02030099 CITY OF CUPERTINO - - - -
BmLDING DMSION FERMI 'CONTRACTORLINF,ORMATI*;_:
BUILDWG ADDRESS: PERMIT NO.
10880 NORTHPOINT 02030099
OWNER'S NAME: APPLICATION SUB DATE
NORTHPOINT H.O.A. 03/20/2002
PHONE:
3 20 2002
PHONE: SANITARY NO. CONTROL NO.
G . ARCHITECr/ENGINEER: BUILDING PERMIT INFO
he i BLDG ELECT PLUMB MECH
U Description
2 LICENSED CONTRACTOR'SDECLARATION JObDhon
Z_;, I hereby eRm that 1 am licensed under provisions of Chapter 9(commencing
In with Section 7")ofDivi,i.3ufthoBu ncxavedProesionsCode,and mylicense REMODEL EXISTING POOL CABANA.
c x s: is i. ..a and affect. �(p
`p W V pittns7v�essz -CooMLN[@ac��� �{�y�� ®
i7 ARCHITECT'S DEO(ARATION B— �g•�
g 1 understand my plans shall b used as public records MAY 1 4 2002
i i p o Licensed Professional
OWNER-BUILDER DECLARATION
w 1 hereby affirm that 1 am exempt from the Conmetor's License Law for the
?G following reason.(Section 70313.Business and Prefixal..Code:Any city or countyBUILDING
�I L��NG $5 O O 0 0
which mcphres a peemit m conswct,Minn.impm,e,demolish,or repair any nrvnurt
3 prion.its iuvence,also require.dus appL,.tI.such purr ter fit eeslgmd,,.0 mem
that he is licensed Puuuu)IQ the previsions of th.Co. .&.License law _(Chager 9 �`q ]'f, pyo
(commencing with Sation j(p0)of Division Sof the Butiness evil Profgaians[ode> ;.'; ;;:..'3':3 TOY1']OTLr:�TAa; ': t Valuation
or Net he is exempt thehfmm and the basis for the alleged eacmptiou.Any violnion 'v
of Section 7031.5 by my epplicnerf.a permit subjects the appliesn to a civil penalty `
of em mors than live hundred dollars($5M). 101APN$0 ATION - Occupancy Type
1:11,as owner of the property,or my employe.with wages es their We cempem,uhm, 102 - PIERS
w'ilf do the'work,and the structure is not intended.e offered(.'sale(Sec.7044. -
Business'and'Professions Cod.:The Commerce's License law does not apply m an 103 - UFER Required Inspections''
owner of property Who Wilds or improves thereon,end who does such work himself
or through his own employees,provided that such improvements are n.intended or 104 - REBAR
comfitna pletion,
sale:iLer Wildethelhaof Wild
- - -.... ..... . _
tiding or improvemem is sold-within one-year of 10 5 - ANCHOR BOLTS •, I' - -
c.mpleton,the owner Wilder will have the When of proving that he did not Wild.r � !
Improve forp.pos..f.ae.). 106 - SEWER & WATER
sive _-- -.._...__ .sive-._.__-gait. . .-_.. _. _ UNDERFLOOR PLUMB
fl 1,as owner a[the pmpcnY,am exclusively contracting with licensed conbaeren to 2 0 2 _
construct the project(Sec.7W.Business and Professions Code:)The Conmmor s 2 O 3 - UNDERFLOOR MECHANICAL
License law does not apply t.an owner of property who builds.Impmva thereon,
aW.oW.CrmUm..f0s AUCh Preynct4wnh a.convect .licamod.pursuant m the.
Contractor.ext License Ipw.. . s
- - 204 UNDERFLOOR FRAME
_.. .
❑Tem exempt under Set. " ' 'B RPCfonhis rt. 1 205 - UNDERFLOOR:' INSULATION
owner " Daie`' " 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
Thereby affirm under penalty of perjuryone of(he following dedentions: 303 - ROUGH MECHANICAL
sV�
( O I have and'wlll maituin a Certificate of Consent to selRinsurc for Worker's 304 - ROUGH ELECTRICAL
Compensation;as provided for by Section-3700 of the Labor Code, for the
perf.munce of the work(.which this Permit is issued. 3 O 5 - FRAME
'- ❑l hack eW will meiniiin Waitees Coinpmgation lnsoronce,'0 nuptired by Section 3 06 - HOLDOWNS
3700'A the labor Cade,for'Ne perfohnance'of the ivolk'for which this pare,is 3 07 — INSULATION
, Issued My Workers C repe'n,te�rt. ......
