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CONTRACTOR INFORAIAT N:~
i
BUILDING ADDRESS:
PERMIT NO.
1075 MILKY WY
I 02040023
OWINER'S NAME:
ZAMLICH JAMES G AND GWENDOLY
APPLIC TION SVyB DATE
f W04/2002
HONE:
SANITARY N0. CONTROL N0.
ARCHITECT/ENGINEER'
{ BUILDING PERMIT INFO
If BLDG ELECT PLUMB MECH
L-1 L2 C: -1 I..
LICENSED CONTRACT'OR'S DECLARATION
_1
Job Description
1 1 hereby nllirm,hat 1 ore licensed under provisionx of Chapmr 9lcomrne,leing
wilM1 Section7fKln)of Division lof the qusincss and Pmfessiooa Code. and mylinnx
� FIREPLACE REPLACEMENT..
j full tQpryryo� and eRca.
urpp xapfa: 'y -i uc.a 73" ' f -
Commcmr
1 C'0p �-/�
` 9� Ov�ALED
7T"' AItCHITF.Ci'S DF.CIA ION
1 unJcrstand my plans shall M used es publemds
MAY
0 2 2002
jLicensedPmlex.lanal
DECLARATION
OWNER-BUILDERreptform License Lair, county
1 hereby alrmn tem I am exempt from tha C,,ions
follwhich ng mason. (semho constru t. she, and .e. denuna coag: Any ria o,ru county
o
,r rc tarn a mm m construct. n tar. imprice, emu, a ,
De orensiignnyawment
y
] BUILDING
$3000
yniresme nnrrrann ro,sarn Dermi fsoicense gaodataemcm
applicant
..
- _ .- ._. _ ..... ..
d pursuant a Contractors
Ic"ha
(honhenchrifxth Senhnn70W1 Division 3 BusinessLinnsclausims,mr9
3 �� B e� 4r. f6a
Valuation
ro,moygm of of the nap ion. Any vi code)
or that to cum n nhn,crnm:,oe the basis for he alleged exemption. Any
D g
portly
.
r 7031.5
of Section nm s ny day appfinran rpt a py,mh,ubima me oprrram m. civil pyml,r
l
of opt mare in.. five hundred dooms ($!dy).
1014PN 44MI IDAT I ON
Occupancy Type
1 CLmownerofdmpmpeny.mo,yc ployeeswih wageansheiramecomisms"n,,.
t
wwill do he work. and he someone is nm intended or offered far sale (See ]044,
q-ioss, and Professions Code: The Comment's License Law does not appin m an
103 —
UFER Required Inspections
jowner of pmreny, Who builds an improves hereon, and who does such work himself
10 4 -
REBAR
ho �hh ply .p :don l: onrt adori
're re: I If. W h Wildg p n m within .ye or
- 105 —
ANCHOR BOLTS ..... -.. _ .` ...
I' fiction.the hu1J11did[
m1 the 1d frgththat net or
p4rof renes f I)
r106
—
SEWER & WATER
01, as owner ofth propcnn an; exclusively contractingwin,l used so I aboactimsh,
- 202 =
UNDERFLOORS PLUMBING
mune, be poijec, (Sec 7044 Bus fess and Profession, Code) The Comment's
License Law does not apply to an owner of proproy who Woldrmpm,es hereon,
,
2 0 3 —
UNDERFLOOR MECHANICAL '
and who contracts for such Projects With . contractors) unnxd.purauant to he
204 —
'UNDERFLOOR FRAME .
Customer's Licensetaw.
am . . fin uspn
0 daemon smacr SeeB & P C f rc
205 —
UNDERFLOOR INSULATION
Owner Data "
301 —
ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
i 302 —
TUB & OR SHOWER
Ihereby afrmrunder penalty ofperjury one othe following dnh,moons:
303 —
ROUGH MECHANICAL
❑ I have and will maintain . Cenirc.m of Coastal to sylemsme hr Worker's
3 04_
ROUGH ELECTRICAL
Compensation, as provided for by Section 3700 of ,he Labor Code, for the
performance of the work for which this permit is issued.
305
FRAME
k❑ 1 have and will maintain Worker's Compensation lrmummn , as nqui,ed by Section
306 —
HOLDOWNS
1 37W of the Labor Code, for the performance of the work for which this permit is
307 —
INSULATION
k issued. My Worker's Cnmpcn.mtiva lnnumnec res cr .nd Policy number ore:
Aw:ikFY.CI>4t µ jis!. Cyoi93T'nj
308
SHE] TROCK
iryn
.—
,
. CERTINCATIONOF M NFROM WORKERS':
309 -
EXTERIOR LATH
COMPENSATION INSURANCE
_. .31.0...._..INTERIOR
LATH..
