01030151 CITYOF DIVISION
NNO
BUILDING PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS. PERMIT NO.
7835 ORION LN I, 2 01030151
OWNER'S NAME: APPLICATION SUB DATE
AM B . K.DEVELOPMENT CORP. 03/27/2001
PHONE: m,T .1 SANITARY NO. CONTROL NO.
w°p ARCHITECTIENGINEEJER:O C•� BUILDING PERMIT INFO
DG RECT PWM MECH
L-J L-J L' I L
LICENSED CONTRACTOR'S DECLARATION
5 Job Description
°z_ I nan7 )em that 1 nm licensed anger provisions of..Code.and(commencing
F''4 wimseetforeandefect. n3onneBuanessandPmressinnscWe.andmyreen SFDWL 2296 SQ. FT. LIVING SPACE,
pm s� Is m fall force dna effect.
—ecrca u<easeCl LieN ov 756 SQ. FT. BASEMENT
x°aD Da" I contra"°' 427 SQ. FT. GARAGE
tat-u O CG' ARCHITECT'S DECLARATION
J 1 unJcraunJ my plans shall he aced m puMi<recoNs
a'
Sao Licensed Professional FINALED
OWNER-BUILDER DECLARATION
vi 1 reason.
.(Gent that 1 1 .u sin from the GonioCo ,Any c Law fur me
F' a following u res a(Semon 10715.Business andProfessionsimprove.
deli CWe:Any city or county
structure ed x D which requires a permit to co,snua,alma improve,demolish, fiele.sig any swnum
MA 3 0 7002
t;_ _mats saI. q ' topplcant fixwwho Cormarmh lolgeJsmmmem — F .-..._. -
(Dorn licensed parsu imthepf .t sof the Ce BusinesLicense La (Chapter -Sq. FI Floor-Area ,\ ,^ nation
(gam 'c ems r masa the sontmmellasnes d1 r.: nscWej � i3', ` . . , LSI r..s3.',s. {..7:v' $305515
or tont he is exempt thcrtfrom and the basis fm the alleged exemption.Any violation 1
of Section 70315 by any applicant fora permit aubjectc the applicant In.civil penalty ..
lwf not mart mad five hundred dollars t1500). 3 62�pplyyI �r
tSU 1 yin . Occupancy Type
O Lax owner of the property,or my employees with wase•as their role compensation,
—will'do he work:and the structure is may intended or offered for sale Sec:7044;
Business aid Professions Cade:The Contractor's License Law does not apply to an 101 - FOUNDAT IlbNuired Inspections" '
rih
owner of property Who builds or improves thereon,and who Jens such work himself
or ereou n his own employees. budded that,such improvements are not intended e yerm or 10 2 --_PIERS -_
offered of t ale.¢however,me 1„rJain tis stud within one �of "- ----" "-
completion,the owneohuilder will have the burden proving that he did not hu W or 10 3 - UFER :"'• "• '
improve for purpose or sale.). 104 - REBAR
OI as owner onhe property, 1 .'ely contracting with a v t rsto 105 - ANCHOR BOLTS
construct the project(Ser,7044 Rusincss and Professions CW )The Contractor's
U 1 0 r
License Law does not apply to an owner of property who milds or improves thereon 106 - SEWER & WATER -
''� " anJ.who.conees mah.pmjects with.a conerho licensed pursuart.t .- _
r 'enntm fors lJeemensefor emmo the w. 202 - UNDERFLOOR:;PLUMBING- -- -' —
--
❑IamexemptunderSec. ;B&P,C,rorthis reason _203 - UNDERFLOOR' MECHANICAL
own2r o`mfx" 204 - UNDERFLOOR FRAME
— 1'WORKER'S COMPENSATION DECLARATION 205 — UNDERFLOOR INSULATION
I hereby affirm under penahy or perjury,;nb or the following declarations: 301 - ROUGH PLUMBING
❑ I nave add w11i'moimmn a Cesifld;e of Chosen, to self-m.urt for W.sloos 3 02 - TUB & OR SHOWER
Compensation, as provided for by Section 37W of the Labor Code, for the
perrnrtnanee onndwnrk,for wm�n this pe�mit,i�i.xum.,,,., 303 - ROUGH MECHANICAL
- ❑I haWhrd will maintain Wmkcr'i Compensation his amnch.a va,r i]by Section 3 04 - ROUGH ELECTRICAL
3700 or the Labor Code.for the perrormanae or the work for-which this permit is
is.a a'Myw lan` pe . to insurance fie Policy'bumxr art _ 305 - FRAME �—
carrerShkNI, +r:'1� f PulicyN. 2�1S-N1 vrq 0 30,6+. -. HOLDOWNS- _. .,�.-, `:
'CERTIFICATION 5PExLmrr1ONFROM,W RKFRS y'" 307 — INSULATION
COSIPENSAT INSURANCE' " _ __
IThiA
f'' seclionnec1'not tie compined if the --308 „- , SHEETROCK-----� : .. �';t,;l;t.;;:' -.j•.
