07070001CITY OF CUPERTINO t g�
BUILDING DIVISION PERMIT4� Jut
uU1LDf>[]69sS:QUINTERNO CT
OWNER'S NAME:
JULIE WING & ROB FISHER
IN
.E:
ARCHITECT/ENGINEER:
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and eff$
License Clazs Lic. !!
Date ContractorfeQ,� • `�
RCHITECTS DECL �,+TaM� �
I understand my plans shall he used as public records ,Ado!!
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
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 the applicant to a civil penalty of
not more than five hundred dollars (5500).
p 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 or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law docs not apply to an owner of
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 sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
I. as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License Law.
❑ I am exempt under Sec B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self -insure for Workers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number are:
r. �13
Carrier. Policy No.: MOW
CERTIFICATE OF EXEMPTION FROM WO CERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Namc
Gender's Address
1 certify that 1 have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(Wc) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the ranting of this Permit.
APPLI NN ST ND AND WILL COMPLY WITH ALLLQN-POINT
SOU R 5/
TI
S g lure ofppli ontractor Da
AZARDOUS MATERIALS DISCLOSURE
Wil! thea icant or future building occupant store or handle hazardous material
a. dcOned by Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑ Yes eNo
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management
District?
❑ Yes 16Nu
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safcl odc, Sections 25505, 25533 and 25534.1 understand that if the building
does not curt y na that it is my responsibility to notify the of the
rcouireme wh1 t typlrrw issuance of a Certificate of
or
'ERMIT NO.
GROUND FLOOR LANDSCAPING 07070001
INC' PERMIT ISSUE DATE
443 LA3WELL AVE
SANITARY No. CONTROL NO.
(408)2)5-5225
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
Job Description
ADD EXTERIOR STAIRS FROM UPPER DECK.
Sq. Ft. Floor Area
3 5 7 0 9 0, 5 9ABb Number
Issued b�:
Re -roofs
Type of Roof
$10718
Required Inspections
Valuation
occupancy Type
Date
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new rlaterials for inspection.
Signature. of Applicant
Date
All roof coverings to be Class "B" or better
�• BUILDING DIVISION PERIVIIT�,+.y�=AJ'''!��A�=°`Vn t �t"v`•'*"'`1 `'
Y8c:�8,Y1`ii+DE�•1 ltxevL*.a}y, Y:t�'..'.aifiF'3^uti:�4?*''�1"?:L",._
PERMIT NO.
BUILDt6Yff6r:QUINTERNO CT GROUND FLOOR LANDSCAPING' 07070001
.. PhIlMrr 15511E DATE
OWNER'S NAME:
'JULIE WING & ROB FISHER 443 LASWELL AVE
SANITARY NO. CONTROL NO.
PHONE (408) 295-5225
1 bmebY affirm out I w 1"i sued uMu Punt inns of CMpmr 9 (..touring
with Section 7") or DM.60.3 prdm Boldo••• mW Rofesdmts Code. and my litems is
,n full fart, and crrryhla
Liccmc aaia {{.-.., fix. a
Da¢ Conliann f(��
RCNffE tmc DECthn,,n i��5+
1 tinea,,. d my. plans shall M uaJ u Puhnc rtcnrJs
Li.d Pmlcasi... I Imo'
OW NEA-OUnn" fr DECLARATION
1 hcrthy .(Trio that 1 I.S.acmpt (rum the Contra Co Liana Law for ft
my
following on. (Schon 703 LBudncs and Rofmsiom C.k: Any city.r county
which mquira a permit In d. lb t. dmr, improv,. demolish, nr .pair any Swetum
prim c it, usuanc,. also of to ft dm ajsjoc aof foranch am prmit m sin. signed sammc 9
Nat ur is tamed rSomant m the Division
of the Commd.'s nd com,Ptor Itaw (, Ca ) 1
teat ho IS ngwith Section]000)of Division J ofd. BusineccrudProreaiom Cade)tar
that be is cacmpt admfrom and or buu Ito the a1h:gW csempdon Any niasipn of
Section ]0313 by any applicant for a pnmit mblau the applicant to a 4v51 penalty of
out more than roe hmAmd dollars (SS(10}
0 L is owms of tri poPMY, m my cmPloyas what wag= u dmh tole coup—tim..
win do the wmrlc and the mumuno is not imended or andrW Int attic (Sec- 7044, Business
andpmfeesioM Code The Contractor's Liceme Law docs tot apply to an wrmr of
pmpeny
no builds. impmrs dwcan,and wbodaessuch work himself mduough his
ow,smployss pioviddd that Such imps—ca art not inm,dcd.oQcrW fmaa B.
ho+svcr. the building. improa<mcnt u told within one yon of mmplcdon. du owrc-
builtler win have tM burden of pmving that In, did ant build Or tmptrvc for purpom of
0 I.. wncr of de pmpcny. am mcjhoi ly conuc+ing widt lirrnawl ..rano. or
coon tot the project (Sec. 7044. Bushes and Pmf®moto Cade) Thc Cucv ' V'
roam Law docs not appy an an owner a pmpWy who Wads or improves thereon, and.
who contract, for such pmjccu with a conuaay.(a) li..d pots..t to the Cumacuar"
Licnm Law
O lamurmptuMm See .B9PCroutho ssoo
OwncrDate
WORKERS COMPENSATION DECLABA'i1ON
I heeby aa'um utlu annually of perjury ant of the following dnlarao.m
❑ I btn iod wDl mmntaio aCwfiam of Convent th self-insmc f. WorkuYs Comps
adon, m povidcd for by S sdon J]DO of et, lath. Codd. Ito d o { rImmann or Oe
work for which this ptnul is iaucd.
