03110087 (2) CITY OF CUPERTINO �"'" '
BUILDING DIVISION PERMI' " CON1'RAC 0 INFORMAT ,
BUILDING ADDRESS: STERLING GENERAL CONSTRUCT 5T No 03110087
22934 LONG DOWN RD PERMIT ISSUE DATE
OWNER'S NAME:
ERLEE WHITE 1566 SAB 2003
E:
SANITARY NO. CONTROL NO.
(408) 266-2036
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 0 0 0
j0 LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter Y Icommcncing iy
i withScaion7 )ofDivialon3o(thcBusincuentlPmfessiunxCodc,andmyliccnrcis wapp c
In full form n ffen. �yll• CAR DAMAGE REPAIR
a i Liccme s LiB.d
_ Av U G to DEC
� //�RCHITE,use c RATIOd 0 a 2003
< 1 undcmanJ nT5•fdsns shall be sued as public rcenrds
y
L'crenud Pmlcssionel
OWNER-BUILDER DECLARATION BUILDING
I haem
hash, M.tial I am expt from the Convactora License law for the
j O following mason.(Section 7131.5,Business and Pmfes inn Code:Any city or county
g ff which requit.a permit m conatram,alter,improve,demolish,or repair any structure 83495
Zy prior to its issuance.also rcquirn tM applicant for such permit o file a signed statement Valuation
t� tMthc 1.licensed punuannnthc pro visions of the Convectors UCC.law(Chaptm9 Sq. F[.Floor Area
—� (commmem,with Section 7000)Of Division 3 of the Business end Pmfeuinns Critic)-1
.. that he is eserept therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for apertnit subjects the applicant to a civil penalty of 34k?NO Ri8er00 Occupancy Type
not more than five hundred dollen($500).
❑I.as owner of the propmy.w my employes with wages as their sole compensation,
will the the work.and theawcture is not intended to offend fes to(SIC. Busin... Required Inspections
and Pm(moon Cotle:The Commetors Lim.law docs not apply to..owner of q P
property who builds orimproves themon,and who doessuch work himself orthrough his
own employees,provided that such improvements are not intended mo0ercd formle.lf.
however,the building or improvement is sold within one Year o!completion,the owner.
builder veil lave the burden of proving that he did not build or improve fm purbose of
pts.).
0 1,as owner of the property,am exclusively convecting with licensed convectors ro
construct the project(Sec.7044,Business and profession Code:)The Contractor'.Li.
cense Law does not apply to an owner of progeny who builds or improves demon,and
who concocts for such Projects with a convector(s)Iianmd Pursuant In the COntncturs
License law.
1 am aempt under Sec. .B d:P C for this mason
er
Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ore or the following deelantlons:
❑1 have and will maintain a Ceniheme of Consent to self-inum for WorkefsCompcn-
ution,as Provided for by Section 3700 or the labor Code.for the performance of the
work for which this permit is issued.
1 have and will maintain Workers Compeneuon Iusunnee,as required by Section
3700 of the labor Code,for the performance of the work for which this permit is issued.
M Workers Com nsationlnsursuaoo era Pulicynumhmam:
Y p L
Ceeik Iarjf �� ryrtC�r✓(t' o tcy No.: WIG ER O ZW
CERTIFICATE°F E%�}APTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisuctim need not be completed if the permit is Corona hundred dollars($100)
in,loss)
1 unify that in the pc,fMm Cm of the work for which this Permit is issued.I shall not
employ any pcoon in any manner sat as in become subject to the Workcri CompeesNon
Laws of Celifomid Data
Applicant
NOTICE TO APPLICANT:IL after making this Quintero of Exemption,you should
become subject to the Worker's Competwtion provision of the lahor Code,you mine
O forthwith comply with each provision or this permit shall is,deemed revoked.
7y CONSTRUCTION LENDING AGENCY
I hereby affirm that dere is a construction lending agency for the perfurmanec of
i 7 the work for which this permit is issued(See.3097.Civ.C.)
