02050134 CITY OF CUPERTINO
'.•-BUILDING'DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: .. PERMIT NO,
7893 ROBINDELL WY 020,s50n1�34
�IW 'A�JGO E AND E-PING S APPLIC05Y/22/2002
/•PHONE: SANITARY NO. CONTROL NO.
O ZZ ARCHITECDENGINEER: / BUILDING PERMIT INFO
❑ BLDG ELECT PLUMB MECH
i W
LICENSED CONTRACTOR'S DECLARATION
0 5„E . ." - - Job Description
O Z_.� 1 hereby R mm I am licenua under priwi ions of Chapter 9lcommOMing DEMO
F r_{_tu wiohSmiy ]0yU)of Divisi Sof the Business as fessiom Code.andmylicenx
'S4 ix in full h#gWnJ erfec
0 z a Licen ClaaaaFF Lic.p
O a U to Cotnmam liCl
W 0 fi+ ARCHITECT'S D
C—�.3 I undrnmnd my plans shall be used us p c mcoNs V
F
> \
i p:0 tLiccnsM Pmfcssiunal C
OWNER-BUILDER DECLARATION
hereby sec that I am cacmpt form she Contncmr's License Law fa the
7olldss'ing reason,(Smion]031.5.Business and Pmfcaions Code:Any city or caunry \ $13350
YC tub ch 9 permit t t Imnmprosc dem
oh.h p' y.wcmre
u,3 'I in as
ss also Tey ,—'he
th pplaam for
such permnmfleei -
s�w fn 1,,, .-_ ...
thht he ori dp.N ' me
h p moa of the Course Ltt uLa lCM1 laer9 s\ -3,6-Lq 910 flQOC(�ea�h TT vj+yyJ Valuation
co-oar.,
comm ra ng with Seci a ]0001 i D'vt form
3 of the Buslnet a J Proressiuns Code) I „ 1 v {v,s k,�
or that
be
d escmpi therefrom and the basis for she alleg<U aemptlon.Any violation
of Senion]03 ES by try applicant for a permit mbjcax the applicam to a civil penalty
nrnnt more than Rve hundred enuaa(asw). NO MN:R9Nk9 INSPECT ONS''; ' r'. Occupancy Type
Cl L as owner of da,pmpeny,or to,employees with wages astheir sole ema,m anon,
-wllVdo-the:work and the structure is not intended or offered for sale'(Sec:7BR,"' Required Inspections
'Business'and Professions CMe:The Contractor's License law does not a DS apply an 9 p
awnc
r of property Who Wilds or improver tremor,and who docs such work himself
or through his awn employehowever,t e u building
that such{m en,is sol ere not intended year or
.-or
for sale If;however,the buildin mvcmcni i sold within one (
ge hamlet,
yeldn
t,.pmvtion.the owner-W ilJer will have he Wrden of pmotng them he did not Wild or
improve for puryrx of salol.
zi colas ownerpothe property,am exclusivelycomrofengwiltlicensedmnuacmtsm ., • I' t,
_ - contact the project(Soy to a:Business end property
who
Cod,.)The Ces therw's
= License Law docs not apply m an owner of ampcny wM10 builds or improves t,to due
'_. land actors kens.for.Law_.projcxu.with a comtxmr(s).licenuJ pursant.m the
Conmactoh License law.,., -
--' esemtundcr Scc.' ", T' r�B&PCforthis¢ason Its"• L4'''c.it
I '
on" :F 44P k ' Date - +
WORKER'S COMPENSATION DECLARATION
ihereby vRrm under Penalty ofperjury,otte of the following declarations:
f YI; I have and will'mainmia a Ccnifieam or Consent I sem-imure for Worker's
T ti Compeamion, es porvided for by Section 3700 of the Lamm, Cale, for the
'performance of the work for which this permit is Issued.,
[; :❑1 have anE will mafniain Worker's Compemedon In£urunce,ai required by Section
a er IaMr'CoU< f r tM1 perform f the k f h h this permit rs
mid ed M Workc Co open.roost Imur nc orr d Pt li y ber ore �O _
i'"cFki'k10: t,
' ',:•!CERTIFlCATION OF E%EM F M.WORKERS, - �'+
- ���m COMPENSATION INSURANCE„''a L,_; -
stt: (Thi se2tvtnnecd nut W aimpleovi if the permit is for one hundred dollars
(51001 or lcasJ t ..y+, , . I
'n
7:-'rmiky thnr in the perfurmnncc'of the work Tor vv�bicri sh p< it is kWmd:I
t,hall not anploy'any sermon in any manner,so as hi becunac subject to the Workers'
Cmnpe.iianimi Laws of Ctilifumnint,Dte,
APPIct - ." ..... _...._. -_ ." ._ _ ._ _._ " . ._..._ ._.. __._" . ..
