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02100143 (2) CITY OF CUPEKI'INO s' - - --bus^ • • BUILDING DIVISION PERMIT CONTRACTOR INFORMATION "IIIPl4(4A2DRT_jPTOE LA PERMITN92100143 RPhTh4E:PREETZ APPLJCATT`UY'1 6TY2002 PHONE: SAN]I'ARY NO./ CONTROL NO. ARCI ITOIC rENGINET:R: BUILDING PERMIT INTO BLDG ELECT PLUMB MECII X00 LICENSED CONTRACTOR'S DECLARATION Inh DescrI [y�, z�F I homy alErm that l am licensed under provisions of Chapter 9 lennnmencing INSTALL SKYLIGHT pR'-INA�..E® <i $� 0 thSe ion]0(XBnf Division usinccs and Nofccsions Cndc. amy license is t,om UII{(rca cand . z O'er z I.ic ise Cats Lac..p �f�� pN—p 1 meta, DEC 1 0 2002 ARCIII ECLARATION us 0� Lic• . Jfthal' 'SJ as public moods -- S OWNER-BUILDER DECLARATION BUILDING s'yl`<5 I hereby miter that I am exempt from the Contractor's License Law`or the $2200 _p O following reason.(stttinn 7031.5.Business and Pmfcxsions C'nJc:Any city nr aunty x$ whichmyoiresnpermit, mn,thealter.Improm,demolish,ore a sigedswcture "s—�• poor to its ixsuancc,a6o requires the applicant for such Permit flcasigncJCmcmcm t=�< that he is licensed pursuant to the provisions of be Contractor's License law(Chapter9 3Yg9H2ZD�v8At@m Valuation ce (commencing with Section 700h)of Division 3 of the Business and Professions Code)or y $ Nat he is exempt thcmfrom and the basis for the alleged exemption,Any violation of section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of PN-N Occupancy Type not mots than nm hundred dollars PSW). 102 - PIERS 0 I,as owner of,M propert,or my employers with wag¢as their sole compensation. will du me work,and the swcwm is not intended or offered for sale(See.7044.Business and Professions Code:The Contractor's License Law does not apply a an owner of 104 - REBAR Required Inspections property who builds or improves thereon,and who doessuch work himself ormmugh his nemployees,provided that such improvements arc not intended or offered for sale.If. 105 — ANCHOR BOLTS however.the wilding or improvement is sold within one year or completion,the owner- 106 — SEWER & WATER budder will ham the burden of proving Thar he did not wild or improve for purpose or sale.). 202 - UNDERFLOOR PLUMBING ❑ I.as owner of the property.am exclusively contracting with licensed contracars to 203 - UNDERFLOOR MECHANICAL comstrvm the P ljeel(Sec.7044.Business and Protection Code:)The Contractor's Li- certulawd not apply w�te of property who Wilds orimprumsthemon,antl 204 - UNDERFLOOR FRAME who conte ter Bach projects nnamntractngs7]tarnsed pursuant the Contractor 205 — UNDERFLOOR INSULATION C case I ar punderSce. B&P C for this mason 301 - ROUGH PLUMBING \p�e 302 - TUB & OR SHOWER wp¢K MS COMPENSATE[ NDI:CLMt7CTl0 303 - ROUGH MECHANICAL Ihereby affirm onlet Penalty ofperjury oneofthe following declarations: 304 - ROUGH ELECTRICAL ❑ I have and will maintain a CeniBcate of Consent match insum for Worker's Compen- 305 — FRAME mann,....sued for by Section 3701 of the labor Code,for the performance of the work for whim this pcmoit is issued. 306 - HOLDOWNS ❑]have and ill maintain Wnr 's Compensation Insurance,as myuircJ by Semina 307 - INSULATION 01h the ,Cade ton Ne or Com crfthion Insurance, rk for whim thisir by its J. My worker m mit In c carrier and Policy number are 308 - SHEETROCK earner: Bey D 309 - EXTERIOR LATH C TW UKKORS1 1 It COMPENSATION IN ANcls 310 — INTERIOR LATH IV (This section need not he completed if the permit is for one hundred dollars($100) 311 - SCRATCH COAT mlcxs) 313 - ROOF NAIL 1 certify Ihat in the..moronce ooh n k ro, m this,mit is isseed.1 shag not 501 - FINAL ELECTRI CAL ENERGY cmrluy any per, moron nal, t Ic n n ctm�ukcns'Compenmlbm Lawtofcarro c 502 - FINAL PLUMBING ENERGY ami nth ,a erre 503 - FINAL MECHANICAL ENERGY E G a g t is cni0<am of Eatmrtr esu 'ma the Workers Compensation prov'ms nfthe law 5'04—= FINAL BUILDING ENERGY z\O forthwith ftmrly with such rrovishmt or this.crmhs a rented motcd. 505 — FINAL ELECTRICAL CONSTRUCTION LENDING AGENCY 506 — GAS TEST (-. I hereby alfirm that there is a 2maluct m lending agency lot the coormmaciel tx > the work for which this permit isissued(SccIDN07.Civ.C.) 507 - FINAL PLUMBING 1 Q Lcmm's Name = z bundhAddass 508 FINAL MECHANICAL U O 1 utility mat 1 have read this application and auto that the above information is 509 — FINAL GRADE comect.I agree acus with all city and county ordinances andstate lawsrelatinga �U building construction.and hereby authonv<represenatives of tai,city a cater urym the 5 FINAL PLANNING } above mentioned property for Inspection purpose's. 14 FIN I W RKS (We)agree ,save.indemnify and keep harmless the City of Cu,mm,against l liabilities., gromm.cosi an circuits which may in anyway accme against said City / 21 fJ z in consey cofinegrand ofthiapermit, v �(// APPLIC UNDER ST DS AND WILL COMPLY WITH A L NON-POINT Issued by: 50 .)LAT ON Date e-roofs Si am u A iWn omrucut U c ATERIALS DISCLOSUR: Type Of ROOF Will the applicant or future wilding nacupam store or handle baraNuus anade al x defined by tier Cupertino Municipal CcAr,Charter 9.12,and the Health and Safety .Sc Y,es 25532nd)'' All roofs shall be inspected prior to an roofing material being Installed. ❑Yes No P P Y g S Will the a pruant m rte nodeing occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove r emit husurJous air contaminants as defncd by the Bay Area Air Quality Managcmcnt all new materials for inspection. District/ l s ❑Yes lf�'�Nt W� .m,rtl, reaJNchamod" matcriaismquimmcntmnMrChapmr6.95oft eCalifon am,yCMc, ort 2SN15,25533 and 25531.1 unJClstanJ mat iftw wilding ham a t am.thm it is my m,00mili,m notify she occupant I the which our mmprimmisermnceofacethru of 'co y. 'g nature of Applicant Date nm7lu agent D e All roof coverings to be Mass "B" or better CITY OF CUPERTINO BUILDING DIVISION PE _ T CONTRACTOR'INFOR .ION: ' BUICP4G1A2DRg5SjPT0E LA PERMIT Ng12100143 OwrBgsBVE:PREEETZ APPLICATITII�YT6Tw 2 O O2 41 ONE: SANITARY NO.// 11 // CONTROL NO. ARCHITECT(ENGINEER: BUILDING PERMIT INFO BLDG EIECT PLUMB MELD 1120, LICENSED CONTRACTOR'S DECLARATION �pp Iberchy.ffpnthat Iamlicensed under provisions ofChaptn9(commencing INSTALL SKYLI Jpb eseription �Zly wiNuS 'Ion TaoB)or DivisionJor oineuud NOC=iaucodc.andmyliccnxm ZogN b II res and ct. /'� FONALE® Z LK class Lic.g t�7/!_�./'/ oz—es _ — serer ~ ARCH ECLARATION lex d plan al Ja public renods D['rk O rs002 nit,y. Gllaa L 30 t; Lk d of sit'a O OWNER-BUILDER DECLARATION rc 8 I wreby affirm Nal 1 am exempt from the Contractor's License Law for the O1 1f�g�'�� $2200 co a: following rcuon.(Section 10313.Business and Pmfcuiom Cake Any city or county BUILDING e to$ which¢quires a permit to coatruct,alter,improve,Jeroolim,or mpair any Structurew—'^ prior m its issuance,also requires the applicant for such permit to rile a signed statement Nal he is licensed pursuant to Us,previsions of be Contractors License law(Chapter 9 3�g9E38A1@m Valuation (commencing with Section 7")of Division 3 of the Business and Professions Code)or to $ Out be is exempt therefrom and Nea0 -0for be alleged esemption.Any violation of section 7031.5 by any applicant for a permit subjects be applicant to a civil penalty of p N Occupancy Type not mare than fva hundred dollars(stool. 102 - PIERS p y YP I,as owner of She property,or my employees with wages as their sole compensation, will do that wuh,and the structure isnot intended or offered for We(Sec.7014.Business and Pmfcaions Code:The Commences License Law does not apply to.n owner of 104 — REBAR Required Inspections property who builds or improve;daemon,and who does such work himself or through his ownemplo)ees,provided Nal such improwmmmus..of intended or offered hurrahs.If, 105 — ANCHOR BOLTS however be Wilding or improvement is sold within one year of completion,the owner. 106 — SEWER & WATER Wilder will have the human of proving Nat he did not Wild or improve for purpose of ale.). 202 - UNDERFLOOR PLUMBING ❑I,as Owner of Nc property,am exclusively contracting with licensed contractors to 203 - UNDERFLOOR MECHANICAL conswct Ne p fen C.7014,Businw and Proleuioa Code:)The Contractors Li. cello Law notapplyloan wnerof,fropery who wilds orimproves Nemo.,and, 204 — UNDERFLOOR FRAME Co.wh. for suchprojecu ithaconuacmr(S)IiarvedpursmntmNeConuacmfs eCo 205 - UNDERFLOOR INSULATION L' m p traders BAS PC for Nisreaon 301 - ROUGH PLUMBING rte ��ate 302 - TUB & OR SHOWER W 'SCOMPENSATI NDECLABndo` 303 - ROUGH MECHANICAL I hereby alarm under penally of perjury one of be following declarations: 304 — ROUGH ELECTRICAL I haws and will maintain a Ccoilmae of Consent to self-insure for Worker's Compcn- 305 — FRAME wo,on,u provided for by Section 37M of the labor Code,for the performance of the t fn which this permit is issued. 