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03090157CITY OF CUPERTINOy-.*+% BUILDING DIVISION PERMIT �.NTRACT R, INFORMATION BUILDING ADDRESS: BOYD THOMAS C AND JANE P PERMITNO03090157 ,R'S NAME: PERMIT ISSUE DATE NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO ELECT BLDGPLUMB MECH E 0 Z 0 LICENSED CONTRACTOR'S DECLARATION lobDescri tIOD P 1 hereby affirm that I am licen.er provisions of Chapter 9 (commencing with seen IKKI)af Divnion3ofthoB .and Pmfcasinns Code, and my license is „ m rase ro e r g21 DECK (E) BACKYARD : Lice Im,n a Da Cont CONTRACTOR: FREIDIN LANDSCAPING & DESIGN ARCHITECT LARATION understand my plana .hall W uxJ u public rtcnrds PINALED Liccnud Pndcssional 5 OWNER -BUILDER DECLARATION i I Law for the .Sect on I am exempt from Ne COoms Co Any (� Q �J maxamerchy cense O followhich ire rcmon. : 11151.5, Business and mo Cnne: Any city nr county OCT 1 a/ LOOa7 which rcyuiroa a o..1fd oe matron, ,,he ; t far s. ch it1m d a sig any dstate roto erout t t, r ve, demolish, y barheitsiensedprsuant to the theapplieanf for Contrator'tLiense Law statement bar(cohctscingwiit pursuant the License Law (Chapterode)or Sq. Ft. Floor Area at Divinoof eBusinessa ofDasisn3Mthcegedexeand n.fAnyviCodc)of $ �':��.y$tjfiQ000 dot Is - thd onion and m and the buts the alleged exemption. Any violation of Section 31.5 b any ap it pliatto aundredicmlfonpertnit subKcu theepplicam to.civil penalty of - -- -- - --" 3 M1W ,. Occupancy Type P Y no,...i1. rom not mart Nan Rw bundled dollars (5500). ------ ❑ I, as owner of the property, or my cmploycu with wages as their auto compensation, ME do the work and Ne structure is not intended tampered (Dude (See. 7044aa enor, B.,in and Professions Code: The Conv•, License Jou not Jonot apply to an owner of Required Inspections property who builds or improves thereon, and who does such work himulfo through his 101 - FOUNDATION awn employees, provided that such improvements are not intended or offeree for sold. If. 102 - PIERS however, the building or improvement is sold which one year of completion, the owner. builder will have the burden of proving that he did not Wild or improve for purpose of 103 - UFER tele.). 104 - REBAR ❑ 1, as owner of the Property, am exclusively contracting with licensed contractors to convect the project(Sec.7W4, Business and Professions Code:) The Contractors Li- 105 - ANCHOR BOLTS. crow law does not apply loin owner of property who had Ids or impmvu lheuon.ud 106 - SEWER & WATER who contracts for such projects with a conlranorD) licensed pursantto the Convector'.' ,rise Law. 202 - UNDERFLOOR PLUMBING in exempt under See, , O h P C for this reams 203 - UNDERFLOOR MECHANICAL . WORKER'S COMPENSATIONDECLARADTION 204 - UNDERFLOOR FRAME I hereby affirm under penalty of Pit one of she following declarations: 205 - UNDERFLOOR INSULATION I hese and will maintain a Cinuficam of Consent to ulf-imam for Worker', Comprn- 301 - ROUGH PLUMBING ration, u provided for by Station 37W of the labor Code. (n, the performance of die 3 02 - TUB & OR SHOWER work for which this permit is issued. 303 - ROUGH MECHANICAL ❑ 1 have and will maintain Worker's Compensation Insurance, as mr,flmd by Section . 3700 of the labor Code, for the performance of the work for which this ponnit is issued, 304 - ROUGH ELECTRICAL My Worker's Compensation Insurance carrier and Policy number art: 305 - FRAME Cameo Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' 306 - HOLDOWNS COMPENSATION INSURANCE 307 - INSULATION CThda.trim ncad not he completed if the permit is for one hundred dollars(SIM) 308 - SHEETROCK it, Ices.) I certify that in the pr amens. of the work for which this permit a Banco. I shag but 309 — EXTERIOR LATH cmployany persmi y7 syam aroma subject the Workins Compensation all 310 — INTERIOR LATH uw,orcdiry � Ap is I 311 - 313 - SCRATCH COAT ROOF NAIL NO TOAPPtCANT:1 aftermnsmithis CertificateofExemption, should dyou e .object to the Workers Camlenmtion provision of the labor Cnde, you moil zronhwilhcomply with such provision orthis permit shall Wdeemed mvoked. 