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02080095CITY OF CUPEK11NO BUILDING DIVISION PERMIT OR FOR CONTRACTOR INFORMATION: Bue l c D[ ESIQAK VALLEY RD. PERMITN(02080095 ISREGGRY BAKER fiTJ APPLICATIggIA511Y2002 //11 PIIONE: SAN["TARY NO. COMROLNO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICIiNS ED CONTRACTOR'S DECLARATION 9 te�tt,, �jb Description I hereby affirm Inas I am licensed under provisions of Chapter (commencing ADD 3 9 5 4 SQ with Seelion ]ag) of Division 3 of the Basaltic, and PrnfcssionnCwle, and my license is . . in fall lance and etfec, License Class Lic.I /� FINALE® DateContracun ARCHIILCI"S DECLARATION I understand my plans ,boll W used as public records MAY 0 5 2003 Licensed Professional OWNER -BUILDER DECLARATION I herchy al Grim that I am exempt from the Contractur's License law for the [� $ 88000 BUILDING following reason. (Sn'tion 7W m I.S. Business and PrdeminCode: Any city or county which requires a permit to construct, alter, improve, demolish. or repair any structure prior ro its iswunee, alit mquires the applicant Int such permit o file a signed...miter, 3421 An Qi3Ar09 Valuation that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commend ng with Section 70)ap of Division 3 of the Business and Professions Cock) or that he is exempt thcrtfrom and the basis for Ile alleged exemption. Any violation of N -N WRTO= 1 1 U N Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mom than rive hundred dollars (E50). 102 — PIERS ❑ I. as owner of the property, or my employees with wage% as their. side compensation. TJFER 103 Required Inspections will do the work, and the structure is not intended or offered for sale (Sec. 9144, Business and Profisna% Code: The Commander, License law does not apply to an owner of 104 - REBAR propeay who builds or improves Ihtmon, and who does such work himself or Through his swnemployecs, provided thalsuch[mprovemcrsare notintended nrnQcred rursale. If. 105 — ANCHOR BOLTS howeve, the building or improvement is wld within one year orcompletion. lneawner. 106 — SEWER & WATER builder will have the burden of proving that he did not build m improve for purpose of .,It.). 202 — UNDERFLOOR PLUMBING Oasmvner oflhe property. am ewlasivelyeanlratting with licensed eontamora to 203 — UNDERFLOOR MECHANICAL + swct the project (See. 714,1, Business and Proftssinns Code:) The Contractor's Li" cense law does not apply to an owner of property who Wilds or improves lhemon,and 204 - UNDERFLOOR FRAME who contracts forsuch projects with acontractm(s)licensed pursuant tothe Cmnmetor's' 205 — UNDERFLOOR INSULATION License Law. ❑ I am exempt under Sce. . B A, P C for this reason 301 — ROUGH PLUMBING -te v u v 302 — TUB & OR SHOWER WORKER'S COMPENSATION -ECL R [ON 303 — ROUGH MECHANICAL Ihereby amrmunder pensityOfimpair Due Ofthe folmwingdeclarations: 304 — ROUGH ELECTRICAL ❑ l have and will maintain a Certificate of Consent) self -insure for Worker'sCompem 305 — FRAME sation, u provided for by Section 3701 of the labor Code, for the performance of the work for which this permit is named. 306 — HOLDOWNS I leave and will maintain Worker's Compensation Insurance, m recleaned by Section 3 07 - INSULATION 3700.1 k, LaWr, Gale, for IN pcdorm ams of IN .,it for which this permit is issued. My worker's Compensation Insurance carrier and Policy number am: 308 — SHEETROCK Carrier: Policy No.: 309 — EXTERIOR LATH CERTIFICATE OF EXEMPTION FROM WORKERS' 310 — INTERIOR LATH COMPENSATION INSURANCE (Tbissection ncedma Wcomplued iflhe permit;, hoose hundreddollam($1W) 311 — SCRATCH COAT onlem,) 313 - ROOF NAIL I certify that in the Kill, oe of ha work or which his per.,(,s i.%wed.I shall not 501 — FINAL ELECTRICAL ENERGY empluYanYperserninanyy(yan� rsdka d�cm, sunfectmine Workers'Compensatinn lawaor Fahfomia.Dal✓ n!/ /— 502 503 — FINAL PLUMBING ENERGY - FINAL MECHANICAL ENERGY pp 1 /� A lila NOTIC APP :IL fmrbm'm"sCcmE'atcofEsempunn.yousnould Wcome subject to he worker:, Compensation provisions of the tiroir code, you must 504 — FINAL BUILDING ENERGY fordrwim comply with such provisions or Iris permit shall W deemed revoked. 505 — FINAL ELECTRICAL CONSTRUCTION LENDING 506 — GAS TEST agerAGENCY I hereby affirm bene %sect cnnstmnion lendingngagency for he Performance of ,he walk for whiehthis farm itisissued (sce.aan.Cir, C.) 507 — FINAL PLUMBING Isndcr's Name 508 - FINAL MECHANICAL lender's Address I certify Our 1 have «ad this ... licuti m and sum but Be above information is 509 — FINAL GRADE correct. I agree to comply with all city and county ordinances and slam laws refiring to 5 FINAL PLANNING building construction, and hereby anchorite representatives of this city m enter upon the abnve-menuoncd pmpeay(or inspection purposes. 14 FIN BLI CA W RKS (we) agree to save, indemnify and keep harmless the City of Cupertino against liabilities. judgments, costs and expenses which may in any way accrue against mid City in consequence of the of this permit. l granting APPLICANTUNDERSTANDg q,ND WILL COMPLY WITII AL1. NON -POINT Issued by: Date GULAT N O RCE RE[p1- f_%/a %1Re-roofs Type of Roof 'ignalme of ApplicanUCnmractor Date HAZARDOUS MAT' LR DISCLOSURE Will the applicant or furore but g teupanl suite or handle hamnous material a, defined by the Cupertino Muni al Code, chapter 9.12. and Be Health and Safely 'tide, Section25532adf All roofs shall be inspected prior to any roofing material being installed. sur If a roof is installed without first obtaining an inspection, I agree to remove wills a octant m meat ddmi , tr5t t ai , m devices which pp cupau y Amen mit hamNous air comaminan as cd by he Bay Area Air Quality Management all new materials for inspection. District ❑Yc, 11 I have read the humNous materials requirements under Chapter 6.95 of the Califor ria l R.1th& Safety Cad. Sections 25.515.35533 and 255311 understand hit if he building does not currently haw ale had that%is my rcsry+mib.1.1y to nnhytlr....Pant of he myaircmems whi mile be pdo %swan or accairea'''te itcu��ra��,nc"""y.', Signature of Applicant Date /,,, All roof coverings to be Class "B" or better Owr ,..Ihun,.da,cn Dam a��v, CITY OF CUPEPtT ]NO CITY OF CCUPERTIINO 0 2 o d' a' Y PERMIR\MU TIL 11 CATI ON FORM APN # Date: p0 0 V Ig dam: Building Address: MECHANICAL Owner's Name: Phone #: Ye y ",-5 e, C,�'0-6AS -/goo Contractor: II rr �x License #: t. Con. Tax for BQ Zone Contact: Phone #: Applicant/Contra tor: Fax #: ullding errnit Info: Bldg Elect Mech escriptiU—If w Residential: ' U d► Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: C) BELEC200 ArchitecUEngineer•ation: Va Des; 1.\(' r �5 $r60 C) 0 Type of Construction: Occ'apancy Group: Energy Add Multi BUILDING Quantity ]Fee ID Fee Description Fee Group 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 BELEC 1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL 13 EN ERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BNEWMULTI New Multi -family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical =MECHANICAL BNUCOMMP New Comm Plumb I PLUMBING 1 of 3 #— 0 X37.2 ooZ 0 ix w - hQ- UZ U tnQa OZt- �5&JZ =,n �aL af4 a0 UJ I. - La C .'apo xm� tt1�H tZa o�cs�c uj z z .r rn r-. aQ az UC wF F. a U CITY OF CUPERTINO BUILDING DIVISION PE1 RMIM®1CDt511. JL: �lyll }t c • ` °v: Bulr2It3c&1E_3EsOAK VALLEY RD. PERMIT N(02 0 8 0 0 9 5 GW EERY BAKER APPLICATIOIUVBT,5� 2 0 0 2 // '�- PHONE: SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o a 0 0 LICENSED CONTRACTOR'S DECLARATION 1 hereby affilm that I am licensed under provisions of Chapter 9 (commencing ADD Description 395.4 SQ with Section 7000) or Division 3 of the Business and Professions Code. and my license is , in full force and effecL License Class Lic. p Date Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the $88000 following reason. (Section 7031.5. Business and Professions Code: Any city or county which requires a permit w construct, alter, improve, demolish, or repair any structure prior to its issuance. also requires the applicant forsuch permit to file a signed statement that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the ;basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of NN Occupancy Type not more than five hundred dollars (1500). 