Insret.and Policy numere. '
c ee6bbfTi�YenCpolay 3�0000007oz/J 308' '' SHEETROCK. - ^
c TIFICATION OF EXEMPTICR FROMworyKEas, 09`�'�; XTEI�IOR •L71TH
" - COMPENSATION INSIIRANCE;„'• t,
,._,.... .... ._.....-.._.. _ .,...... .....-'3T0 ;--.�I3TERi0R...LATH,---:-.,...__._ .
Cfhn uction'tixd n.be core aired it
p pcmdt is f.one hundred dollars
(s�oo).neu.) , 311% -; SCRATCH COAT
tai cer4ry ih:i,io as"perfoimetrce of the woik Lir which,rn'permi,fi iv�:df] _.. 313' ROOF NA'LIr�-t.. :.:. ._ •-: •--••.,•.•...• ••.._. .. _.
shag not emplay any kwon in an?muner,ao ai to bmbme mbjwt to the Workers 501 — FINAL .ELECTRI CAL t ENERGY
Camk xislian Uws df Celifomia.Date.
- 502 .. . .FINAL. PLUMBING ENERGY_
'NOnCE TO APP LICANT:IL Co nukmg thtsnim., f tof he Labor C ,you should --
bewmeicomplothe WochprCoionsor is permitsnseftheLab.C,cfuYou mum 503 - FINAL MECHANICAL 'ENERGY
o p' foMwithcomplywittii.c '. isionsmthispermitshallhdeem_ rt .... -50.4 .FINAL -.BUILDING ENERGT
•..d�,fCONSTRUCTION LENDING AGEN
E~ hereby am nm,tmae;,ea.n; ,ianleedinge; f. pwd m, a 505 - FINAL ELECTRICAL
of the work far which this permit is iuveE(Sa:3077,Clv.C.) "
m'� Leen506 GAS TEST ”
c.z —sours -" .:. :. 507 FINAL PLUMBING
F 1 cmify Chet application I lure read applicationted nem that Ne above information is
508 - FINAL MECHANI CAL
t fs'Eat mWJm
coriem.I egret to epmplY with all city W county,o)dinu.es and state law..[all.& 509 - FINAL GRADE
: 0.V dingnsemaion;aridhertby eutAoriu mpr ritives clads city m emaupon
' W tbeebov.-mxmi.oW,pr_operrryry rya in.pectj.npurpme... 510 — FINAL PLANNING
o-A,t (We)epee to sive,inEEwify and keep harmlm the 06 of C.PertfAo igeinn -
L)L limibtie t,judgmequ.c..g and perces which may in my way accrue egumt,uid 514 FINAL PUBLIC- WORKS
C.1;Z City in consequence of the grating of N pevNt. "
PLICANT Uf BSTAND AND L COMPLY WITH ALL'�'ON^-POINT"
oDRCE. noys/ �- Issued by: Date d Z
Stgnemrc ofAppI1exQt/Cwrmwt.1 i •'.:-*"." .•. DateRe-roofs
HAZARDOUS MATERIALS DISCLOSURE " ''
"! Will the applhan,.future Wilding oecap int note s handle humdoi¢mat:nal - Type Of ROOT... ..
udefi W by.th Cupemno My cpalCodP ChePtcr— mdth HNth and Sefcry "' - '
Cede Oyes 25332(a)+1 5 e.'1 i . .•
All rogfs shall be inspected poor to.any roofingmatenal being installed.
Wits tn.appr�mt or f m tiling oc pmt use Air Qm.t Management nn If a roof is installed without first obtaining an ins ection;I a ree to iemove
em t hawili the ah lit t o, a defined by the Bey a ee equipment
Qat or Mites when g p g
itLEK_�
°ianoiT all new materials for inspection. Applicant understands and will comply,with
" alCnoti-point sourceregulations:t a sad rte havrdous memntla regmrcments under Chepind 91 b(Va
eilth&SefdyCede,Sectins 73505;15533.W25534.1 understand the,g doss poi curtemly hove a un ,that a Is my r¢ponnb Ivy to notify the' -' -f the rcqu' m nu whuh'mus met p o m u}umee of a Certifies.of., .. _. . _SignatureofApplicant Datetire rtgW ager, All roof coverings to be Class "B"or better
"
S ? ti A.t_'...;—�•-, .�t - __ - - -- .- {_ -OFFICE .. . . .. ._ ..._ .. ..._ . . .. _
C• OF CUPERTINO 3 `r'` Y 7
CUPITY OF ERTINO PERMIT APPLICATION FORM
_ Date:
Building Address:
Owner's Name: Phone#: f}7$ '4+ •� 'f"'�
No I 01to � , O u '2 sS 977
Contractor: License#:
Ca,ti'S r c. ,rl 73-82Y Z 3
Contact: 11 Phone#:
13iL� h, FLOvA-'1—lfUfW1/9tU �2e7—e)65'f
Applicant/Contractor: Fax #:
?Sq.Ft.
