08020113 CITY OF CUPERTINO +" 'dt«r«n...� :v3�,•sF' �^ ' °
BUILDING DIVISION PERNUTCUNTRACTtTR�I1VFU�IA IO
,+w`a .?=R'� •t; kFu 'E. a zSt.
BUILDING ADDRESS: PERMIT 440.
21837 TERRACE DR PERKO CONSTRUCTION 08020113
NER'S NAME: PERMIT ISSUE DATE
JU ROBERT 254 HAMES RD 03/12/2008
PHONE: SANITARY NO. CONTROL NO.
(831) 818-0072
ARCHITECfIENGINEER; BUILDING PERMIT INFO
'BLDG ELECT PLUMB MECH
0 0 0 0
uo0 LICENSED CONTRACTOR'S DECLARATION Ib Description
rj fOm I hereby otits,1 am licensed under undeprovincesO
of Chapter 9(commencing
n� with Section 701)(1)of Division 7 of the Business and Professions Code,and my licenxu REVISE FNDTN & SUBFLR DETAIL—ORIG#07040080
-.�or in full force and ellen.
z unceme Clan LY.
Dalo Contractor
ARCHITECT'S DECLARATION
S I andemtsnd my plan still W usod as public records
yQ�a Lkcnmd Prurcuioal
3 OWNER-exampt fr m the Com ION
E s S hereby maso.(Rol Nat 1 1. exempt from the Cssions o e:A License Lar for the
i p o following moon.(Saito 703 I.S, 1.acne. and Professions Code:Any city or county
$ which mqulma•permit re consmct,alter.improve,h Permit
file
repair nY structure
.j�
thin
Ise inits lasedpu m Ltoirea dC aPionso for menracus'mRleae Law(Cned hapter
�e
(commencing
ccewcd pursuant mthc of Division
of the Conuhorsnd Prof Lar(Chaemr9 Sq.F[. Floor Area Valuation
$ (eommcnda with Sutler 7000)of Division Sof the Builnaa and Profession Coils)or $0
that he is eancept rh^^fmt and the bask for We alkged eacmption Any violada of
Section 71331.5 by any Applicant for a permit subjects the applkmt m a civil peaky of ppN Number Occupancy Type
M1 mom than five hundred dollars ISM 3 5 617 0 2 0 :tl t7
❑I,urwrcr of tie property.wmY cinPloriea with wgnutie4 mkeampwafian,
will do fico v wk-and the alrunwe is ant intended wavered for oak(Sat.7044,Busihau
and Professions code:The CMMs Lkeme Law does cot apply in an answer of Required Inspections
Property who builds or improves rhrcon.and who does awls work Wassailer through him
own employees,provided thstsuch improvements art not Intended aro@red five We.If.
however,the tumbling or Improvement is sold within one your of completion,the owner.
Wilderyrlll Mw W burden of pro all that M did not Wild or improve for purpose of
. 1/1,a owner of ere property ao coelmalmly contracting with licensed conaanon to
car�tmct the pro)ett(See.7W.Bwinwa and Profession Code:)The Cwanoh U.
Law does tot apply m an.of property who builds m improves themm�.cod,
who condoner far such projects with r(s)licensed purmunt mthe Cameramen
Lke m ave.
s lam ere .B Is Pe for reuen
our
Dan x
WORKER PPNSATIONDECLARATION U
1 hereby,Bim u ly of perjury am a(dte folbwini dwlamuiorre
(3]ham and will maintain a CartiRcem of Canmm in self-Iwum forWormes Camper- -
utlon,in provided for by Section 3700 of the labor Cade,for that performance of the
work for which this permit is lamed.
❑1 have and will maintain Worknrs Compensation losurm n,u required by Section
3700 of the labor Cade,for the performance of the work for which this permit is issued. '
My Workers Compsm ion insurance arrive and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EKEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This sced.hand rut be cwnpkud V Ne permit k fortune hundred da0an($100)
or loss)
1 mdry that In the pwfaman N that we r whim thia 46 is Word.I alWl red
umploymyNnerirt. "In sis it, a Warkdn'compnaufim
Laws of Callfomis Date
Appliont
NOTICE TO APPUCA :If,New making nm of Eaemption,yen thwW -
become sublet m the worker's Compenu n ➢ isiom of the Labor Code.you mum
vJO forthwith comply with such provisions milabll Wemmod invoked.
