00090122 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
HUII.DING All>gF S6
1 PHIL LANE PERMIT NO.00090122
OWNER'S NAME: APPLICATIO S d Dp'I'
NO I_I � /c /201210
PHONE: SAN]"I'ARY NO. CONTROL NO.
G z Z ARCM 11iC/FiNGINEER BUILDING PERMIT INTO
00
E CC 131.I1G Ell PCT PLUMB MECII
F i W CI CI lUl I__I
LICENSED CON1 RAC'I'OR'S UIiCLARArioN Job Description
ZO l=O I hereby affirm that]an,licensed under fims kims of Chapter 9 mnmmencins .
lu xlth Sccf,m7IXMb,d Divi,i,m 3oflhc ltusin,xs anJ Prnfe„inns Gale.a,Wm lircnsc
< ;n ran bare:,ml enbrl 73�►7r� 229E LIVING SPACE/ 452 GARAGE
C z ce¢ Licen.cc Cla%a.CO
LL a LLoatc �OWI�'�"I'IFII
I"nxn i -�'
ais, LisCLARATION
wI hereby affirm,mm]an,exempt tiara the Cn umoor'x Licen,c Law for rite
L Z 6 fol4,x'in,reds....Section 7131.5.ltu,ine,v and Prae,arab Code Any dry or eaun,y
E x❑ which ayaire,a pecrou m con,tmct,niter,Improve,demolish,or repair any xtmemic /
i3� priorn,it,I.,ummq eln(mynlro,hcupplicum lursuch Weirlilariileexigncdstwemen,
mat be is licensed purotant to the pms;,inn,onite Commutes u¢me law(Chapter 9 Sq. Ft. Floor Area V�IIUat1'�7q
(comnmucing with Sectio 700X)of Division 3 of the Business and Professions Gide) $:_5410100
or non he Is cacmp,memfmn,:rod the bale for the alleged eaempunn.Any violation
of Serlion 7031.5 by arty Tplia,nl fn,a pamik sal1ccl,tee appllrant to a civil penahy
of not mom than Bee hundred dollars($5001, APN Number Orcuancy Type
❑L a,own,0In.propany.or by cam"l"yce,with vri"'ax fair-,ole eompe routdo,t. 2F 1 1 2026. 00
will do the work,and the,Imatute is no,intended or(acral lin,ale(See.7(A4.
Business and I'mfe,vons Cale:The Contractors License law docs not apply to an Required Inspections
r of property who build,of hnpravcv thereon,and who doe,such work.himself 101 — FOUNDATION
orvihnmgh Ills awn cmployem,rowidal that odea Itopnrvcmcros are nm imi nlcd or
(Neral ror,alc.If.hm,'Cven the huild;ng or impmvemmit is sold within one year of 102 — PIERS
n„nrlcoo ,mc—mribolderwill have the burden ofpmningthat hedid not build or
np ove p„y,(s,o 103 — LIFER
❑I,as ow net the property.am exclusively contracting with ficenmJ contractors it) 104 — REBAR ,
i�irouuet the project(see.70,04.Bosun„and rmre,sn,m Cwco"a Commtl(,s 105 — ANCHOR BOLTS
amne Lu,,dome not apply ,,an owner(t'prolva iy who ani Ids or Improves thcmom,
and who contracts for such pr)ject,xith a aontranoos)licensed pursuant to the 1 06 — SENER 2 WATER
Licemc Law.
❑I an,e.en,im,mder.ccic .B&r C rormi.,r.obn 202 — UNDERFLOOR PLUMBING
Dw'"`t °oic 203 — UNDERFLOOR MECHANICAL
WORKER'S COMPENSATION DECLARATION
I hereby ill code,pena]ty of]<,ianonvolf he tolwwing ledaraboo,: 204 — UNDERFLOOR FRAME
❑ 1 have waI will owidod a Ccy Secti nl'Conran, m self-immc for Worker's
205 — UNDERFLOOR INSULATION
c(mprmsaaon. a, provmcd Inc lir scream 37110 of the Labor bads, to, the 301 — ROUGH PLUMBING
pertonnance of the work for which his permit is ismN.
