03070085 (2) crfY OF CUPERTINO
NTRACTOR INFORMATI*" » "' `'' " -'
Buts-oboe DlvfsloN PERMIT .COON
`
BU LDING ADDRESS: ROCKWOOD CONSTRUCTION CORP .PERMITNO03070085
23752 CA2TIRTON RT-
OWNER'S NAME: 14583 BIG BASIN WAY, STE 3 PRMlnssue DATE
NE: (408) 868-9026 SANITARY NO. I il 9 CaTIROLNO.
CHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 lT 0
I o o LICENSED CONTRACTOR'S DECLARATION
❑ I M1cmhy affirm that 1 am,i Dai un-or pr ,L000 ver Chapter 9(commencing Job Deserip[io��[1
4=W with Sermon] puri Divixionlof the Busirm. Pmfessio Cod,.andmyliccnseis f1V4�'1
m ton lin err (�s3�!{ ADD 169 SQ. FT. /REMODEL
j�? Liccnx Ct Lic.p
`^=� ARCI{ITELTSDsrRA"- oN- ` =-"� cr<,r.��f� FEB 1 2 2003
LK 1 understand my plans shall M used ss public mcmdo
eo„
Licensed Prefic,skmal BUILDING
c 5 OWNER-BUILDER DECLARATION
1 hereby Ornrm on 1 tat exempt from Ne fessins Co e:Any
Law for the
u w O following reason.(Sudan 703 1.5,Business and Professions Code:Any city or county
<m which myuires a pcmit m cnnarucL alcor,improve.Jemnlish,m repair any structure
rimy prior In its issuance.also mquircs the applicant for such Permit to rile a signed statement
< that he isreen.edpursuant tamepm.isionsnnheContractor aLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation
cl--O (commencing with Section 7")of Division]of the Business and Professions Core)at
U�$ but M is exempt dMmfrons and Inc Buis for the alleged exemption.Any violation of 35618071 . 00
Section]m1.5 by any applicant for a Permit subjects the applicant to a civil penalty of ppN Number Occu ane
not mon than fin hundred doll..(S500). P Y Type
D I,as owner of the propecity,or my employees with wages as their sole compensation,
will do the work,and the awctum is not intended or offered for sale(Sec.70a4,Basin., _
and Pmressions Codc:The Contractor's License Law does not apply to an owner of 10 2 - P Z ERS d Inspections
property who builds or improves thereon,and who dues such work himself Or through his
own employees,provided that such improvements are not intended or offered for sale.If. 103 — UFER .
however,Ne building or improvement is sold within one year of completion.Neowner-
builder will have tM wrdcn or proving that he did not wild or improv for purpose or 104 — REBAR
sal`')' 105 — ANCHOR BOLTS
D 1,as owner of the property,,B exclusively contracting s with:)Thlicensed contractors e
onamn the project(Sec.70,14,Business and Professions Cale:?The Contractor's Li106 — SEWER & WATER
come,LawBoca not apply toinowner orproperty who Wilds orimprovesmenton,and. 202 - UNDERFLOOR PLUMBING
who contracts for such projects with a contractor(s)licensed pursuam to the Contractor's
bL'erae Law. 203 - UNDERFLOOR MECHANICAL
lame mptundcrscc. .B&�PrC�fa�rt�hi�s�.�..a 204 - UNDERFLOOR FRAME
tC311,1
rev DuagM I3 205 - UNDERFLOOR INSULATION
WOR K ER'S COMP�ION DEC t"a�}[ON
Mrcby affirm under penalty of perjury one of tlfa.fnB6 ins declariumme 301 — ROUGH PLUMBING
and will maintai n a Certificate of Consent to self-insum for Worker's Compcn- 302 — TUB & OR SHOWER
provided for by Section 3700 of me Labor Code,for the perforroar�or the 303 - ROUGH MECHANICAL
which this permit is issued.
and will maintain Worker's Compensation Insurance,as required by Section 304 - ROUGH ELECTRICAL
e labor core.ver the performance or the work for which this pcm,R is issued. 305 — FRAME
er'a Cnmpe eci io.Insurance canicr.ad FOR,camber,are: 306 — HOLDOWNS
Polky Na,
�f—
CERrIFiCATEOFE)(EMPr10NF KERS' 307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
or less.)(ihuscctionnced norhecomple¢J fix poinitisfnronchundriddollars(SI00) 309 - EXTERIOR LATH
I certify mat I. he perfamm.ee of the work for which this permit is issued,I:hall our 310 - INTERIOR LATH
employ any person manner.wast become subject the Workers'Compensation 311 — SCRATCH COAT
Lawrarcr
are - /II/63 313 - ROOF NAIL
NOTI li a V
NOTI APothe :IL Bcrmasation sCcrinsorthe aborCnic.youmuld 501 - FINAL ELECTRICAL ENERGY
Mcome Subject to the workers vision or this provisions or the toed Care,you mut
U'Z, forthwith comply with such provision.Or this Permit Shan MeccmcJ rewkee. SO2 — FINAL PLUMBING ENERGY
z0
CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
�-. I thereby affirm that them is a construction lending ageney for Performance Of 504 - FINAL BUILDING ENERGY
file > me work fur which this permit is issuer(Sec.3W7,Co,CJ
lender's Nam= 5 0 5 - FINAL ELECTRICAL
!a7
Dz <nderrAdd rs 506 - GAS TEST
U O 1 cer fy that I haveread this applieaten and room mat the awv.informal..is 507 - FINAL PLUMBING
cancer.1 agrm LOCOmply with all city and county ordinances and sure laws relating to
pU building construction.and hereby arithurom representatives of this city to enter upon the FIN MEC CAL
W abovcbacru ned property for inspection purposes.
G (We)agree to save,indcmni fy and keep harm leu the City of Cupertino against O 9 FI
fq liabilities,judgmena.costs and expenses which mayinanywayacemeagains1.tici1, 5 NG
U inensegvenccofthcgmming oflhis Permit. III/
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by:5 C WORKS ale
S REGULATIONS.
i 63 Re-roofs
ignawrc of AppliaH
HAZARDOUS MATERIALS DISCLOSURE Dae Type of Roof
Will IM applicant tar future wilding Occupant nom or handle hazardous material
as defined by the Criterion M�pal Code,Chapter 9.12,and the Health and Safety
Code,oyes zsvz(an All roofs shall be inspected prior to any roofing material being installed.
cs
Will the applicant or future building Occupant nae a If a roof is installed without first obtaining an inspection,I agree to remove
pp s P a Air Quality
or Marta which
haiamnus air contaminantfu defined by me Bey Area Air 1]uality Mana6emem all new materials for inspection.
ton [fi/
�; DYcs Nu
I have mail the haaallous materials mqulmments under Chapter 695 of the Cali for
nia1{cahh&SJf LICWc,S ...25505.25577and25534.1unre.00nd IhatifIM wilding
dors not curtcndy Hast a mnank Nat it is my rcspomiiiliry to nnily tM Occupant of me
mqua no hiehmusII,ractIm.,toisauanccol"Cemncat�roaunanc. Signature of Applicant Date p /
�� 11/c3 v
wacr or aritwrivcr."at Date All roof coverings to be Class "B" or better
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION .
BUILD1NGanBIM6 . CASTLETON ST ROCKWOOD CONSTRUCTION CORP PERMIT N%3070085
OWNER'S NA kYAN MAKARAM 14583 BIG BASIN WAY, STE 3 BMIT Lb�`7° /2003
ONE 11VV HHIICC SARATOGA, CA 95030 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: PHONE t. ADD 169 SQ. FT. /REMODEL BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
csz
W00
u E . i '� °� A` � " gav TO ARRANGE INSPECTION ]OB DFSCRB'I-ION
r w W$PECTIDNS r .x % DATE sWSPEC. CALL 777-3228 MONDAY-FRIDAY 24 HOURS RR S
p n z �n .-. t u BEFORE REQUIRED INSPECTION.JOB ADDRESS ❑ SFDWL ❑ KITCHEN REMODEL
'^ w FOUNDATION/PIERS/H.D.S. �'p�3
NO PERMIT k ARE NEEDED WHEN PHONING. ❑ADDITION ❑ PLUMBING RE-PIPE
❑ MULTI-UNIT ❑ STRUCTURAL
o `u UFERGROUND —a MODIFICATION
PAD/SETBACK-CERT -RESIDENTIAL_COMMERCIAL—OTHER_ CI INTERIOR ❑ CHIMNEY REPAIR
wpb GARAGE SLABS/PREGUNITE IMPROVEMENT C1 SWIMMING POOLS
- -• - - - HA7ARD0_ S FIRE AREA C3 BATH REMODEL/REPAIR Q DEMOLITION
60o xPOURNO CONCRETE UNTIL WABOVE HA"S'BEEN;SIGNED
w= UNDERGROUND/SLAB YES Ir = C1 OTHER -
'z
Y ❑ Y 1 undersand Nv a Clau A roof assemElY is rttluirtd.
$=`o UNDERGROUND PLUMBING
UNDERGROUND ELECTRICAL C) NO ma;,l Lc.B.o.+
COMMERCIAL
1D0 NOTrPOl1RIFLOORtUNT1ISs`ABOV EFI S''�BEEN SI NED , EXISTING ROOF COVERING ❑ NEW BLDG/ADDITION C1 DEMOLITION
UNDERFLOOR PLUMBING O TENANT ❑ FOODSERVICE
Number of existing coverings IMPROVEMENT
UNDERFLOOR MECHANICAL
(] OTHER
UNDERFLOOR ELECTRICAL Toboved Tobereuined
e m
UNDERFLOOR FRAMING VENTS
UNDERFLOOR INSULATION -0
POACE NOSUBFLOORUN]T<lIi`AGNED , TYPE OF ROOF COVE G
B 'I HAfi;BEEN; I
ROOF SHEATH/DIAPHRAGM �. EXISTING: y1cPROPOSED:
PLUMBING �a ElBuill-Up Roof ❑ Built-Up Roof
TUBS&SHOWER PAN C3 Asphalt Shingles ❑ Asphalt Shingles
MECHANICAL C]-0
Shakes / E]Wood Shakes
ELECTRICAL/POOL BOND -Q j ❑ Wood Shingles ❑ Wood Shingles
FRAMING/STAIRS/E.EGRESS -63 ❑ Olher(Spcci fy) �Osher(Specify)
sNSULATION/VENTILATION Provide LC.B.O.Repon No.
EXTERIOR SHE KI1NTIti�°DOWN A$BEENISI Pre vide Mfg,Insullotion Spees.
EXTERIOR SHEARMOLD DOWN j � �
INTERIOR SHEAR/HOLD DOWN PION SPECIAL INSPECTION REQUIRED 1:1 DATE INSP
SHEETROCK/SHEETROCKSHEAR --0
EXTERIOR LATH/W-SCREED
SHOWER LATH -
--;(VQ%TAPE OR�PG:4STER;UMCTL'AEO,VE HASB EEN SIGNED ;k�;
SCRATCH COAT
SEWER/WATER
TEMPORARY APPROVALS
OCCUPANCY
D ZO
? h PLANNING 777-3708
z `> GASTEST IMPORTANT
yp GRADE(P.W.777-3354)
Z FIRE-CALL(408)378-4010 When a permit has expired, a charge totaling one-half
HANDICAP the fees to obtain a new permit must be paid to
O U ELECTRICAL — — eactivate the permit.
PLUMBING
J Z MECHANICAL
ENERGY If a ermit has been expired for more than one year,a
VISUAL FINAL ONLY arge totaling the full fees to obtain a new permit
BUILDING ust be paid to reactivate the permit.
OCCUPANCY OFBUILDINC_I NOT EERRSI71'ED � ` `� ❑ Initials
4 f v.RyK h i L S�SidY kJ ,,5
UNTIL-BUIL-DINQ'FINAL IS.SIGNZV DI BUILDING ylyx A
CERTIFICATE OF OCCUPANCY ❑
PRE-INSPECTION: PLYWOOD: IN-PROGRESS:
INSP. DATE INSP DATE INSP. DATE
TEAR OFF MSPECTION: BATTENS: FINAL:
INSP. DATE INSP. DATE FISP. DATE,
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION