09010077 CITY OF CUPERTINO
77 `'tis
DING DIVISION n�,�
BUIL PEltlY111 :•H -:
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: PERMIT ISSUE DATE
A N CONTROL NO.
PHOWejl
WAIPAM
408 449-3344
ARCHITECr/ENGINEER: BUILDING PERMrriNFO
BLDG ELECT PLUMB MECH
u0p LICENSED CONTRACTOR'S DECLARATION Job Description
m I hereby affirm that I am licensed under provisions of Chapter 9(commencing
ZW with Section 7000)of Division 3 of the Business and Professions Code,and my license is
H in full force and effect. INSTL 3 SKYLIGHTS
j rj? Licensc Class Lie.k -
E-a Date Contractor
ARCHITECTS DECLARATION
J g U I understand my plans shall be used as public records
a
n y Licensed Professional
n y OWNER-BUILDER DECLARATION
f I hereby affirm that 1 am exempt from the Contractor's License Law for the
C q o following reason.(Section 70315,Business and Professions Code:Any city or county
.4 which requires a permit to construct.alter,improve,demolish,or repair any structure
11 Z Y prior to its issuance,also requires the applicant for such permit to file a sighed statement
E_ at he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9 Sq.Ft.Floor Area Valuation
that
y- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 4 5 0 0
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 APN Number Occupancy Type
not more than five hundred dollars($500). 35704032 . 00
❑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 of offered forsale(See.7044,Business Required Inspections
and Professions Code:The Conuactor's License Law docs not apply to an owner of q P
property who builds or improves thereon,and who doessuch 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 Trot build or improve for purpose of
sale.).
dl.as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's U.
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 Contractor's
License Law. ��
❑lam exempt undclSaA - ,B&P C for this reason
Owner. N ' Date
WOR 'S C MP N DECLARATION I
I hereby affirm under penalty of duty one of the following declarations
❑I have and will maintain a Certificate of Consent to self-insure forWorkersCompen-
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 fdr which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Carrier. Policy No.:
OF EXEMPTION EMPTION FROM'WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if thepermit is foronc 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 an n s c o object to the Workers'Compensation
Laws of California.D
Applicant
NOTICE TO APPLIQ9 :If,afterkdaffig this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you muse
,J 0 forthwith comply with such provision or this peanit shall be deemed revoked.
Z H CONSTRUCTION LENDING AGENCY
(-+ 1 hereby affirm that there is a construction lending agency for the performance of
a 7 the work for which this permit is issued(Sec.3097,Civ.Q
W A Lenders Name
z L.endees Address
U O I certify that I have read this application and state that the above information is
Vh' correct I agree to comply with all city and county ardinanees and state laws relating to
0building construction,and hereby authorize representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
tF.t Cn liabilities,judgments,costs and expenses which may in anyway accrue againlsaid City
U Z in consequence of the gran. g of this permit. /^2 re
-+ APPLICANT UNDER ANDS ND W]LL OMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGUL S.
S6
Re-roofs
Signalum of Applintractor - Date
HAZARDOUS M ALS DISCLOSURE Type of Roof
Will the applicant or future building occupantstom orhandle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.1:4 and the Health and Safety
Code,Section25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yea ice'
Will a roof is installed without first obtaining an inspection,I agree to remove
ll the applicant or future building occupant use equipment or devices which
(:mit hazardous air contaminants as dcLned by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes W
1 have mad the ous materials requirements under Chapter 6.95 of the Caffor-
nia Health&Safer C Secuus n s"' 5,2553 75534.1 understand dtatif dtc building
Y
does not curend a that it is my nsibility to notify the occupant of the
requirements ich Tutt x t p'r of a Crnificatc of ry• Signature of Applicant Date '
Owner or authanxcd agent Da '
All roof coverings to be Class's"or better
0077
CITY OF CUPERTINO
CITY OF
CUPEf�TINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# 3,570 Date:
Building Address:
Mailing Address (if different from building address):
Owner's Name: Ry uJ 1 w ►m&)"E Phone#: (408) 2-TZ 63 76
Contractor: Phone:
I)VN th11*01VAtD Fax:
Contractor License#:
Cupertino Business License#: O 634-
Contact:
4-
Contact: j 0 d So Wrt4 3 Fp S r kbt�I Phone: (40?) q47 33 4��
Fax:
Residential Commercial El
Job Description: F
I 95TAri,L 3 S KYLi Q.,r-1,Ts
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT,V-B
Valuation: �G Square Footage:
Project Size: Express ED, -8fandard ❑ 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.builditL3,reeg.org
Revised 01/07/09
i
Proposed Locations of Skylightsson
w
V.% CF. P e ue 0-.( r North
S V
low
f
Y 3
5J °
iI f
t
x
entran
-
A entrance
skylight
21"x27"
C.
B-master
bedroom skylight
30"x46"
J.
µ C-kitchen
skylight
30"x46"
„s. W.
..
I
A.
O
H � 21.5'
Ymrt�
A=21"x27"
B=30"x46"
C=30"x46"
entrance
22'
a"o in
M N
st .5,
ma r
batMimi M�mh
co Laundry 8,
`eI itc a utility
0
kkh
14 9' 6.9'
1 18'
� Pool bath
M
N
r 21.5'
8 amity
"as
1'
S
8'
CD
12. roof joist support
26.5'
Framing Details: 9%eeP 4w
ght d C3 o >5Ky 21'cb 01,4Zx6 cui
,b U z V
e ►>'4 �y
DoubRoist pa
hangers
hallway
ROOF VIEW CEILING VIEW
Double Roof opening Double 16"
1"x27" 24„ Hallway flared
hangers joist
typical 4 ends opening
1"x37"
Double block Double
Nailed at 12”on Double block
center staggered hangers
typical 4 ends
Double
2x6
hanger
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
CUPEINO
Building Department
JOB ADDRESS: PERMIT#
IZZYY FAL-M "&&)Uj�7 : WU-ZT,/vo O 4 0 00-77
OWNER'S NAME: ANABE PHONE# �q ?.-Z -
GENERAL CONTRACTOR D oN rRc FAX#
I am not using any subcontractors:
Signature Date
Please check applicable.subcontractors and complete the following information:
61 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &1 Uwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/Vinod
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
er/Contra for Signature Date