❑I have and will maim„in Marker',Co„tl,r,,,ano„Iroomoce.as m,brcd by S,elion 302 — TUR 8 0 R SHOWER
370()of he tame Coale,art the pert u.nce(f the work for which'his penin is 303 — ROUGH MECHANICAL
i,sned My W''YWI Coal...ion Insurance carrier and Policy numhr arc:
crerYf�15 n011orc,No.:yr2e1.zxI! d 304 — ROUGH ELECTRIQAL
CERTIFICATION OF EXEMPTION TROM WOIrshi S' 305 — FRAME
COMPENSATION INSURANCE
306 — PI01_DOl+1NS
p7,i„«eon nerd ora rte complemd ince Peron is for one lnandme eoaa,s - 307 — INSULATION
(su1Bl or Ier,a
I cendy that in the performance of the work for which This permit is issued.1 308 •- SHEETROCK
shall not employ any Person in any Branner,o as to nec"me subject to the Workers' 309 — EXTERIOR LATH
Con veon ion Laws of Cd,tnntla.Date
Alydlcan ,—
NOI'ICETDAPPLICANT:I1;aMrmusic,thisCcnlficnmofExcripium.youshould 31121 INTERIOR LATH
7 M(ttire.hj,ctlomeWorker,Compensationpro,mansnfineLawrCode,youmu,' 31. 1 — SCRATCH COAT
O O Ibnhwld,comply with such pruv War or this wount,hAI be deemed mvokcd.
2 CONSTRUCTION LENDING AGENCY 313 — ROOF NAIL
iIhemhyaffirm that them isacons,mcn(nlending agency for the perrom,aace 501 — FINAL ELECTRICAL ENERGY
of the work orwhich Iris ry'oul is d.uad(See Y07.Co.C.)
G p I.cmlrr Namc 502 — F I NAI- PLUMD I NG ENERGY
:D l I<nder',Addnc,
U 0 Icendyma(Ihas,mad'his upptictuantand ,am that mcahavelnlnnnminnis 503 — FINAL MECHANICAL ENERGY
et �QD
I.. P com .1 agme to comply xith all city mid county ntdmaumv and,tam laws mlaling 504 — FINAL NAL BUILDING ENERGY }�
O U rob Id' smien( Ili by tea p rives fthis c yl ter fa A
y ,,a,) m, n do I ,yI ,t I I 505 — FINAL ELECTRICAL `�\\
6. (W) grc nisi, J n 'fy ndk ,c came, City fColima ug,nxl __
N liabl i 1 JE Is. 1 1 c"
,es h hY any Y rm g root said 506 — GAS TEST
U :Z Ci,y,n c dor anudmg of lass nut.
A1'PLICAN7 s DS hYWITHAI No• 'olm' Issu 507 — FINAL PLUMBING. Date
r SOl' .E RCGU NS. ��
— r H_
Sign,i„bare( npp'e ILA'A,,, — — •Data Re-roofs 509 — FINAL GRADE
MALAR 5 Mding .p t share 5 andi
lull the a C"l"am w from"Pal Cg(,Chant score2,and
thehanl,loius Safety Type of Roof
„domedbyme 120).'n(M„nicipalcxm.G,npmrm.lz,amdm,B,a1m:,,nasafely 51.0 — FINAL PLANNING
C,rdc.5cction^_5.)2017
❑Yes 0N All roofs shall`61 fhspectFtJTI11Idf Ioh7h�Btdchldg 6al6Hi'olibeing installed.
Will the n),ream(.slurs,hood'„ng at r,a,a,mn.,l ordc.ire,which If a roof is insttUtib with(SiiOORt dbieihliQ(dn7inkpdtion, 1 agree to remove
emit limanbus an rn bouninans as defined by(lieBay Arco Air Costly hlnntgmnenl
District? all new materiplp[gr insp lr3gry: pliclaplI oderstands and will comply with
oyes 0N all non-point so ce u a ns
I has,read tee ha Mous malemalx myuimmcnls undo Chapin,(.m5 of he p ..t(�eriy re g ,�Qdr. I IV PROGRESS
Culifomiu Health Sa Sate,,Code.Sections 25505.35533 and 25534 1 undcaaand that
iI Ilie building dncv bol curcmly nave a,chub,,khan it in any rc,po....li ily ,,notify the
svrupam°>'u mems which,into,be mel prior,u fcsm,ne,of a C ream of
”""pa" Signature of Applicant Date
awn — i— >w�— All roof coverings to be Class`•B•' or better
OFFICE
OF
CI BUILDING DIVISION CONTRACTOR INFORMATION:
PERMIT T ;co_i-i.s-,l
BUILDNG ADDRESS: PERMIT NO.