(Tat f union Baa not be eo,,,Plenee if the p<rtmi n is for one tonere: dollars
(51001 or leu.)
311 —
SCRATCH COAT
.313 —
ROOF NAIL
eafhe for Perron
enfyhrinerson
in an
shall 11 as to becomeshs
, employ ny pen y ginner ,o becomes Eject , rte Workers'
tothe Woken
501 —
FINAL ELECTRICAL ENERGY
Applicant Law: of California Dan
e
-
... 502 —.
FINAL PLUMBING ENERGY
NOTIApplicant
thExemption. ottee, you ould
Ncame subject the NT:IL anmmnsationg Provisions icate
li become sutjccunnhc Worker's Compensation prorisionx of the Lotter Code, you must
st
503 —
FINAL MECHANICAL ENERGY
Ibahwihromplywihsucnpmvtionao,hisNord, shall bedeemed invoked,
504 —
FINAL BUILDING ENERGY
CONSTRUCTION LENDING AGENCY
505 -
FINAL ELECTRICAL
I hereby arum, than there is a construction lending agenry for the performance
of he work for which this Permit isissued (Sec.3a97.Civ. C.) -'
506 —
GAS TEST
Lender's Name - -' •'
LemeasAddress
507 —
FINAL PLUMBING
508 -
FINAL MECHANICAL
I certify the, I ban mad this .ppheader mad.mle hnkie
aabove information is
coven. 1 agree to comply with all city and county ordinances and state laws relating
509 —
FINAL GRADE
toWilding construction, and hereby authorize represenwives of this ch, to enter, upon
heaWve-mintmneapropertyforinspectionpraircats.
510 —
FINAL PLANNING
(We) agree rb.ave, indemnify and seep h tmolesa the City of Cupertino against
liabilities, judgments, costs dad anpeaxs which may in any way game .gains, pie
514 —
FINAL PUB I C WORKS
l City in consequence of he graming of his permit
i RCP HCAT7 'CDERSTANDS AND WILL COMPLY WITH ALL NON -PO NT
AE}:I c 'IONS. y— y .o .
I
Issued by:
Re -roofs
6 V
Date
g,gnturcorAirplicaaucooenew, e:.'...
HAZARDOUS MATERIALS DISCLOSURE
.
Will he applicant or future Wilding occupant store or handle haimdWa material
u defined by the Cupertino Municipal Code Chapter 913. and the Hahh am Safety
Type of Roof
'
f Code. Section 355321.1^
6 ❑ Yet INo: ,.`.: - �',
All roofs shall be inspected.prior to any roofing material being. installed.
aorfmW
alk,a Will cappBm um ndmgoccupant asennipmenror devices which
nctus
If a roof is installed'
without first obtaining an inspection, I agree to remove
haratd air contaminants as defined by the Bay Arca Air Quality Management
ii,
all new materials
for inspection. Applicant understands and will corn ly.with
oven
all non -point source
regulations. '
1have read the hazardous mmcrial% mquiememn under Chapter 6.95 or the
�r California Health & Safety Code, Sections 25505.25533 and 25534. 1 understand hal
:f the Wilding does not cvtrcntly have a moon that it is my responsitility, to notify the
--No. of he rtquirtmen,s which must be men prior to issuance of a Certificate of
0 c
S4 -OL
Signature of Applicant Date
_
�wd6:
All roof coverings to be Class "B" or better
ora hpriva agyn, - .,e
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—CITY OF CUPCH2TIN0 �y� I rn7TTD �t!"rni? YXTTl n njii&A TTnl3.T`
staff afar_ nnncrnv
BUILDINGADDRESS:
1075 MILKY WY
PERMRNO.
02040023
OWNER'S NAME:
ZAMLICH JAMES G AND GWENDOLY
iAPPLIC IONSUB DATE
104/04/2002
.
PHONE:
PHONE:
I�SANT IARYNO. CONTROLNO.
f
GARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
1 hereby aRrm that I em licenced under, provisions of Chapter 9lcommencing
with Smi.n71g101of Division 3 oflhe Busiac,arol Professions Coderthd my license
is
lob Descri p tion
FIREPLACE REPLACEMENT.
in full reye d affect.