CONSTRUCTION LENDING AGENCY
52 I Wreby Nim that there Is a consuuttlnn kndiry apeory far dice perfwmarco of
Fri the work(w which his pemil I.Wood(Su.3097,Civ.C.)
W�Q Larches Name
Z Lenders Address
U O 1 cWfy that I have rvA this application W sum that that above Information Is
IL E comet.t&I=m comply with N city and county melanomas and atom Iowa relating m
Q LS'J Wilding contraction.and hereby auNarim repreaenufivea ofthu city W enter upon me
ti] shove-mentiahad property for inspection purposes
y (We)agree to save•indemnify and keep hamless Oat City of Cupertino aIsland
y
liabilities,judgments,cuts siod expeams which may in my way accrue against said City
UZ in cansequuneo grandngaflhiapcmit.
APPLICANr RST N .WILL PLY WITH.A{.L N-P� Issued by: Date
SOURCE RE 0 5 4a
Re-roofs
Signature of ApplicanVContrectar Da
HAZARD ATEAIAIS DISCLOSURe Type of Roof -
WlBmeapPRantwfut Ilding moment mom w handle hazardous material
as dunned by Oat Cupertino Municipal Cade,Chapter 9.1 Z and tW Haalth and Safety .
Section 25532(&)?❑YOyer /two
` / All roofs shall be inspected prior to any roofing material being installed.
win the applicant rat Term¢building occupant use egmipmmt or ACWw whim If a roof is installed without first obtaining an inspection,.1 agree to remove
cmil haaNma sir conumianss defined by the Bay Area Air Qallly Management all new materials for inspection.
Dwrict7
Yes o
I hewuwtsmamrials mqummennumler Chanmrd.95ofthe Califor.
nia Hut"Stions
nM5.2553] 534.Iumkmmmrl thafrde Wilding
does rat cvmotly ve•mow cut h u my re hilit l m mdfy de wcuPnt mf the
regairememtsw n mm cot f.cenina a Ocaupan Signature of Applicant Date
Owner or auto rind'grill Dam'
All roof coverings to be Class'%{ or better
CITY OF CUPERTINO +" 'dt«r«n...� :v3�,•sF' �^ ' °
BUILDING DIVISION PERNUTCUNTRACTtTR�I1VFU�IA IO
,+w`a .?=R'� •t; kFu 'E. a zSt.
BUILDING ADDRESS: PERMIT 440.
21837 TERRACE DR PERKO CONSTRUCTION 08020113
NER'S NAME: PERMIT ISSUE DATE
JU ROBERT 254 HAMES RD 03/12/2008
PHONE: SANITARY NO. CONTROL NO.
(831) 818-0072
ARCHITECfIENGINEER; BUILDING PERMIT INFO
'BLDG ELECT PLUMB MECH
0 0 0 0
uo0 LICENSED CONTRACTOR'S DECLARATION Ib Description
rj fOm I hereby otits,1 am licensed under undeprovincesO
of Chapter 9(commencing
n� with Section 701)(1)of Division 7 of the Business and Professions Code,and my licenxu REVISE FNDTN & SUBFLR DETAIL—ORIG#07040080
-.�or in full force and ellen.
z unceme Clan LY.
Dalo Contractor
ARCHITECT'S DECLARATION
S I andemtsnd my plan still W usod as public records
yQ�a Lkcnmd Prurcuioal
3 OWNER-exampt fr m the Com ION
E s S hereby maso.(Rol Nat 1 1. exempt from the Cssions o e:A License Lar for the
i p o following moon.(Saito 703 I.S, 1.acne. and Professions Code:Any city or county
$ which mqulma•permit re consmct,alter.improve,h Permit
file
repair nY structure
.j�
thin
Ise inits lasedpu m Ltoirea dC aPionso for menracus'mRleae Lw(Chaned •ter9
�e (comme ccewcd pursuant mthc of Divioa of ere Conuhorsnd Prof Lar(Chaemr9 Sq.Ft. Floor Area Valuation
$
(commencing with Sutler 7000)of Division Sof the Builnaa and Profession Coils)or $0
that he is eancept rh^^fmt and the bask for We alkged eacmption Any violada of
Section 71331.5 by any Applicant for a permit subjects the applkmt m a civil peaky of ppN Number Occupancy Type
M1 mom than five hundred dollars ISM 3 5 617 0 2 0 :tl t7
❑I,urwrcr of tie property.wmY cinPloriea with wgnutie4 mkeampwafian,
will do fico v wk-and the alrunwe is ant intended wavered for oak(Sat.7044,Busihau
and Professions code:The CMMs Lkeme Law does cot apply in an answer of Required Inspections
Property who builds or improves rhrcon.and who does awls work Wassailer through him
own employees,provided thstsuch improvements art not Intended aro@red five We.If.
however,the tumbling or Improvement is sold within one your of completion,the owner.
Wilderyrlll Mw W burden of pro all that M did not Wild or improve for purpose of
. 1/1,a owner of ere property ao coelmalmly contracting with licensed conaanon to
car�tmct the pro)ett(See.7W.Bwinwa and Profession Code:)The Cwanoh U.
Law does tot apply m an.of property who builds m improves themm�.cod,
who condoner far such projects with r(s)licensed purmunt mthe Cameramen
Lke m ave.
s lam ere .B Is Pe for reuen
our
Dan x
WORKER PPNSATIONDECLARATION U
1 hereby,Bim u ly of perjury am a(dte folbwini dwlamuiorre
(3]ham and will maintain a CartiRcem of Canmm in self-Iwum forWormes Camper- -
utlon,in provided for by Section 3700 of the labor Cade,for that performance of the
work for which this permit is lamed.
❑1 have and will maintain Worknrs Compensation losurm n,u required by Section
3700 of the labor Cade,for the performance of the work for which this permit is issued. '
My Workers Compsm ion insurance arrive and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EKEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This sced.hand rut be cwnpkud V Ne permit k fortune hundred da0an($100)
or loss)
1 mdry that In the pwfaman N that we r whim thia 46 is Word.I alWl red
umploymyNnerirt. "In sis it, a Warkdn'compnaufim
Laws of Callfomis Date
Appliont
NOTICE TO APPUCA :If,New making nm of Eaemption,yen thwW -
become sublet m the worker's Compenu n ➢ isiom of the Labor Code.you mum
vJO forthwith comply with such provisions milabll Wemmod invoked.
CONSTRUCTION LENDING AGENCY
52 I Wreby Nim that there Is a consuuttlnn kndiry apeory far dice perfwmarco of
Fri the work(w which his pemil I.Wood(Su.3097,Civ.C.)
W�Q Larches Name
Z Lenders Address
U O 1 cWfy that I have rvA this application W sum that that above Information Is
IL E comet.t&I=m comply with N city and county melanomas and atom Iowa relating m
Q LS'J Wilding contraction.and hereby auNarim repreaenufivea ofthu city W enter upon me
ti] shove-mentiahad property for inspection purposes
y (We)agree to save•indemnify and keep hamless Oat City of Cupertino aIsland
y
liabilities,judgments,cuts siod expeams which may in my way accrue against said City
UZ in cansequuneo grandngaflhiapcmit.
APPLICANr RST N .WILL PLY WITH.A{.L N-P� Issued by: Date
SOURCE RE 0 5 4a
Re-roofs
Signature of ApplicanVContrectar Da
HAZARD ATEAIAIS DISCLOSURe Type of Roof -
WlBmeapPRantwfut Ilding moment mom w handle hazardous material
as dunned by Oat Cupertino Municipal Cade,Chapter 9.1 Z and tW Haalth and Safety .
Section 25532(&)?❑YOyer /two
` / All roofs shall be inspected prior to any roofing material being installed.
win the applicant rat Term¢building occupant use egmipmmt or ACWw whim If a roof is installed without first obtaining an inspection,.1 agree to remove
cmil haaNma sir conumianss defined by the Bay Area Air Qallly Management all new materials for inspection.
Dwrict7
Yes o
I hewuwtsmamrials mqummennumler Chanmrd.95ofthe Califor.
nia Hut"Stions
nM5.2553] 534.Iumkmmmrl thafrde Wilding
does rat cvmotly ve•mow cut h u my re hilit l m mdfy de wcuPnt mf the
regairememtsw n mm cot f.cenina a Ocaupan Signature of Applicant Date
Owner or auto rind'grill Dam'
All roof coverings to be Class'%{ or better