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04070201 - PUB ro - LD 0 L). L) �} Y y ' i3C O � y O n '� - O O O ' O O m U LL a- d 2 U U. O cn Z d RIM LQJ!" CD r LO d I m w L) ! zo zn p. Li U') ,.. O G U I ' t O I' o O c N ' mf I. m £ Ce Lo I m U + W L) 2 t U ��, L �o - !i m O o LL o all w p U') I+ Z It O rLOw m 1-4 I� Q w o p o o H a a Ef Cl) M1 2 ❑3 2 a {( i x�CD LO LJ n a z i '` E 7 y1 Lj 6 � (I1 C uJ � D aY Cf? t . v Z - C dQ' C i ? vOi i r J U d O © O d U , } L iL ai ai � a a a n IL a } /- �-�y � � o o i d Z LU cD z Z5 Z W C OL o _a__ { 1 dLr; a_ o o - _'7 IJ! LO LO .' H W Z a1 if O I 2Uo o 'aZ O ?wo N -- O ! N -I ' I ma U U, dilkA o.. �" U-1 o o l o c ca �1 € 21 0 a i a- •� n l~L x� a N ' N E " (U �, 7 w 0 o f cn o CL �� U LL 4 z Cl ,� `_ rn d U (D a� 1 a z�n U U U U `B�. �c � O U � C ws, na a� t) a`r cL IL O d in U O EL o � L W u� d U U U 4 _ _ �_ J° a' CITY OF CUPERTINO 7 g� T�7�G BUILDINCDIVISlON PERC�11aTT�CTC��.211�T1114`j�'J( ::. ... BUILDING ADDRESS: PERMIT NO. ADMIRAL CONSTRUCTION 04070201 OWNER'S NAME: PERMIT ISSUE DATE PHONE: 1711 BLIGS819M HiLL HE) SANITARY 3 OL 10. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 L p zo LICENSED CONTRACTOR'S DECLARATION U I hcrcby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description Z� with Section 7000)of Division 3 of the Business and Professions Code,and my license is " y in full force agd effect. 11_157.. S 7 j'�? Liccnsc•f1aSs� Lic.91' ` METAL FENCE nF❑ Date 'fr J •- Contractor_i�)'iV\'t.�la - �W A CHITECTS DECLAR9T•ION a a �Fhmdemand my plans shall be used as pufilit records a U iO F- Licensed Professional rn< OWNER-BUILDER DECLARATION a I hereby affirm that 1 am exempt from the Contractor's License taw for the E20 following mason.(Section 7031.5,Business and Profcssions Code:Any city or county K,� , which requires a permit to construct,alter,improve,demolish,or repair any structure FZ y prior to its issuance,also requires the applicant for such permit to file a signed statement s that he is licensed pursuant to the provisions of the Contractor's Licenx Law(Chapter 9 Sq. Ft. Floor Area Valuation FC-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or a 5•• 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 ,,��TT ����,,��,�..{{��er OCCU not mon:than five hundred dollars($500). 3 �`l "U O O Occupancy Type ❑1,m 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 forsalc(Sec.7044,Business 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 sale.If, however,the building cr 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 Contractor's Li. . cense Caw docs not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contraUor(s)licensed pursuant to the Contractor's V' n.Law. - arc exempt under Sec. B&P C for this mason Owner Date 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 Worker'sCompen- sation.as provided for by Section 3700 of the Labor Code,for the performance of the ' work for which this permit is issued. ❑1 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 Worker's Compensation Insurance carrier and Policy number arc: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ` (This section need not be completed if the permit is for one hundred dollars($100) or less.) 1 certify that in the performance of the work for which this permit is issued,I shall not employ any person in any.ma 'cr so m b ome subject to the Workers'Compensation , Laws of California.Date — Applicanl`- NOTICE T APPLICANT:1�-a br_m is 4u c-atf Escmption,you should become 4 ject to the Worker s ompensation 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 [-r- I hereby affirm that there is a construction lending agency for the perfurmanee of 7 the work for which this permit is issued(Sec.3097,Civ.C.) a Q Lendcrs Name ' Lender's Address U 0 I certify that 1 hays read this application and state that the above information correct.1 agree to comply with all city and county ordinances and state laws relating to Q V builoing construction,and hereby authorim representatives of this city to enter upon the W above-mentioned property for inspection purposes. HCl. (We)agree to save,indemnify and keep harmless the City of Cupertino against fq liabilities,judgments,costs and expenses which may in any way accrue against said City !' U Z in consequence of the granting of this permit. �+ APPLI NT UNDER11, ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Da SOURC EGULATIO u E� �T)-� Re-roofs Sig aturq,af Applicant/ ontmctor I - Date HAZARDOUS MATERIALS DISCLOSURE . Type of Roof Will the applicant or future building occupant store or handle haiardous material defined by the Cu 53pertino Munic)'pal Code,Chapter 9.12,and the Health and Safety 'Code.Section 25❑Ycs y2(a)? �,//, All roofs shall be inspected prior to any roofing material being installed. Muni If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants defined by the Bay Area Air Quality Management all new materials for inspection. District? C]YC No [have mad the havardous materials requirements under Chapter 6.95 of the Cali for- nia Hcalth AN fcly Code, SICU otions 25505,25533 and 25534,l understand that if the building docs not cJrtdnOy have a t pant,that it is my responsibility to notify the occupant of the requireme is high mus et prior to issuance of a Certificate of Occupancy. r t�f _ Signature of Applicant Date Owne�-hori,� �� •Date All roof coverings to be Class"B" or better !CITY OF CUPERTINO* clTYOF PERMIT APPLICATION FORM 6 ,7 c�ZO/ CUPEkTINO APN#G -7 Z U / Date: Building`AdcW.ss: l Mailing Address (if different from building address): l v3+p B u1 �6 4 , L \, Owner's N e. Phone#: R o�- Cj►l-t -t CkurCA- Contracto - AV�A1 UL �, A,� 5 License #: Contact: �P 5 Qc( Ec(g1, Cupertino Business License#: Building Permit Info: I Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: g,t� I–D —tom t � ►�1 C L� �GlE V C t-I Residential ❑ Commercial �( Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Projec Occupancyup: Type of Construct' / Please the this b f the pr t is a / second-story ition: Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL 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 1 of 3 7 37 2- w Community Development 10300 Torre Avenue x" .` ' Cupertino CA 95014 °; . Telephone(408)777-3228 CITY Of Fax(408)777-3333 CUPE�TINO Building Department JOB ADDRESS: PERMIT # tv3+0 gu h J t-,►Lo 407 Z0 OWNER'S N Cvl*St rtqdPHONE 3 GENERAL CO RACTOR: IAD�Ai 2A, FAX # t 10 3�_Q 6 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 a 'on Fencing 164 g: 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 ile A 0 �A�wnery��r Signature Date