NOTICLTO API LICANf Ir mak gtn'.Cns rE' pt on,you sEnald 't• tt '•
0 becora xub)ttt to the Workefs Compens ton Prov s oris of to W Wr Cale,you must
forthwith comply with such provisions m this permit shall be dames mocked.
CONSTRUCTION LENDING AGENCY 'a
I h byIron that there c st et n lending ager y for the peiforman;e
W r f the work fm wheb thispe t is issued(See 30c17 Cis GI
..Ikndcfs Name-. . . .. _ ..=.. _ .... ".... .. ..... ....
Lender's Address
;•,1 ccnify that 1 have read this city
mumu o and some thin oho d wa i laws relating g
W- 'wren;I egrte to comply with all city ami county ordinance and<mm laws elating
'.0. ao building constmction,and hereby'huo' enoaives of ohih city to enter upon
f� .the b t dp perry f ectarrows.
tr•,
Q. (Wq ag 'i- de dya ep hmmlcss the city ofC p<nino 11 against /
h lieb 1 u I dg t, .t. see. yin any y gaiast said
U.Z City to tonscquFncc of th confirs 6,th pumit.
"'+ v1pPl.IGANTDNDEft kNDS VD ]OS 'LYWITHAL ' ''" I,NT
Issued by, Date
SOUR E RECULAT 5.
P tun apcan tinct Re roofs
a eof APP
,AZAR U MA RIALS DISCLOSURE
plic m f i W IJ' g upam tore or Handle haraNuus matcnal Type Of ROOF -
rdfed sh Cupen Tru '<ipa od Ch pt 913,and the Health and Safety 4�t j•%1_sj ty-• +• + ,_ .,
Cadc.S Yaam 255RW1 .1 ., ..tnY• l I �. a ! s �r'•:.5•i•1 r.:f it
- ' .. .All roofs.shall be.inspectedrprior to any.roofing.material.being.installed..
Will the applicant o'future building occupot use er,tipment or devices which If a roof is installed without first obtaining an inspecti66t ILagree�to}emove
mini bacandmis air ii.rumminam, defined by he Bay Arca Air Qumlity Management
D t cr all new materials for inspection.-.Applicant understands and will comply with,
all non-point source regulations', .,1 17 .l,
'I have matl the hazard ak reyairtments.under Chapter 6.95 of @e.
m
Cnlifomia Health&Safely tions 35505.25533 and 35534.1 undemmnd the,
if the Wilding doe!md ml M1d -a a that
it is my responsibility ai notify one
f occupant of,toe mqu men s tubi W no prior w issuance of n Certificate of
Occupancy..' t
'-• _ v Signature of Applicant, - _ _.- - - DateQKne, ,. . .
pdae m All roof coverings to be Class `B'r or better
OFFICE . _ .. ....
HT Y OF CUPERTEN00O /
CITY OF
Cu PTY OF FSE IT AI�I�UCCA` EGN FORM
APN# � �� � � Date: � A
uilding Addre_ss:,
19
13
Owner's Name: {�1-EPhone#i:1 qoe '77.3 - 146 e
Contractor: License M
Contact: ^^ (( 'Phone#'
5;e Nec�a�e 400 - 26 -7/ 70
A tJContraptor: Fax M
Build' g ermit Info:
Bldg t ,Plumb Mech
escription:
Residential: 6 ���� Commercial:
Sq.Ft.Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation42
:
-3
Type of Construction: Occupancy oup:
Quantity ]Fee RD ]Fee Description Fee Group
APTFEE EACH STORY OVER 3
HOTELFEE EACH STORY OVER 3
OFFICEFEE EACH STORY OVER 3
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
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BIENERGZY Eimeirgy BU[LDEN G
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm.Housing Mit. Fee BUILDING
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-FamilyRes MECHANICAL
BNEWMULTI New Multi-family Res ELECTRICAL
of3
0 (937S-
1
CITYOF CUPERTINO
BUILDING-DIVISIONP1 CONTRACTOR INYO ATEON.
9UILDING ADDRESS: PERMIT NO.
7893 ROBINDELL WY 02050134
AME: APPLICATION UB DA
HUGO E AND E-PING S 05f 22/2002
PHONE: SANITARY NO. CONTROL NO.
