04020151 (3) CITY OF CUPERTINO caste `
BUILDING DIVISION PERMIT CONTRACTOR INFNORMAT�i .
eUI1DING ADDRESS: PERMIT NO
K DESIGNERS 04020151
PERMIT ISSUE DATE
OWNER'S NAME:
SANITARY C MROLNO.
E:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
C I hereby affirm Our 1 am licensed under p wisio�u of Chapter 9(commencing
Job Description
ire with Section 7")of Division 3 of the Rmimm,mod pmfesainns Code.and my license is
I
w= in c
full fos�c - Q
uenml Lie L 8 VINYL SIDING
fp Dase ��J AR HITECrSD ATION
t srue^d my It..shall M used as public rewrds
to
C Licensed Professional
OWNER-BUILDER DECLARATION
1 kmhy^Rim Nal I am exempt from the Contractor`s License Law for the -
o O following reason.(Section 1031.5.Business and Professions Code:My city or county
e which requires a potmit in conduct,slot.Wpmw,demolish.or repair my stmnum
prior m its ismance.aldrequires Oe applicant fmsueh permit re I)...igncd statement Valu&P
thin='a at M islittftscd pursuant 1.the protmiomnf ftCounnumn's li..Law(chaplu9 Sq.Ft.Floor Area tio
IZ-s (Commencing with Section 1000)nf Division 3n1'the Business and Polloun...Code)-1
Nat W is exempt therefrom and IN hats for N.alleged exemption.Any violation of
Section 1031.5 by arty appltnnt for a p.rnit subjects the applicant to a Civil penalty of 3 svl�et0 0 Occupancy Type
not mote Nan five hundred dollam(5500).
I,asowuerofdiepmpe y.mmYu^playeeawlth.geaesth.irsolewmpenssd^^,
will do dtc work end the mash re is not intended m.flentl formic(5.[.106/,Business Required Inspections
and pefecrions Code:The Cemrzsioe,Lieerve Law does-1 apply w an owner of
pmp,oywW Wilds erimprews thereon,and wW dommehwmk hiseselrerthmugh his
Own employees.provided Nat such improvements ase not Intended moffCou for We If.
howewn are building or improwment is sold within one yea of eompleuon,ON owne,-
bullder will has.dm burden of proving Nat M did not Wild m Impmw,for F.Parse of
tate.). �� !{
❑1,as construct IN p of ct property.a..B sinus and confessions with llttm.d centracrers l' `
acee,LaNe does
(Sec.1066.Business ore ProfestrY who
Code:)The Conhamon.Lb ]
[otic law docs not apply to am^tuner of propery who Wilds or ant to
chremn.and /
who contracts Law.for such pmjecu with a Convactor(s)licensed pursuant re Um Conoanoh D�
License law.
1 em exempt under Seu .B&P C fro Nis tenon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under puWsy of perjury one of the following declasaione
1 Aaw and will malnuin a Certificate of consent wolf-iam.fm Workers Compcn-
ution.to provided for by Section 3100 of the LAW,Code.per the pciformaoe of the
work for which this permit is issued.
Q 1 haw and will malnlaln Worker's Cpmp.rWYnm Insmaret.as"timed by Section
3100 of Ne labor Code,for the performance of the work for which this permit is issued.
My WorkcfafC
mmlrpnsat.Ihom.me nand Polity,number am:
"cr. � Policy No.: 1 1 00 Z
CERTIFICATE OF EKEMFrION FROM KERS'
COMPENSATION INSURANCE
(Thissection need not W cemplcred if the Permit isfmmne horn dellam(Slol)
kas.)
I certify Nat in the perfmman¢of the work for which this perim,Is issued,I shall not
employ any person many ma tr crso as to become subject o the Workeri Compesretiem
laws of California.Date
Applicant
NOTICE TO APPLICANT If,after making this CeniOa¢of Exemption.You should
become subject to the Workers Compensation previsions of the Labor Code,you in=
�Z forthwith Comply with men pnownv or this Permit shall N deemed mw ucd.
O CONSTRUCTION LENDING AGENCY
I hereby affum Nat Nese is a comwcrion lending agency for the pedorman¢of
k 7 thework for which this Permit is ss ed(S 09.3 .Co.C.)
Nine.
tl Q Lcmicr's Na .
Lc
L Lenderi Address
Q 1 ttaify Nat 1 haw read this."head..and We Na the abew information is
L (—' correct I agree to eamply with all city and county osdinar m$end state Is.relating to
r upon
Wilding( e)IS=to,and wk¢byofy and ephumalisesefCity or to cnteno ager Nc
=LU mow-mentioned property for inspection purposes
(We)agree to saw,indemnify and keep hannlrss dm City of Cupertino &21-
raslanudChy
ai
JZ in...exiuemeofthe grantinsofthis pennit Date
^'. APPLICANT UNDERSTANDS AND WILL COMPLY WITH AIL NON-POINT Issued by:
OURC7GULATIONS -2 Re-roofst] Leri ^ 7,� /
I
Signature ofnppIiCmOComraemr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant stem orhandle hanrdaut material
as deRncd by the Cupertino Municipal Cade.Chapter 9.12,and the Huhn and Safety
Code.Section 25532(6)1 All roofs shall be inspected prior to any roofing material being installed.
❑Yu allo
Will the applicant or future building occupant true equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit Well ms air contaminants as dc0ncd by Ne Bay Ara Air Quality Management all new materials for inspection.
DuoicR
❑Yes [i9.[Jp
I haw read the hnallousmsmrials requirements under Cliapterb.95 of Ne Califon.
nuHwlNkSaycty Cade,Suu=MM5.25533am125536.1undmr Nmifd¢Wilding
does nor unruly haw a mnmt.Nat it is my respowbility m nouly the meupam of Ne
mquimm which mustbcmet poor toissumccofaCcnifca fOccmpmcy. Signature of Applicant Date
r
wncr or amhmrimd agent Date All roof coverings to be Class"B"or better
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EXISTING SIDING: WOOD O MASONITE OOTHER TEAR-OFF: .O SHAKES #STORIES:
)KSTUCCO OLP I _#SQ'S OLP 101 02
O SHAKES O CINDER BLOCK OOTHER (311/2 03 s
(DING Colors indicated are the only colors authorized.Adherence will prevent job delays or cancellations.
For Bennington product color:write in O marked other-
rHORIZONTAL TYPE: O FINAL TOUCH COLOR: O SANDSTONE O MIST BLUE O ROSEWOOD
0 BENNINGTON ANDALWOOD .O PEARL O MAIZE '
L\�7,_#SQ'SC1 OTHER OWHITE 0EVERGLADE 0OTHER
I HORIZONTAL TYPE: O FINALTOUCH COLOR: 0 SANDSTONE 'O MIST BLUE O ROSEWOOD
O BENNINGTON O SANDALWOOD 0 PEARL 0 MAIZE
_#SQ'S O OTHER OWHITE O EVERGLADE O OTHER
I VERTICAL(INDICATE LOCATION ON DRAWING) COLOR: 0 SANDSTONE O MIST BLUE O ROSEWOOD
0 SANDALWOOD O PEARL . O MAIZE
_#SQ'S OWHITE O EVERGLADE 0 OTHER
I OUTSIDE CORNER POSTS QTY _ COLOR: O SANDSTONE 0 MIST BLUE O ROSEWOOD
—'aSANDALWOOD O PEARL El MAIZE
_#SQ'S OWHITE O EVERGLADE O OTHER
]FLUTED CORNER POSTS QTY COLOR: *WHITE ONLY* -
(INDICATE LOCATION ON.DFlAWING)_
3-INSIDE CORNERIPOSTS.QTYI m 0 Nl COLOR: 0 SANDSTONE 0 MIST BLUE O ROSEWOOD
1,1
arta f'I.11 -r X4'1
(RECOQMMENDATION:SHOULMAILCjH�SIDING COLOR) WANDALWOOD 0 PEARL O MAIZE
O WHITE O EVERGLADE 0OTHER
J-CHANNEL(STANDARD)(WINDOWS&DOORS ONLY) COLOR: O SANDSTONE O MIST BLUE 0 ROSEWOOD
7 REMOVE EXISTING WINDOWS&DOOR TRIM MSANDALWOOD O PEARL O MAIZE
0 JUMP CASINGS(IF LESS THAN 3/4") O WHITE 0 EVERGLADE O OTHER
O WIDE J-CHANNEL QTY_WINDOWS COLOR: O SANDSTONE 0 MIST BLUE O ROSEWOOD
QTY_DOORS O SANDALWOOD 0 PEARL O MAIZE
OWHITE C1 EVERGLADE .0OTHER
B@ABLE VENTS QTY__A_ TYPE: O OCTAGON �IslyROUND COLOR: O WHITE ONLY
(INDICATE LOCATION ON DRAWING) . 0 SQUARE . ❑'HALF-ROUND
0 RECTANGLE
EXTRA LABOR
O:REMOVE&RESET FENCE POSTS (WOOD ONLY) QTY POSTS
O,INSTALL SIDING ABOVE PATIO COVER 0 YES R&R'PATIO COVER 0 YES-REQUIRES PROD.DEPT.
ONO O NO INSPECTION
O REMOVE&REINSTALL STORM WINDOWS QTY_
O REMOVE&REINSTALL WINDOW AWNINGS QTY_
O:REMOVE&REINSTALL WINDOW SECURITY BARS QTY_
O REMOVE& REINSTALL STORM/SECURITY DOORS QTY_
O REMOVE&REINSTALL EXISTING SHUTTERS QTY_ (IF NOT CHECKED OLD SHUTTERS
WILL BE HAULED TO THE DUMP)
O MOVE OBSTACLES AWAY FROM HOUSE 0 WOOD PILE O MISC.
0 REFRIGERATOR
O STOVE -
DRY-ROT REPAIR-SIDING ONLY APPROXIMATE SO/FT OR LINEAL FT.
'NOTE:(WE CAN NOT REPAIR ROOF OVERHANGS LOCATION: 0 FRONT O LEFT SIDE(FROM STREET)
. OR RAFTERTAILS) 0 BACK O RIGHT SIDE(FROM STREET)
GIVE BRIEF DESCRIPTION OF ADDITIONAL WORKTO BE PERFORMED:
LIST WORK.NOT.AUTHORIZED.
EAVES AND OVERHANGS Colors indicated are the only colors authorized.Adherence will prevent job delays or
cancellations. For Bennington product color:write in O marked other-
, O SOFFIT- O*SOFFIT ONLY—LINEAL FT. WIDTH(INCHES)
COLOR: O SANDSTONE O WHITE . O PEARL O ROSEWOOD O OTHER
O SANDALWOOD O MIST BLUE O EVERGLADE O MAIZE
*NOTE:SOFFIT ONLY MAY STILL REQUIRE FURRING AND AN'L'WRAP.
O FASCIA O FASCIA ONLY—LINEAL FT. WIDTH(INCHES)
COLOR: O SANDSTONE O PEARL O BROWN O.DOVER GRAY
. . O SANDALWOOD .O EVERGLADE O GRECIAN GREEN O CANYONS CLAY
O WHITE O ROSEWOOD O RED O WICKER
O MIST BLUE. O MAIZE O CHARCOAL Cl ALMOND
O INSTALL NEW FASCIA BOARD—LINEAL FT. WIDTH(INCHES),
OPEN RAFTER TAILS OYES O NO LINEAL Fr.
CUT BACK EXISTING RAFTER TAILS OYES ONO LINEAL FT.
O EXISTING GUTTER LINEAL FT.
O PORCH CEILING(WxL) 1. �D X 2. X 3. X 4. X
(PORCH CEILING MATERIAL RUNS PERPENDICULAR TO HOUSE.ANYTHING OVER 12'REQUIRES DOUBLE J) .
