04030048 TY OF CUPERTINO * tIV "
BUILDING DIVISION PERMIT O�1TRACWINF'UTZ1�Tt''T.''I0N.,,
euaDINGADDRESS: SMI CONSTRUCTION INC PERMITNG04030048
R'S NAME: PERMIT ISSUE DATE
NE: SANITARY ITO. CONTROL NO.
ARCH=/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
A0c LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm Net 1 am licensed under provisions,of Chapter 9(commencing Job Description
i`uj with Sectian]pIU)ofOivieion3of rile Business uW Profcuions Code,end mylkens, A,
�^_ in full foae and effect.
5�z Lteumc Class, Lic.10 REVISION-- N HOSUE USE ONLY
i Data Comment-'SDECL 0 NEW IT ISSUED/ORIG. #03120014
Y
ARCHITECT'S 1A,used
DECLARATION
1 understand my plans shell M1e uaJ a public records,
G Licensed Professional
3OWNER"BUDER DECLARATION
E 1 hcrchy ILaRlrtn that 1 am exempt from Ne Contracmrs License Law for the
0 0 following mason.(Secdun 703 1.5,Business and Profcuions Code:Any city or county
K$ which requires a permit to construct,altar,improve,demolish,or¢pair any structure
prior an its issuance.also mqumas the applicant for such permit to file a signed statement
Ithat W is licensed pursuant to the previsions of the Contractor's,LI ensc Law(Chapter 9 Sq.Ft. Floor Area Valuation 1 0 3
m $ (commencing with Section 701 of Division 3 of NC Business and Profcuions Code)or 4
..
that he is exempt therefrom and the basis for the alleged eanription.Any vloladon of
Section]W 1.5 by any applicant for a permit subjects the applicant to a civil penalty of . .APN Number Occas Type
not moa than Five hundred dollen(MOD). - Occupancy '7 Pe
❑1,As owner of Ne property,or my employees with wages As Nei,mole compensation, 31605052 . 00
will do the work and the structure is not intended or offend for sale(Sec.7044,Business
And Professions Crude The Comncars Liam Law does not apply to an owner of Required Inspections
property who builds criterions Nemon,and who does such work himself or through his
awn employees,provided that such improvements as not intended areRered forssle.if,
however,the building or improvement is sold within one year of eampledan.Ne mvner-
builder will have Use burden of proving Nat he did not Wild or improve for purpose of
a
1,as owner of Ne property,.B sine sia d Professions
with licensed ennVeebn a Q
co wn db pro%not (See.e,an Business and ny who Wilds
Cade:)TheContractor'sreacmre Fid a--,
Genu law doss nal apply a m owner of property who Wilda rs improves Nemon,and v-
who canmcts for such pmJeets with a eonwetor(Q Ilanxed pursuant be the Contnears
Lew.
:crept under Sec. B&.PCfor s,rcNan
S Dau D
WORKER'SC P NSATIONDEC N
1 hereby e18rm under penalty o(perjury oro of the following declantiou:
I have and will maintain a Centrists of Consent a calf-insum for Worker's Camper. _
Wa b.u provided for by Section 3700 of the Labor Code,fm the performance of the
work for which this permit is Word.
0 1 have and will maintain Workers Compensation Insunna,as required by Section
3700 or the labor Coda.for the performance of the wark for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Cartier: Policy Net:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
ohisseNao nod not W completed if Ne permit is formas hundreddollars($1(X17
or ass.)
I anfy Nat in the performance of the work for which this permits is Wood.l shall not
employ any person in any mannerso As to become subject to db Waited Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Comficale of Exemption,you should
become subject to Ne Worker's Compensation previsions of the labor Code,you must
,J O foMwith comply with such provisiou or Nis permit shall be deemed revoked.
,z.m
51 CONSTRUCTION LENDING AGENCY
(-m mom. I hereby arum that thea is a construction lending agency for the performance of
IYNe work for which this permit is issued(Sec.31307,Civ.C.)
Lenders Name
z Lender's Address
U 0 L artify that l have mad this application and sale that the above information is '
it, F correct I agree as comply with all city and county ordinances and sem laws relating in
0U building construction.and hereby amharian aprescntativu of this city acnier upon the
Liz
above-mentioned d pmpc m for expenses purposes.
iy (Ws,)agree be save,indemnify and keep harmless the City of Cupertino against
flabilf/7
in
of ls.ca65Nal of this permit. may in any way acCNC Against mid City I�
C)FFyii A APPLICANT
of Degerming of this per mit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATION 0 -7
° r Re-roofs
room of ApplimnUConet ata
HAZA S MATERIALS DISCLOSURE Type Of Roof
Will the applicant at future building occupant store or handle ha adoes material
As de0ned by the Cupertino Municipal Codc,Chapter 9.13,and the Health and Safety
A
E:Section zss3z(ar / All roofs shall be inspected prior to any roofing material being installed.
