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03010064 (3) CITY OF CUPERTINO n BUILDING DIVISION PERMMP CONTRACTOR INFO RMAT a BUILDING ADDRESS: STARBURST CONST CO PERMITNO, 21904 DOS PALOS CT 03010064 WNER'S NAME: 1207 REDCLIFF DR APPLICATION SUB DATE RENNICK LYLE V AND LESLIE J 01/10/2003 PHONE: (408) 448-1328 SANITARY NO. CONTROL NO, ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 1-00 LICENSED CONTRACTOR'S DECLARATION Job Description O O O O I hereby affirm Nn 1 am liceesed der provision of Chapter 9(commencing �Zj 70tH Sation]O(p)af DivisionJmNe ens and Profruions Code,end my license is < in full force a effect. Q ~g- Oamnse .. D- 'c.N oS�.UO�� _ MS BATH> I �D Imo® z.ZnIt F-q ARCHITE TTy�S�}_+�A�LARATION O W `a,lfndcmand my plans shall M use as Punic records V LmensedProlcumnel APR 42003 S j OWNER BUILDER DECLARATION p� a'¢�t 0 I hereby.(firm Nm 1 am exempt form the Contractor's License city o for the BUILDING uyl-Oo whichingmoron.Permit ]03 loubcl,"her, and Professions Code:Any city orcounty $1 which sequins a Permit In moat the pate.impose,demolish,fie a sig any structure F Z pratr w sl lensed¢,plata mgWRe theapplicantof for suchCon Porth'w GICs Law(Chapter F€0 (commiscing wit Pursuant to the Provisionsor lM Conusinessnd Preelaw(ChaPHr9 Sq.FL Floor Area $12 D'6IOa000 (commy+ Oat 15 exempt Section of Divisionr tof hat Business end Pro AyviolaMe)or - Nn he b escmp0 Hetefmm and the baeis for the alleged exemption.Any violation of Section On by anyapplicant for apermit wbjecu the applicant H.civil penalty of Occupancy e not mom On Bvc hundred dollar(g5W). p yTyp 0 L as owner of the pmPeny,or my employees with wage as their rule emnear lien, will do the work,and On son corm is not intended or offered for We(Sec.7W,Business and Pmreesions Code:The Conuactofe License Law doe not apply 70 an owner of 102 - P I ERS equlred Inspections property who builds or improve Hereon,and whodoessuch work himself or through his ownemployee,provided dmuuch improvements are not intended or offered for We.It. 103 - UFER however.the Wilding or improvement is wad within one year ofcompletion,the owner- lO4 - REBAR Wilder will have the barden of proving Hat he did not Wild or improve for purpose of sal`')' 105 - ANCHOR BOLTS ❑ 1.ass owner of the property.am exclusively enumerating with licensed conernattroa to 106 - SEWER & WATER construct IM project(Sec.]INC,Business and Prof WOM Code:)The Com acloa a U cense law doe not apply to an owner of property who Wilds or improves Herron.and, 202 - UNDERFLOOR PLUMBING who License Laa1qu for such ProjectsN wieronuaaorp)licencenm d pursuant Contneofs L 203 - UNDERFLOOR MECHANICAL ❑ luneemptunderSee. ,B&PCBerthismasoa 204 - UNDERFLOOR FRAME sere, Date 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING I hereby arfion under Penalty of perjury one of the following declarations: ❑I haw and will maintain a Cenifcate of Consent o self-imum for worker,Compcm 302 - TUB do OR SHOWER cation,M provided for by Section 7700 of fee Labor Code,for the performance of the 303 - ROUGH MECHANICAL work for which this Permit is issued. 304 - ROUGH ELECTRICAL ❑I ban and will maintain Worker's Compensation Insurance,as required by Section 305 - FRAME 7]00 of the Labor Code,for the performance of He work for which this permit is issued. M Worn oder' tmpenu0ionl upncecartier n'Policy 306 - HOLDOWNS : 101 307 - INSULATION CERTIFI COMPENSATIONIINSURANCE FROORKERS' 308 - SHEETROCK or (ITIS section need not be,completedif He permit is for one hundred dollae(g 100) 309 - EXTERIOR LATH Ieto]rY 310 - INTERIOR LATH e certify that in fficon in performance arne of He work for which His Permitil issued.)Nell not 311 - SCRATCH COAT employ any person in any mannerw a ro become Subject w the Wortrn'Compensation Laws of Califomia.Date 313 - ROOF NAIL Applicant NOTICE TO APPLICANT-.If.site,making this Certificate of Exemption.you should 501 - FINAL ELECTRICAL ENERGY Wcome subject o Ne Worker's Compensation provision of Ne labor Code,you must Z M 502 - FINAL PLUMBING ENERGY fowuh comply with such provisions or this permitshall W deemed rewind. zo CONS RUC ON LENDING AGENCY 503 - FINAL MECHANICAL ENERGY F Nr I hereby affinn Oat there is a construction lending agency for due Performance of 504 - FINAL BUILDING ENERGY x the work for which this permit i,Issued(Sce.3097,Civ.C.) Lender's Name 505 - FINAL ELECTRICAL W Q Z Lenders Address 506 - GAS TEST 0 1 certify Hu 1 have rod this application and state Hal the abive information is 507 - FINAL PLUMBING {L H correct.I agree to comply with all city and county ordinances and sate laws relating to o V building construction,and hereby aohorim representatives of this city to enteruptn the 5 FINAL MECHANICAL shove-mentioned properly for inspe pro,purposes. O9 - FIN E (We)agree to save,indem and keep harmless On City of Cupertino against r.y V) liabilities,judgments,costs and es uses which may in anyway accrue against mid City 5 N G O F77 in onscqucnce of Nc ming. oris permit. A PLICANT UND TA AND WILL COMPLY WI HALL NON-POINT Issued bys 1 WORKS Date I UR signal ofApplicanUCon c r Dam Re-roofs =AZ US MATERIALS DISCLOSURE Type of Roof Will He applicant or o a Wilding occupant store or handle haerdous material r� as dented by Ne Cupenlnt icipal Code.Chapter 9.12,and 0W Health and Safety 41 Code.Section 25512(.)7 All'roofs shall be inspected prior to any roofing material being installed. V. o Will the applicant ort Wilding occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove emit h.'n1ms all ronuminants M defied by He Bay Area Air Quality Management all new materials for inspection. District El Y., t I ban mail the do mamr lsmquimmenuundu Chpwr6.95or He Califon niaHMIN&SafetyC m255115,25377 and 255JC.1whrswd thnif the Wilding d o0 currenty ve he no.Nat itis my responsibility to oodfy the upant of He to met Prionoissuan¢ofaCcnifica r and(. Signature of Applicant Date Gwnermwmori, ,g �D,te All roof coverings to be Class"B" or better • RE --'z JAN 1 0 2003 BY: ►N ACC D�� over,H C ITy o5 CUPERTINQ (/ FSA D ORDINANCES DAT SIGNED ,This set of ons and sem" be kept on the Pecdications MUST lawful to Job at all times and it is un make any changes or alterations on same without written the building Dept., Ci permission from The stamping of this nTy of Cupertlnn . Sf'' ue Held to �utl specif. apt' Val of the , olJ>ef or r� r oVCit f a i ation of any provis .- Cit) nonce or SPstfP taw • n , I s � i / CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM 6 3 CUPEI�TINO • APN# J © Date: ip /// Building Address: C CJ Owner's Name: Phone#: 6- Contra or: License#: 'Contact: �1 Phone#: 132 ApplicanUContractor: Fax #: ildi Permit Info: / Bld "/ Elec Mech ✓ escription: Residential: Commercial: Sq.Ft. Floor Area: �y tJ $/Sq.Ft.: Architect/Engineer: Valuation: r All /1 I Type of Construction: Occupancy Gro p: QuantityFee ID Fee Description Fee Group BAPPLOTHER Other Appliances 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<= IOOOA ELECTRICAL BELEC1001 Elec 600V> IOOOA 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. Housin Mit Fee BUILDING BMNEWMULTI New Multi-FamilyRes MECHANICAL BNEWMULTI New Multi-family Res ELECTRICAL AIL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM 0 New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING 1 of 3 X77 6