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03010071CITY OF CUPEWI'INO>r BUILDING DIVISION PERMIT 1 NTRACTOR'INFORMATION ;' BUILDING ADDRESS: MATZ CONSTRUCTION PERMrr NO. 20044 WHEATON DR 03010071 OWNERS NAME. 10574 ORANGETREE LN APPLICATION SUB DATE GARRETT WADE 01/13/2003 PHONE: (408)257-6376 SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MEC11 o 0 0 r ON LICENSED CON'IAdunderSoviimsof hap I hereby affirm that I um licensed under provisions of Chapter 9 (commencing JobDesSNUALE® lh Section 700(yof UivisinnJn(thcB sent Pndcwinns Cole. and mylicenw is or re d t _n a i s ENLARGE BATHRM "- Co ter 2 "!" OCT 1 5 2003 ARCI IITECCS QE ARATION I understand my plans shall be used as public records SUHMING Licensed Prolu sional OWNER -BUILDER DECLARATION 1 hereby a(Srm that 1 exempt from the Contractor's Law for the Any following mason. (Section 703 1. Cock: : r, Business and Professions Code: Any tiny or county c which requires a detrain re cancrum, alcor, improve, demolish, or repair any sumame s e prior to its ceased p also requires the applicant for such permit liens signed statement t that Sq. F[. Floor Area $15i9'IDQauon mencingwitpursuantRohepnrvivision3theheBuiness ndPriclaw(sCode)r9 (commencing withhecJnn ]land Division 3 Or Business and Code) or t(ithe that he is al nd. Any vi Nal he i7 exempt therefrom and the Frio for the alleged cxcmpnt Any lineation of J_Awkgw;ep Occupancy Type to Section any applicant for a permit whjuu the applicant Ira a civil penehy of than five not more than Bve hundred dollen (S30). 1, ss owner of the properly, or my employees with wages as their sale compensation, 102 - ire PIERS squd Inspections . will do be work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professioms Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided Nat such improvements are not lnmnded or offered for sale. If. 103 — UFER however, the building or improvement is sold within cote year of completion, the owner - 104 — REBAR builder will haw the burden of proving that he did not fund or improve bra purpose of sale.). 105 - ANCHOR BOLTS ❑ I, as owner of the property, am exclusively contracting with licensed contractors to 106 - SEWER & WATER consumer the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- emeraw Lawdoes not apply toanownerorProperty Who Wilds orimproves marine. and 202 - UNDERFLOOR PLUMBING who contracts for such pmjecu with a conuacmr(s) licensed pursuant to the Conuai Wc..Uw. 203 - UNDERFLOOR MECHANICAL I and exemtptler$ec. BPC bonds reason 204 - UNDERFLOOR FRAME Qwnsr-J�� 205 - UNDERFLOOR INSULATION a! WORKER'SCOMPENSAIO LCLA ON - ROUGH PLUMBING I hereby affirm under Penalty of perjury one or the following declarations:301 302 — TUB & OR SHOWER ❑ I haw and will maintain aCerificate of Comantto self moure for Worker's Comped senora, as provided for by Section 3701 of the tabor Cale, far the performance of the 303 - ROUGH MECHANICAL work for which this prmit is issued. 304 - ROUGH ELECTRICAL ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3 05 - FRAME 3700 of Ne Labor Code, for the performmce of the work for which this permit is issued. MyWr'kers Compensation I maance tender and Policy number are: 306 - HOLDOWNS Policy Na: 307 - INSULATION CERTIFICATE OF EX COMPENSATION�ONFRA ERS' 308 — SHEETROCK Cris rection need not be completed if the permit is Bonne hundred dollars (SIM) 309 - EXTERIOR LATH orless.) 310 - INTERIOR LATH 1 cermly Ihat in the performance of the work for which this permit is issued, 1 shall not 311 - SCRATCH COAT employ any person in any manner w as m kcome Subject the Workers' Compensation Laws Canfmnia. of Applicant 313 - 5 01 - ROOF NAIL FINAL ELECTRICAL ENERGY Nanen'TO APPLICANT: IL arm' making IM1is Cenilicatc of Exemption, you should becomubjcenatheWorkersCnmpenwtionpr�visi�nsnitheLab�rCOJc,y�umuss 502 - FINAL PLUMBING ENERGY forthwith comply with such provisions or this permit shall M deemed revoked. 