02040134 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMI CONTRACTOR INFORMAL T:
BUILDING ADDRESS: PERMIT NO,
11238 BUBB RD MCCLURE JAMES E II AND MkNTOVA 02040134
OWNER'S NAME: APPLICATION SUB DATE
MCCLURE JAMES E II AND MANTO A 04/24/2002
PHONE: SANITARY NO. CONTROL N0,
Dealt, �CHITECT/ENGWEER: BUILDING PERMIT INTO
E BLDG ELECT PLUMB MECH
u ru u
LICENSED CONTRACTOR'S DECLARATION
y 1 hcrcby effi.Thai I am licensed undo provisions of Chapter 9lcommencing Job Description
L I:t� with Section 7000)of Division 3 ofthe Business end Professions Code.and my license INSTALL WINDOWS �A�r 4���'®
:z s< is in full fora and effect.
U License Class Lic.N
Data Crnveerar MAR 0 'r 2003
LL O Fn ARCHITECTS DECLARATION
g 1 understand my plain shall be used as public.cords
i
Ike, Licensed Professional ��'�®'��
'd Oen I in eUILDE from
he RATION
u� 1 hereby.(Sectfrom on 11. exempt from the C Professions
rs :Any c Law for than
h?< following rtawa(Section 703 construct.
Business and Professions Cade:Any city or county $3000
210 which requires n permit to conxwet,oboe improve,demolish,t,ore.repair any structure
gis t thatheto itslensedidu requhes theappliaer fa such pcmdt m ciemo,Laduewnem
that he is licensed pursuant 7 the ofD Division
of the Convertors ad Pr Lew(Chapter..Coil 9
(commencing withSectiontheion9000)o the basiseof tthe Business endion.Any
Code) Sa SFr,, r{�Tea Valuation
or that he is exempt thbnfrom and the basis for the alleged exemption.Any violauan •3 O L V b(�'-t�U " � f �
of Settum 10313 by airy.,plural fore permit subjects the applicant m.civil .by
.four marethen five hundred doll.ls5W). 101'4PN�ATION Occupancy Type
C 1.es awns of the property,or my employees with wages u their sole compensation, 102 pIgRS
will do the work,and the swcmre is or intended or offered for We(Sec.1044,
Basinaa end Professions Code:The Contrenor's License Law does not apply to en 103 - UFER Required Inspections
owner of properly Who builds or improves thereon,end who does such work himself
or through his own employees,provided that such improvements art ort intended ce 104 - REBAR
offered for sale.If,however.rhe building a improvement is cold within one year of 105 — ANCHOR BOLTS
completion,the owner-builder will have Ne burden of proving that he did not build or
improve forpurpaseafaaie.). 106 - SEWER & WATER
C h u owner of he Property.nm exclusively contracting with liamed contmcmn to 202 - UNDERFLOOR PLUMBING
concoct the project(Sec.1044,Business tend Professions Cade:)The Contractor's
License Law does not apply toanowner ofproperty who Wilds orimproves thereun, 203 - UNDERFLOOR MECHANICAL
.and who contracts for such projacts with a antranall)licensed p nuancm the 2 04 — UNDERFLOOR—FRAME '
con tor.License IAw.
