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02080040BUILDING DIVISION PERMIT BUILDING ADDRESS: 20745 SCOFIELD DR M AND LUCILLE A PHONE: $.l'3Mg1YYYyVISI:fa116Rff:A LICENSED CONTRACTOR'S DECLARATION IM It M Nat 1 am littnxd under pppro islons of ch.p a, 9 (commencing withsasion )of Division3 of the Businexe WyPmfcasi... Cale. and my licenx I in pal a and effect. Q ✓�f s' I } b q can f 6J Lic. N D ccNN@@m�m Hs egeNi SSo4ATrt5 ARCHITECT'S DECurjtAT10N I understand my plans shall he uxd as ��II a records Licensed lamfessural OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following mason. (Section 7031.5, Business and Professions Cale: Any city orcounty which requires a permit to conmmst, olleq improve, demolish, or repair any structure prior m its issuance. also mquims the applicant for such pamd to Ble a signedof temeln or Nat he'll exempt therefrom and the basis for the alleged eruption. An, viotation of Section 703 L5 by any nMiicnm for a permit subjects the applicant to a aml penalty I of not mote than Eva hundred dollars ($5(W). ❑ 1, m owner of the property or my employees with wages as their sole compensation, -will'do the'work-and'the machine is a., intended or offend -for .1, sax: 96,4: Bulkiness said P,ofeasions Code: The Comracmr's License Law does not apply to an owner of property Who builds or improves thereon, and who does such work himxlf or through his own employees. provided that such improvements are not intended or offered for rule: If. however, building a limp. of prof is snot within one year of completion, the owned sale.). will have the buNen of proving that he did not build or impmve for purpou of sale.). ly contracting with licensed commemrs to and Professions Cade:) The Contractor's ❑tem exempt under Sec.` BAPCfmthis.xx. :name, : ..,-"' - "t" time „ WORKER'S COMPENSATION DECLARATION 1 hereby effrm underlpenally of perjury titre of the following declarations:- ❑ I have gaud -will mainuin o 6mduete'of Coniem'to self -insure for Worker's Compensation; as provided for Iby Section 37W of the Isbor Code. for she Performance of the work for which this permit is issued, ; 'art e i anJ P y be rc policy Ib 4 �4 41 o'a ? EKEM ON FROM WORKERS, - gsAT10N INSURANCEt'�-s'-• '• � "' - implcted if the penal, is for ane h odond dollars ;.I_-,•9 i... . _.. - . .. ,an provision; or this permit shut[ be deemed revoked. INSTRUCTION LENDING AGENCY 1'' `" r tti ie is'a conm xatbn lehding agency for the peifoniume, permit i; issued (sec 3W7, Civ C) '` iL. p[iciatim aad shim that the rdan a annotation is y and county ordinances and state laws relating ahonte remeientatives of this city to enter union any CONTRACTOR INFORMATION: HANSON & ASSOCIATES 1539 EL OSO DR (408)517-0300 f PERMIT NO 02080040 APPLICATION UB DATE 08/08/2002 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description VA REMODEL/ KITCHEN/ BATO(fi�0 FAMLY RM ry 1. APR 0 9 2003 BUILDING s 7 IONI: 1 Val "I., •,o OCCUp! 102 - PIERS Required lnspections cel• 103 - UFER ...._�._. _.._ .. REBAR _ -- - --- 105 - ANCHOR BOLTS SEWER__& -WATER._._r......_._ 202 - UNDERFLOOR PLUMBING ' " 2'0-3 - 'UNDERFLOOR —MECHANICAL'_-_._. 204 - UNDERFLOOR-' FRAME;,Ii' 205 - UNDERFLOOR INSULATION 301 - ROUGH PLUMBING 302 - TUB & OR SHOWER 303 - ROUGH MECHANICAL 304 - ROUGH ELECTRICAL 305 -, FRAME 306 - HOLDOWNS 307-" ' iINSULATION" :;. (: ty308� i `. 'SHEETROGK= 30'9cn-; EXTER-IOR.... LATH ---__..310""' INTERIOR LATH ' _.._..:_z_..33=1- - SCRATCH .COAT 313 - ROOF NAI'li 50.1 .... -..._FINAL_. ELECTRICAL .-ENERGY---..-- -.-.---..._____......._._. 502 - FINAL PLUMBING ENERGY _. 5.0.3 --------- ..FINAL _MECHANI CAL ..ENERGY ... ..... .,....... ------- ........ _.. 504 - FINAL BUILDING ENERGY'.:'' " 505 - FINAL ELECTRICAL 506 - GAS TEST .,.. 507 - FINAL PLUMBING I -'tY 508 - FINAL MECHANICAL 509 - FINAL GRADE 510 - FINAL MING 514 F` FTA WORKS Issued by: Date m (sre ntpifcanticommdror ': I ❑ le 'HAZARDOUS'MATERIALS DISCLOSURE 4 e,� Re roofs W 11 the 'pphcat rftuurt buJd ng acupem mortmhandle hazmd ,material defnr4 by the Cuperu M pal Cod Chops 9 12 nd the Health and safety - - - a <Sa w t x-1901 1 Ir d u s `OYe u. 1 dl_ I" j cteid' ngl_[.I q;,an1,Y:-rr. roofs shall. bFoofn matenal barn installed,_„_ hall.be ”: win topapplrc est (;~hire build $ anpamnseey tP ntore�yian w'nch _..All .Ins .aI ..__. If a roof is ins'falled4ithout first obtaining an inspecti6h;id'agree to`remove em t hazvtlous air c n<ammana as defined by the Boy Asea Au Quality Managemem Drmet L all new materials for ins ecnon Applicant understands and comply with aY� In -will = -all non point source pegulati'ons . a rl I - - 1 have'rtid'the hazaMous mut n IS lrcyn r6mems under'Chapier 6.95 of the' ,. . , ' Cal fomie Hwhh & S f ty Code; Seni s 23505; 25533 and 25576 I undemmnd that if,the building dyes not hmxpnant, that li is lnyresPpns 'lymnohfy Ne' '. -_ _..... ._.. ....... ' ccupwit of she u emems.whien:m - 'pdnr m suaact or Certificate me of , mn Pi y: of Applicant._. Dale ...Signature ..... .... . ... ... 1 -_ ._. All roof coverings to be Class B" or better - a ra thnrapeagent - curve ,y,, _.....__OFFICE f, ., � F • . _ .:..e_ r .. .. V , ole . n CITY CUPEkTINO MY OF CUEDIERTH4 FERMff 1L AFFLHCA JL JlO Y®RM APN # )Fee ED Date: Fee Group ` BAPPLOTHER O MECHANICAL Building Address: BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING Ow Name: BCONSTAXBQ Phone #: BUILDING W,r,s !LL / z-an BUILDING Contractor: BCONSTAXR License M BUILDING l D BELEC1000 51 ELECTRICAL Contact: BELEC1001 Phone M ELECTRICAL BELEC200 517-0306 ELECTRICAL Applicant/Contractor: B ENERGY Fax #: BUILDING BENERGYADD ti 5 l J BUILDING Buil in Permit Info: 13INVESTIGA (ec BUILDING BI g Elect Plumb Comm. Housing Mit. Fee BUILDING esial: n: , d � ///b �VQ, A I Aq Residential: BMNEWMULTI New Multi - Family Res MECHANICAL Sq.Ft. Floor Area: BNEWMULTI $/ ELECTRICAL Ar tect/Eng'neer: _ Valuation: YW r D M '„Cl I/i °'� New Comm Mechanical MECHANICAL Type of Construction: �1 11 Occupancy roup: PLUMBING J L �l / N UA�� 0 Quantiv )Fee ED Fee IDeseun ton Fee Group BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONS,TAXH 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 B ENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING 13INVESTIGA 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 PLUMBING loO uWOC SUE N Q V y 2 Q Z y [ � to u �- X�a� F u) a < FAO � rn a - uj XCo 0 ui ° c I-Z) i2C iZ z p 9� �E t G �- p CTTY OF CUPER'TINO BUELDING DIVISION (CO ll dl1t�' TOR 11.irlL' ® A` 71 ©N-. (CONTRACTOR gD � BUILDING ADDRESS: PERMIT NO. 20745 SCOFIELD DR HANSON & ASSOCIATES 02080040 TOgYnODNEY M AND LUCILLE A 1539 EL OSO DR APPLICATION 08 /08/2002 PHONE: • (408) 517 -0300 SANITARY NO. CONTROL NO. ARCHITECT(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u LICENSED CONTRACTOR'S DECLARATION J )b Description I hereby affirm that [ am licensed under AProfs of Chapter 9 (commencing with Section 000) of Division 3 of the Business Professions Code, and my license ' REMODEL/KITCHEN/BATH/WINDOW is a ful a and efl'ecL 0 I 1 / Cr 1 �7 J -f 1D FAMLY RM leer ass _ Lic. q D - Con "A "A.ttarJ • AsSOL1ATR ARCHITECT'S DECId!%2ATION I understand my plans shall be used as he records Licensed Professional OWNER- BUILDER DECLARATION 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 which requires a permit to construct, alter, improve, demolish, or repair any structure - prior to its issuance, also requires the applicant for such permit to file a signed statement " ` S ,'t. -Floor Area.,, -. ,`1 { ' Valuation thavite i5 licensed •pursuant toldt�leprdyisions of the Contractors License Law (Chapter 9 46g '3 (cornin with Secuon]1bd0) of Division of the Pusiness and Professions Code) or thai'he'is eiempt therefrom and the basis for the alleged exettipdon. Any violation (',i t uq' ; ,.� �., {� ; ? ,, -.. S t i 'A 't ` • - ; of Section 7031.5-by any applicant for a permit subjects the applicant to a civil penalty of not. mere than five hundred dollars (5500). - - APN Number Occupancy Type ❑ I, as ownerof the property, or my employees with wages as their sole compensation, 101 FOUNDATION 102 - PIERS Required Inspections, -will do the work, and the structure N nor intended or offered for sale (Sec. 7044, Business and professions Code: The Contractor's License Law does not apply to an owner of property Who builds or improves thereon, and who does such work himself 10 3 - UFER or through his own employees. provided that such improvements are not intended or - ,offered for sale. If, however, the building or improvement is fold within one'year'of _ 1-04 = REBAR , ' - completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). • - 105 - ANCHOR BOLTS " .... .. ��L3.