19201 PHIL LANE 00090122
OWNER'S NAME: APPLICATION SUB DATE
MO LI 09/20/2000
PHONE: SANITARY NO. CONTROL NO.
G c z ARCHITECTfENOINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
N<i L I U CJ L_.I
y i LICENSED CONTRACTOR'S DECLARATION
•5„ Job Description
—0 1 hereby(1)of that I em licensed under provisions of Chapter 9(commencing 2296 LIVING SPACE/ 452 GARAGE
v,tm with full ion]ad effect, on3 ofihc Busincsn and Profcssiens Cole.and my bccnse
c,,2' Lice full forte end effect.
Ma V License Class ed x
Ulm Contractor
S Et O ARCHITECT'S DECLARATION
�;� 1 undcmand my plans shall W used as public records
3 Q O Livene=d Pmfaasi...I
a e OWNER-BUILDER DECLARATION
1 hemby affirm than 1 am exempt from he Contractor's License Law for the (e
C Z< following omomi.(section]oils.Business and Professions code:Any coy or county 0 2 3 4 0
E%0 which 9 Perot t construct, Iter, mprove,demolish,or repair any structure _ _
a. oro pn«t u uwe.alsorequ N provisions
dim Lt...
Lowdsmapter9
- -thatm J 'ficinwit pumukn m7M) sinr Ne theBur«aLicd Pe Low(Chapter Code) not s-f,r ,S;q' .};y,or:p,=�J,,! `�y-I is ' Valuation
(commencing with Section om an f Division 3 of the easuwss and Profess vi Cade) a l,a Pll3 1177 LL22SS -l7 l f
of that hers exempt Ianydiom end the Buis for the subjects
the ea Beano 10 Any violation
-of Section 7031.5 by any applicant 6r o permit object the applicant m a civil penalty
ofn«rmr.than Five hundred dollar(s5W). 101APN DATION � ''' Occupancy Type
C 1,as owner of rhe popeny,or my employees with wages as their side compensation.
will do the work,and Ne ato«um is hat inwndof or offered for sale(Sec.7614.
Business and Professions Code:The Contractor's License Law does not apply to an 103 — UFER Required Inspections,
owner s progeny Wim builds or improves Nawon.and who does inch work himself 10 4 — REBAR
or thmugb his own employees.povided Nsuch
Nat impromers as
vcnnot imendof or - t _
offend(or sale.If,however,the wading or improvement is sold within one your of 10 5 — ANCHOR BOLTS t' "' r
completion,the owner Wilde will have the Nolen of proving that he did not Wild or
improve for purpose of sale.). 106 - SEWER & WATER
ommus, herprjectSecny..mBusinexclusively
ssandtr«Profersi...Nimanmoatmem m 202 — UNDERFLOOR PLUMBING
icenseLow does
fapplyu aower,ssendar,w oNildxor)Theco doerema 203 — UNDERFLOOR MECHANICAL 1
License law dao nm rapplysuch
roan owner,of pmpmy who)lids ofd poom as t to the
and who mmrute for such projtt¢with a conuacmgs)littmed wrswm m the 204 — UNDERFLOORS FRAME- - - -- -
01 in exempt
pt madeense Law.
❑lam cacmpt under,Sec. ,B&PCfor this aason 205 — UNDERFLOOR' INSULATION
owner Date ' 301 — ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
I thereby off n under reality of Perjury one of following almlamtions:
303 — ROUGH MECHANICAL
0 1 have and win maintain a Certificate of Consent to self-inure for Workers 3 04 — ROUGH ELECTRICAL
Compensation, as provided for by Section 37W of the IJWr Code, for Ne
- - pnfmaccome of Ne work for which this permit n issued. 3 0 5 — FRAME '
C l have and will mainam Worker's Compensation Insurance,as required by Sectio, 3 06 - HOLDOWNS
3700 of the LAW,Coda for the pert.mance of he work for whim this permit is 3 07 — INSULATION '
sou d.My Workti's Coope satoo Insurance carrier and Policy_number am,-,•
308, - :t.SHEETROCK.
