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09020053 CITY OF CUPERTINO � �� '� BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 934 HYDE AVE TBD - TJ BE DET PERMIT ISSUE DATE OWNER'S NAME: A CONTROL NO. PHONE: BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH 0 0 0 000 ed LICENSED CONTRACTOR'S DECLARATION Job Description U I hereby affirm that I am licensed under provisions of Chapter 9(commencing = with Section 7000)of Division 3 of the Business and Professions Cock,and my license is EXTND REAR OF BLDG BY .4FT TO END OF RF OVERHNG—1 H in full force and eff r. L y y 1 L' Z License Clara Li u*s<ar T;UPGRD ELECT PANEL TO 2 AMP p Date A ARCHITECTS DECLARATION p t understand my plans shall be used as public records �yU rn Licensed Professional O OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the in O following reason.(Section 7031.5,Business and Professions Code:Any city or county Pi which requires a permit to construct.altar,improve,demolish,or repair any structure JJ "H prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation < that he is licensed pursuant to the provisions of the Contractor's License[aw(Chapter 9 S q YFS (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $2000 J3 - that be is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(M)• 3 7 5 3 9 0 C 3 . 0 0 ❑I,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 Required Inspections and Professions Code:The Contractors 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.). ❑1,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractors 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 OwnerDate WORKER'S COMPENSATION DECLARATION I 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- .ion,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 WorkersComp/enation Insurance carrier and Policy number are: Carrier: 5,4.tr �w Policy NO.: _ 9fl Z!A OF EXEMPTION FROOM WORKS S' 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 Workces Compensation provisions of the labor Code,you must O forthwith comply with such provisions or this permit shall be deemed revoked. z r-w CONSTRUCTION LENDING AGENCY E.r rte. 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.) W Q Lender's Name ]Z Lenders Address I certify that I have read this application and state that the above information is LUL 0 correct.1 agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. Oa (We)agree to save,indemnify and keep harmless the City of Cupertino against E"t liabilities,judgmcns,toss and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. D to ` + APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued t y: SOURCE REGULATIO Re-roof3 ' Signature of Applicant/Contract0r Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino M:;No ici Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. Yes Will the applicant or future building occupant use equipment or devices which If a zoo�is installed without first obtaining an inspection, agree to remove -lit hazardous air contaminantsu define by the Bay Area Air Quality Management all new materials for inspection. strict? ❑Yes o 1 have read the hazardous materials requirements under Chapter6.95 of the Califor- nia Health&SafetyCodc,Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant.that it is my responsibility to notify the occupant of the. Date requirement h must met prior to issuance of a Certificate of Occupancy. S ignatu-e of Applicant �... ZI1N dq-- All roof coverings to be Class'R'or better Owner or authorized agent Date q o C)o� 3 I at CITY OF CUPERTINO CITY OF CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN #2755 o u v Date: ZA J 01 Building Address: p 3 q y� � 14C y r�4/w,D CA rO' Mailing Address (if different from building address): Owner's Name: �A R5 H�� A ��� Phone#: HOA: (Exterior work only) Yes E] No � oSL gas If yes, provide letter from HOA Contractor: aa� Phone: o 2.3 S 2 CLA 4 h) CO r1 S �7'H f.�l vw Fax: Contractor License#: C= 6q6'4 I L Cupertino Business License#: Contact: M r• C 1�1e��3 4h Phone: S Ca qi'�(� &�S 5 1LCe- Fax: Residential Commercial Job Description: up FOV-4-6 2-00A Building Permit Info: Bldg ❑ Elect Nf Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: I-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B ❑ Valuation: Square Footage: 2a� /N ,j�,et�d /�-o v a4V 00•s Project Size: Express Standard ❑ Large- ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.builditg.reen.or Revised 02/05/09 CITY OF CUPERTINO CITY Of GENERAL BUILDING APPLICATION CUPE(�TINO FEE SC-.HEDULE Quantity/Sf Fee ID Fee Dacription Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B addition it stucco application 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1WINMEWSTR New Window-structural shear B wall/masonry(includes plan ck fee) 1 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechan:cal Permit Fee M I PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B when not over counter) hourly-stand alone 1 BCBSC Cal Bld;; Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICR Seismic Residential B t 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel &Documentation B IBUSLIC Business License B C�2vtC,-� SCO /1�� o� IHSS 5 of 5 Community Development y.4 10300 Torre Avenue aw, Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF `'UPEKTINO Buildirt De artment LOW=rN DRESS: a 2 J / PERMIT # l7l � 'S NAME: 2 A ✓� �'1 PHONE # Yoe GENERAL CONTRACTOR: CQ FAX# ? 2 1 D I am not using any subcontractors: Date Signature Please check applicable subcontractors and complete the follow*n information: Date LICENSE # SUBCONTRACTOR BUSINESS NAME Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature ate