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05010117 - PUB n i F r U- � y o` c aoi _E E ti c 1 U (U v,Er CL E (D [L v Hit OL O' N" '�, '`'�" ' `D" 6� d O" 7 �CL 4 Q T U U" O ua z ! ; e � " A I 1qr'( p„ to C7 c4 � y O H H H� Co A a A 'D H O H 0 1 A �o o " o J z O F CD O c4 o U Ha L) to M r ( Ma [ M H m U' U 0 O W P7 .i 1 1 H o to C4 o M F. a to M 14 o o a o 'n f $ a F xw Z 4 as o aAa w Z rr, O W i O A .i r- U U' M F W H H R. O Cl H H M T I QZ > q O N .1'. A w M H VCS QP d~ { O a t!] .i O H M P Lp J y co �y 7� U OCl) U kD O 'j.'� W 00 F .i ' W V C7 F b O O F4 I O M .-I t!] N O to .] O . ffZ Q1 kD .7. `T. F4 H N CD 7 O O n (CD f9 Z� o. ro i o o p4 a o F- 94 � 1 4 4 I Ol i M H H c O L) H q F^ �'p r 91, J .] U' U1 L] ,2. H O H M H M f M U cc o [�ff E Prf l a j o q o tan rai a CL a cM4 a to o o ff 5 w 'o CD U) 111 � �i 1 1. 1 40, 0 CL N S 'o ? 0 i ; ju ! z 1 a r a Cl CLD as O O O ...e. 0CD CD 1( CLLJ LO CD C, u° .j C, ui CILw LO O CL �rcli�� �; �ILLJ� Li LL oorrC:, 1 a' z z 1 �� cli S �f1� caQLJ d u # 1 . �,�r � ��w ""l [ NLO 'O 7 h N F. O '�. �. 1 f d fel 0 O 3 f 1 G7 f IL W a V fi I LCT "CW t a S CD OLO 0 x ' a x x W a x LO o „u n © _ � Z �_ a �0 7 w o a N a y 54 Co a> > a et LOv 3 M (u to f v ,�' a a v o CL IL O d w U O a o � ;, 9, CL i ) d-7 Q CL u u u IL CITY OF CUPERTINO ffl BUILDING DIVISION PERMIT ��1 1 ' f� V, 1�'��€ NX .: f BUILDING ADDRESS: MAR I NKO BALDE PERMIT NO05010117 2TRNIRNR pz� ON RID OWNER'S NAME: PERMIT ISSUE DATE PHONE: SANITARY O. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 o LICENSED CONTRACTOR'S DECLARATION q1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. z License Class Lie.N SFDWL-3 STORY (2400 ' —LIVING) t o Date Contractor GARAGE-625 S ARCHITECT'S DECLARATION Q FT BACK LOT ] U 1 understand my plans shall be used as public records 4 iU.y Licensed Professional 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 k m� which requires a permit to construct,alter,improve,demolish,or repair any structure a Z In prior to its issuance,also requires the applicant for such permit to file a signed statement 4 a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq,Ft.Floor Area Valuation I-a (commencing with Section 7000)of Division 3 of the Busintss and Professions Code)or y W$ 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 anC APN Number OCCu not ore than five hundred dollars(5500). P Y Type 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.74,Business 3 4 217 10 1 . 0 0 and Professions Code:The Contractor's License Law docs not apply to an owner of Required Inspections 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 We.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.). f].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 Contractor's License Law. ❑I am exempt under Sec ,B&PP C for this reason Owner ,,- - AA Date am-7' S aS WORKER COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: UKI have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. [v�1 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(his permit is issued. My Worker's Compensation insurance carrier and Policy number am: Carrier, Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This Section need not be compacted if the permit is for one hundred dollars(S 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 Californi tc - Applicant -d /L R----- NOTICE TOAPPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must z forthwith comply with such provisions or this permit shall be deemed revoked. z O CONSTRUCTION LENDING AGENCY E-r►�•+ I hereby affirm that there is a construction fending agency for the performance of Ri> the work for which this permit is issued(Sec.3097,Civ.C.) aQ Lender's Name z Lender's Address U Q I certify that I have read this application and state that the above information is (y correct.1 agree to comply with all city and county ordinances and state laws relating to 0U building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. Ow (We)agree to save,indemnify and keep harmless the City of Cupertino against rF-i f/y liabilities,judgments,costs andexpenses which may in anyway accrue against said City U z in consequence of the granting of this permit. APPLICANT UNDERSTANDS D WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURC�E-,REGULATIO . /f�G�tG<� 7 — Re-roofs Sig aturc of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal 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 0wo 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 hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes gNo I have read the hazardous materials requirements under Chapicr6.95 of the Califor. nia Health&SafctyCode,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant.that it is my responsibility to notify the occupant of the requirements w,pic ust .i• �' be prior to issuance of a Certificate of Occupancy. Signature of Applicant Date c�L 7 dwncr or authorized agent Date All roof coverings to be Class "B"or better a0FC1WITY OF CUPERTIN(* NEW SINGLE FAMILY DWELLING �Z7 ( � f t CUPERTINO 7 PERMIT APPLICATION FORM APN# �� � � � � Date: � 1410 Building Address: Mailin�A ss i fe t from building address): Owners Name: e#: b C X) Contractor: � 10, License#: �gs_ --7//4 - Contact: Phone: jb 7 Cupertino Business License#: >)W-Fax: Building Permit Info: Single Story ❑ Two-Story ❑ Three-Story Basement ❑ Sq.Ft. Floor Area: $/S It. v , 2 ae 2 Cost of Project: �U 090 r- Type of Construction: V Quantity 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 Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 I 7iQ 1 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Ufy OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT# 0 77 3 MF✓ZPA/,� eXN` orV 2-D C) OWNER'S NAME: /Vl 4 WAllZo 60. 406 PHONE# 447 9"8S 7e- 7 6 GENERAL CONTRACTOR: A4 49ii✓e­f CDE'- FAX# fob ,;1 5 767' I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # 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 Date