1 hast and will maintain W.trls Comprnsadm Insurer,¢, u mqu'ucd by Sadw
3700 of the Ubm Code, for ac pafarmamc of oto wort for which this pdrmi, u laved.
My Worme, ComPemadon Icon carrier and Policy numb. art:
Carrier.�[fC'�Si Paltry Na.: RK '
CERTIFICATE OF EXEMPTION FROM W ORAE¢S
COMPENSATION B<suA CE
(Thbsecund rind botbe complc.d n de pmnit it for one hund,ddoDare (SIOn)
or less)
1 e,n;fy the, in the perroom. a the work I. which this .it is iuucd. l shall not
cmuluv my anon in any numr an as th brmme subject to de W.kcrs' Comp:madu
Applicant
NOTICE TO APPUCAN : if, after making this Ceni iam of Uctoptlon, you should
hznme mhy. to tW Wohc's CourNmaidon pmvioom or the Labor Cotic, ypa moa
Ofonbwia amply with coach povid... au p?mit Shall Inc dmmctl rtvoicl
7 . • ` CONSIRUCnON LENDING AGENCY
I atemhy aRrm sat acre is. comtmednn lending agcmY' for the pctformana of
the work for which this pamit is land (Sec W. Cin, C.)
7 Uncles Nun,
Lcmh,ea Addles
iz
i agrd, sal 1 have rod this city
and application county
o sum au the Stars information (.dun u
F' rntmct. I qrc m comply with all city +red mpnry muui a ran and State laws y upon
,o
C) ho,i-numumud and y I.ituactionP rcprtsc„utiv,s of this city to cnmr up,n de'
+� .hoot-(Wn) amu pmfeny fmiomir, an loughs.
y a
(We) agmc m ave, and .,m and kap harmless w City ru Cupenino agvmt
y rat liabilidm,jadgmcnudosu and up:nsss which may in my way ¢cmc+gainst said Gy
) z in comc menet of ac granting or this p.rmik
ap.,r4 b;Nr]PtSTAN SAND WILL COMPLY WITH ALL tiON-POINT
a`gmmrt ORP"` "'SUS ld T=ALS DISCLOSURE .
will lima Tom mfor. Wildingoccupant nm, Or haMk hvardoui manni+1
u L--rned by darCoputjun Municipal Code Chapmr 9.11, and the Holth and SafnY
Cod,. Satan 25532(.)?
OYm IJ Nd
will an, applicant . future building oauPant is dquipnent . d_`la which
molt hvando. tar cvtumimnu . defined by de Bay Aura Air Quality Management
D strict?
DYm �No
1 hand madtri cnm no mat hes rOluimmcnuundo Chipn;6.95atmCdif.-
aaFlnithkSaf cdc. Scoiom 15505, 25533 and 15514.1 m,da.•Sund that if do Wilding
d,. -..nu . hllYYee rEnaru that it 4 my mspondhility to nodfy ac oet@am of ac
Job Description
ADD EXTERIOR.STAIRS FROM UPPER DECK.
Ft.
$10718
3570906
Required Inspections
Issued by:
Re -roofs
Type of Roof
Date
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better
nrvoF
CUPEk�TINO
i�lcn�ej 1x(vre_ 3 (tqrt,>s c6cv),,' t teZ
CITY OF CUPERTINO
PERMIT APPLICATION FORINT &kx'r>=ihoe
d 707060 /
APN # 3:S117 � � / �
Fee Description
Date:
BAPPLOTHER
Other Appliances
MECHANICAL
Buildin- Address:
Mailing
Address (if different from building address):
AU 08 4rcf t -.,o
cr
MECHANICAL
Own Name:
N ULI'G Z)h
�V,-
Phone #:
L[D%-Izs- 100(o gh8 08 Yw -Wok
Contractor: r L
Boiler> 1M to 1.75 M Btu
License #:��
lT
Boiler> 1.75M Btu
MECHANICAL
Contact: Phone:<io8
.LS `fiiZ3
Cupertino Business cen e#:
lr-{' _ Fax:
Ind/Off/Comm/Quasi
ov
Building Pennit Info:
Con. Tax for BQ Zone
BUILDING
Bldg Elect ❑
Plumb ❑
Mech ❑
Jobb scription:2,_1Qc:oc
Constax — Resi/Mobile
BUILDING
Residential i r .,y
k.
Commercial ❑
Sq.Ft. Floor Area:
Flee 600V > IOOOA
Sq.Ft.: '
Cost of Project:
Elec Svcs 600V <= 200A
Occupancy Grs}}ip:
K--'�
Type of Construction:
Energy
Please check this.box if the project is a
BENERGYADD
Energy Add Multi
second-story addition: ❑
Project Size: Standardo Large
❑ Major ❑
BUILDING
Quantity Fee ID -
Fee Description
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
BBOILER]
Boiler <= 100,000 Btu
MECHANICAL
BBOILER2
Boiler> IOOK to 500K Btu
MECHANICAL
BBOILER3
Boiler> 500K to IM Btu
MECHANICAL
BBOILER4
Boiler> 1M to 1.75 M Btu
MECHANICAL
BBOILERS
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 <= IOOOA
ELECTRICAL
BELEC1001
Flee 600V > IOOOA
ELECTRICAL
BELEC200
Elec Svcs 600V <= 200A
ELECTRICAL
BENERGY
Energy
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
BINVESTIGA
Investigation fee
BUILDING
1 of3
J(L