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02050007 CITY OF CUPERTINO - - - BUILDING DIVISION - PRRMI10 CONTRACTOR INFORMATI&,: BUILDING ADDRESS: PERMIT NO. 10203 MINER PL NU—DESIGN MANUFACTURED 02050007 OWNER'S NAME: APPLICA71ON S14B DATE GOLAN SAUL AND LINDA 1566 LA PRADERA DR #3 05/ 02/2002 1PHONE: SANITARY NO. CONTROL NO. p (408) 374-4362 WOO ARCHITECVENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 5 y i LICENSED CONTRACTOR'S DECLARATION I hcaby eKrm Nat 1 vm bcensed under provisions°f Chapter 9(commencing J b Description j_Cw withSmion7")ofDivision 3ofNeBusine5IAnd Professions Code.entlmylicense SUN ROOM (14%18) m 1 is in fu in d -]( ire st.a License Asx Lic.M ''r//77 A/� F B N A f:.F.0 'O y D D e m e ConaacCL7iR TAt Y rJl 13 u y ARCHITECT'S DE 7fATItIN~/•r�y'- � O I undemand y plans shall h used a5 public records n 0 vsOOrs r JUNG L L !ro 2 Licensed Professional OWNER-BUILDER DECLARATION usi LL I hereby.firm than I nm eamnpm from the Coniravor's License Law ferrite BUILDING (_?a follov:ing reason.(Section 7031.5.Business and Professions Code:Any city or county $15000 1'S 01 which requires a permit to construct,aunt,improve,demolish,or repair any structurer'3- A. its issuance,also requimsta.."licw fors.Npermiuo fileasiguad uamorm - - thathgialicensedforwent tothe provisionsofthe Commclor'sLicense Law(Chapter 9 t,�},� A.� Valuation (commencing with Section 7000)of Division 3 of the Business and Professions Code) ',3' � OCJ,1Y.�f.V,�; l'f .. or than he is exempt therefrom and the basis for the alleged cinmptiod.Any violation ' -or Section 7031.5 by any applicant for a psmdr.ubjccta rhe applicant on A civil pcnelry of not motethonevchundred dollars(s500). 101`YPNP1nD@NDATION Occupancy Type ❑I,es owner of the propmy,or my employees with wages astheir sole compensation, 102 PIERS will do the work.and the s=nore is not intended or offerm for sale(ser. 10 3 — UFER Required Inspections Business and Professions Code:The Contractor a Licenu law does not apply mo an owner of property Who Guilds or improves thereon,and who does such work himself 104 — REBAR or through his own employees.provided Nat such improvements are not intended or 'offered for sale.If,however,the building or improvement is sold within one yea of 105 — ANCHOR BOLTS completion,Ne owner-builder will have the burden of proving run he did nor build or improve for Purpose of sal'.). 106 — SEWER & WATER ❑l, a mme:of the property,Am exclusively contracting with licensed contractors to 202 — UNDERFLOOR PLUMBING construct the project(see.7044,Business and Professions Code:)The Contractor's 203 — UNDERFLOOR MECHANICAL License Law dors not apply to an owner of property who builds or improves thereon, nM who comae¢for such Mijecrs with a mntraamf.)licensed pursuant to the 204 — UNDERFLOOR FRAME f irv`u �sco.cennde. .B&PC for this mason 205 — UNDERFLOORINSULATION Owner' Date 301 — ROUGH PLUMBING WORRER'5 COMPENSATION DECLARATION 302 — TUB & OR SHOWER I hereby affirm under penalty of perjury one a the following declarations: 303 — ROUGH MECHANICAL ❑ 1 hive and will maintain a Certificate of Consent to self-insum for Worker's 304 — ROUGH ELECTRICAL `.� Compensation, As Provided for by Section 3700 of the Labor Code, for the Performance of the work for which this permit is issued. 305 — FRAME ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 306 — HOLDOWNS 37W of the Labor Code,for the performance of the work for which this permit is 307 — INSULATION ed.My Workers Compc ismim I......c carter and Policy number arc: �tiq{f/ar5'TA 7F'FN/�'pohc�Y{[1na�r/—on2 /)0�' 0, 308 SHEETROCK - 5 - CAICATION OF EXEMPTION FROM WORKERS'( a 1 3 0 9' 1- . t)XTERI OR LATH' COMPENSATIONNSURANCE 31-0- -- INTERIOR LATH-- — rmissectlonneed not be completed if the Permit nfor mehundred donars SIM).,less.) 311 — SCRATCH COAT 1 certify than in the performance of the work for which this permit is issued,I 313 — ROOF NAIL .. - shall not employ any person in any manner so As to become.abject to the Werke. 