306 - HOLDOWNS ❑1 have and ill mount wt' s Compensation Insurance.a mquimd by Section 307 — INSULATION 37M.fNe rCash,fortes ormmce ofdirwo'krorwhobdiape across d. My worker m rz' In a carricrand Policy nu wr am 308 — SHEETROCK carrier: tray 309 - EXTERIOR LATH C IF COMPENSATION IN ANCE RICERS 310 - INTERIOR LATH (Osis section need not be complemdif the permit is for one hundred dollars(gLou) 311 — SCRATCH COAT orietS') 313 - ROOF NAIL Icemlythan in0epjCo....ofN amid is this permltisinced.Ishllnot 501 - FINAL ELECTRICAL ENERGY employ any pc �ny ma nik. I c s tt cwrkeri Compensation Lawsorc`.Iiror 4 e tt!! 502 - FINAL PLUMBING ENERGY V°ph Erb .e erma' it is enifca¢ofExempt' 503 - FINAL MECHANICAL ENERGY its atotWworterS comp natio.prow' sorthe aW 04 = FINAL BUILDING ENERGY forthwith omply with such provisions or Nis permit s a cemed revoked. 505 - FINAL ELECTRICAL CONSTRUCTION LENDING AGENCY [-. Iwrehy affirm Nat Jere is a construction lending agency for the performmce of 506 - GAS TEST a >. Sw work for which this Permit isissued(Sec.3o97.Civ.C.) 507 - FINAL PLUMBING I7] Q Under's Namc D. Under',Add. 508 - FINAL MECHANICAL U O 1 certify Nal I have read this application and Stam thn the above information is 509 - FINAL GRADE (•' correct.l agree in comply with all city and county ordinances and state laws relating a O Wilding construction,and hereby audience,mprocto aNes or dib city to c.w,.pnn do 5 FINAL PLANNING ll////VV//////��— .Wm ve. entioned property for inspection a uses. (We)agree to Save,indemnify ee fy and keep hasmleu the City of Cupertino against 14 FIN I W RKS rh Iiabilitio,ju menm,costa an expenses which may in any way aceme against Said City U lir couseq cof Jte grand of this permit PLICAPIr UNDERST DS AND WILL COMPLY WITH A L NON-POINT Issued by: Date5WPAO " V 50ULA ION —Re-roofs Si atu OT A roan ontmnor D A ERIAIS DISCLOSUR Type of Roof Will the applicant or future Wilding occupant store or handle hanothwas musnal an defined by the C.,min.Municipal Code.Chapter 9.12,and the Health and Safety Code.section 25533(x)? [D Yes All roofs shall be inspected prior to any roofing material being installed. AN. Will the applicant or future building occupant use equipment ordevicef which If a roof is installed without first obtaining an inspection, [agree to remove it hauJous air contaminants a dc0ocd by the Bay Arca Air Quality Management all new materials for inspection. thief? Y�o ❑Ycs I maJNchanardo smao:rials requirements under Chapter 6.95 ofthe Califon ilia Heal Safety Code, Ota Z5 5.n533.d2S534.1undcrsundthviff wilding woody have a rest.Net it is my responsibility m notify 1M occupant f Ne u n which urt metpimurluuarlccofaCeNOe 0 r y. gnamreofApplicant Date .1.1. a agent u D All roof coverings to be Mass "B" or better . � CITY OF CUPERTA "0PERMIT APPLICATION FORM D Z `r'' 5Z3CUPE TINO APN# 2 Date: Building Address: Owner's Name: _ Phone#: O Contractor: icense#: Contact: Phone#: D ApplicandContractor` Fax#: ,1 Bui,lii g Permit Info: Bldg Elect Plumb Mech Job escrip 'on: -fresidential: Commercial: Sq.Ft.Floor Area: $/Sq.Ft.: Architect/Engmeer: Valuation: Type of Construction: Occupancy Gro p: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances 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 ELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUELDING BENERGYADD Enny Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BNEWMULTI New Multi-family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING lof3 � ZJ/(� a cli o Go "AI bl fl' IL" 7N, .......1L VJ^ J ...... vl�l ........... r nr .... . . ........ .......... 1 " 1 t • ` � 1 t � l 1 l t LI o c 3) xj- t t 1 b `, ,111 T , }' �,' I IN � O � 4 W C �5'_• C,C. 1 _ H i .O l Iii L I I C m n. [J V J Z n W 0 CD I O O O w T , 4. , 1 " � T i� }