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03020041 (2) CITY OF CUPERTINO BUILDING DIVISION PERMI @ONTRACTOR TN'F®RMA SU "Rv»8Qb¢� 'aT314is«q P-;3--^ f -R�w'$ fi„row �'adls BUILDING ADDRESS: PERMIT NO. 10255 VIRGINIA SWAN PL OWNER'SNAME: APPLICATION SUB OATS PAM 7 DAVID MCCULLOH 02/12/2003 HONE: SANITARY NO. CONTROL NO. ARCHITEC MNGINEER: BUILDING PERMIT INFO BO EO PLO MECH O LDG X00 LICENSED CONTRACTOR'S DECLARATION Job Description as d F I Mislay alrw m Ii that I and under provisions of Chapter 9(rommercing with Section 7”)of Division 3 of the Business and Professions Code.and my license is G31O in fullromeandef t. ' DECK & ARBOR AT BACK. YARD 02133 License Class --Z Lic.N I 87z w,t-� Dale Contractor rote y�� n ARCHITECT'S DECLARA ON Iya�11"II [� �m�rr�S1 N+y d 1 understood my plans shall M used as public records u u v vv {E�1J a,LL t� Licensed Professional k-�yO OWNER-BUILDER DECLARATION JUL 2 5 2003 nelE 1 hereby affirm that I am exempt from the Contractors License Law for IM 1 2 O o following mason.(Section 7031.5.Business and Professions Coale:Any city or coomy $ which mquires a permit to conswci,site,improve,demolish,or repair any swcwm FZY )riot 10 its assurance,also requires the applicant forsuch permit to rile a signed slalcrom that he is licensed pursuant o the provisions of the Contractors License Law(Chapter 9 Sq. Ft. Floor Area $1ag�IQ11[IOn (commencing with Section 7000)of Division 3 of the Business and Professions Code)ur — that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects one applicant to a civil penalty of79— Occupancy Type n6 ve mom than fihundred dollars(M), ❑1,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended m offered far We(Sax.7064,Business and Professions Code:The,Contractors License Law docs not apply to an owner of 10 2 - P I ERS equlred Inspections pamper builds ilds or improves thereon,and who doessabt work himselforNrough his own amployees,provided thatsuch improvements ae not intended orolTered for sale.it. 103 — UFER however,the building or improvement is sold within one year of completion,the names. builder will have the burden of proving Nat he did nm build or Improve for purpose or 104 - REBAR '°I`')' 105 - ANCHOR BOLTS ❑L.sOwner oj the propertSec.70,W.Business exclusively connecProfessions Cash:)The Conn0acmrsm 106 - SEWER & WATER comwct the project(Sec.71144,Businev end Professions Code:)The Contrubrs Li. cense law docs not apply to in owner of property who builds orimperves thereon,and 202 - UNDERFLOOR PLUMBING Lend Law,contracts for ancnpm eetswith.erntrumrcallicensed parsa,dlmthe Conuacmr. License L203 - UNDERFLOOR MECHANICAL ❑I and,exempt under See. ,a&P C for this on 204 - UNDERFLOOR FRAME OwnerDate 205 - UNDERFLOORINSULATION WORKER'S COMPENSATION DECLARATION I hereby alRw under penalty of perjury one of the following declanfionso 301 — ROUGH PLUMBING I have end will maintain•Ceniftcam ns Of Coent to selginsure for Worker.Compcn- 302 — TUB & OR SHOWER satires,as provided for by Section 37M of the Lata,Code_for the perfowanee of the 3 03 - ROUGH MECHANICAL .,it lar which this pewit is issued. 304 - ROUGH ELECTRICAL E]1 have odd will moinmoo Workers Compensation Insurance,u required by Section 305 — FRAME r 37M ofthe Labor an,for c peIf....of use work for which this permit is issued. \\ My Workers Compensation Insurance carrier and Policy number v — rue; 306 HOLDOWNS Grrier. PION MOM O: CERTIFICATE OF E%EMP PON FI WORKERS' 307 - INSULATION COMPENSATION INSURANCE 308 - SHEETROCK (This section need not be completed if the permit is for one hundred dollars($1M) 309 - EXTERIOR LATH orleu.) 