Clem a 's d �B3�&�PL�gImmisrawa. 205 - UNDERFLOOR INSULATION
own` Dated 7- 301 301 - ROUGH PLUMBING
WORT ER'S COMPEN /^N ECLARATION
hertby effrn under penalty ofperjury one of rhe following daclaretions 302 — TUB & OR SHOWER
303 - ROUGH MECHANICAL
1 have and will maintain a C""care of Constitute
ul6imurt for worker's 304 - ROUGH ELECTRICAL
kr_ ompemauon, as provided for by Section 37M of the Labor Code, for the
Performance of the work for which this permit is issued. 305 — FRAME
D I have end will munuin Worker's Corepcnsation Insurace.as raptured by Section 306 - HOLDOWNS
3700 of the Labor Code,for the performance of the work for which this pcmdt is
hard.My Worker's Compensation Instance carrier and Policy number an: 307 — INSULATION
Carve Policy Nix: 308 - ,SHEETROCK
cERTIF]CATtON OF EXEMPTION FROM WORICERS', • ' 3 0 9 - EXTERIOR LATH
COMPENSATION INSURANCE' -
(TMs sectionneed not be completed if the Permit is for one hundred dotart - .310--,_ R__`INTE R I-O "LATH--- — - -
($100)mliu.) 311 - SCRATCH COAT
1 certify that In the paimernenae of the won for which this permit is Wisi d,I 313 - ROOF NAIL
camnnlsaupoyem mnnDmaraae(�6eaW g�je whewadei 501 - FINAL ELECTRICAL ENERGY
App'Q 502 - FINAL PLUMBING ENERGY
NOf�CE ICANI:If,afw making this Cutiflcau of Exemption,you should
Z becomea a a the WorkersCompensnienprevisionsofthelaborCode,youmust 503 - FINAL MECHANICAL ENERGY
O O
forthwith comply with suchprovisionsN this permit shell be domed rooked. 504 — FINAL BUILDING ENERG)i,.
CONSTRUCTION LENDING AGENCY
F Ihereby affirm therthem iseconzwaionicndinyegenryfar dwperfannena 505 - FINAL ELECTRICAL
of the work for which this rami is issued(Sec.3091,CC)
W q Lenders Anna .° iv. 506 - GAS TEST
U Z �nder.Adareaa 507 _ FINAL PLUMBING
1 certify that 7 have read this application end stem that 508 FINAL MECHANICAL
W.
nhe above information is
corner.l.granm comply with all city and councountyonlinances and sum laws reluing 509 - FINAL GRADE
� m Wilding concoction.and hereby euthariae repasomaivis ofthu city to enter upon
the above-mentioned property for inspection purposes. 51 O - FINAL PLANNING
Gr, (We)agree to save,indemnify end keep harMess the City of Cupertino against
In liailides,judgments,costs and expenses which may in tiny way..a against said said 514 —
FINAL PUB I C WORKS
V z City in consequence of the grandog of this permit.
API (CANT TANDS AND WILL COMPLY WITH INTIssued b
.. 50
DNS. Z y: Date
Vi apfApplomsrtaCmmra,lur Date. Re-roofs
HAZARDOUS MATERIALS D1sCLOS
dl the applicant our fumy building acvpent am or batik Woallous material Type of Roof _
- a defined by she Cupertino Municipal Code,Chapter 9AZ and the Health ad Safety
Cade,Section 25532(.)1
CYes - All roofs §hall be inspected prior to any roofing material being.installed.
Will the appear to funuc building Occup rt use equipment our devices winch If a roof is installed without fust obtaining an inspection, I agree to remove
tDisuict?
it hemrdaus tar commitments as defined by the Bay Amo Air Quality Managemml g P g
all new materials for inspection. Applicant understands and will comply with
°Ycaawroall non-point source regulations.
1 have reed the baardon materials requirements under Chapter 6.95 of the
lifomiaHealth&Safety Code,Sections 25505,25533 end 35534.I understand that
the buil&ng dos not ciamu tly have a mneme Out it u my ma,mibdity to ratify theeupam of the requirements which mst W ma prior to iuuance ofa Canifium of
Signature of Applicant Date
m ad,gen� — Z All roof coverings to be Class"B"or better
OFFICE "
ITY OF CUPERTINO • D ?� "� ��
c TM r PERMIT APPLICATION FORM
CUPEI,TINO
APN# y Date:
Building Address:
G9,0,0-
Owner's Name: Phone#:
M � GI. Nv� -z l 6
Contractor:.
Contact: Phone#:
Applicant/Contractor: Fax#:
'ng Permit Info:
Bldse Elect -----Plumb_, Mech
lob Description:
Residential: NS t, 01 /yaw C ercial:
Sq.Ft.Floor e_a,. $/Sq.Ft.:
Architect/Engineer: Val do D
Type of Construction: Occu rcy p:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILER1 Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler>500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V<= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC 'Comm. Housing Mit. Fee BUILDING
BMITIGATR Res. Housing Mit Fee BUILDING
1 of 3
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CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11238 BUBB RD MCCLURE JAMES E II AND TOVA 02040134
W NER'S NAME: APPLICATION SUB DATE
. CCLURE JAMES E II AND MANTO A 04/24/2002
f PHONE: SANITARY NO, CONTROL NO.
C z z ARCHITEC'UENGINEER: BUILDING PERMIT INFO
m OFc� BLDG ELECT PLUMB MECH
yaK C� 1—t L-7
Z LICENSED CONTRACTOR'S DECLARATION
m 1 hereby oRnn that 1 am licensed under ons of Chapter 9(commencingJob Description
'_�� with Secdnn7000)of Division 3 of the Business end tFmfessimo Code,and my licensINSTALL WINDOWS
is in furc
ll foe and effcd.
i 0 a w O C' License Class Lic.M F'N ® L E
Date Contractor !"�
1 p Q 13
ARCHITECT'S DECLARATION
to
1 understand my plans shall be used m public records MAR U 7 2003
3 $o LicensedeeLicensedrrormfieasaionm
OWNER-BUILDER DECLARATION
1 hereby affirm than i am exempt from,he Contractor'scense Law for the
�?o follu ng rta.on(Sam n]03158 - ass and Professions Code::Any city or mommy BUILDING $3000
C$ which q permit s a pet to con uuctalum improve demolish or repair any structure
prior,priorto itss mance alw q res theapplicart forsuchpermn,ofileaugited am,rmorm
3t. that h I" frd pursuant to th pro -ons of the Camracmrs License Law(Chapter 9. - -- -- -" �-"- - - - - - -
t ,.cuy ,c�ax,.�,,srF�T a'..: ., , 's.. Valuation
(comm be is
Sectionmrn and
Dinss, 3ofthe Business oil ot.An vi Cade) I.1Ii f k.3.0'L'��',(JJ J.]V'b S 1 t�1=;
or Natio is exempt there am end the basis for the the eiemant to Any l pennon
of not mom
than
n by any hundred
ll rerr a permit subjects the applicant to a civil pewlty-
ornotmomthanfi.emmnareaamlarafssoB). 101A N�DATION '`'- " Occupancy Type
[11,as owner of the property,or my employees with wages as their sole rompenwtion,
will do the work,and the'stmemm iss-not intended"M offered for sale ser.7044, Required Inspections
Bminas'and Professions Code:The Contractor i License Use does not m apply en 103 — UFER q "
awner of pmpery Who builds or improves,hemon,and who does such work himself
or through his own employees.provided that such improvements an,not intended or 104 - -ANCHOR
:offered for.],,If,however,the building or improvement is sold within one yeu of --- - - - - - _.. __.
completion,the owner-builder will have the human of proving that he aid no,build or 105 - ANCHOR BOLTS
impromfimpurpatae
teole.). 106 - SEWER & WATER
erot
0l assnthepmptrt hisivly m tradig thir;alc'onvanarstd - 202- - UNDERFLOOR" PLUMBING f !"_6i- - - -
meprot t(sm,]o4Basrte naProfessions
Cod<)The commctor's 203 - UNDERFLOOR MECHANICAli
Limas Law does not apply m an owner of prolog,who builds or improves thereon.
,and.who contracts for-such projects.with.e contradicts).licensed pursuant.to the ..-_._..- .. "._..
Con 'of n Lew. 204 ---UNDERFLOOR''FRAME
❑lam a µmnderSe &Pcfor iareaso" 205 - UNDERFLOOR' INSULATION
ovine Da '°LH-d"'^ 301 - ROUGH PLUMBING
WORKER'S COMPF,N N F.CLARATION
302 - TUB & OR SHOWER
a h<rebyafrimunder.penopyofnequoymeonngfollowing deel.ra,ions: 303 - ROUGH MECHANICAL
0 0 1 have aad'vwill maintain a Camficam of Consent to self-insure for Worker's
Compensation, as provides! by Section 37M of the Labor Code, for the 304 - ROUGH ELECTRICAL
performance of the work for which this permit is issued. 305 - FRAME -•
01 have and will maintain Worker's Compcnaatlbn Insurance,as required by Section 306 - HOLDOWNS
3700 of the Labor Code,for,he performance of the-work for which this permit is 307 - INSULATION
v issued.My Workers Compensation Insurance cattier end Policy number are: '
c, _' 'Par<yNa. 308 = ;SHEETROCK, a
1CFRTIFICATION OF EXEMPTION FROMWORKERS'l;- -r',' 33.0,9t�- �EXTERI OR''LATH
COMPENSATION INSURANCE",' . ,._
-- -�-'3I07,=;;INTERIOR_.liATH,-----"
finis section need not be completed Bthe permit is for one hundred dollars
(s�00)oness.) 311 - SCRATCH COAT
O ZO , mweihmsauaaet oemAcpryynawlhh(iCemAWwNorcrToknpeneIprfr'romaaCvifaiotanemyrvDopinig^nestaYntikosqirm�mStr ithnappsr aCm(r//tin(utiio-fl)nrpcs,arsnsefpotehf eElxacbmopprauCoand.eye,soywuosasuhAmoeuun,lsdt'
31ROOF-NAIL'
FINAL ELECT
Co. 501 ItCAL- ENERGY
, - . 502 FINAL-PLUMBING- ENERGY
beco503 FINAL MECHANICALENERGY
fonh --
-. ..
hanb d mdrevoka. -504 - -FINAL--BUILDING. ENERGY . _
FF+ - -" CONSTRUCTION LENDING AGENCY - 505 - FINAL ELECTRICAL,
G I h soy effim,h uh sued i o lending agency t ,h pertoem cc 5,0 6„" GAS, TEST_ _
fr] or the 'x k f _h h thisperm t issued(Sec 3097 C' C)
Q Lcnd rsN t__ . _ _._-_
QLend Adders 507 - FINAL PLUMBING.,-.
t1 0 1 carrifythatIhave read this application and state that the move information 1, 508 — FINAL MECHANICAL
iz E" cared I agree t ply with II city and county.o d noncar and state laws relating 509 - FINAL GRADE
O.p to Wilding conammmn,ad hereby mnomn.odoeemativea cofflai,city to enter upon
W
'he above-mentioned property for inspection purposes., „- 510 - FINAL PLANNING
Oa twe)agree to lava,indemnif, ml
y and keep borcss the City of Cupertino against
t•w W liabilities,judgments,costs and expenses which may in any way acema against said 514 - FINAL PUB I C WORKS
V Z City in consequence at the ggrouting of this permit.' _
APILTCANT UNEIMTANDS AND WILLCOMPLY WITH N N- INT Issuedb r
S L "RE ' ONS. - Z Y Date
to, of,pplie-MCo On Dam Re-roofs
HAZARDOUS MATERIALS DISCI OSUR
r mute pplica t fuuW ldin accv t mane m handle haiallous nwew Type of Roof. • vr:_ -- — -
by d Safety .
Gaddafi OcYt35 3Zpe,m Municipal Code Chirpier 912 and the Health n All roofs shall"be-inspected,prior to any roofing mn
ateal being installed.
r Will the applicant or town huildingOccupant use equipmentordevices which If a roof is installed without first obtaining an inspecti(in• Fagree'to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District? all new materials for inspection. Applicant understands and will comply with
all non=point source regulations( ”
1 he e read the heeardmus material requirements under Chapteri6.94'of the
CithE mite Health&Safety Code,Sections 25505,25533 and 25534,I understand that
ifthebuilding doesnot curtenIly heveetenan6 that it is my responsibiliry to nmi(y the - - " ' - "'
oLuip m of the iiquircments which must be met poor to issuance of a Cenificam of
pay.
"� _ „•�,Z Signature of Applicant Date
woe r a nmdrea again Data
All roof coverings to be Class•`B" or better
c.
_i
.. ...OFFICE... _.... ._ .. _ ..._.