501 - FINAL ELECTRICAL ENERGY n CONSTRU CTiON LENDING AGENCY 502 - FINAL PLUMBING ENERGY jIbattery am. East them H.tiolruetinnlending agency fnnWPerformance of 503 - FINAL MECHANICAL ENERGY the work fur which Ibis pmmil 1, issued (Sec. 309E Civ. C.) j Iander,Nemr 504 - 505 - FINAL BUILDING ENERGY FINAL ELECTRICAL L Lcndcr'sAddreas I ccnify that I have read this eNdid.u.. end roto that the ahow information is correct. 1 agree to comply with all city and county ordinances and state laws rotating to 506 - GAS TEST building construction, and botchy amhorim rcprurchniive, of this city to enter upon the G FI&&ING above-mentioned ruffianly for inspection purposes (We) agree to save, indemnify and keep himlleu the Cary of Cupertino against 0 8 F IL A liabilities, judgments, costs and expense, which may in any way accrue against mid City Z• in consequaded of the 5 n granting.fthis pormtt. APPLICANT UNDERSTANDS AND WILL COMPLY WI ALL NON- OINT Issued by: 5 Date ER UL 4 NAL PUBLIC WORKS Re -roofs Type of Roof re of pdica Comnaor Date AZAR MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material ed by the Cupertino Municipal, Code. Chapter 9.12, and the [real th and Safely in oman 2ss3xa)TA ❑Yc,Wiil All roofs shall be inspected prior to any roofing material being installed. a roof is installed without first obtaining an inspection, I agree to remove the aPPlicam or furore buildingocv:upam tau tyuiPmenl ar devices whichIf aNnus air contaminants u dcOncd by Ne Bay Arta Air Ouality Management all new materials for inspection. /t ❑res �JJyla.- I have read the hmarduua materials requircmcnv under Chapter 6.95 of the Califon .is Heflin k Safety Code, Scmnas 25505,35533 ad 25534.1 understand on Iifde Wilding doa nm emor nlly M1avc a Icnan4 Nat it ix my rcspor¢ihilily to nntily the t'cuPant arc rcyuircmc b mel prions iasumcc of a Conificae of Occup cy. i"` g tureofApplicant Date All roof coverings to be Class "B" or better rte; Da i � rl CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS:BOYD THOMAS C AND JANE P PERMIT NO 03090157 222 STENDRAL LN OWNER'S NAME; ROYE) THOMAIS. C Ah1D,,-TANE--P— PERMIT ISSUE DATE /2.2012003 �? PHONE. SANITARY CONTROL NO. ARCHTTECTIFNGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed un, cr provisions of Chapter 9 (C(iruffi=ing with in I Lee,Lie lass DECK (E) BACKYARD CONTRACTOR: FREIDIN LANDSCAPING & DESIGN D. understand my plans shad he used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 703 1.5, Business and Professions Code; Any city or county which requires a permit to construct. alter, improve, demolish, or repair any structure Sq. Ft. Floor Area Valu :L 0 0 0 prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Low (Chapter 9 (commencing with Section TOW) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of 3 V19 ngikel 0 0 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 0 1, as owner of the property, or my employees with wag" as their sole compensation, Reyuired Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of 101 - FOUND ON property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements am not intended or offered for side. If, 102 - PIERS however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for Purpose of 103 - UFER sale.). 104 - REBAR 0 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law dries not apply to an owner of property who builds or improves thereon, and- 106 SEWER & WATER who contracts for such projects with a contractors) licensed pursuant to the Contractor's Law. 202 - UNDERFLOOR PLUMBING Lkense exempt under sec. B & P C for this reason 203 - UNDERFLOOR MECHANICAL Owner Date 204 - 205 - UNDERFLOOR FRAME UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 301 - ROUGH PLUMBING 0 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance: of the 302 - TUB & OR SHOWER work for which this permit is issued. 303 - ROUGH MECHANICAL 0 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 304 - ROUGH ELECTRICAL My Worker's Compensation Insurance carrier and Policy number are: 305 - FRAME Carrier,. __Policy No.: 306 - HOLDOWNS CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 307 - INSULATION (rItis section need not be completed if the permit is for one hundred dollars ($ 100) 308 - SHEETROCK oricss.) 309 - EXTERIOR LATH I certify that in the pe ormance of the work for which this permit is issued, I shall not employ any i ny man a , become subject to the Workers'Compensidion 310 - INTERIOR LATH Laws of Califp ate 311 - SCRATCH COAT t 46 " — 7'O APP after making this Certificate of Exemption, you should Ve is to the Workers Compensation of the Labor C*de,, you must 313 - I ROOF NAIL ubject provisions forthwith comply with such provisions or this permit shall be deemed revoked. 501 - FINAL ELECTRICAL ENERGY 502 - FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY I I hereby affirm that them is a construction lending agency for the performance of 503 - FINAL MECHANICAL ENERGY the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name 504 - 505 - 506 - FINAL BUILDING ENERGY FINAL ELECTRICAL GAS TEST Lender's Address 1 certify that I have read ibis application and state that the above Information is 4 cormcL I agree to comply with all city and county ordinances and state laws relating to 4 building construction, and hereby authorize representatives of this city to enter upon the FIN PLUMB FI above-mentioned property for inspection purposes. 4 (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 08 I --A=. n T -T A f"f2\ F 1�4 AL F I in consequence of the granting of this permit. Wn[ALL DINT APPLICANT UNDERSTANDS AND WILL COMPLY NON 5 5 Issued b), 5 Issued by: 5 ING Date ;4OURCE IIL 514% 5 4 L PUBLIC WORKS 4R! Re -roofs Re -roofs Type of Roof 11AZ— S* n re 01 CPWpic+CnU=tor Date AZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal.Code. Chapter 9.12, and the Health and Safety Code, Section 25532"a)'y All roofs shall be inspected prior to any roofing material being installed. 0 Yes A 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 hazardous air contaminants as dc:fmcd by the Bay Area Air Quality Management all new materials for inspection. Distri.? C3 Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor. nia Heafth& Safety Code, Sections 25505,25533 and 25534. 1 understand th ifthe building does not currently have a tenant, that it is my responsibility to notify the upam the issuance Certificate Occup cy. Date requircrain h met prior to of a of g tura of Applicant All roof coverings to be Class "B" or better norDo Cf-t'Y OF CUPERTINO -7 SCITVOF PERMIT APPLICATION FORM CUPEkTINO r, APN # Fee Description Date: Other Appliani a Building Address: K3 0.3 a 00... Bldg Permit sq. foot 27Z --Z, 54-enWhul Pl',. Owner's Name: llwzpyv� 6yn i MECHANICAL Phone #: Contractor: f License #: 7z Boiler > 500K to IM Btu Contact: �eyl,l� Boiler > IM to 1.75 M btu Cupertino Business License#: Building Permit Ififo: i Bldg)a Elect R Plumb El Mech El Job Description: Residential BUILDING CojzCi Sq.Ft. Floor Area: Con. Tax for BQ Zone $/Sq.Ft.: Cost of Project: f9 1111504 Was Occupancy up: ?6 Type of Constructio: Constax — Resi/.Mobile Vffli Elec 600V <= I OOOA 1 of 3 Fee Description I Other Appliani a K3 0.3 a 00... Bldg Permit sq. foot BUILDING 181.14 Boiler <= 100,000 Btu MECHANICAL Boiler > 100K to 500K Btu Boiler > 500K to IM Btu Boiler > IM to 1.75 M btu i Construction Tax BUILDING Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone 1111504 Was �L"WEIRV-43 Constax — Resi/.Mobile Vffli Elec 600V <= I OOOA Elec 600V > 1000 ELECTRICAL Elec Svcs 600V <= 200A BUILDING Enley _gy_Add Multi N oo-soo.Igi I gal 15111 Qk v� 1 of 3 x: C1 OF CUPERTINO CITY OF Cl[ ERTIN . PERMIT APPLICATION FORM Fee I ! + , Fee Group Ill�lr rlr. 1 rl r rll ♦ �♦ �:. 1. Relocation . . A. s _ ♦ A ELECTRICAL ♦ A ♦ Theatrical ELECTRICAL Vent Fan SingleDuct I�Bv 1914 11 P, CA 12 A Ventilation SystemsBUILDING A Scb Specific Plan BSEISMICOM Seismic Commercial BSEISMICRE i r��rul ■Tern' Temporary-BldgP it_ BTENT♦pist�Svcs A Business License r ; sq foot ELECTRICAL ----Electfical #i.. , t ,. Permit . A ON �� A% � r i� i ►% � � lei!' t r ' I S I ' • 1/ i1tll G I �\i ilr�'I� r s i Plumbing '' ar <t '+ �� • • ' • • !' -_ s as ' : 1 !f A d -dress Chang- :—objuir 3 of3