310 - INTERIOR LATH e unify that a the performance of the work for which this permit is issued,1 WII not employ any person In any ma rsoulo eco subjectuthe Workfrs'Compensstion 311 - SCRATCH COAT uPsto^Calif ' .Dat - - �^ ., 313 - ROOF NAIL NOTICE TO APPLICANT:If.Sher making this Cenificam of Exemption,you should 501 - FINAL ELECTRICAL ENERGY become subject to the Worker's Compensation provisions of the Labor Code,you most pz mrmwimcomply with such provisions orthis ranniIshaEedeemed mvnked. 502 - FINAL PLUMBING ENERGY 7 q ti '' CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY F I hereby from dom them 11.construction lending agency far the Performance of 50'4 - FINAL BUILDING ENERGY IYithe work for which this pewit isissued(Sce.3197,Cis.C.) W Lender's Name 505 - FINAL ELECTRICAL 0 �z Undies Address 506 - GAS TEST U O 1 certify that 1 have read this application and state that the above inf anommo is 507 - FINAL PLUMBING D. (~ correct.I agree to comply with all city end county andironttund some laws relating I.building construction.and hereby andimisere eumxtives of this cin to eneru upon U above-mendonedproperty for inspection purposes. y %9F NAL MECHANICAL G (We)agree a save,indemnify and keep hawleu We City of Cupertino against Nto liebiliti(W)gre1.cosh indenifyand kie mayinanyway heCtccmeagertino igCity GU Z in consequence of the grunting of this pewit.APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued byWORKS Date SO C REGU IONS. �k I Re-roofs Signature of Apptucam vacmr Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant sure or handle haurdous material as,defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and SafetyInde, en 25532(a)?0race Na All roofs shall be inspected prior to any roofing material being installed. kWill 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 handouts air contaminants u dcrined by the Bay Area Air Quality Management all new materials for inspection. District? C]Yes No I have mad the hxaard amrials requirements under Chapmr6.95 ofthe Califon nia Health&Safety Code,Secdom25505,25533 and2553d.1 understand thalf the balding does not current,have a a nam.Nm it is my responsibility 10 notify the occupant of Ne rcyu' rata whi muv be met priono issIcc fa CCNfmyte of cuParty. Signature of Applicant Date Z-I Z-D Owner or euthoured agemV Date All roof coverings to be Class "B" or better j O � Q ?ITY OF CUPERTINO • o cir °F CUPEI�TINO PERMIT APPLICATION FORM APN# Date: Building Address: 10 -L 53- Vi'r )'111'61 .f,,.4h Plfa , CN )'bh 0 «l Owner's Name: J ll0 f Phone#: q nol �jJY// /7 Contractor: 'J, ,f— m` r m/ , License#: Contact: 11C ryod Q 7 3 9� Z 30-Z Cupertino Business License#: /o�- Building Permit Info: bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential ❑ 4!c1 as Sq.Ft. Floor Area. $/Sq.Ft.: Cost of Project: /per _ Occupancy Group: Type of Construction: uand 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 I Energy Add Multi BUILDING BINVESTIGA I Investigation fee BUILDING BMITIGATC Comm. HousingMit. Fee BUILDING Z� '0 yf I of 3 ���� 6 Z 5 , FEB ;fix - T � APPROI FE® IN ACCORDANCE WITI THE CITY Of3 CUP.ERTINO °9DF" AN ORDIr'At ICES DATE— SIGNED T This set of plans a .d sl: xificatians 0M, tv be kept on the , , at all titres and I%91 V lawful to make any than les or Ak 401. on same without written perm,st a 1 4 99, the building Dept., City < "Cnk,. trt VA The stamping of this plah and t0zh h-ki;W ls' N SHALL NOT be held to F )arA a C+. '3& M � O ipproval of the violation A sny ri 910W w )f env City Ordinance of Sh to t0v M t� �N N. w •. v� - o .v3¢� x � Q � ¢ Z�uC) A R BOK �45e_ $iir��dLed, S?