010500451
:U^•:
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
B IL GADD 55: PERMIT NO.
STII �t/ISTA DR -BLDG 3 01050045
°M5`1'2INO COMMUNITY SERVICES A�P�IcgTb°�u/1001
PHONE: SANITARY NO.. CONTROL NO.
Z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
O
q - BLDG ELECT PLUMB MECH
fug' u r� u u
Z LICENSED CONTRACTOR'S DECLARATION
Ilierehy affirm that l am licensed under provisions of Chapter 9]commencing BUILDING 3 __�q,¢gSCra DtlOp IVING UNITS TOTAL
with Section 7") of Division 3 of the Business and Professions Code. and my license z tO7�k''' L
Uis in muvnnatod effect TYPE C-1 (850 SQ.FT.) 6 EACH
License Clns. Lic. p 2
Date eamno 4� TYPE C-2 (886 SQ. FT.) 1 EACH
ARCH] TECuse DECLAic rel N R N /� LED I underaianI my plans shall be used az public records 1 y 11r�i
Licensed Professional
OWNER
-BUILDER DECLARATION APR 0 2 2003
H
1 hereby eRrm that I am exempt from the Comtacon's License law bathe
a folich on teason. (Section vii mutt. , mess and improve.
de Profession, Code; Any city ar county
D wi ch requ e. st m construct, alter improve demolish or file. signed r any structure
mwnncm
.pct t i e Ira reqs he theupionso thefor sucCohractor tLcseLaw(Chapter
hapt em--
- teeth IbmsdpSectio totes Provisions of theContractorsBusiness
sland Proawons Cor) !�}, i S ,Ft -Floor Areasx n
recommencingwnhSecton7U0(nd thebod, or tithe Bu:meuanapmreen vi ease) 1. 1-,•} 9'f i. •'i;, rse`t .:; t: Al.`i 0:c;
.,bar he is 31.5 b zany applicant
p li and the Casts for Ne subjects
the ex<mant to Any violation
of Section a than five
hundred
oil for o permit subjttu the applicant a civil Penalty -
of not more man fve nanarea annnra (asnn). APN Number ', 1 �'r: , Occupancy Type
0 Las owner of the property, or my employees with wages as their sole compensation,
will do the'wark; and the structure is not intended or offered for sale (Sec. ]044. 101 - FOUNDAT
Business and Professions Code: The Contractor's License Law does not apply to an 11%ired Inspections
(wncrof property Who Guilds or improves thereon, and whodoes such work himself 102 - PIERS
m th eh h ...... lnyces V.,,d,d that h improvements arc not intended or-
'iuf cred far sale If. however, the building or impro0ement is sold w min one-year of ...... 103- - UFER .... ._._ ,.. _.. - ... _... _... ..
mmplet on, the owner Wilder will have the burden of proving that he did not build or c
tmpr°ve far purpose of sole). 104 - REBAR
i -105- - 'ANCHOR BOLTS
O �wner of the arop<ny am exclusively contracting with l censed convecmn m - - - _ - 'I've\ .. s-
I:.,
_ construct the project (Sec. 7044, Business and Professions Code:) The Contractor's 106 - SEWER & WATER
Licanse law does an apply to ea owner of property who Wilds or improvrs thereon,
sa0�who convects for.such. Pori with a contr«mr(s) licensed putmam m the __ ..._. ..202- ---UNDERFLOOR_PLUMB ING -- ---- - - - --- -_ - -
Conta°arsLicenseLaw. 203 - UNDERFLOOR'�MECHANICAL
01 am exempt under Sec. B;& P C (.,,his ..,an
gomer Data t' 204 - UNDERFLOOR FRAME
' - WORKER'SCOMPLNS1.ATIONDECLARATION 205 - UNDERFLOOR INSULATION
Ihereby afrn„under Penatty'ofperjury one ofthe following declarations: 301 - ROUGH PLUMBING
0 1 have and will maintain a Certificate of Consent 'to sal6losure for Workers 302 - TUB & OR SHOWER
Com,comiuon, m Provided for by Section 37M of the IaWr Code, for the
performance ohne wore mr which thin permit is issued. 303 - ROUGH MECHANICAL
G l habeand will maintain Worker's Compensation lnsure«e. .required by Section 304 - ROUGH ELECTRICAL
37M of the LsWr Cade, (or the perf ..a,c of the work for which this permit is 3 0 5 - FRAME
issued. My Work&, C pe - y
FI 306 ''- .HOEDOWNS - e.__ r,_ .. _ _...... -
_._.,
u°n nsumntt aameten o c numbet ere
sec a.
Gem' ♦ r T1 ' iA ul cY Nu //19Y9 io i ti ryp•i' tt
:�ICATION°F EMPTIONF FROM WO K R':" 13.07 6-11fINSULAT ION' 1.
COMPENSATION INSURANCE', •'."', •. - `
' ('Phis section need nm be completed if the permit is for one hundred dollars
309 - EXTERIOR LATH '
r-
'al(wl rlesaJ,.. work
.,. :.........310----INTERIOR...LATH.�,..;,.•-.
' I eemployhany er ninanperformance nuns work mr which j ctote crkc 1 311 - SCRATCH COAT ! . ,'; t 14 '� ' :... , . ^• . ._ ...:_ ...
shall not employ any person m any manner m subject m the Wohcri f
camper .van laws of caldomia.Date 313.. __..ROOF NAIL
Applicant.-' as m become
NOTICE TO APPLICANT, If, after making this Cenifcme of Exemption, you should 501 - FINAL ELECTRICAL" ENERGY "
become subject to the Workels Compensation provisions of the Labor Code, you must'
fonnwitncomply isiminch powisimiscur this permitxhauxdemand ranked, 502 - FINAL. PLUMBING ENERGY
CONSTRUcnONLENDING AGENCY " 503 - FINAL MECHANICAL ENE GY-a - -
" "I nerehy'amrimdintthem isaconmpcimnlending agencyf ithePerfonnaW` 504 - FINAL BUILDING ENERGY -
of Jia wants for which this Perron is issued Hiec. 3097, Cie C)
Undies NaB t _...__ .,. _..SOS = FINAL -"ELECTRICAL
Lender. Nance
,. ;, y, y that i have read this application and state that the above information is 506 - GAS TEST
mrtect. 1 agree m comply with ail city and county cob .... a, end state laws relating 507 - FINAL PLUMBING
mWilding construction. mia hertby iuthorize zepiesimatives of thin city m curer upon' 508 - FINAL MECHANICAL
a he abovemcmio«d prop ny for inspection purposes.
V es, j g t wast, it a exPicinify d keep hamay in tan wayity aci peitino agmost 5 0 9 - FINAL GRA
O liabilities, I i c t , costs and expenses keep
which .may' a y c ai ninst mid
Citytnc sequence or the gram Sof thspe- t
APPLICANT '/,EE�RzsS�TC��,N NDWILLCOMPLYWITHALLNN-volrrr� [ssued �5s10 �_ NA NG Dale
SOURC W T 971 / ^ /
�0/O ROOF PLYWOOD NA
ssdef NbymSignabroo[Ape CL
HAZARDOUS
MAIM-A— M
RbD r.9.120. avd the�al�, Re-roo�s q////n��3� •�
Will the applk t«f m Wilding Dec pant oars or haMle hezallousiwmal e of Vf_ ROOF BATTENS
nan3safety
Type 6-..ROOF..IN,-PROGRESS
Code Sectmn 25532(al s; ; i x + ! f t x{• i r', t ,' i s s 3
❑ yes
"" o. All roofs shall be inspected.pnor to any roofing material being installed _ _. _
.,; Willtne pplicantorf t Wildingoccupant seshropm m rd' i«, which If a roof is installed without first obtammg an inspection; Pagree to remove
auto hazard is air contaminants as defined by the Bay Arca Air Quality Managepienl
District, all new materials for inspection Applicant understands and will comply with
°Ye"° t " all non -point source regulations
s.l havercad the hazardous mammal Mquiremems under Chapmr'6.9a oLth, i
Califainor Health &Safety Code. Sections 25505, 25533 and 25334. 1 understand that '
p .,qhe,
prior my respo blitym noufythe
Occupant to issuance of a Cenif ime of -
t t a d an se t aveat t t top Signature of Applicant Date
8 Y
« am f t re ti rcmem. tch moa be ran
Z.
.OFFICE - -- . .............
r ,. 1
All roof coverings to be Class "B" or better
� t oozed e e i
:U^•:
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
B IL GADD 55: PERMIT NO.
STII �t/ISTA DR -BLDG 3 01050045
°M5`1'2INO COMMUNITY SERVICES A�P�IcgTb°�u/1001
PHONE: SANITARY NO.. CONTROL NO.
Z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
O
q - BLDG ELECT PLUMB MECH
fug' u r� u u
Z LICENSED CONTRACTOR'S DECLARATION
Ilierehy affirm that l am licensed under provisions of Chapter 9]commencing BUILDING 3 __�q,¢gSCra DtlOp IVING UNITS TOTAL
with Section 7") of Division 3 of the Business and Professions Code. and my license z tO7�k''' L
Uis in muvnnatod effect TYPE C-1 (850 SQ.FT.) 6 EACH
License Clns. Lic. p 2
Date eamno 4� TYPE C-2 (886 SQ. FT.) 1 EACH
ARCH] TECuse DECLAic rel N R N /� LED I underaianI my plans shall be used az public records 1 y 11r�i
Licensed Professional
OWNER
-BUILDER DECLARATION APR 0 2 2003
H
1 hereby eRrm that I am exempt from the Comtacon's License law bathe
a folich on teason. (Section vii mutt. , mess and improve.
de Profession, Code; Any city ar county
D wi ch requ e. st m construct, alter improve demolish or file. signed r any structure
mwnncm
.pct t i e Ira reqs he theupionso thefor sucCohractor tLcseLaw(Chapter
hapt em--
- teeth IbmsdpSectio totes Provisions of theContractorsBusiness
sland Proawons Cor) !�}, i S ,Ft -Floor Areasx n
recommencingwnhSecton7U0(nd thebod, or tithe Bu:meuanapmreen vi ease) 1. 1-,•} 9'f i. •'i;, rse`t .:; t: Al.`i 0:c;
.,bar he is 31.5 b zany applicant
p li and the Casts for Ne subjects
the ex<mant to Any violation
of Section a than five
hundred
oil for o permit subjttu the applicant a civil Penalty -
of not more man fve nanarea annnra (asnn). APN Number ', 1 �'r: , Occupancy Type
0 Las owner of the property, or my employees with wages as their sole compensation,
will do the'wark; and the structure is not intended or offered for sale (Sec. ]044. 101 - FOUNDAT
Business and Professions Code: The Contractor's License Law does not apply to an 11%ired Inspections
(wncrof property Who Guilds or improves thereon, and whodoes such work himself 102 - PIERS
m th eh h ...... lnyces V.,,d,d that h improvements arc not intended or-
'iuf cred far sale If. however, the building or impro0ement is sold w min one-year of ...... 103- - UFER .... ._._ ,.. _.. - ... _... _... ..
mmplet on, the owner Wilder will have the burden of proving that he did not build or c
tmpr°ve far purpose of sole). 104 - REBAR
i -105- - 'ANCHOR BOLTS
O �wner of the arop<ny am exclusively contracting with l censed convecmn m - - - _ - 'I've\ .. s-
I:.,
_ construct the project (Sec. 7044, Business and Professions Code:) The Contractor's 106 - SEWER & WATER
Licanse law does an apply to ea owner of property who Wilds or improvrs thereon,
sa0�who convects for.such. Pori with a contr«mr(s) licensed putmam m the __ ..._. ..202- ---UNDERFLOOR_PLUMB ING -- ---- - - - --- -_ - -
Conta°arsLicenseLaw. 203 - UNDERFLOOR'�MECHANICAL
01 am exempt under Sec. B;& P C (.,,his ..,an
gomer Data t' 204 - UNDERFLOOR FRAME
' - WORKER'SCOMPLNS1.ATIONDECLARATION 205 - UNDERFLOOR INSULATION
Ihereby afrn„under Penatty'ofperjury one ofthe following declarations: 301 - ROUGH PLUMBING
0 1 have and will maintain a Certificate of Consent 'to sal6losure for Workers 302 - TUB & OR SHOWER
Com,comiuon, m Provided for by Section 37M of the IaWr Code, for the
performance ohne wore mr which thin permit is issued. 303 - ROUGH MECHANICAL
G l habeand will maintain Worker's Compensation lnsure«e. .required by Section 304 - ROUGH ELECTRICAL
37M of the LsWr Cade, (or the perf ..a,c of the work for which this permit is 3 0 5 - FRAME
issued. My Work&, C pe - y
FI 306 ''- .HOEDOWNS - e.__ r,_ .. _ _...... -
_._.,
u°n nsumntt aameten o c numbet ere
sec a.
Gem' ♦ r T1 ' iA ul cY Nu //19Y9 io i ti ryp•i' tt
:�ICATION°F EMPTIONF FROM WO K R':" 13.07 6-11fINSULAT ION' 1.
COMPENSATION INSURANCE', •'."', •. - `
' ('Phis section need nm be completed if the permit is for one hundred dollars
309 - EXTERIOR LATH '
r-
'al(wl rlesaJ,.. work
.,. :.........310----INTERIOR...LATH.�,..;,.•-.
' I eemployhany er ninanperformance nuns work mr which j ctote crkc 1 311 - SCRATCH COAT ! . ,'; t 14 '� ' :... , . ^• . ._ ...:_ ...
shall not employ any person m any manner m subject m the Wohcri f
camper .van laws of caldomia.Date 313.. __..ROOF NAIL
Applicant.-' as m become
NOTICE TO APPLICANT, If, after making this Cenifcme of Exemption, you should 501 - FINAL ELECTRICAL" ENERGY "
become subject to the Workels Compensation provisions of the Labor Code, you must'
fonnwitncomply isiminch powisimiscur this permitxhauxdemand ranked, 502 - FINAL. PLUMBING ENERGY
CONSTRUcnONLENDING AGENCY " 503 - FINAL MECHANICAL ENE GY-a - -
" "I nerehy'amrimdintthem isaconmpcimnlending agencyf ithePerfonnaW` 504 - FINAL BUILDING ENERGY -
of Jia wants for which this Perron is issued Hiec. 3097, Cie C)
Undies NaB t _...__ .,. _..SOS = FINAL -"ELECTRICAL
Lender. Nance
,. ;, y, y that i have read this application and state that the above information is 506 - GAS TEST
mrtect. 1 agree m comply with ail city and county cob .... a, end state laws relating 507 - FINAL PLUMBING
mWilding construction. mia hertby iuthorize zepiesimatives of thin city m curer upon' 508 - FINAL MECHANICAL
a he abovemcmio«d prop ny for inspection purposes.
V es, j g t wast, it a exPicinify d keep hamay in tan wayity aci peitino agmost 5 0 9 - FINAL GRA
O liabilities, I i c t , costs and expenses keep
which .may' a y c ai ninst mid
Citytnc sequence or the gram Sof thspe- t
APPLICANT '/,EE�RzsS�TC��,N NDWILLCOMPLYWITHALLNN-volrrr� [ssued �5s10 �_ NA NG Dale
SOURC W T 971 / ^ /
�0/O ROOF PLYWOOD NA
ssdef NbymSignabroo[Ape CL
HAZARDOUS
MAIM-A— M
RbD r.9.120. avd the�al�, Re-roo�s q////n��3� •�
Will the applk t«f m Wilding Dec pant oars or haMle hezallousiwmal e of Vf_ ROOF BATTENS
nan3safety
Type 6-..ROOF..IN,-PROGRESS
Code Sectmn 25532(al s; ; i x + ! f t x{• i r', t ,' i s s 3
❑ yes
"" o. All roofs shall be inspected.pnor to any roofing material being installed _ _. _
.,; Willtne pplicantorf t Wildingoccupant seshropm m rd' i«, which If a roof is installed without first obtammg an inspection; Pagree to remove
auto hazard is air contaminants as defined by the Bay Arca Air Quality Managepienl
District, all new materials for inspection Applicant understands and will comply with
°Ye"° t " all non -point source regulations
s.l havercad the hazardous mammal Mquiremems under Chapmr'6.9a oLth, i
Califainor Health &Safety Code. Sections 25505, 25533 and 25334. 1 understand that '
p .,qhe,
prior my respo blitym noufythe
Occupant to issuance of a Cenif ime of -
t t a d an se t aveat t t top Signature of Applicant Date
8 Y
« am f t re ti rcmem. tch moa be ran
Z.
.OFFICE - -- . .............
r ,. 1