Permit'Info:
Elect Plumb Lech�)
ription:
ial: A Commercial:
oor ea: $/Sq.Ft.:
Architect/Engineer: Valuation:
Type of Construction: Occupancy Gr p:
L
uantiFee ID Fee Description Fee Group
ty ION
THER Other Appliances MECHANICAL
EE BldgPermits . foot BUILDING
1 Boiler<= 100,000 Btu MECHANICAL
2Boiler> 100K to 500K Btu MECHANICAL
3 Boiler> 500K to 1M Btu MECHANICAL
4 Boiler> 1Mto 1.75 M BtuMECHANICAL
R5Boiler> 1.75MBtu MECHANICAL
AX Construction Tax BUILDING
AX Ind/Off/Comm/ uasi BUILDING
AXB Con. Tax for B Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELECI000 Elec 600V <= 1000A ELECTRICAL
13ELEC1001 Elec 600V> 1000A ELECTRICAL
BFLEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
• BMITIGATC Comm. Housin Mit. Fee BUILDING
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CITY
DISONO
VIIINPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10880 NORTHPOINT 02030099
OWNER'S NAME: APPLIG TION SyB DATE
NORTHPOINT H.O.A. 0320/ 2002
K
HONE: SANITARY NO. CONTROL NO.
COO ARCHITECTIENGINEER: BUILDING PERMIT INFO
m{ BLDG ELECT PLUMB MECH
<L I_�
y 2 LICENSED CONTRACTOR'S DECLARATION Ob 1
5 Z-C 1 hereby affnm that I am licensed under provisions of Chapter 9(commencing
_„i: xmhSedon7000)ofDivision3ofineeyinessandPrnm::ionsCode.andmyr=ense REMODEL EXISTING POO & .
S e4.7 J is �y1yf Tee end ellen .X
0 < Laren Class a,1 �7 /� �s�v z i MAY Y 4 20p
OyU p mkJd
3 cu G ARCHITECTS DEKkRAT1ON 2
u
i seg 1 unaersiand my plans shall be used as public records �ElkDl��
ep
So O Licensed Professional
HE OWNER-BUILDER DECLARATION
1 hereby affirthat I am exempt from the Contractor's License Law for the
t?a m following reason.(Section 7031.5.Business and Professions Coda Any city or county
$50000
f D which requires a permit to consumer.alter.improve,demolish,or repair any structure
prior to its issuances also requires the applicant for such pmmluo File a signed matemem _ v_1 __ -----------
__-
Nit he is licensed pursuing to the provisions of the Contraeors License Law(Chapter 9 _
�`p �.,k ),�r�,r a• Valuation
(c omni he is exem Seebefirai'and sion of the xcmn tbai cions Code) ( �{;`s'�'t3.Yg0•Y V/(�Tz .'�7`Bsi�j��}'L:�,, {}`��
or that he is 31.5 b therefrom end the basis for the sts the aempdbn Any violation -of Secnot mo 7031.5 by airy hundred
dollars a permit subjects me applicant to a civil penalty
-nrnmmriretnanrvenundreddnnar<(ssoB). 101APN41Mh4bATION Occupancy Type
❑Las owner of the progeny,or my employees with waxes as their sole compensation.
will-do the work,and the structure'is not-imended or offered for sale(Sec:764',- -
Businds'nnd'Piofessions Code:The Contractor's License Law does not apply to as 103 - UFER Required Inspections:•r - r I (f
toner of property Who builds or improves thereon,and who does such work himself 104 - REBAR _
or efed g6 his own employees.provided that melt improvements are not intended or
oReica fo'r sale.If.nawever,
the Wildin t rs solJ:ithin ons.. .( _ --” -"'-' - " - '
gorimen r4prn yearn 105 - ANCHOR BOLTS •T sr' .., ... .,. ..,.�
improve for the owner-builder will have the burden r4proving that he aid net bulla or
im�roverorpurposeor,dej 106 - SEWER & WATER
---- sively ---- --- _. ... - — -
- — -
❑1,I owner ,, property,am Business and contracting Cods.)The
menscal contractors - r.Ul :'ri 't'I 'r
ocensetIh awoesn (see,]Baa.ownero dnaProRadobildsorThevestmcrore 203 - UNDERFLOOR MECHANICAL"
License Law dues not apply wan owner of progeny who builds lir improves thereon, ' '`''
_dna who.eonuaeu.ror.:volt projects with..eomranru(,).Eceased.pursvam.m the. ...- _ ---2 04- UNDERFLOOR"FRAME ------- ------- —
Comrac ors License Law.. , ,,
[31 mnexemptnnder Seo.' P:,9'k P C fim,hi,ma,.n 205 - UNDERFLOOR:' INSULATION
Own r Date " 3 01 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
Ihereby afrmmaker tenalryofa;urynm6,orthe,following declarations: 303 - ROUGH MECHANICAL
❑ I have dad will mammin a cenm=am of Consent to self-insure for Workers 3 04 - ROUGH ELECTRICAL
Compensation, as provided for by Sectioa-3700 of the Labor Code, for the
'performance of the work for which this permit is issued. 3 0 5 - FRAME
❑1 have and'*in mamma iVoikcr's Conrpaurchion Insurance,'as requileJ by Seelon 3 06 - HOLDOWNS
3700 of the Labor'Cde,for the performance of the work for which this Permitis 3 07 - INSULATION
.. issued.My Workers Compensation Insurance carter and Policy.number are: - . ' I N ON
_. 308' --, SHEETROCK, -
�c er wY itN� n4polcy :`37 shmzr ca 070L
' CERTIFICATIONOFEXEMPT FROM WORKERS', I: ' 4 . 309 �'-'a'EXTERIOR ^LATH
COMPTNSATION INSURANCE - _ _ _ -.— _.-_-
3'1'0 .3NTERIOR -LATH —1;tl ,
,:u, (Thissectnnri dnotbeeammtdifthepermtisforonehundreddollars 311'*' -' SCRATCH COAT
(slot) 1 )
. 1 mlry tht`nmeperr nn it nom-certnr. ,teal 313 -- ROOF -NAIL-'; . . _...
sh'ull alt mnpl1,any pe nany mann to became object worker, 501 - FINAL ELECTRI'CAli'iENERGY ?
Cmr,ameuion laws of California. ale: -" L" b.
_Appirchi r' , . , "• - 502._-. .FINAL_ PLUMBING - ENERGY_
NOTICE TO APPLICANT If,after ournagtph Cemgga�e of Eaempeonlyqu should 503 - FINAL MECHANI CAL'ENSRGY
Q 0 become b3'eu theta k C npedsat pro . ns of to lab C de;you must
conn Mcomply with inchp ons of this permit shall Is,deemed invoked, - .FINAL -BUILDING- ENERG_X
CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
a'; Ih -by ff hat th conn tI fine a8c Yf the perruim - `-__.. ..
nfthe workrprwnmrh psairsh srssud(S 3309],Civ Cj ' _ _ 506 GAS TEST
'Lrndefg Nims,.: w ... .-- ....:L _..__..__.._. r._. _.." ----
p;z Leader,Address:'-;:'.. ---, 507 FINAL PLUMBING ...
v=o 'l, 508 - FINAL MECHANICAli
I certify that I have read this application and state that the above inrorm.rion is
tat.-F:. eone6.I agree m comply with all city and county.ordlnances and state laws relating 509 - FINAL GRADE
C.0 rebuildingconstruction,and hereby authorize mprcsenmtve
isofthis city to enter upon 510 - FINAL PLANNING
�+,r� the ahovamemioned property for inspection purposes._ .
Q. We)her m cove,indemnify keep harmless the City of CLpcnino against
rex liabilities,judgments,costs and expenses which,may in any way acerae.,am,,,aid 514 FINAL PUB IC WORKS
' U Ciryy �� consequence of the granting of th':permnit.
.- OPLI NTUNATIpTANDAND CLCOMPLYWTTHALLOIS BIT"'
Issued by: ! Date OL
Y / eSig t r rApplicanVc r eo Dnte Re-roofs
HAZARDOUS MATERIALS DISCLOSURE' 'l
W the applicant o futurt Wading ottapant store or.handle hauNous mat nal _ Type Of ROOF
as defined by to CupertinoMunicipal Cad Chapter 9.12.and theH It it S !cry -
Crah S t 25532ta) \, l t 'r,' .... »N i s,,v.• 3 t., r..r i" •fir'. i .' . t r.
El yes \ No l All roofs shall be inspectedprior to any,roofing.material being.installed._.—
Will the applicant or f tore Building occupant use equipmentrdev«:wenn If a roof is installed without firs[obtaining an inspection', Pal tui iemove
�m t h yard nam is is defined by tl Bay Arca A Q I ty M.agement
mom - all new materials for inspection. Applicant understands and will comply-with
❑Yes... - .: - .. - ..
" 'all hon-point source-tegula[ions. : 1
1 h read the hazardous material requirements under Chapter 695'of the
'California Health&Safety cads.Sections 2550l25533 and 25534.1 uderstad that
iftheb'td n6 do5 not u eyh
at, t that tr mybet'r hilly hil t notify th<
occ p r of to t h ch mus t prior.i"iss enle' Fi e Cenifcme of
re re
Oc pathey. Sign_atu_re_of_Applicant Date
J Za)o
`~ oxnero awmri cd agent.., 'Dme - All roof coverings to be Class"B"or better
_..
OFFICE.