[, as owner of.rhe,propeny, am exclusively contracting with licensed contractors to - 106..._ _SEWER_...& WATER--- -- '- -- - -- - - - ' construct the project (Sec. 7044, Business and Professions Code:) The Contractor's 2 O2 - UNDERFLOOR PLUMBING ' License Law does not apply to an owner of property who builds or improves thereon, .Land -who contracts for such projects with a contractor(sl licensed, pursuant to the . - -... -- __203 - UNDERFLOOR'- MECHANICAL' -" -` -- `-` - "- - • • -'-• Contractor's License Law. ❑ I am exempt under Sec.. - ' ', B & P C for this mason 204 - UNDERFLOOR FRAME',' 'Owner Date 205 - UNDERFLOOR INSULATION • " WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING I hereby affirm under penalty of perjury orie-of the following declarations: 302 - TUB & OR SHOWER ❑ 1 have and will maintain a Certificate of Consent to self -insure for Workers 303 - ROUGH MECHANICAL Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.. 304 - ROUGH ELECTRICAL ❑ I have and will maintain Workers Compensation Insurance, as required by Section 305 - FRAME 3700 of the Labor Code, for the performance of the work for which this permit is 306 - HOLDOWNS rand Policy number are: ' tbN BPISAYfbN issued. My Worker's,C�tmpensation Insurany5o?" , ._ ....,._.._ _- .... $TRtE ++tt ­U C ' "er)+fS4MFtJ GE FuN ji folic 16 jr 9 ,' 0 30.7 -„ T T CERTIFICATIONtOF EXEM - FROM•WOR KERS', . +3.08 ' : = 'SHEETROCK - COMPENSATION INSURANCE ' ' 3 fl 9 - - EXTERIOR''-LATH ' (This 3cctiori need not be completed if the permit is for one hundred dollars 310 - INTERIOR LATH ($ 100) or less.) - 311 - SCRATCH-COAT- I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject,to the Worker! 313 - ROOF NAIti � Compensation la vs of eahfomia: Date 'Applicant 501 - FINAL ELECTRICAL ENERGY. NOTICETOAPPLICANT: If. after making this Certificate of Exemption, youshould 502 - FINAL PLUMBING ENERGY become subject to the Workers Compensation, provisions of the Labor Code, you must forthwith comply with such provisions or thivpermit shall be deemed revoked. 503 - FINAL MECHANICAL ENERGY.. _ CONSTRUCTION LENDING AGENCY' 504 - FINAL BUILDING ENERGY I hereby affirm that there ii a construction lending agency-for 'the performance t 'of the Work for which this permit is issued (Sec. 3097, Civ. C.) . - FINAL ELECTRICAL 505 Lender's Name 506 - GAS TEST Lgnder's Address 507 - FINAL PLUMBING • I certify that I have read this application and state that the above information is a correct 1 agree to comply with all city and county ordinances and state laws relating 508 - FINAL MECHANICAL to building consuuctiod, and hereby authorize representatives of this city to enter upon j the above - mentioned property for inspection purposes. 509 - FINAL GRADE (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 said City in 510 - FINAL L I NG consequence of the gr rung of this eriilit. 'COMPLY 514 F` F A WORKS ./ AP CANT U: RSTAN S AND WI WITH ALL NO:' DINT I Issued by: Date S E c IGVS. 4 dfi 0 Si- rc o , pplicanVContra6tor Date j Re -roofs HAZARDOUS' MATERIALS DISCLOSURE ' Will the applicant or future building occupant store or handle hazardous,material Type pf Roof .. by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety - Code, Section 25532(p)? dY °s All roofs shall_be inspected priQZ to. any roofing material being installed. Will the apphcant'ot future building occupant use equipment or devices which If a roof is irisfalled' without first obtaining an'inspeetiob; 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 ❑Yet - all non -point source regulati ions. I have read the hazardbusma[erials requiremem[s under Chapter 6.95 of the 16nfornia Health & Safety Code, Sections 25505, 25533 and 25534 1 understand that if the building does not currently have a tenant. that it is my responsi ' ity to notify the occupant of the uirements which mus a met prior to issuance o of VCertitcate Pa R Signature of Applicant Date All roof coverings to be Class `rB" or better nee or au nmhized agent . Da[.a OFFICE