02100172 (2) CITY OF CUPERTINO
BUILDING DIVISION PE s T 'CONTRACTORdNFOR
BUIEDI<`6ej3kE5lgfYANNISPORT DR CRW INDUSTRIES PER MIT NO 2100172
owANDERSON STEVEN J 1157 DELL AVE . APPLICATIIDO"P6ZL4.TR 2002
All
ONE: %(408) 378-2477 SANITARY NO./ / CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECN
�00 LICENSED CONTRACTOR'S DECLARATION hhD O O O
Ihereby amrmthat Iamlicensed under provisions orChapter 9(commencing REMODEL BATHRMTpRI' D
with Section 7000).f Division 3 of Ne Bose ssand Professions C e,and my license is
FEZ inful1.1g,, a ,cy Z
ZOY�— License Cl V
oZ—� Dam
�''—e f'y — APiCHITECT'S DEILARATION A="16aatG
s G w U I sugerstand^Y Plans x1,11 Ic usctl m public reemds
L. a dmSPmfcssnnal DEt, 1 2 2002
OWNER-BUILDER DECLARATION
<x 1 herebyaR
by rm Nun at I exemm
pt from the Comcots License law for the $85000
W�xdp0 following moon.(Scetun]OS LS.Business and Professions Code:Any city mcounty BUILDING
$ which mequires a Permit n OF
WOucL improve,
alter, demolish.or repair any structure
Fiy poor to its issuance,also requires the applicant for such permit to file a signed summcnt
Y G Nat he is licensedpursuanttothcprovisionsoftheContractorsLicenselaw(Chapter9 35545Bt4IF76eBAfh@ Valuation
w�S (commencing with Section 7100)of Qivision 3 of the Businesa and Professions Code)or
y — that he is exempt therefrom and the'balia for the alleged exemption.Any violation of
section 7031.5 by any applicant fora permit subjects the applicant to a civil Penalty of
not more Nan five hundred dollars(5500). PN N Occupancy Type
102 - PIERS
❑1.o ownerof the pmpeny,re is emnloyeu with wageazthey anile compfusine ,
will do the work,dna the structure is Out intended or offered!resale(Sec.](40,Business 3:83 UPER
and Professore Curie:The eommeor'a Licnve law does not apply n an owner of 104 - REBAR Required Inspections
property who builds or improves thereon,and who doessuch work himselforthrough his
own employers,provided that such Improvements are not intended°rorteree fursale.If. 105 — ANCHOR BOLTS
however.the building or improvement at sold within one year of completion,the owner
-
Wilderwinhavetheburdenofpovingthathedmnorwilaorimproveforparp°se°f 106 — SEWER & WATER
side.). 202 - UNDERFLOOR PLUMBING
❑I,as owner of the property,am eschi ively contracting with licensed contracnrs to 203 - UNDERFLOOR MECHANICAL
construct the project(Sec.7004,Bvinco and Professors Coact The Con✓acmrs Li.
cense law does not pply in an owner or ymperty who wilds Or impmves thereon,and 204 — UNDERFLOOR FRAME
who contracts
Lace for such pmjecuwith aconvacmr(s)1i¢,sed pursuant to the Contnnm's
License
Law.
205 - UNDERFLOOR INSULATION
w
h
❑ 1....mptumWersee ,B&PC for thisreazon 301 - ROUGH PLUMBING
OwnerDate302 - TUB & OR SHOWER
WORKER'S COMPENSATION DECLARATION40 303 - ROUGH MECHANICAL
I hereby affirm unser penalty Of perjury one of the following declarations:
O l have and will maintain ACeirdiicaw of Cover,mself-insure for Workeh Compcn- 304 — ROUGH ELECTRICAL
sation,az provided for by section 3700 of the Labor Code.for the performance of the 305 - FRAME
work for which this permit is issued. 306 - HOEDOWNS
❑1 have and will maintain Worker's Compensation Insurance,az required by Section 307 — INSULATION
3700 of the labor Code,for the performarm cruise work fo hien this permit is issued.
Mykcr'sCO—m-pensatiOnlnsunntt�carnera°na`yPObc-y berare: 78 308 - SHEETROCK r1�$
309 - EXTERIOR LATH
GERTIFl
COMPENSATION INSURANC310 — INTERIOR LATH
or (This section need nut be completed it do,pemmn is for one hundred dollars IS 100) 311 — SCRATCH COAT
Iclea,l 313 - ROOF NAIL
employthatinthc in any foomamrsoas work to
subject to Permit is issued.Ishtllnot 501 - FINAL ELECTRICAL ENERGY
employ any person in any mannerm az n become subject the Wortrri Compensation
laws mrc.liromi,.Dam
ApplicantApplicant502 - . FINAL PLUMBING ENERGY
NOTICE TO APPLICANT.If.after making this Cenificam Of Exemption,you should 503 - FINAL MECHANICAL ENERGY
become subject to the Workers Comp,madion provisions of the Labor Codc,you must
zz. forthwith Comply With such Provisions orthis Permit sha0wdeemedrevoked, 504 - FINAL BUILDING ENERGY
h CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
F Ihereby a�irmOat door isaconswnionlending agency for doPerformanttof 506 - GAS TEST
LendcrsAame
IY
the wvrtfor which this Permit isissued(Sec.309].Civ.CJ 507 - FINAL PLUMBING
a q
a Z L naersnearess 508 - FINAL MECHANICAL
U O 1 certify that 1 have mad this application and slate that the above information is 509 - FINAL GRADE
is, F COMM I agree m comply with all city and county ordinances and state laws relating to
0 U building construction,and fameby authorise neproematives of this city w,Ow,.,n she 5 FINAL PLANNING
U.1 awvcmemionedPmpcnntsand specamswhichmaon purposes,
S 4 - FIN
F q (We)agree to save,indemnify and keep harmless the City of Cupenino against C.aC7(IC W/ W RKS
y liabilmim.rieofdo,c rartiq,of this csoiichmayin any wayaecroe agaiwaia City
U z mconsegmcee of the granting of this permit.
^ APPLICANT'LINDERST AND WILL COMPLY WITH ALL ON-POINT Issued by: Date
SOURCER U ION
s ppl,ean✓ ommolon
�- 1 Z`✓-oZ Re-roofs
�_✓ ON
MATERIALS DISCLOSURE Dam Type of Roof
Will the applicant or future builtling ottupam score or handle havardov mamnal
U defined by the Cupertino Municipal Code,Chapter 9.12,and Om Health and Safety
COac.Se dion y.23532(a)7 All roofs shall be inspected prior to an roofing material bei,
�Y" B't`'° P P Y g g installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit har olous air conuminanu defined by the Bay Area Air Quality Management
Oi...ictl all new materials for inspection.
0 Yes1.
1 have real the havafdnus mammals requirements under Chapter 6.95ofthc Califor-
nia Health&Safety COdc,S°niona 5505,25533 ana25530.I understood Narifthe building
does of ett rcntly h a WooL Nat it is my responsibility to notify Iw attupant of tan
re mmenlswhi tau he a prior in issuance of a Certifiggle of ancyf
1� Signature ofApplicant Date
our aehonrcdagent Date All roof coverings to be Class "B"or better
r
p ( � CITY OF CUPERTINO Z
CUPEI�T
CITY
INT PERMIT APPLICATION FOR �/ 7
APN# Date:
Building Address:
I. CoY6&)k)1-5 XbR
Owner's Name: Phone#:
L5 /---L.c d- a04�3 7Gn/- 3 989
Contractor: License #:
CIO •'2dL45 /ii-5
Cont a t: Phone#:
A--,e '�a - , / 7(9i - 3v3�
Applicant/ContraFt Fax #:
Permit Inf .
Id E X Plumb X ech
Job esc l:::: n:
esidential: o i 1:
Sq.Ft. Floor Area: $/Sq.Ft.:
Arc utect/Engineer: Valuation: O—Db
Type Construction: �1= Occupancy oup:
VK l
Quanti Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/OfflComm/ uasi BUILDING
BCONSTAXB Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax —Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V> IOOOA ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD -Energy Add Multi BUILDING
BINVESTIGA Investi ation fee BUILDING
BMITIGATC Comm. Housin Mit. Fee BUILDING
BMITIGATR Res. Housin Mit Fee BUILDING
BMNEWMULTI New MultiFamilyRes MECHANICAL
BNEWMULTI New Muulti-famil Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
1 of 3
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is l
IN
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IN mrIPVATEF `WIT H-T4E C4TY--G6
)Aft
ED
,
This set'.. pans anan
_jq!e_aL@jLhMQS_aqd It is U11
4 lawful to ma!,,e any changes or
alterations
oFtiw without -vTi4eq-Mmission-ftrom
By
the building Dept., City of Cupertino.
The st
MDI be held to permit or to be 30
Ipproval of the violation d'any
-It any-City
—---------
------------------- ---------- -
2,
CUPERTINO VD7341,11D 9RD1Nj1?4C C
DATE
111,is set
be kept
OCT 2 4 2002
lawful tr JIS
1P but"I
SHALL NOT rt In
—jj)PTMrL)l L5v v --
.If Any Cov 0 r OW 11dI/