Yes, �Na
Will the applicant ser/mwm building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants u defined by tits Bay Ams,Air Quality Management all new materials for inspection.
District?
❑Yes
I have mad the huardaus materials requirements underChepter6.95 of the Califon
nia Rest"SafetyCode,Secdou 8505,35533 and 75534.1 understand thinlithe Wilding
Jas nae cunendy haw a boom Nat it is ery ouponsibility to dry rhe eccupam of dmc
aye' mcntswhichm dpdmutemAnce.f.can6caa eupanay. Signature of Applicant Dale
b D�
Orion or Authorized ages te All roof coverings to be Class"B"or better
_ CITY OF CUPERTINO - - ry 4" �y77 ,7•77y�y�y7 "�'
BUILDING,UrvfsloN 'PERMIT *+ 1[t1 �Ll li 31Y1O1M s
BUILDING ADDRESS: - - PERMIT NO,
JOYLUCKNPLACE 04100160
OWNS AM RD PERMIT ISSUE DATE
ONE: SANITARY OL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
. 0 ELECT PLUMB. MECH
O
O p LICENSED CONTRACTOR'S DECLARATION .. -
�z+ 1 hereby affirm that I am Secured under provisions of Chapter 9(commencing, Job Description
n< with Section 7falea ufDivision 3 of the Business said Professions Code,and my license is
O in full forte end uffe",
5 z Lieenxelass Lle.x EMERGENCY WATER HEATER REPAIR
't_ °ex ARCHITECT'S SPECIAL INSPECTOR CALLED
�y rq�q 1 understand my plans hit W=ties public records
OyI-�
C3 Licensed Professional
OW NER-BUILDER DECLARATION
.�<I I hereby affirm that 1 oro exempt from the Contractor's License Law for the
i O O following meson.(Section 7031.5,Business and Profession,Code:Any city or county
u$ which requires a permit to conatmct,eller.improve,demolish.or repair any almctu a
I,is^ prior m its issuance.also supplies the applicant forsuch permit to file a signed satamem
a that be is licensed pursuant to the provisions ofthe Costu ler'sLi=nsalaw(Chapter9 Sq.Ft.Floor Area Valuatio�
(commencing with Section 7000)of Division 3 M the Business and Professions Cartel or S00
that he u exempt therefrom sod site basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant be a civil penalty of APN Number Occupancy TSI
not mom than five hundred dollars(M). - P y ']Pe
❑I,asowner of tip progeny,army employees with wages astheir cele=mpenetlon, 31605053 - 00
w0ldo the wont and the structure is nal intended aronertd forsole(Sec.7061,Busimen
and Profession Code:The.Contributes Licence Law doe,WI apply In an owner of - - Requl nspections
property who Wilda or i m proms die icon,and w ho does such work hi.sel f or through his
own employees,provided that such improvements tie autinxnded mortared for We,If, _
however,Ne building or improvement is xld within ane year of complNon.the owner v
builder will have the burden of proving Nu he did act build or improve for purpose of .. -
0 1.has owner of the peo=ny,,B exclusively sand confessions with licensed convectors i.
construct the project(See.n an owner
of and property
who
Code:)The Conlrecron's Li. ,.
echo law don not apply je an ownar of property who builds or improves Norma,and
Lwho ima.contracts for such projeM with econuanar(s)Iicenxmin Commencesd purauathCommencesLicense I.
I.exemp un � B&PCfor#its moon
Dace t 7
WORKER'S CO ENTION
I hereby afRsm under penally of perjury am of the following declarations:
Iha. and will maintain a Certifscaw of Consent an selfinsum for Workees Comper.
action,as provided for by Section 3700 of the labor Code,for On,performance of the
work for which this permit is issued.
❑1 have and will meinain Worker's Compensation Insurer=,as required by Section
37W of the Labor Code,for due performance of the work for which this permit is issued. - ,-
My Worker's Compensation Insuence carrier and Policy number arc: - -
Caller. Policy No, _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This amount need not be completed if the permit is foronc hundred dollars($100)
or less.)