WRAPS
OWINDOWS #SINGLES #DOUBLES #TRIPLESCOLOR
O ENTRY DOORS #DOORS COLOR r
O GARAGE DOORS #SINGLES #DOUBLES COLOR
O POST WRAP QTY COLOR
. O BEAM WRAP LINEAL FT. COLOR
O BELLY BANDAVATER TABLE LINEAL FT. COLOR '
O FREEZE BOARD LINEAL FT. COLOR
O OTHER-DESCRIPTION
TRIM COIL COLOR SELECTION: SANDSTONE•WHITE•PEARL•ROSEWOOD•BROWN•RED•DOVER GRAY•WICKER•SANDALWOOD
(INDICATE COLOR IN SPACE PROVIDED) MIST BLUE•EVERGLADE•MAIZE•GRECIAN GREEN•CHARCOAL•CANYON CLAY•ALMOND -
DESIGN WORK
O SLANT DE�` IGN #S71,74H
COLOR: OSANDSTONE O MIST BLUE OROSEWOOD
(INDICAT L T(A j. NNGi FI 11 O SANDALWOOD O PEARL O MAM O WHITE O EVERGLADE OOTHER
Cl FAN DESIGN #'SQ'S ,�c COLOR: O SANDSTONE O MIST BLUE 0 ROSEWOOD
(INDICATE LOCATION ON DRAWING) O SANDALWOOD O PEARL O MAIZE
O WHITE O EVERGLADE O OTHER
O ACCENT PANELS � #SQ'S Cl SHAKES_#SO'S COLOR: O WHITE O CLAY O HERITAGE GRAY
(OUTSIDEANSIDE CORNER POSTS AND J-CHANNEL O PRAIRIE WHEAT O KHAKI C1 SLATE
REQUIRE SIDING COLOR COMPONENTS) O TAN O GRAY
DESIGN ACCESSORIES
HUTTERS. OTY(PAIRS) *COLOR: O WHITE O BLACK O DK.GREEN .O RUSTIC RED
(INDICATE LOCATION ON DRAWING) O BROWN O DK.GRAY)DK. BLUE O WINE/BURGUNDY
*PER YOUR SHUTTER RING SAMPLE- NOT AVAILABLE IN
ANY OTHER COLORS.
*BRASS LAMPS QTY (INDICATE LOCATION ON DRAWING)
O MOTION SENSOR LAMPS QTY _ (INDICATE LOCATION ON DRAWING)
* INCLUDES SURFACE MOUNTING AND ATTACHMENT TO EXISTING ELECTRICAL OUTLETS ONLY.
WE DO NOT PERFORM ELECTRICAL WORK.
RASS MAILBOX O BRASS MAIL SLOT O BRASS DOOR.KNOCKER O EAGLE-BRASS O EAGLE-BLACK
❑BRASS KICKPLA ;' . CaE � BRASS DOORBELL O FLAG KIT
o^PAINT COLOR lC_LAiJO�
QTY_I COLOR QTY_
DOOR OPTIONS
- GARAGE DOORS (ATTACH SPECIFICATIONS SHEET) QTY_
C1 ENTRY DOORS (ATTACH SPECIFICATIONS SHEET) QTY_
O STORM DOORS (ATTACH SPECIFICATIONS SHEET) QTY_
GUTTERS •
O EXISTING GUTTERS Cl REMOVE&HAUL AWAY
O OPEN RAFTER TAILS-LINEAL FT. O INSTALL NEW FASCIA BOARD- LINEAL FT.
Cl EXISTING FASCIA BOARD-LINEAL F-r. O REMOVE&REINSTALL NEW FASCIA BOARD-LINEAL FT
—
•INSTALL 5"O.G.GUTTER-LINEAL FT COLOR: _
O INSTALL 5 1/2"FASCIA GUTTER-LINEAL Fr. COLOR:
(CALIFORNIA ONLY)
O INSTALL NEW DOWN SPOUTS D ONE STORY oTY O TWO STORY QTY