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02030102 CITY I BUILDING DIIVC'ISSIIONVOPERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 10600 +/-PORTAL AV CUSAC CONSTRUCTIO;7 INC 02030102 OWNER'S NAME: APPLICATION SUB DATE CALIFORNIA WATER SERVICE CO 12842 VALLEY VIEW ST 03/20/2002 NONE: (714) 898-5747 SANITARY NO. CONTROL NO. O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO edr BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION • z I hereby affirm that 1 um licensed tinea bovilimosof Chapter 9(commenci I ng Job Desch t -ith S<ction](Ipp)of Division Sof the Bust dl'rofcssions CWC.end my liccnu INSTAL 2 STROAGE SHEDINALED ;x lZ is in fulll'orccanp r(�c' OG9 (8X8 EACH) =to ou a Li<cnse ClaD_f.`t 9 Cz.V Umc.uM - s 3 0 Dare/ 737 GH�CT S DPCLA` OCT 17 2002 g I understand my plans shall W used as public records ;JAi JEa� o LL Li<emud Proficutionid BUILDING o OWNER-exempt RDECLARATION 1 herby affirm the 1 am exempt from the Contractor i e:A.,c Law for the F 3 a which re reason.(Section 7031.5,Business and improve. demolish, Code:Any tiny or county O which requires a permit m ronswn,aper,improve,demolieh,or repair any structure we so es priori t c 9 the applicant for such permit to file a signed statement .. . _._ ...-.._. ._ ..-_.._ .__ ta. hat hys Taco. dp „nim to the Provisions of the Contactor a License Law(Chapter 9 S Ft.,Flopr Area ? , - ;�,, Valuation coed nrmg to sent on,]OW)arD'v,ion3onne Business and Professions coee) { I; x,,'!d tit_ , t_.' t au,! - or that he is exempt thiref mn'sod the basis for the aR foad euempn°d.Any violation .of section 73711:3 by any applicant for a broot subjects the applicant to a civil Penalty - 'of cut 0v than five hundred daha,Mgt). APN Number i� Occupancy Type °1,as owner of the property,Or my employees with wages as their sole compcosaion. -will do'the"wank.add the'sweureSs cut intended'Oroffered for sale(See:7044: 102 - PIERS Required Inspections ]= 'Business Code:The CoThe Contractor's License Low does not apply to on q p ` owner of property who build,or improve,thercom and whe does such work hima.f 103 - UFER or through his own employees.provided that such ion orernm,art nil imended or -offcied for Elbe lChowever,the buildin --" t issold wirhin one sear-of - -- --" -' "" -_ - --`:'-;---- --- --- -------- ` - ge burden 104 REBAR improvvion,the owneobu ley.will have the buNcn of proving that he did not build or ` improve Tor pnrPos or sale.3. 105 - ANCHOR BOLTS __... ... - --_--- - — — . _. ... _. .._.. _ - _ .. ..- °E es owner oIII he property a1.exclusively contacting with limnud c Commons to - C :`]"i.: • .., . License theoc.project(see.]tau,ownerBusiness and property whops code:.The contactor, 2 02 - UNDERFLOOR PLUMBING , License Low docs not apply m an owner of progeny who builds or improves thctmn, and who.eonuans for such.pmjcna with wtomacmr(s),ficen,ed puaurad ta.tbe .-. ".._-- -2 0-3- UNDERFLOOR MECHANI CAL- '- Contaeors license Low, . O l am esa,cRt onde,Sec.' ,8&PC Twin,reason 204 - UNDERFLOOR• 'FRAME ' � owner. Gari " ' ' ' " '' 205 - UNDERFLOOR INSULATION -'WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING ihereby.M...derpenaltyofpejury'one oflhe fol lowing declarations: SO2 - TUB & OR SHOWER ° l have Em 'and will imnuo'acons `Cerl of enrto stiff...re In,Worker, 3 03 - ROUGH MECHANICAL ComPcnseion, as provided for by Section 37M of the Letter Code, for the - Performance of the work for whichthis permit isisvurd,; 304 - ROUGH ELECTRICAL OI have and will mainiaiti Worker's Colnpcusmion Insurance,ai required by,Smion 3 05 - FRAME - 3700 of the Labor Code,for the performance of the work'for'which this permit is 3 0 6 - HOEDOWNS issued M�y,Worker,Co pc- d' 1 rant c e and Po.icynumberace amen glrnrKI,�� - y �394 - �,, •• 307 tINSULATION" CERTIFlCATION OFEXEMFROMWORKERS" _ 3'(]81'nS HF F'I'R�C K9 i..'.•, COMPENSATION INSURANCE'S __-_- - - 309 .;_EXTERIOR—liATH . .. __ . f1T c un bn aced not be iomplered if the permit is for one hundred dollars _ " ($IW)orlcss.l 310 INTERIOR LATH flatnth p f fth wink for whicht pe t'. issued.'I 311. .._, SCRATCH COAT cqApplicanto.y manor t become b lu theWorkers ... 313 - ROOF NAILi ` sl^i ,npe. t employ. oic 11 Date ' 501..-...FINAL _ELECTRICAL...ENERGY.- _. ......_ NO'1 ICE IO APPLICANT If.ane Woking to C�rrfi,ioe of Exemption,yad mould 502 - FINAL PLUMBING ENERGY ODbecome subject to the Workers Ctimperoationprovsmn.s of the Labor Code,you must ronnwitncotdplyulitn,urnproviafonaortni,permitanaubcaecmedrcvokea. 503 FINAL..MECHANICAL ENERGY.. -._,..-,._ CONSTRUCTION LENDING AGENCY 504 - FINAL BUILDING ENERGY a > I hcmby effem that here is ii e6ristruction lending agency for th'performance - oftbew ekfarwhichmsspangsi,issued(s a 309],Civ.Cl . --_ 505 _ FINAL ELECTRICAL yG -Lecar'INomc:., ......_..ter.-. .. . . . ._ - 506 � GAS� TEST . . .._ .. _ . _. .. ._._ . ._ ..... . _ .. Z linden',A4droo, +- .. .. V O 1 rectify ihm 1 have rted this epPliution and stat thanhe above information is 507 - FINAL PLUMBING Ise-.F. 6;ecr.I agree to comply with all city and county ordinances and state laws slating 508 - FINAL MECHANICAL O.itJ to building construction:and hereby authonce repsaenatives of this city to enter upon >,.W the aMve.megnoped property for map redo purposes.,, •. 509 - FINAL GRADE . t: (W 1W Fre id save indertmlfy and kap hdnnlesa the City or Cupertino against - .. to babdt 1 gmcm,.c t eeapcn ,which v n r r «roe against said 510 FINAL PL ING V z citygenceofthepyyyntng fthiip n 514(`.- IN WORKS Al' LIC UNI F S K�S ANb WILL MI LY WITH ALL ON P 1 Issued by: Date nc of Aprlican ontreno 1 note Re-roofs W II the up' plieant or furore Wildingecu ant stone or handle hazard as defined by the Cuperl Municipal Cde.Chapter 9.13.and the Health and at .b _. .Type Of Roof HAZARDOU5 MATERIALS DISCLOSURE .ma Safety ., CM s ti 2ss3Hq) " - t r r.t 1`. 'Z .j k .. , E;Yes '_ - .,° , r t _All roofs shall bemspec[ed poor[o_any roofing matena] being installed,.- Will the pd to far,,;;b Mag p qmp devices which If a roof is installed.without first obtaining an Inspection, I agree.to remove •I h adou a e um antaz d r ed by the 8 y Area Ai7ousslay Mimaigaborm' all new materials for inspection Applicant understands and will comply with ❑Y fj'+° , t all"'- n-point source regulations - I nave read the hazardous mmenols requirements under Chapter 695 of the Cal if°mia HEnlm&safety,Code)Sections 35505.25533 end 23534,I undersand that -'ftheb IdJoe scum tlyh earn t tM1 t t' yre po b.tyt ratify the oceup t It eq h h must tan pr t usuo ce of C n ficate of Occ pa k 3 /x2 Signature of Applicant Date _ W.< n,need age—fie, All roof coverings to be Class B" or better- 16 - I .OFFICE INO CIBUTLDI,Nc urvESSIONPERMIT • CONTRACTOR MORMATIOO BUILDING ADDRESS: PERMIT NO. 10600 +/-PORTAL AV CUSAC CONSTRUCTION INC 02030102 OWNER'S NAME: APPLICAPON SU DATE CALIFORNIA WATER SERVICE CO 12842 VALLEY VIEW ST 03/202002 (-1• PHONE: (714) 898-5747 USANTRY NO. CONTROL NO. ' 'elWO 00 o RCHITER/ENGINEER: BUILDING PERMIT INFO g F BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 6„? Chapter Job Description IbenbyarnrmNmlamBanxdundmpundPio..rmCodp..hd.,IW,(commencmg INSTAL 2 STROAGE SHEDS . with Section]000]of Division 3 of the Busi ass and Professions Code.and my littnu 'oin"'Co w6 ecxlil! `fk9C (8[�X8 �EApCH) Dan S tin FUII�Il sea LE 13 u(r CHITECf'S Lid 9— If @Y�(� Og I understand my plans Nall be used es public rtcmds �� ;off Li<cnxd Professional o u 1 7 2002 o OWNER-BUILDERfrom Or C.Mos0N 1 hereby M.that 11. aempt from Ne Conunsmr's :Any c Law co the t i a followingmason (Section]031.5,Business and Professions Cade:Any city or county IFC which requires a permit,°construct,olteq improve demolish,m repair any structure mmmm a.3$ .prionoiu iuuaru.ata°rtquins Neopplicant fm such pumiuo Blea ska (Cl pm _ _ t he�is Bcepaea wmaantw Ne pionaim,,arthe canuamwe uceau L.w(Cn.p,ery Dor” Valuation (commencing with SeChm]000)of Division l of the Bu;mess aM Professions Code) _ or Nn nn fie is exempt therefrom iM Ne basis fm Ne alleged atinptio,l.My violationgi2n of genio0"",]ol LSbyany applicam far a permit sub sea Ne applinnt w a civil penalty 'of Out moxN—fi,chundred dollars SSW). APNNumber " Occupancy Type r 01.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(See.73441 10 2 - PIERS Required Inspections Businau and Professions Code:no Contractor's License Law does not apply to an owner of property Who builds or improves thereon,and who does such work himself 103 — UFER or through his own employees.provided Nat such improvements are not intended or :o Vied for sale.16'howevv the building or impiownient ii sold within one yea o104 f - -"_-' completion.the owneT.Wimerwill haveNeWNenofproving that hedid not Wild or - REBAR ., improve for purpose or sale.). 105 - ANCHOR BOLTS .._.....ex. _ 106 - ' SEWER_-&..WATER. . .. . .. ..... O I:u owner o(the Property,em BuOld siness d Professions with licensede Common m .. - iceuacs the present(see. to a,owner and property cndorl The veto tenon, 202 - UNDERFLOOR PLUMBING License low dee,not apply to an owner of property wha builds or improves Ncrcon, ar,d who.conmcu for suchprojects wits a.cemraetme>.licearxd pannam.on On - -203- -' UNDERFLOOR MECHANI CAL- Convactoes License Tow. ❑l am exempt under Sec. .B&PCfer Nis rtaxn 204 - UNDERFLOOR FRAME Owner q,ORKER'SCOMPFNSATIONDECLARATION 205 — UNDERFLOOR INSULATION 301 - ROUGH PLUMBING ' Ihereby affirm under pe.IY.f perjury one of the following declarations: 302 — TUB & OR SHOWER (r°• 1 n,ve.rid will maintain a Cenireen or Consent to self-insum for Worker's 303 — ROUGH MECHANICAL <e oa,=..ian, a; provided for by Section 37W of the labor Coda,for the ,fotmance of the work for which this permit is issued., 304 — ROUGH ELECTRICAL 01h.r<and win mumwri w°rlm r'a C,An pebsstien minn„ce.ai rtgavrtd 6y section 305 — FRAME 3]0o f,hL bar Code fa the pert rte, of N orkf Which this .it is 306 - HOLDOWNS Issued MyW kers COmpensau I 'unto c end Pdiey be c: 307''- INSULATION— I. em IFurtD . EMN PH t. EETROCK' .ccRnP]cncorSrPcwpsnnorrwsuFRnf°h1cz�oR1�ER� .... .._- 300-. `�- TERTOR'-liATI"I -...... ........ . .._ .. .._-- - ---.: rib,seemm�need not x'complemc f the permit a for one hundred dollen INTERIOR LATH (s100)or less) . ;I .-.._ ..o ane ... . . - _ eemrr Nat in Ne performance ar,Ncwed for which this permit is iaa,ea,1 - SCRATCH H � COAT. . . . ... .. .•. _..:... -- dull nod employ any person in any manner eo'u to become mbject tb Ne Workers 313 — ROOF NAIL .501. F..INAL ..ELECTRICAL. Compensation laws of Cebfomia.Data Appueane. __, - - ENERGY....-_, _..., . . NOTICE TO APPLICANT:If.after making this Cenificne of Exemption.you should 502 - FINAL PLUMBING ENERGY be moe,ubjaua the Worker,Compenndism mWisimrs of the labor Coda you must 0fonhwiaiComplyWithsuchprovisionsorthispermitshalltedeemx[revoked. 503. -. FINAL-MECHANICAL ENERGY.. C v CONSTRUCTIONLENDINOAOENCY 504 - FINAL BUILDING ENERGY-. 1 h by affirm N,them ,a construe lending gent,fm theperform cc of the workr Which this perms isis.cd l3 '3077cit.C.l ;, 505 — FINAL ELECTRICAL Lenchn'.Name D7Zl<oda,Aap,Rx��--- 506 - GAS TEST - VO .,1 ccnify Nat I have read this...icnkm and state Na the above information i, 507 - FINAL PLUMBING 1 .:Fs tmle'cr 1 agree m comply with a]city and roomy Coinsure,and nate law,relating 508 - FINAL MECHANICAL Q:V to buil ding consuuction:and hereby adthOriaemPmunutlV6 or this city to curer upon , .W Ne alw .memmm,d pmpeny I.,impaction purpoxi.... 5 0 9 - F I NAL GRADE pis (W gree id save,indemnify and kvp hlmJeu the City''of Cupertino against n -(At hab itis j gmeem.cmta and aape.v,.men mar to war accroe.gtdits,said 510 - FINAL P I NG V,,z City in a equence of he a ting or Nis pcmdC; • AP sec set. s,wow¢-LMeLxivml'nLL •ori.Pfl 514 - IN WORKS 5 - . . C..� Issued by: Date of'ApphcanV oomemm ::'.' •' .' •- Re-roofs p HAZkRD0U5 MATERIALSDISCLOSU i WFII y 0.C idant m future ip Wilding ottChWerem 6,needle Heallom mmeriel Type Of Roof. . .. .. .. - .r. as defined:Si.by the @pcmno Municipal Cpde @spiv 911 and the Health and Sal ty Cod 5 u 55370 p I. +]• 11, p: f y � - i'. riY°a f' °^ i a • ^ .All,roofs shall be inspected prior to any,toofing.ma[erial,being,installed------ . _... 'Will th.applicant m fymre b Wing cvpent tau equipment or devices which If a roof is installed without first obtaining an inspection;I agree.to remove emit havrdous air con inaMls a dermad by Ne Bay Ambt Ail QuahT,Manugcmcm' Elyes all`non= Dint source re u,attons Applicant understands and will comply with District' _all new materials for inspection. 's. 1 have toed Ju it ovammenela mquimmems undo Che iv 6.85 of the California Hi O&Safety Coda Scctiom 75505,5533 and 553x.I undcmend Nat f he build dans nock y lonve.temnt that t s y re'P.Milhilny to notify,the tit upait Nc requf 9 Which mustq, et p m w'ruen or a Cemfcate of ' °`'° Signature of Applicant •Date All roof coverings to be Class"B"or better` w e Nonzd ag m m OFFICE.. ..... . ... ....... ... : ..... .._.... .. ._. - -. ..... ;t( '1 CITY OF CUPERTINO p Z o,3 CUPERTINO PERMIT APPLICATION FORM Date: # 316 - 3 - 3 - ao- aoo-Z li o� o o Pdg�� Auz Oilwn ' Name: 9 Phone 21.t� 6i -14m--k 9 vsc� COf6 Contract �� sT �� License#: f g,3 Y-2 4 5Contact: � � Phone#: ld cow uL {" 1 Applicant/Co ctor: Fax #: Building Permit Info: Bldg Elect Plumb Mech Job Description Ie�ial: —TAT—W4— 2 Sq.Ft. Floor Area: q. .. Architect/Engineer: ( Valuat' Type of Construction: Occup Group: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI 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 17�Ss,- 1 of 3 2-17 , 7. Adik �+Povcr, 3ne3nr IN ACCORDA',CE WITH TI E CITY Of' iviaoa , CUP_ERTINO ES ANn ",• � JRDINANCES DATE SIGNED This sef ,)f pans bs ked. on i"e ''""'cdhons MUST Df H7 Iswfr to mr„re c s nd it is un J UOp F nP mc, or alterations th, Iv^ ,ssion fror. d,nc , , .. . MAR 2 0 2002 r . . isn .I 't t.no. , _J ,"j spccificah,ns y JC l'C rI t 11 ; ,;r to h n the v1 iatn;n i any rr an '� .nance ,r ;, p tsionr All dt(e Ldw N r L ri z8 copy IP � w It � dQ D=c =6000T I Y I—vv•o7i t5.TJ.j r 2 HUM A 1H a ENGINEERING TITLE: °AT& M. STA34-01 (north of) 10602 NORTH PORTAL AVE. GpJ-IF0RH�q CUPERTINO, CA. 95014 Zan DISTRICT: DATE: SCALE: PROJECT ID.: PLAT NO.: PUT sur LAS 1/17/02 1"=60' 00000562 P19 "AVON � O V DRAWN BY: CHECKED BY: APPROVED BY: DWG. NO.: Nrer� �F9 SERq�G� MSUTo an ❑ A8 BWT DEPARTMENT REVISION: El DE ANZA BLVD \ y w V i as VlSin 0 �� 3NVl ADNtla 3Atl A3NV1B ro � m O i O m T m — 3AV 1tl1a0d "3 n A g v n0 CSD � � atloa 3eiom avoa aeion 0) 2 � O 0 ■ o- -q m ND D 0Z � > 00 Z -� Z u N > 3 SZ mm' o w ?„ cz sr m� m� z Ln N� O m �A�mm ND n� � u D6 � ZZ o n 7O 0 ucVLno NN my3-1 z �N O,Z Or'D O r (� 0 O m S Vl OM O m 7 qx S R.O �j C O S Z ^' wN<nAm oN �o -i< Mm c m C) 1 N ADZ u Om ZSI� nm � m0 N N r C O O O, , O( cm,) .Zlm mO C7-)m pr'a O D `7y� y m m ,� 7 O D m K 0y p-� m mC �3 r*-fi � ��\) per Zr m� r ~ .ZOIC m \ / �^i Grp p~ N 0em�?7 m F 1:1 -tom W �N� vcic r o CD f n m n m O`A m O 2 m ■ y m //�� 2 m O Z O n cn mm O Z -,c CA \ N .,m F Ln m0 D G-n--i m Z Z O m �^ zA p O o N o o C m _ O D y L=� n � L" 0 0 N v t" Ny .1 o:Q. 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AI22rom "� o ra TO—PC NOI.LVLS sV'I � N 4 sra•asersn :aae>.nN s A aar3