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02030206rA iy�y'll U' TL 0 1 I U, U, nn� CITY OF CUPERTINO BUILDING DIVISION PERMIT - CONTRACTOR INFORMATIC• BUIl.DWGADDRESS: PERMIT NO. 7459 STANFORD PL 02030206 OWNER'S NAME APPLICATION SUB DATE LIVIA SHIRKEY 03/27/2002 HONE: SANITARY NO. CONTROL NO. dS7-OYF3 ZO ARCHITECl/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH E u u71 i LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm w that 1 n licensed under provisions of Chapter 9 (commencing tj with Session 7000) of Division 3 of the Business and Professions Code, and my licenseSWAP o LOCATION OF DOOR/WINDOWS. Uisinfall foeandeffect. Licenrcu Class FIN LE® Date contractor ARCHITECT'S DECLARATION g1 undersand my [hull be used as rcords plans public .Sr R 3 O r/a APR `OO� OLicensed Professiowl OWNER -BUILDER DECLARATION / 1 hereby affiren that I am exempt from she Convenor's License law for the following reason. (Section Business and Professions Code: Any city m county BUILDING $looao o which requires a permit m construct, alar, improve, demolish, or repair my strustructureetu $,.prior to its issuance, also requires the applicant fm such Rmdtto file a signed statement .. - r §q,T Valuation - that be.i[ licensed pammintto,Nepm%isiomofbe, contractors LicenuLaw (Chapn9 (commencing with S«tion ]000) of Division 3 of Nc Hominess and Pmfes[ians Code? Any \ i 3 (�%®-��'.•, or that he is exempt therefrom and Nc basis for the alleged exempiori. violation of Section ]031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mom than fin hundred drill. 5(1 202" Nl`bMFrRFLOOR PLMBING' Occupancy Type ❑ I, s owner of the propenY. ter mY employees with wages es their sole compensation. will do the work, and the mucture is not intended or offered for sale (Sm. 7010, Baines and Profession[ Code: The Carriacou', License law docs not apply to an 502 — FINAL P EYWW(5sp$tlt BRGY or of property Who builds or improves thereon, and who does such work himself mroa{{n his can employee[. provided that such improvements we not intended or -'offered fat sale. If, however, the building or improvement is sold within one yew of 507 — FINAL PLUMBING completion; the owner -builder will have the burden of proving that he did not Wild re improve for purpose of sale.). co I, tr ow«r of the am con Inc with licensede mconstruct (Sec.7 Business Comnors the project (See. ]001, Business and Professions Code) The Contrweon, License law docs not apply men owner of Propertya.comm who builds or improve Oreo the and Who LOnlRns for such pm)[[a WIIh.,.LOnlfaLlor(a) IICCRYd paRYanl b InC .. _...:_ _.._ .._ _ _.-. .. .. ' Contnnofm License Lew. ° I am exempt ander S - 'B A P C far this rtuon , 00 Z' /�jL, �if :'OR 'S t. C PDamAT10N DELA N 1 hereby affirm under penalty of pe jury one of the following dedwations: a ❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker', Compensation, as provided for by Section 37M of the Labor Code, for Its, performance of the work far which this worm Is Issued. O 1 have and will maintain Workar's Compensation Insurance, as requmul by Section 3700 of the Labor Code, for the performance of the workfee which Nis Pistil is y Rn carrier and Policy number ere: ' I. ed. Wodeta Com a non Wurarce curt,. „ ^,_, _.-I •.,".,, •t ' Carni i e t ,. I s ''Policy No.: ,. ... • ..,.:: ., .