503 - FINAL MECHANICAL ENERGY CONSTRUCTION LENDING AGENCY I hannyallirm that there is a construction lending agency far the performance of 504 - FINAL BUILDING ENERGY the Permit the work Name 505 - 506 - FINAL ELECTRICAL GAS TEST Lender's Address I minify that I have read this application and stem than the above information is 507 - FINAL PLUMBING correct 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby amhorre representatives of this city to enter upon the5 FINAL MECHANICAL above-mentioned property for inspection purposes. Q 9 — FIN {We) agree to save, indemnify and keep harmless the City of CuKrti no against liabilities, judgments, costs and expenses which may i n any way accmc against said City 5 N G J In consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by51 WORKS Date l SOURCE REGULATIONS. Re -roofs Type of Roof of ApplicaDam Sig re HAZARDOUS 11A2ARDOUS MATE RIALS DISCLOSURE Will the applicant or furore building occupant mare or handle hamNnanmaterial eCh as defined by the Cupertino Municipal Cuda Chapter 9.11, and the Health and Safety Cwt, seehoazssJxan All roofs shall be inspected to any roofing material being installed. ❑Yea prior 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 mil hazardous air e m and nants as defined by the Bay Area Air Quality Management all new materials for inspection. District? / ❑Yes tNt1 1 have ren the havasdous materials requirements under Chapter 6.95 of the Califor- nia Health 5 Safety Crack, Secdom 35515.355]7 and 2554.1 understand than if the Wilding does not currently haw a tenant. Nat it is my respond hit try to malty W Occupant of Ne rcour nes which Icmelprio nation ceoracc' amorwcupancy. Signature of Applicant Date All roof coverings to be Class "B" or better saner nr aulhnrixaJ agent CITY OF CUPERTINO BUILDING DIVISION PERMIt BUILDING ADDRESS: MATZ CONSTRUCTION PERMITNO. 20044 WHEATON DR 03010071 OWNER'S NAME: 10574 ORANGETREE IN APPLICATION SUB DATE GARRETT WADE 01/13/2003 PHONE: (408)257-6376 SANITARY NO. CONTROL No. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing Job Description Division of eue'u., an with Section 7000)ofDlvlsl'on 3 of 8 1 d Professions Code, and my license is d i rce an e t, Lu .14 5 I C, L imn 1c, # 3 W ENLARGE BATHRM Da Co tar 014 Z:2 ARCHITECT'S RATION I understand my plans shall be 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 7031 .5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure 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 Law (Chapter 9 Sq. Ft. Floor Area $ 15 0180ation (commencing with Section 7000) 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 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Occupancy Type D 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of _LV 102 - PIERS Required Inspections property who builds or improves thereon, and who does such work himself or through his own employers, provided that such improvements are not intended or offered for sale. If. 103 - UFER however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of provingthat he did not build or improve for purpose of 104 - REBAR sale,). 105 - ANCHOR BOLTS 1-] 1, as owner of the property. am exclusively contracting with licensed contractors to construct the project (See, 7044, Business and Professions Code:) The Contractoes Li- cense Law does not apply to an owner of property who builds or improves thereon, and, 202 - UNDERFLOOR PLUMBING who contracts for such projects with a contractor(s) licensed pursuant to the Contracor's License Law. 203 - UNDERFLOOR MECHANICAL IV I am exempt der Sec. & P C for this reason 204 - UNDERFLOOR FRAME 0 1 7 205 - UNDERFLOOR INSULATION WORKER'S COMPENSA'ft0_N N 6ECLPO 301 - ROUGH PLUMBING I hereby affirm under penalty of perjury one of the following declarations: 302 - TUB Sc OR SHOWER 0 ]have and will maintain a Certificate of Consent to solf-insure forWorkees Compen- sation, as provided for by Section 3700 of the Labor Code. for the performance of the 303 - ROUGH MECHANICAL work for which this permit is issued. 