1=nify Not in the perfp�Xnnance of the work for which this permit is issued.I shall not
employany in myrulnnerso in arbecome subject to the Workees'Compensmon
Lawsof atifo D Iia
Aunt
N CE TO A LICA :If.after asking Nis Cenifneax of Exemption.you should
tooc to the Worker's Compensation provision of the Lobar Cade,you tent
0 fo Ih ca ly with such provinces ar this permit shall be deemed ravci
z r.a CONSTRUCTION LENDING AGENCY
(-t 44 I hereby affirm that Nee is a construction lending agency for the Performance of
ai F�-t the work for which this Permit is issued(Sec.3M.Civ.C.)
W�Q Lendces Nemo
z Lander's Adders
U0 I certify duet I have mad this application and nee that the ahem informadmi la '
U. F carmi.I agree w..ply with all city and county ordinames and aux laws elating to
DU building construction,and hereby authadre represenutivea of this city to enter mon the
W ,hove-ms,judgrAproperty
st favi expenses
purposes.
(We)agree ro ave,indemnify and keep harmless the City of Cup irdno against
liabolfA incoidequara ofthelosuang expenscsmay in my way accrue against mid City
A conte mote of the g permit.
U z y grerlin of
APPLICA UN ERSTANDS AdipWILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC G ON
e Re-roofs
I u of A,pIia VCmr ac,. De
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
III the applicant or future building occupant store or handle hvardous material
t as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Code.Sector,255320)?
All roofs shall be inspected prior to any roofing material being installed.
My., Ip."No
Will the applicant or future building occupant use aquipmcm or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit haurdous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Jistdct7
❑Yes (No
I have mad the Incurious materials requirements under Chapter 6.95 of the Califon
.is Health&SafetyCode,Sam.25505.23533 and 25534.1 undersand her ifdx building
does not c any ham a tenant*4 it is my mernan ihility w notify site occupant of the
u' u tent mm grwinuanccofaccoificaoroccma 1 Signature of Applicant Date
4.11 7� `�--ITh All roof coverings to be Class "B"or better
Owm,.,au@prised agent Date
CITY OF CUPERTINO
WATER HEATER
CUPERTINO PERMIT APPLICATION FORM
APN# � +(O d — Date: c]�
Building Address f I N, lilA J 0
Owner's NamN O� �C�{ � � Phone#: � 6 q
Contractor:" avNFF, Phone ���� License#: 6��
Contact: � �j 1 C s r Phone: 32 ^ r2 Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb A Mech ❑
Job Description: yI
Residential ❑ Commerci
Cost of Project: �-
Strapped ❑ On Platfdrm LJ Bonded ❑
New Location ❑ Replacement ❑
Qt . if
A he ble Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING
275-3
i
TYPICAL WALL 1/2" 1 909
ALo
CEIVE ':T
A CT 2 6 4 F
�STAI
s- MANAGE 5' g0?E: STAIR AND .
�o r AIR HANDRAIL
OFPICE> SHALL BE UP GRADED
TO MEET ALL CODE
REG2UIREMEN78 PER �
02 -19'- 4
CBC 1006 4 11338.4.
i
03
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KEY MAP ".
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'FS'iP PIA
SECOND FLOORr� PLAN ve„ q, : ���N
" 64,d
311X3'' ACCENT BLACK �° 7 31r,(
NATURAL SLATE 9�F
BY <EUROCAL SLATE : "�,,
4prrrrrr Onmllr
4
12 X1� �r .
SLATE
BY EUROCAL SLATE
I�.x ;12�Xi2" COPRA RED ' 'REVISION
f— BY EUROGAL SL' ATE
. I.
Special Inspection and Testing
Construction Observation•Engineering Consultants
CRNX ENGINEERING INC.
--- P.0.Box 14198, Fremont,CA 94539•Tel:(510)668-1815•Fax:(510)490-8690
SPECIAL INSPECTORS DAILYAft AftA&KA
Iff
PROJECT NAME: 7�/ PROJECT#:
PROJECT ADDRESS: 8 8 A/' BUILDING PERMIT#: 1241 nom/�D
L• , p
INSPECTOR: �AYh 1-44 I. D.# h8z�'RQ CONTINUOUS
SPECIAL INSPECTION PERFORMED:
DESCRIBE INSPECTIONS MADE INCLUDING LOCATIONS: �vE
V1 Su 115 OC ; � �Z�004
•LIST TESTS MADE: Q Eft
H
Nom.
LIST ITEMS REQUIRING CORRECTION
f
OF
LIST CHANGES TO APPROVED PLANS AUTHORIZED BY ARCHITECT OR ENGINEER:
COMMENTS: ,
NOTE-USE REVERSE SIDE FOR ADDITONAL SPACE FOR ANY ITEM
.To the best of my knowledge work inspected was in accordance with the Building Department approved
design drawings, specifications& applicable.,workmanship provisions of the UBC except as noted above.
SIGNED: 6 0
DATE: