03010119 CTry ON cunwrINO € ' •tt ra't' a
BUILDING DIVISION PERMIT ryYCONTRA�CTORNFORMATION
BUILDING ADDRESS: R & Z DEVELOPMENT PERMIT NO.
21353 VAI AVE #100
y0,31710119
NER'S NAME: 21771 STEVENS CRK BL #1 0 0 APPLICATION SUB DATE
VAI AVE. L. P. O 01/22/2003
NH 408) 252-1101 SANITARY NO. CONTROL NO.
ARCIII'FECUENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECIf
0q 0 0 0
ON
W.r LICENSED CONTRd under
UECons(if hap Job DeseNQIrOI ALF—®
y P I hereby affirm That 1 an
Ila,Business
under and
P000s of Chapter 9(commencing Y_1111111 @mB rti
G? in fu Scorcean effect.
Division 3 o the Business enJ Professions Gale.and my license is
Li mne'Cl.and FENCE 3 Zp03
License Class Lic.N �]
Z— Date COmrat or F[p
=orf` ARCHITLCES DECLARATION
1 understand my plans shall he used as public rttook
dpZ
F4QLicensed professional BUILDING
OW NER-BUILDER DECLARATION
� S 1 hereby affirm ne
that I am exempt from the Comrachas License law for the
m—0 0 Inllnwing meson.(Section 7031.5,Business and Pml'e.Woe Code:Any city or county
n'K which requires a permit to conamaL alter,improve,demolish,or repair any structure kmw.�a pnnnn its redance,also requires the applicant for such period a)Ili,axigned statement BY��
�G that he is licensed pursuant m the provisions of the Contractor's License law(Chapter 9 Sq. Ft.Floor Area ,$ Y tion
o"j $ Vommencing with Section 7000)of Division 3 of the Business and Professions Code)(it
re3 mat he is exempt therefmm and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant fora permit subjects the applicant to acivil penalty of
not mom than five hundred douan(s500). be Occupancy Type
❑ 1,as Owner of the proper.Or my employees with wages as their able compensation,
will Jo the work.and Be swcture is not intended or offered for sale(Sec.7044,Business —
.it Professions Code:The Commences License Law does not apply m an owner of 102 - PIER S equired Inspections
property who builds or improve thereon,and who doessuch work himself or through his
sen employees,provided that such improvements art not intended or offered for sale.it, 103 — UFER
however,the building or improvement is said within one year of completion.Ne owner-
builder will have the burden of proving Nat he did not build or improve for purrose of 104 - REBAR
105 - ANCHOR BOLTS
.es srvncr ohne properly,am exclusively contracting with licensed contractors to 106 - SEWER & WATER
moron the pn,ject(Sec.7044,Business im Professions Code)The Contractor's Li-
Low does nmO
appl rat pro trywbahui scrimpmrcon
vesthe .and, - 202 - UNDERFLOOR PLUMBING
e corm, uforsuc mjecwi acontrn mist licensed pursuant otheConductor's 203 - UNDERFLOOR MECHANICAL
is re a
❑ c c
ptun arts B&P formis ax n 204 - UNDERFLOOR FRAME
OR AT NDECLioN 205 - UNDERFLOOR INSULATION
erebyar rpenalryofperjuryoncafthclollowingdedantions: 301 — ROUGH PLUMBING
Inand will mainfunaCerificamofConsent toself-insure for Wader'sCompem 302 — TUB & OR SHOWER
cation as provided for by Section 3700 of the Unit,Code,for the p ffmor r Oce of the 3 03 - ROUGH MECHANICAL
work far which this permit is isued. 304 - ROUGH ELECTRICAL
❑ I have and will maintain Workers Compensation Insumnce,as required by Section 3 05" - FRAME
3700 of the Labor Code,for the peromomme of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number arc: 306 — HOLDOWN.S'
Cartier Policy No.: 307 - INSULATION
CI3RTIPICPT]ON FROM
WOR KERS
'
COMPENSATION INSURANCE 308 — SHEETROCK
('his scaion need nmbecompleted hone permit ishtrone hunrcddonars(SUN) 309 - EXTERIOR LATH
Isca) 310 - INTERIOR LATH
1 ecnify th n c perp f t y rmi issued,10.11 not
employs anter�t T'rc c ken cmpcnsation 311 — .S'f.'RATI-.'H COAT
poL it re 313 - ROOF NAIL
p cr r. te Exe a,you should 501 - FINAL ELECTRICAL ENERGY
e g er peorth sonde mrvoke,ymumaa' 502 - FINAL PLUMBING ENERGY
O,� forthw' cum ywith sec ichors or this permit shall bedemeJ revoked.
zo CONSTRUTIONLENDINGACF.NCY 503 - FINAL MECHANICAL ENERGY
[� �7 liter yaffirm that there is CONSTRUCTIONLENDING
lending agency On the performance of 504 - FINAL BUILDING ENERGY
Q$ Y the work for which this pennitisissued(Sec.3(197,Civ.C.)
Lender's Name 505 - FINAL ELECTRICAL
ls7 Q
z
cancel,Lmider'sAJdress 506 - GAS TEST
U R 1 cenify that 1 have read this application and state that the above information is 507 - FINAL PLUMBING
(—' l agree m comply with all city and county ordinances and slate laws"Wingm
�U building construction.and hereby authorize representatives of this city m couctipi, the 5 FINAL MECHANICAL
0 U above mentioned property,for inspection purposes. O 9 FIN
0. c7 agree to save.ind - d keep h less the .ity Of Cupertino against
F" y lianilifA
judgmcnts,thecosu expemsc whmhm yin any yaccme against said City 5 N G
V z 1ePPL 'O
N[RSo NO As WIL COMPLY/ ITH ALL -PO Issued by51 - WORKS Date , (�
5 . TIOy
Re-roofs
fig Fyilf"�y ppltcan t DaBA' nMA . ALSD .OSURL Type of Roof
e applicant ilding tacupamstom or handl asarduusmatcnal
r DefinUm Cupertino u arc al Code.Chater 9.12,and the Health enJ Safety
s25532(a)r All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or r lure building Occupant use equipment ordcvices which If a roof is installed without first obtaining an inspection, I agree to remove
it In.'sa ms air contamina defined by the Bay Arca Air Quality Management all new materials for inspection.
District'I
❑Yes N
have he oar usmaterial r uimmemsunWfCbapwr6.95ofNCCalifor-
r t 1 Ctiorss 2551 5513 and u — thin huilding
rcn
Js cram. ,
y rcx mibilii255}1.1 y t notify the r upant f the mtp uanes.facenir or ca ' Signature of Applicant Date
if)wner ora orifi agent / DateAll roof coverings to be Class "B" or better
07/07/2003 10: 00 4082525435 R&Z DEV CO PAGE 02
MY OF CUPERTINO
BUILDING DIVISION PERMIT .KIL
BUILDING ADDRESS . jP•mob 1 R�1 P5�
0 JL 7 r)E3Tl7TQRNPLNT
OWNER'S NAME:
17AT AVE T. ID 21 221 q'I'VAIPMq rRI, AT. J0 nc)
SANITARY Al CONTROL NO.
4nA;)r%2I1 1 r1TOVVerTKn rA Q5()ld
PHONE BUILDING PERMIT INFO
BLDG RLCPLUMB sil
I • �INSPECTION JOB DESCRIPTION
I fi.� 1�r,�J,� "ipj�u,
r.
ON$" a,
3S ALL 7"4211 MONDAY.FRIDAY 24 HOURS
BEFORE REQUIRED INSPECTION.JOB ADDRESS 0 SH��WL 0 KITCHEN REMODEL
UNDATION/PIERWD.S. AND PERMIT 0 ARE NEEDED WHEN PHONING. 0 ADDITION ZI PLUMBING RE-PIPE
LIFER GROUND 0 MULTI-UNIT 0 STRUCTURAL
PAD/SETBACK-CERTMODIFICATION
RESIDENTIAL COMMERCIAL—C 0 INTERIOR 0 CHIMNEY REPAIR
SIPREOUNME IMPROVEMENT
ARAZESLA�B El SWIMMING POOLS
ION, HA7ARDOUSFIRFARPA 0 BATH REMODELAtEPAIR 0 DEMOLITION
UNDERGRQUND/SLAB Dyes 0 OTHER
UNDERGROUND PLUMBING
UNDERGROUND ELECTRICAL C] NO Iflidal— I C.S.0,
,00NOT411POldik
COMMFRCIAF
EXISTING ROOF COVERING
0 NEU'BLDG/ADDITION 0 DEMOLITION
UNDERFLOOR PLUMBING 0 TENANT 0 FOOD SERVICE
UNDERFLOOR MECHANICAL Number of erivinit coverings IMPROVEMENT
UNDEBUNDERFLOOR
NDFRFI,OOR ELECTRICAL 13 OTHER
UNDERFLOOR FRAMING VENTS
GO
FLOOR INSULATION
Rw F $Idkwr,3 TYPE OF ROOF COVERING PROPOSED,
ROOF SHEATIVDIAPH 0 R.il(-UDRw(
❑PLUMBING ..... Built-up Roof
TUBS&SHOWER PAN Lo� Asphalt Shingles F_ Asphalt Shingles
0 Word
MECHANICAL [3 Wmid Shakes ❑ Wood Shaw,
( hoo
ELECT RICAIJPOOL BOND 0 W..d Shingic, El Wood Shingles
FRAMING/STAIRS/E.EGRESS C3 Other fSpecify) 0 Other(Specify)
MCATION/VENTILATION Provide I.C.B.O.Raper,No
Pm-Ido Mfp.Imul6vion spe.$.
EXTERIOR SHEAWHOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROICK SHEAR INSPeCTION SPECIAL INSPECTION REQUIRED 0 DATE INSP
LEX7LERIQRLATH/W-SCREED I
SHOWER LATH
OTT
,3R
I PI:;S.TWjj
NTILAffqy0hA$JIE8N$'G" L4
SCRATCH COAT
SEWER/WATER
TEMPORARY APPROVALS
OCCUPANCY
z 4-1,60 i, 0
V ;
PLANNING 777-3308
GAS TEST
0 'GRADE(BW.777-3354)
Z I FIRE-CALL f4087 3784010
I HANDICAP
ELECTRICAL
PLUMBING
MECHINI(7161,�
ENER
VII ALFI5
NALONLY
UILDING
Oe,GeV*Iiiii6'e6p ou.
UIL&Nd4i
CERTIFICATE OF OCCUPANCY ❑
WSPFCTION PLYWOOD: IN-PROGRESS:
DATE INSP. DATE INSP, DATE
TEAR OFF INSPECTION: BArrliNs rc_ FINAL:
INSP DATE INS? DATE INSP, DATE
NOTE: OSHA,APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION' -