304 - ROUGH ELECTRICAL 0 1 have and will maintain Worker's Compensation Insurance, as required by Section 305 - FRAME 3700 of the Labor Code, for the performance of the work for which this permit is issued. Wkrker's Compensation insurance carrier and Policy number are: 306 - HOLDOWNS 7_ Policy No.: ;M; 307 - INSULATION "E"IFICAOTME OPEFNESXAETMIONION FRA ERS' 308 - SHEETROCK [Phis section need not be completed if the permit is forone hundred dollars ($100) 309 - EXTERIOR LATH artless.) 310 - INTERIOR LATH I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation 311 - SCRATCH COAT Laws of Catifamia __ - ROOF NAIL Applicant313 501 - FINAL ELECTRICAL ENERGY NOVO NOVO APPLICANT. If, after making this Certificate of Exemption, you should becom ubject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 502 - FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby affirm that there is a construction lending agency for the performance of 504 - FINAL BUILDING ENERGY the work for which this permit is issued (See. 3097, Civ. C,) Tender's Name 505 506 - FINAL ELECTRICAL - GAS TEST Lender's Address I certify that I have read this application and state that the above information is 507 - FINAL PLUMBING correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the 5 FINAL MECHANICAL above-mentioned property for inspection purposes. - FI N (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 5 %9 G in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued byS 1 WORKS Date SOURCE REGULATIONS. Re -roofs Type of Roof Sig!!ke of Applicant/Contractor ate HAZARDOUS 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)? 0 Yes All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? Dyes e< I have read the hazardous materials requirements underChapter 6.95 of the Califor- nia Health& Safety Code, Sections 25505,25533 and 25534.1 understand that if Ute building does, not currently haw a tenant, that it is my responsibility to nodry the occupant of the �XuiLs �whkh be met prior to issu co ifaGert ate ofOccupancy. Signature of Applicant Date All roof coverings to be Class "B" or better wner or authorized agent Date CITY OF CUPERTINO 3 PERMIT APPLICATION FORM APN # Fee Description Date: BAPPLOTHER, Other Appliances 3- 43 Construction Tax Building Address: iBCONSTAX 11 Ind/OfffConun,/Quasi BT I ING • Con. Tax for BQ Zone Owner's NamPhone#: r6l' `e Hotel and Motel Contractor: License #: Elec 600V <='l OOOA ELECTRICAL Contact: ELECTRICAL Phone #: Elec Svcs 600V <-- 200A ,,BENERGY . 9 Applicant/Contractor: -IS 704—wJq Add Multi Fax #: 37 C uildifi Permit Info: 11GIn 'r Bldg Elect Plumb Mech Job scrniption: Res. Housing Mit Fee BUILDING i esidential: Commercial: TV -ECHANICAL Sq.Ft. Floor Area: 'New Multi -family Res $/Sq.Ft.: BNUCOMME �7 ELECTRICAL BNUCOMMM New Comm Mechanical Architect/Engin W IT me Tj NEW,= Valuation: ,V7�Type of Construction: Occupancy G4oup: 1 of diol � - 7� Fee Description BAPPLOTHER, Other Appliances BCONSTAX Construction Tax iBCONSTAX 11 Ind/OfffConun,/Quasi BT I ING • Con. Tax for BQ Zone Hotel and Motel Constax — Resi/Mobile Elec 600V <='l OOOA ELECTRICAL Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <-- 200A ,,BENERGY BENERGYA.D-D Add Multi BINVESTIGA 7ttee BMITIGATR Res. Housing Mit Fee BUILDING ! 4..AvN ng New Multi -Family Res TV -ECHANICAL 'New Multi -family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL W IT me Tj NEW,= On - 111 top 1 of diol � - 7� CITY OF CUPS RTINO 114(c," aMym PERMIT APPLICATION FORM CUPEkTINO 10 Fee Description Fee Grou 2 5 &vj Ut 101241roi Vent Fan Single Duct Ventilation S y0in-s-- i Scb Specific ♦Plan . . . . . . . . . . . . Seismic Commercial 011 z 01 Seismic Fee Res IL W M WIN WA WIR 0 Single Family New Add r"61 Special- Inspection Swimming Pool Temporary Power ELECTRICAL T pary Ternp Dist Svcs Business License Electrical sq foot ELECTRICAL ELECTRICAL Mechanical foot MA JIM"Im Mech Permit Issuance We's igu fif-A k7 mi, a PIT ING Plumbing Fee foot a 11 RIJ kyj no I I'm" MAXIMO*$ Address Chp _gc Boiler<= 100,000 Btu Boiler > 1 OOK to 5 OOK Btu Boiler > 500K to 1M Btu Mus 12:13 Boiler > 1M to 1.75 M Btu Boiler > 1.75 M Btu 10