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I... 1 C lamLO cm CD . ,f Fj 111 U 1CD OL co r Q z CL j o w I-- w w 0 o� ri p Lf)a W) M N N i J O J � 0- _> ' cc C rl co CD C:3 N o �� o w'� Q w p o ( ; ru I o ti x x� v a x �t 1 �, �, �__� o v v [� w v w ti w 'p' E - - ar a O' (o LO a� 3 0 ,L WtA y N m C� d 0`7 � !U 4`? d. O Q m �1 O CL O 0_ CL v L CL un M CL Q CL U U U ILas CITY OF CUPERTINORV BUILDING DIVISION PERMIT �n7ESTMINESTER CT TBD — TO BE Berl Es DETERMINED PERMIT NO. 07080257 OWNER'S NAME: PERMIT ISSUE DATE HELTON GLENN. S AND EDMONDS— 01/31/2008 PHO SANrrARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 100 LICENSED CONTRACTOR'S DECLARATION Job Description 02P I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z W with Section 7000)of Division 3 of the Business and Professions Code.and my license is LIVING SPACE 5 0 PORCH 38 COVERED y in full forte and effect z License Can Lie.x PROCH ,�OContractor �,W Date ARCHITECTS DECLARATION OVER NEW ENTRY ON SIDE OF HOUSE/ENLARGEMENT OF cc 1 understand m plans shall be used as public records y BRFAST NOCK BAY WINDOW REPLACE FLAT WINDOW ON a y Licensed Professional S OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from dto Contractor's License Law for dto s O O following mason.(Section 70315,Business and Professions Code:Any city or county <$� which requires a permit to construct.altm improve,demolish,or repair any sWelurc u Z� 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 Contractors License Law(Chapter 9 Sq.Ft.Floor Area Valuation 9 a (commencing with Section 7000)of Division 3 of the Businessand Professio-Code)or $40000 leg .. that he is exempt therefrom and the basis for the alleged exemption Any violation of Section 70315 by any applicant for a permit subjects the applicant to a civil penally of 34212111 ."+y V Number Occupancy Type nes more than five hundred dollars($500) ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(See.7044,Business and Professions Ccde:The Contractors License Law does not apply to an owner of Required Inspections property who builds or improves thereon,and who does such work himself or though his own employees,provided that such improvements are not intended oroffered for sale If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). n:as Owner of the property,am exclusively contracting with licensed contractors to slruct the project(Sm 7044,Business and Profestsions Code:)The Contractor's U- Cc nse Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a conuactor(s)licensed pursuant to the Convectors License Law. ❑1.exempt undo Sec- ,B$P C for thisrcs.nsp Owner A~�_ Data ! —3d-V . WORKERS COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain it Certificate of Consent to self-insure for Workers Compen- station,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 Workers 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 am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he 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 mannT so No ecomC5 bjact to the Workers'Compensadon Laws of Califo ia.Date App6t:aril 1s.`^ NOTICE TO LICANT:tf,.ftr making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code•you must Oforthwith comply with such provisions or this Permit shall he deemed revoked. 'Z"•"' CONSTRUCTION LENDING AGENCY .. I hereby affirm that there is a cortsuvctin-„lending agency for the Performance of p:> the work for which this permit is issued(Sec.3097,Civ.C.) aQ Lenders Name , Z Lenders Address U 0 I certify that I have read this application and state that the above inforrnadon is LL►. correct I agree to comply with all city and county ordinances and state laws relating to 0 V building croswction,and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against r„t c4 liabilities,judgments,touts and expenses which may in any way accrue agalnsl said City V in consequence of the granting of this permit l� M APPLICANT UNDERSTANDS A D WILL COMPLY WITH ALL NON-POINT Issued by: Date J '� SOURCE REGUMT10�S. qVtr6 )_3� o Re-roofs Signature of App t/Conuactor 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 Safely Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yrs pyNo Will the applicant or Futuro building Occupant use cyufpment or devices which If a roof is installed without first obtaining an inspection,I agree to remove trail 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 Chaptor 6.95 of the Califor- nia Health$Safety Code,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 require ns which must bc el ertoissaananfacertificateofa�p e, Signature of Applicant Date owner nthnd gent Date All roof coverings to be Class"B"or better CITY OF CUPERTINO CUPEi�TiNO PERMIT APPLICATION FORM ADDITION/REMODEL L . C) o 2 s-- APN # D 311z_ / 1- L11 . 00 ate: Av 7 <- zco -> Building Address: W e4 v \,,+,v co A q S-ol Mailing Address (if differe€x from bujidiang address).,. Owner's Name: Phone#: Contractor: Phone: State License #: 1 Fax: Contact: C t, 0,,,` Phone: qk6 c"� Cupertino Business License#: Fax: V & l 6 Building Permit Info: 4dzk-.-V;A t eMc3c�.c \ Bldg U Elect M_ Plumb ❑ Mech ❑ Job Description: What is being added? 'W Co,� � � Orf """.��/�� ��_ S.z_L W K�AWS ,y ,� ,,../.. - 'IL '�L 1'1 — -+J DN d(sx,S �4. U�, -•} c t 5C What is being remodeled`? + 01 QII �X1 SC1 �^� W l >5 U" I 1S Residential � Commercial El Remodel Includes Re-Roof: Yes❑ No R �o�-tla( �,�,� ,,o� m,,,Q,,,, ,5� u� at Remodel Includes Structural: Yes No ❑ Square Footage: v 1 l U 5 Addition: 'gyp Remodel: C) Garage: C) Porch: * - 1 Deck: Other: D Cost of Project: Occupancy Group: Type of Constructi,� n: Please check this box if the project is a Q.LLi second-story addition: ❑ Project Size: Standard Large ❑ Major ❑ *For office use only* ❑ Over the counter 1 of 3 r' Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY F Fax(408)777-3333 CUPEIkTINO Building Department JOB ADDRESS: Wk-z-( PERMIT # C.,-V X as G �0-�0S-0'2- OWNER'S NAME: ,�,,� l PHONE # GENERAL CONTRACTOR FAX # q c) :� `[q (, 8 (.4 p 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 ALI , %� u Z 7 D -7 Owner/Contractor Signature ate