-,_ .. _ a... _ .. .... , .. .. -I I .:. ., .. .. i. `''11 �. WORKERS"' CERTIFIC'COMPENATION t 'COMPENSATION \. _ 1 IOURANIC WSURANCE _ ` ''"(TNi sdtion necA not W completed if the permit is for one hundred dollars (S IW) or bu.) ' 1 unify Net in them in nynce ae the work for this permit a issued, l come Compete employ any in any manner so a to become subject to'the Workers' . f California.on law[ of CDare Applicant. ,NOTICETO APPLICANT.'IL you should tniw Cisions Compensation of Labor edle.yn. Compensation Provisions of Ne labor Codd, you Mat buomc objet to the WoArr'sst forthwith comply with such provisions or Nis petmn shell be deemed revoked. Pr •11 CON's"mu TION LENDINGAGENCY I hereby ,firm that them is a construction lending agenry fm the perforituntt' y of the work for which this patrol, is issuW Civ. LfMn'w Nen¢"........... .. ..... .... ..-...... ...,^. .. ... ... .. ___ ...._ Leadel4Addren, .' y 1 unify that 1 have read this application sty mute that theinn.. and state minis l agree m comply with eb city and county sedative end sum Iowa muting tornbi, J to Wieingeonswedon,and hereby of Nii city to oar upon property for l mfouremetivm forimpact.. purposes. r7 Ne abo(We) agree to andike the of against y r (we) agree to save, indcmmpe end keep homy ata me agai which may in any way accrue against said O liabilities, itic[, judg emu and appeases in .. Ciry in course xi a of the granting o(thyy penmL ,.. .. ;, c ance in APPLICANT UNDERST S D JIL COMPLY WITH ALL NON.mw" 1/� ^ ! / fJ� DLLRr�REP�� <•rro;ts"f L�_ Issued by: Date S�M. of Ap LcaMConuxtm hate'' Re -roofs , - - • " HAZMDOUS MATERIALS DISCLOSURE ' .lN I Will the applident m furore Wilding «cvpant carte or hanele hariNtia mYend ' .Type of. Roof definedb Ne Cu nino Munici al Code, Cha ter 9. yd y pe p 12, ami the Health rad Safery . , '• Code:Smtio,2532(q]"p. .:. .. .: .... .. ... .... OYv !..tl, .... No. ". l(�'.t. " �' . :' e . if ..t. •.'. _' .::i".t.: - •t T' ' .,, /ill roofs,shall be inspected prior to any roofing material being installed. •Will Ne appficot m, futvse buildin¢occupem use equipmcm or devices which 't If a roof is installed without firstobtaining an inspection, I agree to'remove haiardous ter comeminenu/Abss def�myl by Ne Bay Arm A r Quality Mwgement i[vin] all new materials for inspection. Applicant understands and will comply with ❑Yoe. all non -point source"regulations. r " 'I have-rmd'ihe heeardom mwenals requiremehts under LTaptee 6.95 of the California Health A Safety Code, Sections 25505,-25533 and 25530. 1 understand Na 'if Ne Wilding does a., curtenly have a town, that it is my respoasib0lrymtmfit, the m compat of the requirements which t W mef prior m isairs". of stCertificate of Occupy 4' .. .� Signature of Applicant Date All roof coverings to be Class "B" or better g vma 'ze4 agot Dau n, _1 • V 1 �i U • 6 -"-Ml L tr; .—w•� rr- U U J Z o, O' j Z� c+ 6 -"-Ml L tr; .—w•� E a C � A CD 1 I: I?wnu or an :. CITY I TINO BUI DING DIVIOF SION CONTRACTOR INFORMATION: PERMIT BUILDING ADDRESS: PERMIT NO. 7459 STANFORD PL 02030206 OWNER'S NAME: APPLICATION SUB DATE. LIVIA SHIRKEY 03/27/2002 HONE: SANITARY NO. CONTROL NO. a S- '- 3 ZO ARCHITECT/ENGINGER: BUILDING PERMIT INFO F BLDG ELECT PLUMB MECH i LICENSED CONTRACTOR'S DECLARATION lob Description ebony)oflhatlamliccnudumderpadPranaofChapter9ndmmeneise SWAP LOCATION OF DOOR/WINDOWS. wish Seaion7000 of Division3 of lM1e Business end Professions Cale. and my license is in full rhos and area. Licenu C]asx Li<. a Dau SDECmosLA ARCHITECT'S DECLARATION < 1 undcrsunJ my plvns shall be used as public rccoNs OLicensed Pmfessio.id r OWNER -BUILDER DECLARATION to 1 hereby M. that 1 in exempt from the Contractors Licenec Law for be a following reason. (Section 7031.5. Business and Prom.,sions Code: Any city or county $10000 Q which requires a permit to construct, alter, improve. demolish, or repair any structure $ .prior m is issuance. also rwaims the applicant for such Permit me a signed mtemend _. __._. - that osis licensed puriuAm_tm Me p,, ki.., Of,hc Can e, License Law (Chapter 9 _ (<nmmcncing with Section 7000) of Division Jof the BYSIIKSaand Prof[salnrr Cody ( {`� [ 1l3�5�(�®rf�'®a,,. )t- ,I Valuation or Thai he is exempt Imemain end the basis for the alleged'r lemptimi. Any violation 'r -1 I' .i �Y � 4 .