Carty. 1 �Poliry No.: a 't kAs 1.; ' r i _lis' f I;p..
l CERTIFICATION OF EXEMPTION FROM.WORKERS', - 309• EXTERIOR' LATH
COMPENSATION INSURANCE ' ........ .. . ...�—._.___ I
310 INTERIOR'LATH"'-' ' ."—
. .(This wdiioa woof a«W co a,loted ifthe read,is f«oa hundred dollen
(gKiDoorlem) 311 - SCRATCH COAT
Ice ploy at in Ne n in my a of the work for come subject
to the
issued,I
313 -..ROOF NAIL_
:non not employ any person in say marine sn as to become subject m rhe Workers' 315 - EXT SHEAR"'
Compcgsatmn laws of California.Dole -
.APPlicant501 - FINAL- ELECTRICAL ENERGY -
' - -
NOTICE TOAPPLICANT:If,after making this Certificate ofExemption.you should 502 — FINAL PLUMBING ENERGY
become subjttuo the Undone.Compensation Provisions of Na labor Cade,you must
zfonh iNeomplywiN.0=hProw.ion.o this p.is danxdamedaomd. 503 — FINAL MECHANICAL- ENERGY. _
CONSTRUCTION LENDING AGENCY 504 — FINAL BUILDING ENERGY . ' ' '
a y I hereby affirm that there is a construction lending agency for the p=rtoimance -
Ofineworkfor whicnthisremail iaissued(Sec.309].Co,C.) 505 FINAL ELECTRICAL
W Q Lender's Name . . .' - .. .
5.Z Uridors'Addase 506 - GAS TEST 1 t ^�QC� Qvei
'U'0507 — FINAL PLUMBING
.1. 1 artily then I hava reed this epplicaion and store that the ebova in(ornestion is /
[z'
correct.I agree to comply with all qty and county ordinances and state laws relating' 508 — FINAL MECHANICAL /�Zb/
0 V a Wilding constriction,and hereby authonm representatives o(this city up
to on., on 7 D/
p w Ne above mentioned property for inspection purposes. 509 - FINAL GRADE
tL (We)agrte to save,indemnify end kap hannlcss the City o(CupeGno against
Tit, uabil'nies,judgments,costs and expenses which may in any way active against mid 51 O — FINAL P I NG
UCity in consequence of the grunting of permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued 514 2., WORKS Date
_ SOURCE REGULATIONS. RT T
Signature ofA,pplicantrcontraamr " Daw: ,' Re-rckD6 - ROOF PLYWOOD NAIL
HAZARDOUS MATERIALS DISCLOSURE
will the pplicant- Torre Wilding oauwm am or handl ba'�m«n matmal Typeo f. — ROOF BATTENS _.
as def ed Ny Ne Cat int M Pel Code.Chapwr 9.12.aM thHealth and!Safety it cm SecY� 2$?21?j aoNo ' rj6;04j'=YROOFq .bN-PROGRESS
._ All roofs.shall be inspected prior to.any,roofing material being installed. . -
Willtheapplicantorfuture building ocupird use equipment or devices which If a roof is installedwithout first obtaining an inspection, I'agree'to`remove
emit hKardous air comamirhms as defined by the Bay Ama Air Quality Management
District] all new materials for inspection. Applicant understands and will comply with.
❑Yes 0N, all non-point source regulations. .
"1 have Health
&Safe,
e,Coovi'm tiosmoods 5W.requirements under 4.1 cou sow of Ne
Cthebuil Healths of cur Cade.Sectionsant,dal itis end25534.1 ty to notify
that
iftheofdring does notcurrently swhic most m.th prior myauance of isymaotit of
cbpam of Ne mquiremcnts which muni W mei prior m issuance of a Cenificete of
°c=upoine,. Signature of Applicant Date
Owner or authorized agent - Dam All roof coverings to be Class`B" or better
^' _ OFFICE -