3 - UFER Required Inspections
r of property Who builds or improves thereon,and who eros such workhimself
or
owner magna his own employees.pro.idin that mpr improvements within in intended are . 104 - REBAR . . .. _ . ._ ..
offered fon we:If.howevere will
wilding m urven of
n sold within not
of .. .
completion,me owner-builder will have the huNen of proving that he did not build or 105 — ANCHOR BOLTS
impmw for purpose of sdc.). 106 - SEWER & WATER _
01:as owner of lite property,not exclusively contracting wit licensed contractors to 20Z — UNDERFLOOR PLUMBING
commict me project(Sec.704,1,Business and Professions Code:)The Contractor's
License law does not apply to M ownr of Pmperty who wiles or improves shaman, 203 - UNDERFLOOR MECHANICAL"
and who contmcu for such projects with e.contractor(s)licensed pursuan to the .. -- - -� -
eontrarmr'a cense Law., 204' — UNDERFLOOR FRAME.
5'll am cx undc B 3:P C for mis...a 205 — UNDERFLOOR INSULATION
�` 301 — ROUGH PLUMBING
" E PENSATTON DE ON
I hereby Ofirn under penalty of perjury one of the following declaration: 302 — TUB & OR SHOWER
303 - ROUGH MECHANICAL
7 1 have and will provided
Certificate of Consent the
for Worker's
Compcnxation, m pmvidW for by Section P00 of me labor Cada fm the 304 - ROUGH ELECTRICAL
periormance of ter work for whim Ores pemut is issued. 3 05 - FRAME
❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3 06 - HOEDOWNS
37W of the labor Code,for be performance of the work for which Ods permit is
issued.My Workers Compensation Iruumnce carrier end Policy number arc: 3 07 — INSULATION
Policy No.: i^ 3OB; ,SHEETR_ R- Lt1THOQK.r.•; ..
:. eRTIPICATION OF EXEMPTION FR°MWOR, RS^P' 'EX'TERIO
COMPENSATION INSURANCE• ,309 •
t
310 — INTRAIOR LATH_.... .... .... ._.........
(this
tsactidc need not bnPermit e completed if peit is for one wtwre dollars
(s1007mis311 — SCRATCH COAT
O
313 — ROOF NAIL
501 - FINAL ELECTRICAL ENERGY Y
502 — FINAL PLUMBING ENERGY
503 — FINAL MECHANICAL ENERGY� 504 — FINAL BUILDING ENERGY':z
'
'CONSTRUCTION LENDING AGENCY'
> Ihereby all.that mere is a comtmction lending agency for the Performance 505 — FINAL ELECTRICAL
of me work ter whim this permit is issued(Sec.3097.Civ.C.) 506 - GAS TEST._
dQ Lender's Name -
D,z amapraaaaresa 507 — FINAL PLUMBING
U O 1 cattily that I have read this application Ind state mai he nwve infonst.eon is 508 —. FINAL ME CHAN I CAL
w ~ cartect.l agree to comply with all city and county ordinances and state laws minting 509 — FINAL GRADE
Q.(J m wilding construction.and hereby authorise representatives of this city to enter upon
fes, heaWve-mrntimed piopeny,for inspection purposes. 510 — FINAL PLANNING
f~ 0., (We)cares m save.indemnify and keep harmless the City of Cupertino against
ILPaid costs and expenses which may in any way.come against said 514 — FINAL WORKS
G. City in'conscqu Ane the granting of this permit.
- APPLICANT i DERS AND WILLCOMPLYN'frH LNON- 01 Issued b Date
City iI G TI 'S. - y'
SignatureofA can9Conm<mr 7A, Re-roofs '
HAZARDOUS MATERIALS DISCLOSURE
Will me applicant or Potrero wilding acceptor somorhamdk 6+rvrdois minimal Type of Roof-- -
"udefined by the Cui,aama Municipal Code.Chapter 9.12.and the health and Safety
Code.Section25532(a)7 i .`.• r;. i -
'0Y°' All roofs shall be inspected prior.to any,roofing,material being installed..
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
ami,hazardous air contaminants as defined by me Bay Arta Air QUahly,Management
Districts all new materials for inspection. Applicant understands and will comply with
°Yes all non-point source regulations. -
I love lead the hazardous materials mquircmcna dunder255 Chapter 6.95 of the
Ca is buil ingHeilit dos Safety Code,Sections ant.that
it
end responsibility
1 try to motif that
if(heagrt of g does not cummly w.•e nr tenant met in is my responsibility m ratify me -
oEcupam of me require u wM1i run prior nab ixsuencc of o Cenificam of
.. GCCYpaMy.
iSignature of Applicant _ Date
Owmu or aumorizcd age D e All roof coverings to be Class iB"or better
:. .. .. .. OFFICE
an0RTY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
APN# 1 ,
Building Address:
d
MAti P0. UN 1T A . GurErLrNv CA 9-50)Li
Owner's Name: Phone#:
Tom `JL1=C (`io8) 2S-4 -6"4$9
Contractor: �JEL� License#:
Contact: Phone#:
ToM `JLEE sdM�
Applicant/Contraptor: Fax #:
it i g Permit Info:
Id Elect Plumb Mech
Description: l�
Residential: ► '-'1J
Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation:
Type of Construction: Occupancy Gr up: �O
Quantity Fee ID Fee Description Fee Group
APTFEE EACH STORY OVER 3
HOTELFEE EACH STORY OVER 3
OFFICEFEE EACH STORY OVER 3
BAPPLOTHER Other Appliances 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
RENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BMTTIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BNEWMULTI I New Multi-family Res ELECTRICAL
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