7 ) lender's Name
z Lenders Add.
O 1 cenlfy dat 1 have read this application and rote that the be.infammion is
E correct.1 agree in comply with all city and county ordinances and sure laws misting to
y to
(Clw
building construction.
to save.
Inde nify and
roephounutiv of this Of
nlcrupnndc
y W shove-mentioned property for inspection purposes.
fY (We)agree ro ave,indemnify and keep hay in an the City of against s against
h incoisequede of th,cauing cxpmsseswhich may in uywyaceme against said City
)7
in UNDERhe STANDS
S A permit.
rr77 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO E REG (q
X017 M>V CJ Re-roofs
S' tort DkrpliC.VC.nlraclor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
a Will the applicant or future building Occupant store or handle hnudous materiel
as defined by the Cupenino Municipal Code,Chapter 9.11.and the Health and Safety
Code,Section V51124)+ All roofs shall be inspected prior to any roofing material being installed.
❑Yea �No
Will the applicant or future building occupant use equipment or dcvims which
If a roof is installed without first obtaining an inspection,I agree to remove
emit harardnu5 air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Disuict7 - '
❑Yes AN.
I have mail the hanrdaus materials tcquircments under Chapter 6.95 of the Cali for.
nice Hcahh sa Safety Cotic,sectors 25505.25533 and 25534.1 urdcmland des if the building
docs not CumcnllY have a WORM Net It u my,responibilby m notify the occupant ear the
.q.7 amms whity X met prior to issuance of ratle of Occupancy. Signature of Applicant Date
Al roof coverings [o be Class"B" or better
o r tarn oneed agent Data
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44 �' r
IITY OF CUPERTINOcl �
OF PERMIT APPLICATION FORM
•CUP.EkTINO
APN# 0 0 Date: I /vo v v 3
Building Address:
2-z013LI Lo" 17dc4Un7 P-C/a
Owner's Name: Phone #:
dever4ce C.l 4e 410 8 7,2s- I1Sv
C ntrctor: License #:
r �I VV01 &t-jrc;L C(>.JQ- //G -7f) Z 8
Co act Cupertino Business License#:
Building Permit Info:
Bldg ® Elect ❑ Plumb ❑ Mech ❑
Job Description:
Residential 12 dvl%le CG . Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Occupancy Group:
3 LI,LI. —�
Type of Construction:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI 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. HousingMit. Fee BUILDING
-2,
1 of 3
OITY OF CUPERTINO
CITY PERMIT APPLICATION FORM
CUPERTINO
uanti Fee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamily Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BNUSFD New Single Family Res BUILDING
BOVERTIME hispection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
MIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Repipe Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pipe PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace > l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
2 of 3
CITY OF CUPERTINO ' ' „,.�,sa rd x�" sga?•,xz s
BUILDING DIVISION PER'mrr KONTRACT(WINFORMATION If
BUILDING ADDRESS: STERLING GENERAL CONSTRUCT UMTND03110087
234 LONG DOWN RD
NER'S NAME: PERMIT ISSUE DATE
VERLEE WHITE 1566 SAB 11/17/2003
NE: SANITARY NO. CONTROL NO.
(408) 266-2036
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
+oo LICENSED CONTRACTOR'S DECLARATION O O O
4 U 1 hereby affirm that I am licensed under provisions of Chapin 9(commencing , Job Description
with Section] )of Division Sof NC Business and Professions Code,md my men.is
I
jain rWuame meek �Z8' CAR DAMAGE REPAIR
License L
�f u9 Date A.b+'U C um Co in'
£ _� �sSkRCIi1TECTI RATID
I a� I understand Iy Aa shall he used u public nmm"
)WU
A A.
