04090100 (3) CITY OF CUPERTINO ��`� �,T ^� a ,#k'' �'
BUILDING DIVISION PERMIT dC® �Rf� QT a Oa'` TION'-
OUILDING ADDRESS: PERMIT N0.
04090100
l
VER'S NAME: PERMIT ISSUE DAM
JAMES GUTHRIE
SANITARY
PHONE: ROL N0,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
CJ 0 t�
40, LICENSED CONTRACTOR'S DECLARATION Job Description
u F 1 hereby affirm Nat 1 am licensed ands,,p "isle.or Chapter 9(Commencing
Zw with Clio 7d if Division Sof NC BusinctxYM Prufcssinnx Codc,and my
liccnsc is �g
j�_^« 'Lice anaerr ✓ 71 7/ GAS LINE TO BBQ [lYq�p,-,11y■■Y�
Lice Clens Z7 Lie.F
^c Dam Contra '"L CONTRACTOR: BAYVIEW INTENANCES
"J /ARCHrtECrS DECL ATION
m
re TSM S all he esu a iC records
asre �2'o 2004
�, Lice J mfeuional NOV /-g--
OWNER-BUILDER DECLARATION
u a C I hereby maso affirm that 1 1. exempt from the Contns Co e:Any
Law for the
Z p o follwhich
cores.pCectian 703 l.;Business and improve,
Lie nm Code:Any city or County
y$ which requires a permit re construct,Clint.lcor.i t for such
demolish.or repair any.amctum
prior m is issuance,obis requires the applicant far such permit to f Ic a signed nammcm
Oat he is Licensed pursuant to the pmvisiom of lbe Comrscmts License Law(Chapter 9 Sq.Ft. Floor Area IUat1pn500
2FC (commencing with Section 7")of Division 3 of the Business and Professions Code)or J
y
Out he is exempt dmrefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant,for a permit subjects the applicant a civil penalty of APN Number Occupancy Type
not more than rive hundred it.[[..($50(B.
❑I,as owner of the Property.or my employees with wages as*an sole compensation, 36909007 . 00
will do Oe work and theswerure is not mended or offered far sale sec.7061,Business Required Inspections
and Professions Code:The Comnctor's License Law does not apply to an Owner or q P
property,who builds or improves thereon,and who does such work himself or derough his
awn employees,provided Oat such improvements are not intended or offered forsale.If,
however,the building or imphowmmt is sold within one year of compledon,Oc owner-
builder will have the burden Of proving Oat he did not build a improve for purpose of
sale.).
❑1,a owner of the property,am exclusively convecting with licensed eimreactors to
consumer the project(Sec.7066.Business and Professions Cade:)The Contractor's Li"
cense law does not apply to an owner of progeny who builds or improve Ocre n,and
who contracts for such pmjecer widt a eonuaelor(s)licensed pursumn to the Contractor's
License taw.
❑I am exempt..our Sac. ,B&P C for this rcamn
knee Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affsmt under penalty of perjury ore of On following declarations:
❑1 have and will maintain a Certificate of Consent a self-insure for Work r'sCompen-
smian,m provided for by Section 7700 of the labor Code.far Out perftemmmc of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the labor Code.for Oe performance of the work for which this Permit is issued. "
My Wor .Compensation pounce art�ie�r and Policy number are:
tamer: z« �'AP NO.:kQ0
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This aecu ilneednm he complemd ifthe permit Is for one hundred dollars($100)
r IC95.)
1 certify Oat in the performance of the work for which this permit is ismctl,l shall not
employ any person in any mann mhGVO subject to the Workeri COmpensadon
Laws of California.ri /0 f
Applicant r-lVY'C
NOTICE TO APPLICANT:If,after making this Certificate or Exemption,you should .
become subject to the Worker's Compensation previsions of the tabor Cade,you must
.JO forthwith,comply comply with each prnvisinor this permiuhall M deemed mvokcd.
z CONSTRUCTION LENDING AGENCY
[—� I hereby affirm Oat there is a comtruerinn lending agency lot he performance of
athe work fur which this permit u Issued(Se1•. T.Civ.C.)
W Q lender"Name ` i/ ///
z Lender's Address
U V 1 certify,Oat I have read this application and sats Oat We about information is
ty coned.1 agree 10 Comply with all city and county ordinances and Sate laws minting to -
�U building Construction.and hereby authoris represent2dwLi Of this city to crime upon the
,r W above-mentioned property,for impaction pugmus. -
y (We)agree to save,indemnify and keep barmleu the City of Cupertino!gaimL
Iiabili Lies,judgments,costs and expemes which may in any way accmc against said City
U z in camequence of Oe griming of bit parent.
^ APPLICANT UNDER ANDS AND ILL COMPLY WITH ALL NON-POINT Issued by: Date
50 RCE'REG L T NS.
G y 7 �/�1�7 Re-roofs
I Signui cof ApplicanUContmcmr Dead —
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or rplum building Occupant store or handle bromcous material
az defined by the Cupertino Municipal Cuff.Chapter 9.12,and thc Health and Safety
ofode,Section 25532(a)9,❑]tion e". All roofs shall be inspected prior to any roofing material being installed.
Will LOU applicant or future building occupier use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hioardous air contaminants az defined by the Bay Area Air Quality Management all new materials for inspection.
DimricO
❑Yes VA.
Have real the huaaNnus mamrialsreyuircmenu under Cnapmr b.YS or Oc Caliron
ria HCdO&SafctyCodc.ShpOw 25505.25533 and 25536.1 undersand Oatif thb building
docs not cit nt}y. a mnank due it is my reamommility to notify We ore fast of We
requi Om at m t,p ' a oracenrieamor capaneg Signature of Applicant Date
� �/�
Owna@orircd!gem All roof coverings to be Class "B"or better
^ � �m—
egIv
SEP 6 2004
,(E)BBQ(Counter Top to Be Redone)— —(E)Seat Wall 75•
.�'. .7. ;Fh �f
3/4'GAS
LINE-
FACTORY
WRAPP D
STEEL- —� (PAYERS) - ! Peth
-,•�: ;•
18'DEPTH
(E)Upper Deck
PA. sA.o •••�•� I EXISTING GAS
_ •» STUB OUT �» '
TOP OF PIP u�1L :F%» f 1122'
MIN.18' 4-( IH) » Residence c 6 » I
BELOW GRADE SAND ABOVE" m
PIPE /
» PATH w :» I
• Q? PAVERS' : »
Vine
• 1 Gallon Plant
-»» '-» » » 5Gallon Plant
(E)Pad
(E)Gets : :'.•..'(Elul-a'wn'.i'� —(E)Retaining Wall
ui
LA".CE ;E-My
Level:Deck
31H�`i
,j 'ans and specifications
°a io;ct all timea and
Cn1 changes os altjratiorlte i
:sttt v"Maon PermissfqIv uA.A..
S Cept Cigr of Cuper(inP9_.._.._..— — — —.. .._.._..— . —
aa cf this Plan and specdlCOV0111 l — — J
�.�. an
.7 be hold tO Penult OO to GUTHRIE RESIDENCE d
•'� t4;e�;$1,3Ifon of any p-LO10g.1'0214 SOUTH PORTAL AVE
CUPERTINO
if anv ',Nr4 ORiaYdfl'L� 01:)mffl I..flY.. -
AP#389-09-007
A
1PX0
E '
SCity of Cupertino,.-
-m Plan Check Transmittal
Permit# 04080110 Control#
Project GAS LINE Plancheck# 1
Address 10214 S. PORTAL AV FileDate 9/16/2004
Owner JAMES GUTHERIE
Description GAS LINE TO EXISTING BARBEQUE
' Plan Check Status (attach comments and return to Building with pian set)
Plan r';y
Dept check#:.,q Date';; Due Date Staff Comment Date Approval?
Building 1 1 9/16/2004 '9/30/2004 1 POH 9/16/2004 E%ll
Assessor 1 1 19/16/200419/30/2004 1 SENT 1 9/16/2004
-5
Additional Plan Check.Fee -.0 Hours
Planning Fees
Housing Mitigation Fee Amount
Heart of the City Specific Plan Fee Amount