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E v, AL a E 6 � y n C7 +o cn a� w „ m o o n 6a� as a� d d ZD < cn U ZD d O d a- cn IL Q w U U U E y Q- W CITE'OF CUPERTINO BUILDING DIVISION pE CQla1TI�ATC�I2INJECaI� ��1�% :< BUILDING ADDRESS: MASTER BUILDER & CONS TRACT MMIT NO0 5 0 1 0 0 5 1 OWNER'S NAME: PERMIT ISSUE DATE LITTLE MUSTARD SEED 2003 ABBEY LANE 01 /07/2005 PHONE: SANITARY NO. CONTROL NO. (408) 866-0999 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 1 O p LICENSED CONTRACTOR'S DECLARATION L U{= I hereby affirm that I am licensed under provisions.of Chapter 9(commencing Job Description _z with etit>a7D(B))of Division 3 of the Business and Pr sions ode,and my license is ' in fall force and effect. ✓ �� _ 7 REV I S I ON- -IN HOUSE USE ONLY j Z License Class !� Lic.# ;moo Date — Contractor.17-D--7,y-� r li irx NO NEW PERMIT ISSUED/ORIG. #04080235 a AR ITECTS DECLARATIOLL!1 ,stand � W< Lurtf my plans shall be used as public rccKas JaV ` H Licensed Professional y OWNER-BUILDER DECLARATION a 1 hereby affirm that 1 am exempt from the Contractor's License Law for the O O following reason.(Section 703 1.5,Business and Professions Code:Any city or county <,�, which requires a permit to construct,alter,improve,demolish,or repair any structure u—'m prior to its issuance,also requires the applicant for such permit to Glc a signed statement za _-< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation$4 5 is F- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 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). ❑I,as owner of the property,or my employees with wages as their sole compensation, 32633102 . 00 will do the work,and the structure is not intended oroffered for sale(Sec.7044,Business and Professions Code:The Contractor's License Law docs no(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 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.). ❑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&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penally of perjury one of the following declarations: ❑I 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. ❑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 Worker's Compensation Insurance tcaarrrier and Polic number are: T 1 AP% Poli No.i. l.?��� CERTIFICATE OF EXEMPTION FROM WOR 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 Worker's Compensation provisions of the Labor Code,you must z forthwith comply with such provisions or this permit shall be deemed revoked. OCONSTRUCTION LENDING AGENCY r--c 1 hereby affirm that there is a construction lending agency for the performance of 3i > the work for which this permit is issued(Sec.3097,Civ.C.) it 0 Lender's Name z Lender's Address J Q 1 certify that 1 have read this application and state that the above information is 1, correct.I agree to comply with all city and county ordinances and state laws relating to � s V building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. y (We)agree to cast,indemnify and kith harmless aCupertino against ..r(/) liabiliLies,judgments,costs and expenses which may in any way accrue e against said City J in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by Date SOU�P&REGULATIONS. 1 _Z_7 ignature of Applicant/Con ractor Date Re-roofs , HAZARDOUS MATERIALS DISCLOSURE Type of Roof `�� Will the applicant or future building occupantstom or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ENO 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 Arca Air Quality Management all new materials for inspection. District? ❑Ycs E No I have read the hazardous materials requirements under Chapter 6.95 ofthc Califor- niaHealth&Safety Code,Sections 25505,25533 and25534.I understand that if du building docs not currently have a tenant,that it is my responsibility to notify the occupant of the req it ems which must be met prior to issuance of a Certificate of Octupanty.- Signature of Applicant Date `Owner or authorizeda ent ' art All roof coverings to be Class "B" or better 0 CITY OF CUPERTIN �7Y of PERMIT APPLICATI®N FORM o kV ( o CUPERTINO APN 32-1� 33 / oZ Date: / Builchg Address: _ Mailing Address (if diff rent uilding a ress): Owner'sPhone #: Contracto . License #: Co ct: Phone: Cupertino Business License#: Fax Building Permit Info: Bldg ❑ Elect ❑ lumb ❑ Mech Job Description: 0,/ rv, Residential El �oeal ' Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ Project Size: Standard ❑ Larg ] Ma'or 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 1 M 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 Z�z� -7 Community Development W 10300 Torre Avenue Cupertino CA 95014 :r Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEI�TINO Building Department JOB ADDRESS: PERMIT # WNER'S NAME: -V4,-�5 , PHM # 9-Lp D� 9 GENERAL CONTRACTOR: ,4-� fN-72- Y,�;,V 1 1_>PpFAX I am not using any subcontractors:. ignature e Please check applicable subcon ors 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 1 � 7,,��-5��/ � � Contrac or Signature Date