1
0 o o ARCHITECT/ENGINEER: J BUILDING PERMIT INFO
^ BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
y N z Job Description
Z
0 y !hereby affirm that I am licensed under prow'ions of Chapter 9(commencing DEMO
P in F-m with Sectin 7 )of Div"' 3 of the Business a fessions Code,and my license
z Y is in full f d effec
s 2 6 Licer Cl Lic.#
°' a u to Contractor
F
u,0< ARCHITECT'S D
�
y.� I understand my plans shall be used as pu c records
Lu
ria[ p p Licensed Professional
OWNER-BUILDER DECLARATION
m= I hereby affirm that I am exempt from the Contractor's License Law for the
following reason.(Section 7031.5,Business and Professions Code:Any city or county $13350
q whicKrcquires a permit to construct,alter,improve,demolish,or repair any structure
a 3_' prior toitsissuance,also requires the applicant for permit m file a signed statement
that tie i.klictnsed pursuant[o the provisions of the Contractors License Law(Chapter 9 3,6} .�tn Sl�.� .e1, i Valuation
(commencing with Section 7 of Divisicn 3 of the Bgsmess pnd Professions Code) 'i' ,1,, Y,'at tYJ'15,'1Oi'. f9't9 .r s .
or that he iA eiempi lherefromiaryd the basis for the alleged eaerpptlod.Any violation
of-Section 7031.5 by-arty applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars(S500).
NO AN V9NkO INSPECTIONS Occupancy Type
❑I,as owner of the property,or my employees with wages as their sole compensation,
wllldc the'work,And-the structure is not idtended or offered for sale(Sec.7044,'
Business and Piofessions Code:The Contractor's License Law does not apply to an Required Inspections'
owner of 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,however,the building or improvement is iold within one year of
completion,the owner-builder will have the burden of proving that he did not build or
improve for purpose of sale.).
-Li -- .__.. ..
- - . ... ... .. .. .- .. ..- ..._ . . . ._ _._._. .__.-.. _ ... _ ._ ._.. _ .... 7,-
<r. O l,� ..as owner of the property,am exclusively contracting with licensed contractors to "
construct the project(Sec.7044,Business and Profusions Code:)The Contractor's
--- License Law does not apply to an owner of property who builds or improves thereon,
,. _and.who contracts for.such.projects with a conuactor(s).licensed pursuant to the
_ Contractors License Law: .
❑1 am exempt under Sea B&P C for this reason
Owhei-' Date '
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury,one of the.following declarations:
❑ I have and will'rnaintain a Certificate of Consedt to self-insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
pertorrriance of the work for which this permit is issued.
❑I haveanti will riiaintaln Worker's Compensation lnsurince,as required by Section
3700.of the'Labor Code,for the jerfcrmance of the work for which this permit is
issued.My Worker c' tpensatlon Insurance carrier and Polity number
artier.
•CERT,IFICATION OF EXEM M.WORKERS',
., COMPENSATION INSURANCE.
'(This section need not be completed if the permit is for one hundred dollars -
(3100)or less.).
I certify that in the performance of the work for which this permit is issued,1 i -
shail not employ any person in any manner so as to become subject to the Workers'
Compensation Lawi of California.Date
Applicant - - - - -
NOTICE TO APPLICANT:If,'after making this Certificate of Exemption,you should
become subject to-the Workers Compensation provisions of the Labor Code,you must
® ® forthwith comply'with such provisions or this permit shall be deemed revoked.
•� "c6NSTRUCTION LENDING AGENCY '
I hereby'affinn That there is a construction lending agency for the performance
> of the work for which this permit is issued(Sec.3097,Civ,C_)
Le
nde'r's Name' _
Lender's Address ,
_ ® 1 certify that I have read this application and state that the above information is
:fidH 'correct;l agree to comply with all city and county ordinances and state laws relating
® (, to building constructidn,and hereby'au esentatives of this city to enter upon
�z the above-mentioned property for i action -oses.
es,j agree to save,Inde tfy as ep harmless the City of Cupertino against /
- w-,V] liabilities,judgments,costs d ses w ay in any way accrue against said
e� City in consequence of th ranting o rhi permit
q APPLICANT UNDER NDS VD
ON LYWITHAL OfiVT Issued b Date
OUR E REGULAT S. Y<
gnatgre of Ap can tract - D e Re-Ioofs
HAZAR U M.. RIALS DISCLOSURE
Will applicant or Euro build' g occupant store or handle hazardous material Type of Roof - - - - -
- at defined the Cupertino Mu icipa ode,Chapter 9.12,and the Health and Safety _
Code,S on 25532(a)^. • _
Yes' All roofs.shall be.inspected prior to any.roofing material.beinginstalled. _
• Will.the applicant or future building occupant use equipment or devices which If a roof is installed without fust obtaining an inspection;I''agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District! ` all new materials for inspection. Applicant understands and-will comply with
°'Yes all non-point source regulations,.
' I have read the hazard m s requirements under Chapter 6.95 of the
California Health&Safety d, coons 25505,25533 and 25134.I understand that _ _ -
if the pudding does not eptly ha e a a that itis my responsibility to notify the
occupant of the req.' menu vhi be et prior'to issuance of a Certificate of
Occupancy. ignature of Applicant _•, Date
All roof coverings to be Class `B"or better
[) ner or orize to
OFFICE