102— PIERS ❑ I, 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. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of 104 - REBAR Required Inspections property who builds or improves thereon• and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, 105 - ANCHOR BOLTS however, the building or improvement is sold within one year of completion, the owner- 106 - SEWER & WATER builder will have the burden of proving that he did not build or improve for purpose of sale.). 202 — UNDERFLOOR PLUMBING as owner of the property, am exclusively contracting with licensed contractors to 203 — UNDERFLOOR MECHANICAL AoAtstruct the pmject (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and 204 — UNDERFLOOR FRAME who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's 205 — UNDERFLOOR INSULATION License Law. ❑ 1 am exempt under Sec. , B & PC for this reason 301 — ROUGH PLUMBING ow --. D to O U v 302 — TUB & OR SHOWER WORKER'S COMPENSATION DECL oN 303 - ROUGH MECHANICAL I hereby affirm under penalty or perjury one or the following declarations: 304 — ROUGH ELECTRICAL ❑ l have and will maintain a certificate or consent to self -insure for workers Compcn- 305 — FRAME sation, as provided for by Section 3700 of the tabor Code, for the performance of the work for which this permit is issued. 306 — HOLDOWNS ❑ I have and will maintain Workers Compensation Insurance, as required by Section 307 — INSULATION 3700 of the tabor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: 308 - S HEETROC K Carrier. Policy No.: 309 - EXTERIOR LATH CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 310 — INTERIOR LATH (fhisscction need not becompleted irthe permit is roronc hundreddollam(SI00) 311 — SCRATCH COAT or less.) 313 — ROOF NAIL 1 certify that in the perform ncc or the work for which this permit is issued, 1 shall not 501 — FINAL ELECTRICAL ENERGY employ any person in an nn r 5A t e m subject to the Workers' Compensation Laws of ali(omia. Da !/ �— 5 0 2 — FINAL PLUMBING ENERGY Applican� / 503 - FINAL MECHANICAL ENERGY NoTICl?ft APPZrCXRT. If, ftcr making this Certificate or Exemption• you should become subject to the Workers Compensation provisions of the Labor Code, you must 504 — FINAL BUILDING ENERGY forthwith comply with such provisions or this permit shall be deemed revoked. 505 — FINAL ELECTRICAL CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance or 506 — GAS TEST the work for which this permit is issued (Sec. 3097, Civ. C.) 507 — FINAL PLUMBING Lenders Name 508 - FINAL MECHANICAL Lenders Address 1 certify that 1 have read this application and state that the above information is 509 — F I NAL GRADE correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorirc representatives or this city to enter upon the 5 FINAL PLANNING above-mentioned property for inspection purposes.14 FIN UBL I C WORKS (We) agree to save, indemnify and keep harmless the City of Cupertino against Iiabilities,judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTAND WILL COMPLY WITH ALL NON -POINT Issued by: 4 ` Ca Date O RCEREGULAT N V2Re-roofs Type of Roof C7 /o ignature of Applicant/Contractor Date HAZARDOUS MA LS DISCLOSURE Will the applicant or future but g upant store or handle hazardous material as defined by the Cupertino Muni ' al Codc, Chapter 9.12, and the Health and Safely Code, Sermon 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes No If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or futu uildi cupant use equipment or devices which emit hazardous air contaminan as d ed by the Bay Area Air Quality Management all new materials for inspection. District? ❑ Ycs o 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health &SafetyCode. Sections 25505,25533 and 25534. 1 understand that ifthc building docs not currently have a tenon that i is my responsihility to notify the occupant of the rcquircmentawhi mu be prio nissuanccofaCerareateofOccupancy. Signature of Applicant Date 11 WOYM All roof coverings to be Class "B" or better Date Ow r or authorized agcn