alwroe ras.l. t p<`mrt is for one hundred dollars 309 - EXTERIOR LATH
'-310"'-INTERIOR`LATH _
, ,'• Ic ri fYtht th pert
of kf h'ch it Permit t. fxlxed.l
t , IL
.hall not employ any,Person n any mann so as to become subject to the worker. 311 - SCRATCH COAT
Co'mpe . r L fClf a,Dm
313 -...ROOF NAIL
NOTICE
O z0bee me mTrOjcAcnPo the Worker's
Cionikinsatioth
provisions
rnv canes at f the
ELahovr,CSAer.you muIse
501 - FINAL ELECTRICAL ENERGY
ro,twanenmplywithsdenpn,.isinnso.mi.pemdtshanxrleemWrevokea. ...502 .FINAL- PLUMBING -ENERGY --
z''m "CONSTRUCTION LENDING AGENCY. 503 - FINAL MECHANICAL .ENERGY T
�-; ,I hcicby anion that mere is a'iorstmctlon fending agency for the lierfmmarwc s
ordhework forwhiahthis permitisi...rd(Set.3097,civ.C.). 504 - FINAL.-.BUILDING.-ENERGY., ,- .. _.._ _.... ...
'Lender's Name - _ _. —
=..z Le,aer,Adprese t . '. 505 FINAL ELECTRICAL,- ,
U O IeertifyihatIhavereadthisapplicationandstatethattheaboveinforiationis 506 - GAS TEST
J IT, F 'cosem.I agree to comply,with all city and county ordinances and stale laws miming5 07 - FINAL PLUMBING
� V
to building cnovoreion,and hereby authorize representruics of this city to enter upon
therhose-mgntionedpr,snyforinspectionpurposes, 508 - FINAL MECHANICAL
CLI (We)agree to save.indenmify and keep harmless the City of Cupertino against
F'ta liabilities,judgments,cost%and expenses which may in any way ar ms,agidnn said 5 0 9 - FINAL GRADE
U Z City s uc ce of the gr m ng n lhi.p t
IAPPI IC \eU DER. SM wILLCOMPLY'WITH ALL NON-POINT lO — FINAL PLANNING ---
so R T +; Issued Date !—�
8 Z4 v
sgnar a can c n < - D ot.; Re-roc6<)2 - ROOF PLYWOOD NAIL
HAZA SMrVERIALS DISCLOSURE rtf
Il the bpplicam or curt Wdthng acdpmt stoea o,hano,haralloab muerial _Type��30f•E. ROOF BATTENS.
asdernWbythe aKnim,,MgniyipalCWe.Chapter v,l2.andthe HedrhaadSafety '604"•- ' POO R4aIN-PROGRESSCode.Section
'`oven ., ❑No,l.. ; '. ...,'_;; r _ All roofs.shall_be.inspected.prior.to any.roofing material,being.installed......... ....
Will the applicam or future building occupant tire pBopmrnt or devices which If a roof is installedwithout first obtaining an inspection;'P agree'to.remove
emir hnimbler,air contaminants as defined by the Bay Area Air Quality Management
Districtall new materials for_inspection._Applicant understands and will comply with
❑Ye.'.' r 0 N n - all non-point source regulations_._
'1 have Teadvhe haadNous materials r,,cremmns under Chbpler 6.95 or the'
California Health&Safety CWe Sections 25505.25533 and 25534.1 understand that
ifibebuiWfng Joe�notchoreally veaenant.that it is my responsibility to notify the
cu er,bit c rt w ens t be mel ioc.to iss.inec of a Cenincate of
- o"fa 'y B .,e%' Signature of Applicant _ Date
Date All roof coverings to be Class"B"or better
ell ill OFFICE-
... ,... . . I,ke3