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04110100Oz z F� aQ az UO OU U �z CITY OF CUPERTINO &-�x0%teWNTP. T - BUILDING DIVISION PERSs%- �u , BUILDING ADDRESS: PERMIT NIb4 11010 0 7482 SHADOWHILL LN NER'S NAME: PERMIT ISSUE DATE RALPH QUALLS JR. 'PHONE: SANITARY NO. CONTROL NO. ARCHITEC UNGINEER: BUILDING PERMIT INFO - _ L ELECT PLUMB MECH LICENSEDCONTRACTOR'SDECLARATION JobEncli 'ALE® 1 hemby affirm that 1 am licensed under provisions of Chapter Y (commencing with Section 7") of Division 3 of the Business and Professions Code, and my license is I. BACKYARD FENCE icanmmaonderr« License Class Lic. X DEC �$ 2004 °arc Gama Ice ARCHITECTS DECLARATION 1 understand my plain ¢hall he teterecords( as public Licensed oval OWNER -BUILDER DECLARATION ArchyPrefic. I hreaso vRtrm thin 11. cacmpl from Ne Contractor's License Law for the BUILDING o following mason. (Section 7(131.5, Business and ince Code: Any city ter county w. de which a permit reconstruct, Amer. improve, demolish. or mash any structure - is isa prior Ill liscensed e. prison to resthe prevision of the Och Conractor'laLicense Law(Chapt ant that he encinwit pursuant theeBUSimrsnlaw(Chapmr9 Sq. Ft. Floor Area Valuation Section? ) of Division r the Cads) at (eat exempt Pmfcon. _ " he is xempth Any vi that he is exempt therefrom and the basis for the alleged exemption. Any violation of and the basis the aged Section 7031.3 by any applicant far a permit subjects the applicant to a civil penally of e Occupancy Type no, not more the. five hundred dollars MOB). I, as owner of the property, or my employees with wages ss their ante compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business Required Inspections and Professions Cade: The Contactors License Law deny not apply to an Owner of property wha builds or improves Hereon. and who does such work himself ar through his we employers, provided Nal such improvements arc not Intended oroffemd forsam. If. however, one building or improvement is sold within one year of compledon, the owner - builder will have the burden of proving that he did not build or Improve for purpose of se.1. ;Q 1, as owner of the property. Am exclusively contacting with licensed contractors to c,.strum the project (Sec. 7044, Business and Professions Code:) The Contractor's Li cense law does not apply to an Owner of property who builds or improvea demon, and who contracts for such projects with a contractors) licensed pursuam in the Contractor's License Law. ❑ I inn exempt under Sec. , B A, P C for this meson . er Data WORKER'S COMPENSATION DECLARATION I hereby anon under penalty of perjury one of our following declarations: ❑ I have and will maintain a Certificate of Consent to self-maurc for Worker's Compact nation, as provided for by Section 3700 of the labor Code, for the performance of the work for which this permit is issued. ❑ 1 have unit will maintain Worker's Compensation Insurance, As required by Section 37W of, tabor Code, for the performance of the work for which this permit is issued. My Worker's Cmmpensaoon Insurance carrier and Policy number are: Carrier. + Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thisuction count be completed if the Permit is furore hundred studies (SIM) or less.) I certify Ibvl in The performance of the work for which this permit Is issucd. l shall not employ any person in any mannersn as to become subject to 'ar'r a Laws of Celifa a. D ApplicadV�r�y �4t NOTICE TUAPP I: If. eMr making this Cc 'Floats of Exemption, you should became subject se the Worker's Compensation provisions of the Labor Cade, you must forthwith comply with such provisions or this permit shall be doomed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the porformena of the work for which Nis permit is issued (Sec, 3097, Civ. C.) Lender's Nam, Lender's Address I certify that I nave read this application and sum that the above Inrolmaliun is correct I agree to comply with all city and county ordinances end sum laws relating to building construction, and hereby authorien aprcsentativen of this city to enter upon the ateme-mcntiunc l property for inspection purpous (We) agree to save, indemnify and keep harmless the City of Cupertino against Iiabili0es.judgmanu.ewts and expanses which may in any way scone againalmol City S In consequence of the granting of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date � SOURCE REGULATIONS. Re -roofs Type of Roof Signewreof ApplicaDau HAZARDOUS HAZARDOUOU S MATERIALS DISCLOSURE Will die or (alum building stare or handle As dermad a CA,Aam tiro Cupertino Municipal Coda Cdapmr 9.11, and the Health and Safely e, Chapter Health and otic, Schon 25533(a)7 io ❑Yes i47 No All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit navardous air contaminants As JCOncd by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes kfNu Ihe. &Safet Coda.SNouns 25305,2553als i and rds255unde ndimer6.95¢Dire Califor" ria HevlthASafetyhe ha Sections 15505,15533rem25534.1 r hrsuer .95 iftheordo building docs not currently have A IAAAAL thin it is my lespons, hifty to Amity the acupanl of the to uimm A icn in Ipdo is ce ja , 'nae ra`r� al ay.6a C ' Signature of Applicant Date All roof covenngs to be Class "B" or better Owner or authamed agent D,e • • D' FENCE APPROVAL CITY OF - CUPEIKT1N0 Community Development Department 10300 Torre Avenue Cupertino, CA 95014 (408) 777-330t 11.15. 0 (DATE) I am an adjoining property owner of P—A.LPW OUA-LLS (NAME) whose property is located at 74-b 2 > W4wT)r7 L'J%41 L.L- . Llsj (ADDRESS) I approve (as per Ordinance No. 686, Section 16.28.040 of the Cupertino �•� Municipal Code) the allowance of a foot high fence facing (8 FT. MAXIMUM) my property. SIGNED: 0 NAME: `l S 45 L?�t tiwuj ADDRESS: FENCE APPROVAL CITY Of CpEk ]NO Community Development Department 10300 Torre Avenue Cupertino, CA 95014 (408) 777-330! (DATE) I am an adjoining property owner of 2,P' L PW @ J A L L aa G 14 (NAME) whose property is located at 74V 2 J p 0 wX-k k 1— L 1J (ADDRESS) I approve (as per Ordinance No. 686, Section 16.28.040 of the Cupertino •t ., Municipal Code) the allowance of a i 13 foot high fence facing (8 FT. MAXIMUM) my property. SIGNED: NAME: 44 ADDRESS: , S 3i �* l til P;O W DQ 0 FENCE APPROVAL CITY Of CUPS TING Community Development Department 10300 Torre Avenue Cupertino, CA 95014 (408) 777-3301 11. 15. 0 (DATE) I am an adjoining property owner of P—Q L. W (NAME) whose property is located at 74-61-5 :�,npLoj %At LL . LN (ADDRESS) I approve (as per Ordinance No. 686, Section 16.28.040 of the Cupertino • Municipal Code) the allowance of a. —7 foot high fence facing (8 FT. MAXIMUM) my property. SIGNED: NAME:I.—'---- ADDRESS: Q -a ✓yoWWLL LN 0 . AP'PRK VZILn IN ACCORDANCE WITH THE CITY Oi CUPERTINO CODES AND ORDINANCES DATE- SEGNEP! This set of plans and specifications Must be kept on the job at all tunes and it is up, lawful to make any changes or alterations on same without written permission fro*t. the building Dept., City of Cupertino. The stamping of this plan and specdicafens SHALL NOT be held to permit or to be E—, 1pproval of the violation of any proyu= .inv Citv'firdniancP U' Stal- • pk54 0 i k�o'r PLANS CHEcxEID BY DAVE,�� PE.ANNPIG DEPj l� i Scc o n o 6-- o,V"aKIMOM DATE cl�cc`faIl � �eanc <�PfOVA� i 5 no'i WIG. ID) FTz ��r dsr 5necf _loy C7cvv�� 1V1 wv� Q RECEIVED NOV 16 2004 ! r -w 4 S`C�txv�ltl� E SCQ� U *�J � mail .11.. rm a� 11 CITY OF • CUPERTINO r L •CITY OF CUPERTINO• 4 Dg1101 DD PERMIT APPLICATION FORM APN # -3(:2-2, 3(:2-2, 09 Fee Group Date: h , lI b _ OLd Buildi g dress: L' - ^ (� ( Mailing Address (if different frombuildingaddress): OwTZs N me:(,., QV(� j f _ gyp' l 1C7 J r BBOILER2 Pho e. C,� _ _� MECHANICAL Contractor: Boiler > 500K to I M Btu MECHANICAL License #U: Contact: Phone: Fax: BBOILER5 Cupertino Business License#: Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ xTob Descri tio Residential '/� ( �Gs l� �G1 �e1n(� Commercial ❑ Sq.Ft. Floor Area: 'BCONSTAXBQ Con. Tax for BQ Zone $/Sq.Ft.: Cost o£Pr cO 4off Hotel,and Motel BUILDING Occupancy Group: Type Construction: BUILDING BELEC1000 Please check this box if the project is a second -story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ BELEC1001 Flee 600V > 1000A Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to I M 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 El cc 600V <= 1000A ELECTRICAL BELEC1001 Flee 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investi ation fee BUILDING 1 of 3