�L'G� /orf / eolw e' G ixb" 1 e.41r xb" r.N*Urs 5p4zzA /6 " an een,4r !"X4" Im er'S Spgad �i'� on J41bope-kd by any ZxV'sOf ers r . PoSa-5 Arm a-,�d in�b o%eck . Sc��vr�5 To4-a 1 urbvr �u,�l�a a4- house! ;s 10 l Ek �D i • F 47 F 1 2 03 �Gili4 a�7c� UG(l�i�� I49GL�tIIcl, HEATHER J.PRIDPRRIID UNOSCAPE CONTRACTOR 812 BARTLETT AVE, SUNNYVALE, CA 64008 �- 'LIC. 9 714842 LCn6-4:9 aC-r�n�5 o.� SIDS Louv�RS vIGiN Po // sLlprcar Li;o v ER. 13EAm v"I l vv P1pc X FEF 1 2 3 BY. vrGw 6Gah15 nr�lc neck on ex,'S�i.,J �nn�rr�e Pad, 5�racfur.rl .ne�nGars f o be P^uSSure 47-e m4ed Deek"9 o zxd Tk�X Led p r 40 lie. w,th. ynjvani2e.<� orAl t4tei-/ncAa -fFEShin�1 �i�' SfucGv �lasl„nc 6rvcoo- In �S�ai«a -fear Flii-.57hin9 J G ulk1_ 1a5�,ii�y eclye. vvAcr�-- !71 errkrS jrgove- O - end j'o,'n�-5 o-Feverl<yPi„J - d+ o-( 445k J wAere- ; b�rl�5 uP }o bo��-nm of Use cud -e� '/ �re,tp5l p)er bloekS trop Durr si/l ot ��y To I st �--Le<l9er PSE r block' sli X Lpntre k- cO�GI. ()o,,r 5/ll o CfnGre-t� PCtJ) (j 115;1( �r©P llz <�Etki�� !l lOicrb/ocK w,/� vo,s/� u Sed pier blceks' Un ire F Ganc,^e C svt on CX) canoe-&Rad ►/7,11 8olf WIA W145A41^,,, nl-9•f 7ol'S� it ® ® y 3�y �R ise. �r'e r- block' ,/ �S3Iy `� 3I�1Rse 'Z'X/Z" S3rinJrr' ���Ulv�� ��U �1c 211x6 ' K,ckcr P%AA •F'ao�elm4l WIM L FC'`Fa 44fczd.�, , S4r,nq-erS •1v 1vi`5� wrl--A �zh bFltr5/, and jv kiekcr Plaits a �i,9 �•ae-nal% _cr-U cantl,arS/anuli.. bran Ir 11 •Zx6" ra5C)q Jl%Z Dleck,'nJ � X00 I%ilbeck,n Te,51' • 'Zx6 �a5ua y.3/�,, •. .-Y3�y►S�xtce..^I. O k�'cke�• PI�,}z (1c) Loncre.;� ,PAS CITY OF CUPER,rINO •� ` 's ` BUILDING DIVISION PERMIT CONTRAC-TTORIN ORMATION: BUILDINGADDRELS: PERMITNO. - 10255 VIRGINIA SWAN PL 03020041 W NER'S NAME: APPLICATION SUB DATE PAM 7 DAVID MCCULLOH 02/12/2003 ONE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDO ELECT PLUMB MECH 1 00 LICENSED CONTRACTORS DECLARATION id z u 1 ibatch,o.70 allirm that 13 IThe B.under provisions of Chapter Y(commencing Job Description with Scm;nn 7ngp rrDmialon 3orJm mdna.and Pmrasinns cotrJe.otomy license is Fo„ infulifixccandef_t�� I 87Z DECK & ARBOR AT BACK YARD zoq� ucnnsn clnsa Lic.x OSN—p Dam Contmcuar Ig. a ARCHITECTSDECIARA ON 2003 g IundcrstanJ my plana shall as public records nD L. Licensed Professional y. 0 OWNER-BUILDER DECLARATION BUSLDING KSK Q f I hereby allirm that I am exunpl from the Contractor's License Law for the �/ e6MO following reason.Scedon7031.5•Business and Professions Code:Anycity,orcoumy K g� which requires a Permit to construct,altar,improve.demolish,or repair any structure mzNod its prissuance,also requires the applicant lirr such Permit m file a signed statement p,aa xx< that M is licensed pursuant to the prnvisinns of the Commetnr's License Law(Chapter 9 Sq. Ft. Floor Area $18140}Ttlon FO (commencing with Section 7000)of DivisionJof IN,Business and Profcasinns Codc)or y $ that he is exempt Ocmfrom and the basis for the alleged excmptinn.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant m acivil Penalty of Occupancy Type not more than five hundred dollars 01500). P Y YP ❑I.as Owner of the property,or my employees with wage as their rude compensation. will Profession, r thework.andthe he Cm snot,License do,I.,apply to an Business .adderty who obuldsor The Contractors Licence Lawutasor applylfenownerof 102 - PIERSown equlred Inspections Property who builds or thavach impr and who rrox am work h f offered Ms howempinyoes,Prnorimrsoc hobs old Within not orOfdoro@red ha owner-aide,If, lO3 — UFER however,me buildingvth or improvement;s hath a Within one year of Completion,provefor the owner- builder of builder will have me burden of proving that M did not Mi1J or improve for purpose of 104 - REBAR a'c.). 105 - ANCHOR BOLTS El 1,as Owner of the property,am exclusively contracting with licensed mntracous In 10 6 - SEWER & WATER construct the project(Sec.Il44,Business and Professions Code:)The Contractor's Li cense law does not apply to an owner f prepeny who Wilds orimproves lhemon.and 202 - UNDERFLOOR PLUMBING who contracts for such projects with a contranorfs)licensed pursuant u the Contractor's ucense,L.w. 203 - UNDERFLOOR MECHANICAL ❑ I sem exempt under Sec. .B k P C for this reason 204 - UNDERFLOOR FRAME ter Data 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION PLUMBING 301 - ROUGH I hereby affirm under penalty of perjury One of the following declarations: 302 — TUB H OR SHOWER ❑1 hiveendwillmainuina Cenificamof Commit,mself-iteme for Woders Compem mutur as provided fm by Section 37MIof the IJMrCodc,for the perfomnmce of the 303 - ROUGH MECHANICAL work for which this pemt;ra issued. 3 04 - ROUGH ELECTRICAL ❑1 have and will maintain Worker's Compensaunn Insurance,as required by Section 3 05 - FRAME 37M of me labor Ceda,for me Performance of the work for which this permit is bound. \\ MyWorker's Compensation Insurance can — canner 306 HOLDOWNS Comm: Policy N., 307 - INSULATION CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 308 - SHEETROCK Gods section need not he completed if the permit is l prone hundred dollars k ffO) 309 - EXTERIOR LATH or1css) 310 - INTERIOR LATH 1 candy that in the performance of the work for which this permit is issued,I shall not 311 - SCRATCH COAT employ any person in any ma ruse as Or Men subjccun the Wnrkfrs'Cnmpensatiun Laws ofC.IV.Did o 313 - ROOF NAIL Applicant ja+ m- �tis� NOTICE TO APPLICANT:If.fficr making this Cariliemc of Exemption,you should 501 - FINAL ELECTRICAL ENERGY become subject o the Worker's Compensation provisions of the Labor Cotte.you must 502 - FINAL PLUMBING ENERGY O ,z forthwith comply with such provisions or this perm it shall be deemed mimord. z0 CONSTRUC]ON LENDING AGENCY 503 - FINAL MECHANICAL ENERGY [:. .`n.. I hmchyaffirm Out there is.consomom.lcodingagcncy lits the perfurmanmof 504 - FINAL BUILDING ENERGY a > W Qthe workfar Which this permitisissued(SO,.NYR,CO.C.) 505 - FINAL ELECTRICAL Lemlcr's Namn az LcnueriAddress 506 - GAS TEST U O I cen;fy that I have read this application and sum that the show information is 507 - FINAL PLUMBING � (•-' come[.l agree to comply with all city and county oninances and state laws miring to DU building construction,and hereby amhodmreronammtismsnrdais city toenter upon the 5 FINAL MECHANICAL W above-memlmodpmpertyfor inspection purposes. O9 FIN In (We)agree In cast,;nde expenses and which harmless the City of Cupertino against rp liabilities,judgments.rosu and expenses which may in any way acemc against said City CJ G+ U 7 in mna,qucnce of the granting of this permit. — t� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by51 WORKS Date 50 C.REGU IONS. C 1 Z-/2-03 Re-roofs Sigamurc of Applicant/ traitor Dam HAZARDOUS MATERIALS DISCLOSURE Type Of Roof Will the applicant or future building occupant store or handle barerdous material a defined by the Cupertino Municipal Code.Chapter 9.12.and the health and Safety code, zss3z(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑tics oyca Nn 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 emit hu.amous air contaminants as delincu by the Bay Arca Air Quality Management all new materials for inspection. District' ❑tins NI I have Mail the hacannus omrials mquimments under Chapter 6.95 of the Califon ria Health 1k safety C,d.Stttions 357115,25533 and25534,L understand that if IM Wilding does not currently haw a union,mat it is my responsibility to notify tM occupant of the rcyui n ntswhi mustMmet prinrmissmmm faCcnilicimolnapanny. Signature of Applicant Date z-r a-o Owner nr aumnrircJ agcn Data roof coverings to be Class "B"or better