-, ••� ' of Section 703 p.5 by any applicant for a Permit subjmrs the applicant to a civil penalty - of rn9mom than five hundred dollars (s500). 202'pNI "EARFLOOR PL MBING' Occupancy Type - ❑ ..... ... f the property, lir my employees with wages as their sole cmir'neation. "Will do the work, and the structure is not intended or offered for sale (Sec. 70W,'" - Business and Professions Codc: The Contractor's License Law does not apply to an 502 — FINAL P 8t44$dsNGsp§tit MRGY't ' owner of property Who builds m improves thereon, and who Jou such work himself or mrou^,h his own employees. provided that such improvements are not intended or 507 - FINAL PLUMBING (,!sale. IL however, the building or im - tis sold within woe- of ....'.. - _..__.._.__ _... .-_- . . -_ _ �® cRertd t Proof pro Yea _ _ .. _. .. completion. theerr-builder will have the burden of proving that he did not build or g improvefor __- _.. _... 1; as o ter f the propcnY exclusively t t g with rccnuJ mnvacmr t consw t Ib0 p j t (g 7w4 Business and Professions Code) The Contractors2QOr- L n L J of apply I r of p pony h builds or,mproves fiction,o a� who I t tor. h P ,.jis 'ith. t t rO licensed pursuant to me. __. Fb _._ _ t_. 01 a e exempt Licenu Law. "i ❑Iamexcmpt under Sc --Dam "•^/�Cfar ��ILDlIr�,.l'GI;:t - ' OR 'S C6 1PENSnT1ON DECLARATION 1 M1ereby aifimt under pcnahy of perjury one Of the following declarations: ❑ I M1nve and rill maintain o Cernficzte of Consent to self -insure for Workers Compensation, as provided fiat by Section 3700 of the Labor Coda for the - performance of the work for which this permit is issued ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 37W of the Labor Code, fon the pcAormance of the work far which has permit is Issued. My Workels Compo ce carrier and Policy number are _ .,.. ..,. .� ..._. _,�.. a5 at10n lllato!'. n, �. ..... .. •. .. ..u... ..J .. _.._. �. ..ev _ , .-. - Carrier'.'.',,, Jtl i1ipMicY No.: 1.. ..1.}, ,..7 �t'�J7� 1 1'k'•sp at .... it " CERTIFICATION OF E%EMPrION MOMWORKERS' s- s !• t 1 .. S w . r . .,..,.t.';.,.....� .'COMPENSATION INSURANCE "s'(This scetimnoeed not as completed if the permit is for one hundred dollars 'l" - (s100) or ]ass.) 'Y 1 certify (hut in the orrf...'a of ihe'work for wh ch Ih s permit is issued.'1 shall'not employ any person in any manna w as to become subject to the Workers' Coimpeassawn Laws of California.Date ' NOTICE TO APPLICANTlIf, after making this Certificate of Exemption. you should nacamc subject to the Worker s Compensation provisions of the Labor Cole, you must � mnhwhn.nmply wan such provisions .r this permit aM1.n x J«mm revoked. `CONSTRUCTION LENDING AGENCY I hereby affirm thxrthere is a construction leading agency fm the Performance' - y of the work for which Nis pe.it is issued (Sec. 3097. Civ. C.) ' a Land Name Urldei'AJdress- I scarify that 1 have read this application and stat. dau be above imlotmmion ,s correct. agree to comply with all city and county ordinances and state laws relating to building contraction. and hereby authorize rtprtuntatives of W city to enter upon the above-mcmlonM Property for inspection purposes. , L . (We) igree io save, indemnify and keep h.lcm the City of Cupertino egitim, 0 liabilities, judgments, costs and expenses which may in any way e«me against said C Cityin consequence of the granting of (hrJ'sa permit " ­, ' "" i ' APPLICANT UNDERSTA 5 D ✓IL COMPLY WITH ALL NN -POINT"' ! UR TI CZ. 991 _ � Issued by: Date Sighamut of AplicantlCommelorol •-'rgat. ",,•' Re -roofs It HAZARDOUS MATERIALS DISCLOSURE ❑Yes N Type of Roof.. _ ... will be applicant m furvu building occupant store or handle hazardous mat • .. as definal by theC penmo M n <pal Cad Ch pt 9 12 d the Health d Safety Code gestic. 2532Os [/f(`I II :bl, t 'hst{`..r - tw t i _ All roofs shall be Inspected prior to any roofing material being installed. w'nm ppi t r t thin IJ g occupant eequipmento devices which If a roof is installed without first obtaining ani inspection, I agree to remove min h b caro net d f W by Ih Bay Am.A Qual Ty Management ia6,a+ all new materials for inspection Applicant understands and, will comply with Y 0Yes ..., -. all non -point sourcCregulatio is. 1 have read'be'h rdous'mamrvdss requirements undo Chapter 6.95 d the California Health &'Sidety Cole, S.Ftions 25505.25533 and 25534. 1 understand (het ifthe Wilding does not currently have a tenant, that it is my responsibility to wary the iaimpom of the requirements which m t be, mct prior to issuance of a Certificate of Occupant t-. ., .. -.. • / '- Signature ofApplicant _ _ _ Date .. -..... .. or:coag at , Date,. OFFICE .... _. - - -_ ... ... All roof coverings to be Class "B" or better I?wnu or an :. CITY I TINO BUI DING DIVIOF SION CONTRACTOR INFORMATION: PERMIT BUILDING ADDRESS: PERMIT NO. 7459 STANFORD PL 02030206 OWNER'S NAME: APPLICATION SUB DATE. LIVIA SHIRKEY 03/27/2002 HONE: SANITARY NO. CONTROL NO. a S- '- 3 ZO ARCHITECT/ENGINGER: BUILDING PERMIT INFO F BLDG ELECT PLUMB MECH i LICENSED CONTRACTOR'S DECLARATION lob Description ebony)oflhatlamliccnudumderpadPranaofChapter9ndmmeneise SWAP LOCATION OF DOOR/WINDOWS. wish Seaion7000 of Division3 of lM1e Business end Professions Cale. and my license is in full rhos and area. Licenu C]asx Li<. a Dau SDECmosLA ARCHITECT'S DECLARATION < 1 undcrsunJ my plvns shall be used as public rccoNs OLicensed Pmfessio.id r OWNER -BUILDER DECLARATION to 1 hereby M. that 1 in exempt from the Contractors Licenec Law for be a following reason. (Section 7031.5. Business and Prom.,sions Code: Any city or county $10000 Q which requires a permit to construct, alter, improve. demolish, or repair any structure $ .prior m is issuance. also rwaims the applicant for such Permit me a signed mtemend _. __._. - that osis licensed puriuAm_tm Me p,, ki.., Of,hc Can e, License Law (Chapter 9 _ (<nmmcncing with Section 7000) of Division Jof the BYSIIKSaand Prof[salnrr Cody ( {`� [ 1l3�5�(�®rf�'®a,,. )t- ,I Valuation or Thai he is exempt Imemain end the basis for the alleged'r lemptimi. Any violation 'r -1 I' .i �Y � 4 .-, ••� ' of Section 703 p.5 by any applicant for a Permit subjmrs the applicant to a civil penalty - of rn9mom than five hundred dollars (s500). 202'pNI "EARFLOOR PL MBING' Occupancy Type - ❑ ..... ... f the property, lir my employees with wages as their sole cmir'neation. "Will do the work, and the structure is not intended or offered for sale (Sec. 70W,'" - Business and Professions Codc: The Contractor's License Law does not apply to an 502 — FINAL P 8t44$dsNGsp§tit MRGY't ' owner of property Who builds m improves thereon, and who Jou such work himself or mrou^,h his own employees. provided that such improvements are not intended or 507 - FINAL PLUMBING (,!sale. IL however, the building or im - tis sold within woe- of ....'.. - _..__.._.__ _... .-_- . . -_ _ �® cRertd t Proof pro Yea _ _ .. _. .. completion. theerr-builder will have the burden of proving that he did not build or g improvefor __- _.. _... 1; as o ter f the propcnY exclusively t t g with rccnuJ mnvacmr t consw t Ib0 p j t (g 7w4 Business and Professions Code) The Contractors2QOr- L n L J of apply I r of p pony h builds or,mproves fiction,o a� who I t tor. h P ,.jis 'ith. t t rO licensed pursuant to me. __. Fb _._ _ t_. 01 a e exempt Licenu Law. "i ❑Iamexcmpt under Sc --Dam "•^/�Cfar ��ILDlIr�,.l'GI;:t - ' OR 'S C6 1PENSnT1ON DECLARATION 1 M1ereby aifimt under pcnahy of perjury one Of the following declarations: ❑ I M1nve and rill maintain o Cernficzte of Consent to self -insure for Workers Compensation, as provided fiat by Section 3700 of the Labor Coda for the - performance of the work for which this permit is issued ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 37W of the Labor Code, fon the pcAormance of the work far which has permit is Issued. My Workels Compo ce carrier and Policy number are _ .,.. ..,. .� ..._. _,�.. a5 at10n lllato!'. n, �. ..... .. •. .. ..u... ..J .. _.._. �. ..ev _ , .-. - Carrier'.'.',,, Jtl i1ipMicY No.: 1.. ..1.}, ,..7 �t'�J7� 1 1'k'•sp at .... it " CERTIFICATION OF E%EMPrION MOMWORKERS' s- s !• t 1 .. S w . r . .,..,.t.';.,.....� .'COMPENSATION INSURANCE "s'(This scetimnoeed not as completed if the permit is for one hundred dollars 'l" - (s100) or ]ass.) 'Y 1 certify (hut in the orrf...'a of ihe'work for wh ch Ih s permit is issued.'1 shall'not employ any person in any manna w as to become subject to the Workers' Coimpeassawn Laws of California.Date ' NOTICE TO APPLICANTlIf, after making this Certificate of Exemption. you should nacamc subject to the Worker s Compensation provisions of the Labor Cole, you must � mnhwhn.nmply wan such provisions .r this permit aM1.n x J«mm revoked. `CONSTRUCTION LENDING AGENCY I hereby affirm thxrthere is a construction leading agency fm the Performance' - y of the work for which Nis pe.it is issued (Sec. 3097. Civ. C.) ' a Land Name Urldei'AJdress- I scarify that 1 have read this application and stat. dau be above imlotmmion ,s correct. agree to comply with all city and county ordinances and state laws relating to building contraction. and hereby authorize rtprtuntatives of W city to enter upon the above-mcmlonM Property for inspection purposes. , L . (We) igree io save, indemnify and keep h.lcm the City of Cupertino egitim, 0 liabilities, judgments, costs and expenses which may in any way e«me against said C Cityin consequence of the granting of (hrJ'sa permit " ­, ' "" i ' APPLICANT UNDERSTA 5 D ✓IL COMPLY WITH ALL NN -POINT"' ! UR TI CZ. 991 _ � Issued by: Date Sighamut of AplicantlCommelorol •-'rgat. ",,•' Re -roofs It HAZARDOUS MATERIALS DISCLOSURE ❑Yes N Type of Roof.. _ ... will be applicant m furvu building occupant store or handle hazardous mat • .. as definal by theC penmo M n <pal Cad Ch pt 9 12 d the Health d Safety Code gestic. 2532Os [/f(`I II :bl, t 'hst{`..r - tw t i _ All roofs shall be Inspected prior to any roofing material being installed. w'nm ppi t r t thin IJ g occupant eequipmento devices which If a roof is installed without first obtaining ani inspection, I agree to remove min h b caro net d f W by Ih Bay Am.A Qual Ty Management ia6,a+ all new materials for inspection Applicant understands and, will comply with Y 0Yes ..., -. all non -point sourcCregulatio is. 1 have read'be'h rdous'mamrvdss requirements undo Chapter 6.95 d the California Health &'Sidety Cole, S.Ftions 25505.25533 and 25534. 1 understand (het ifthe Wilding does not currently have a tenant, that it is my responsibility to wary the iaimpom of the requirements which m t be, mct prior to issuance of a Certificate of Occupant t-. ., .. -.. • / '- Signature ofApplicant _ _ _ Date .. -..... .. or:coag at , Date,. OFFICE .... _. - - -_ ... ...