Licensed Pmfcssinnel
G +�
7 OW NEM exempt
DECLARATION Y
i a C 1 hereby affirm that 1. exempt from the Contractors C License Law for the
p O following mann.(Section 70]1.5,Business and Professinm Code:Any oily or vnumy
42 V which Minima a Permit to construct,alter,improw,demolish,At repair any strucbm
into prior to its issuance,also requires the applicant for such permiuo file a signed statement
FFss that he is licensed pursuant to the provisions of the Contractors Licensehw(Chapter 9 Sq.Ft. Floor Area luation
s+FO (commencing with Section 7")of Division 3 of the B usinesa and Professions Cork)or
$ that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by ally applicant for a permit subjects the applicant to a civil penahy of 3 t11'I�I�IBfl p Q Occupancy
not more OR.five hundred done.(5500). P y Type
t] I,As owner of the property,or my employees with wages As their sole compensation,
will do the work and Ne structure is not intended or offered for sale(Sec.7W.Business
and Pmfessions Code:The Contractors License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for Asia.If,
however,the building or improvement is sold within ane year or completion,Ne owner
builder will have OR burden of proving that he did not wild or improve(of purpose of
ale.I.
❑I,as owner of the pmpeny,am exclusively conArIm ing wit licensed contractors to
consumer the project(Sec.7W,Business and Professions Code:)The Contractor's Ll
cense Law does not apply to an owner of properly who Wilds or improves domon,and
who contracts for such projects with o contracior(s)licensed pursuant to the Contractors
License Law.
❑ I am exempt under Sec. B&P C for this reason
for Data
WORKER'S COMPENSATION DECLARATION
I hereby Nirm under penalty of perjury one of the fallowing Owla.tions:
I have and will maintain a Certificate of Consent to sal r-lasure for Workers Compere
section,u provided for by Section 37M of the Labor Code,for the performance of the
work for which this permit is issued.
1 have and will maintain Workers Compensation Insurance,u required by Section
37W of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance ewer Policy number am:
Cam
VAX 6107"v'N troy No.: 4 L L
CERDFICATEOF EX (TION FROM WORK ERS'
COMPENSATION INSURANCE
(This section need not hecomplcted if the Permit is for one hundred della.(SIM)
,r less.)
I cenify Nat in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so u to become subject to the Workcrs'Com amsetlan
Laws of California.Dam
Applicanl
NOTICE TO APPLICANT.If.after making this Ccnifisme of Exemption,you should
become mhject to the Wo lou'a Compcuolion previsions ar the Labor CndC.you must
z foMwilh comply with such finwialnns An this Permitshall be deemed revoked.
ZO CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency in One pinAUManec of
I� the Work for which this permit Is issued ISce.3097,Civ,C.)
W A Lender's Name
Z
Lender's Address
U Q 1 cenify that 1 hew read this application and sum that the above information is
IL F CaneC.l agree th comply with All city and county ordinances and sate laws misting to -
.7. V building convection.and hereby authorise representatives or Nis city m enter upon the
1'U ahove-mentiuned pmPeroy for inspection purposes
(We)agree to ave,indemnify and keep hamdess the City of Cupenino Against
liabilities,judgments.costs and expenses which may in any way accrue Against mid City
U z in consequence of the granting of this permit
'—t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO ERCG TIOryry�� �
17 AlaV C)3 Re-roofs
S' toreIicanUComrmmr Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle harallom material
As defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Code,Section s 35533(x)? IVNo All roofs shall be inspected prior to any roofing material being 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
III hoxmdnm or comeminants as dchned by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes ANo
I have mW the hauNous materials requirements under Chapter 6.95 Arnie Califon
nix Heahh&Safety Code,Sections 25915.25533 and 35534.I undcrsund Not irthe Wilding
does not currently haw�a,g¢erink Nat It u my responsibility m notify the occupant of the
requi em mm \ met prior to iauancc ofa Ce 'team oraapmcy. Signature of Applicant Date
()At;vG,3
Zo r tar ari,ed agent Dam All roof coverings to be Class "B"or better