501 — FINAL ELECTRI CAL ENERGY Compeasmion Laws m Carmmie.Dale 502. — FINAL PLUMBING ENERGY Applicant NOTICETOAPPLICANT:If,after making this Certificate of Exemption,you should 503 — FINAL MECHANICAL ENERGY z becomesubject subjeco the Worker's Compensation Provisions of the Labor Code,you mush p hwithcemplywith.uchprovialon.orthisPermit"Ihedecmedavokad. 504 — FINAL BUILDING ENERGY,. r Fr', I CONSTRUMON LENDING AGENCY 505 — FINAL ELECTRICAL I hereby affirm thal there is a cons=ction lending agency for the performance a > of the work for which this Permit is issued(Sec.3097,Cr,C.) 506 — GAS TEST a �"Lc dAr'Name 507 = FINAL PLUMBING .z Lender'.Address I certify thio I have Rad this appllcarlon and.rate that Ne above information is 508 — FINAL MECHANICAL W-U t currents.Wild I agree to comply a w e all dry and weds ordinance and sate lows treating, 509 — FINAL GRADE O U .towthrove-cons=niogpMhvcbyauthorinpuposes.eolthisciryroemcrupon 510 — FINAL PLANNING ,y 96 the ew(We)agree Tee toned property m inspec tion ke p ep b"c gsW (Wj.dilaemsave,indcmapervswhihemyinaywayaCupertiainstsaid 514 — FINAL PUB IC WORKS F W liebilinia,judgmaa,coxa end apenus which may in any way accrve Against said U z CiIym consequence of the grarmting of pemtit. / ti A EGULA RSTANDS M'D LCOM WITIi ALI,NON INT Issued by: Date S vmormit"Pplicand imnor ate Re Will HA RDOUS MATERIALS DISCIASURE ' Win the appueanr m mmR wilding occupant vac er buMle haurAea.material Type of Roof As defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safeny Code.Section 255330,}? - 0Yes ° m _ All roofs.shal] be inspected.prior to any roofing material being installed. -'Wnithe.pphr.marraroRbuilai�go<rawmnRequipmenrareeviee:wnirn If a roof is installed without first obtaining an inspection, I agree to remove it bu=As air motaminantsesdefn y the Bay Ara.Air Quality Management dr.n all new materials for inspection. Applicant understands and will comply with 0Yas all non-point source regulations. 6Cs1if..ia e rad the herad s ma¢nals requirement undo Chaprer 6.95 of Ne ealth&Safety Code,Sections 25505.25533and 25534.1 undersand Nat ng iota.,curtrn I haveamn .t hat it is myresponsibility to notify the rcquimeaSignature of Applicant Date nthnriud.gat „e All roof coverings to be Class"B"or better OFFICE • • '- CITY OF CUPERTINO Z � Z�Gr CITY OF PERMIT APPLICATION FORM M CUPEkTINO APIC# Date: 7( G G vG G D 2 Building Address: Owner's Name: Phone #: s044- 9675-'y T-F2 Contractor:. License#: Gt Contact: Phone#: �- Applicant/Contractor: Fax#: /'Buildi�j Permit Info: Bldg Elect L s Plumb Mech escription: Residential: x Se:f AJ o en y. Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: p2-S-9 Ar chitect/Engineer: Valuation: o 0 U Type of Construction: Occupancy Group: s � Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V<= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING O 1 of jt 93 2 /[q3- 7 I /\ SUBMITTAL 0 )L' 0 2 2002 1 yy rAp �Tcli( Oe OORDINANCFS V 10 V-Y CUPOWY ° o/ � 12.1 SIGNED of as andrdloP tions MUST Thisset oba and It Isunbe kept on tt a � or alterations lawtul to ma,eanymission fromo�JoScp aS,1 w cut wotino.on same pept., pathe building oftht sPecilicattonthe stamp g uelit or to be D _ WY SHPLI NUT be rovision" Pit 0 cS OFFEN. royal of the vio ice o of any D c Fitt •� ,vPanv (e Ordina ice or State lav Gid vc64-c E PLOT PLANS CHF .KED B$ DA TE ylFc A ,vll G' 1) ZDATS • %t4— SUBMITTAL �A s �Y+ r [y- II ��, C�'"y.Y 0 2 2002 I 11 L ejr'R0vtV ill ACCOI�• U` I WITH THE CITY 06 CUPER IN DCNCES AN ORDINANCES ..)ATE [,ns set e: ns ano specifications MUST \i ite kept ca 1;.a iob at all times and it is ung avjiv; to ma a any changes or alterations e m :ant= xrhw w igen permission from `. he bu,d ng Cept.. 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