t L .sac b—y Lm.. 73'
S''- y - cJ '— Corer cmr
i
I ARCHITECT -5 DELLAQ TION
1I 1 understand my plana shall be used es publif rerom,
i, Licenced Pmlerrimmi
OWNER -BUILDER DECLARATION
I hereby a10nn that 1 and exempt from The Contractor's License Law for the
p
following am. (s«tion 7031.5. Business and Proallions Cada: Any city or county
which requites v permit to construct. ahcr, improve, demolish, or repair any annotate
$3000
Peart T. a al. q 'be pplcanl forc-0, pe nn. m fileaslgnedamemem
That he is I certed Thormuchto 'be p sof the ts License Law (Chapter
(commencing with Section 7") Division 3 Business
Valuation
of or the and Proletarians Cade)
or hat he is exempt thercroun and The brosis for the alleged exemption Any violation
I
'
of Sect on 7031.5 by any appl cam for v Permit subjects the applicant to a civil penalty
or not more than five hundred dollars(a500)'
101`�PN Y'7Lh�}DATION
Occupancy Type
131.-1awmar of.ha pmpcny. maty employees with wages as theirsole compensation.
l
_ PIERS
willdothe walk. had the structure IS mol haludad m mfico d'for sole (See 7(ma,
Business and Professions Code: The Conbaam! a License Law docs not apply to an
I
103
- UFER Required Inspections
owner of property Who Wilds or improves thereon, and who does such work himself
or through his lava empmytts. provided that Inch improsImm s ate am intended or
offered far rale.If, however, the building oI 'mapacIocanam is s Id without o("
: 104
- REBAR
-.
year
complta thene-Wlmerxllhavethehm r .,
proving as lot buaa or
105
.. -
— ANCHOR BOLTS '.:. ..-. ...
impry f p gorse fro`')
106 —
SEWER & WATER
11 ].-as .. aaarPrIany. aut exclusively vantratzting wallha kd Erahn
202 —
UNDERFLOOR" PLUMBING-... ..... ... .
consumeri
the Project (s c 7tosi Business and a ofd. sildM: Th cm Theyl-:Fs
's
LicenseW tl t apply t erofp party who cop esn
f 2 03 —
.
UNDERFLOOR MECHANICAL
hemm
and whocontractsnfor such p j ¢ with a conTtact t(s) Iicenud,p rsmm s. the
an th'
Contractors License Law.
204 —'UNDERFLOOR
FRAME
O lvo exempt under Stt. , B k P C for this revs..
205 —
UNDERFLOOR INSULATION
Owner Ea"
301 —
ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
302 —
TUB & OR SHOWER
]hereby underpenalty. one
rWho
303 -
ROUGH MECHANICAL •
Cyalicrue of
xill Consent TO m1wimm. f
❑ i have end wise maintain a Cenmcae or Consent t. seUbe,re for work he
Compensation, he provided for by S¢Tion 7]00 or the LaWr Code,, for the
3 04 —
ROUGH ELECTRICAL
pert.rmameeathe work for which this permhisirsne°'
305 -
FRAME
01 have and will maintain Wicker's Compenuti.n Insurance, as required by Section
3 06 —
HOLDOWNS
37M of he Labor Code. for the perfmmance of tha work far which this Permit it
issued. My Worker's Compensation Insurance carr'cr and Policy numWrarc:
307 —
INSULATION
E>6y5yc i+oF� tdy m . Cw1y37'/1
�Camcr'
308 ."
. SHEHTROCK —
CERTIFICATION OF EM N FROM w"iKERs':'
. COMPENSATION INSURANCE
I 309 " -
EXTERIOR LATH
'(Ib s season aced nm W completed if the perms Is for one hundred dollars
_... 31.0---
INTERIOR -LATH.. .._.._..
311 —
SCRATCH COAT '
I c n fy that is the perf.sm chae of Inc work for which NIS PcnrfT is issued. I
- -- 313 —
" ROOF " "NAIL
shall not employ any person In any manner lo as to become subject to the Workers
Compo roan Laws of California Dae
501 —
FINAL ELECTRICAL ENERGY
AOTCE' o
'NO77CET0 qYn after Making thatvisionofthcan, of
502 —.
FINAL -PLUMBING ENERGY _
the WorkersCmpensti
becamesubjectm the Worker's Compensation Permit alml the Labor Code, you must
Laboronyou ,youmust
503 —
FINAL MECHANICAL ENERGY
r.nnwim comply With such provisions or This Permit shanWaeerneacarried,
AGENCY
504 -
FINAL BUILDING ENERGY.
CONSTRUCTION LENDING
1 heraby, vrfom tha Nem is a mnswdi.n lending agency, for theIxrlormance
505 -
FINAL ELECTRICAL
Of work for which this permit is issued (So. 3097, Civ. C.)
S 0 6 -
GAS TEST
tamer's Name' -
507 —
FINAL PLUMBING--
Lenaeranaegss- �
Icenirythalnavereaa]his appiiemi...admatemmthe oWceinfruoauonis
508 —
FINAL MECHANICAL
correct. 1 since m--PIY with all city and county ordinances and state laws mhung
to building construction. and hereby aumbriie nepometnaiwa of this city to
509 —
FINAL GRADE
enter upon
the above-mentioned propany for inspection purposes'.
(We) agree m an, a, indemnify and keep liar nfini he City of Capone. against
510 —
FINAL PLANNING
liabilivaa, judgments, count and expenses which may in any way accrue against mid
514 —
FINAL PUB IC WORKS
City in consequence of the of this permit..
AP 'M)ERSTAN'DS AND x'
^
T /
ILL COMPLY SI"ITH ALI.NON-POINT
t ' RCEEGL . DNS. at _ y ,o ..
Issued by:
v
Date
Signature of ApphcanUC.mmcmr ' ....'. '.. ' '
' .
Re -roofs ,/
HA7ARDOUS MATERIALS DISCLOSURE - -'
Nvill the apPiahart or future Wilding Occupant more or handle hastanclotax material
m Thar
dcficed by Colman Municipal Code, Chapter 9. 11 and The Health and Safety
of Roof
-
Code,3cetion 25532(0?,..
rY� 1, \ No
p
wuIncomed -
All roofs shall be inspected.prior to any roofing material being. installed.
me.ppl a.nt. Wum.B. pantam equip.st d swhich
emit harstraborts, air contaminants as defined by the Bay Area Air Quality Management
If a roof is installed
without first obtaining an inspection, I agree to remove
°s'""' eP11all
�Y
new materials for inspection. Applicant understands and will comply with
all non -point source
regulations.
1have read the haureous materials requirements under Chapter fi 95 of the
COlfomiv Health C safety Cade. Sections 25505.25533 atld 25530. I understand Na
ifthe W ilding does am c.meITdy have a tenant that it is my re possibility no notify the
Occupant
epaid of The requirements which must W men prior to issuance of a Cenihn¢ of
�- Y ta L
Signature of Applicant
Date
All roof coverings to be Class "B" or better
wnbrn umhon.ad ogent ale
dh O
0
APR q)4 Z
i;
IN ACCORDANCE WITH THE CITY 06
CUPERTINn CGOES SND ORDINANCES
b
phis set cl pa n peg..cations MUSE
hee kep"NED kep: on V) a ., I t!mcs and it is un
awful to maP c ;cs or alterations
'n same v^rdh u a -3.m'.ssion from
he hw.dxg I . p . i.'; ' Cj,rertmo.
he stamping �! J s c n n I specifications
,HALL NO ee a ,' ,. ; = ra.t or to tre an
oproval of, Nr. v i,xn •.i any provision
-,v P...'� 0 car S"ate law
SUBMITTAL
#1
f3y_t�f_�`
Q4_61 }9 rrrjz.0-.
Cttirv-1 NC/
CITY of
• CUPERTINO
1
0 . •
CITY OF CUPERTINO
PERMIT APPLICATION FORM
0204100 z2
APN # (,j
jJ
Fee Description
Date: - D y - O 2
Building Address:
/075- /11 iC KY u/
Owner's Name:
Z Ai-? C. C. N, Tia -f E -S
Phone #:
735 - ZoSo
Contractor:
v5/�%'CL TS E✓r' £'.eP,.eJ 5Lr'5
License #:
�33,f�
Contact:
Phone#:
z9z-i,3 L
Applic Contractor:
Fax #:
q71- 07 5-7
Building Permit Info:
Bldg Elect Plumb Mech
Job Description:
Residential: �EOzcj r' Commercial:
Sq.Ft. Floor Area:
$/Sq.Ft.:
Architect/Engineer:
Valuation:��
Type of Construction:
Occupancy Gro :
4
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 13Q 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
ENERGY
Energy
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
BINVESTIGA
Investigation fee
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
BUILDING
1 of 3
CITY OF
CUPEkTINO
• CITY OF CUPERT O p
PERMIT APPLICATION FORM .
APN # (,�
U
Date: - O `/ _ OZ
Building Address:
/075 144 Y W
Owner's Name:
Z A rq L i G k, 7A- f t= S
Phone #:
7 3y- ZOSv
Contractor:
E,vr f'�P.ef SL' S
License #:
-j%33 S y
Contact: 15/ e -7,7
Phone#:
z?z
Applic Contractor:
�jh�� -S
Fax #:
o7 5-7
Building Permit Info:
Bldg Elect Plumb Mech
Job Description:
Residential: ICiQe-AlkIr �fP FJ T Commercial:
Sq.Ft. Floor Area:
$/Sq.Ft.:
Architect/Engineer:
Valuation: ,
Type of Construction:
BBOILER4
Occupancy Gro
Quantity Fee ID
Fee Description
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
BBLDGFEE
Bldg Permits . foot
BUILDING
BBOILER1
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
ENERGY
Energy
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
BINVESTIGA
Investigation fee
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
I BUILDING
1 of 3
7
J