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07010184- PUB h 2 v •� U Q7 v v v `c iu U y a- a- Q7 y S CL v v v Oy Im� u ia- �S{ �', Q 2 U f I C [n Z Q Q7 V p O LO Q °i a o � m a v F O a LO M a a � I 0 a F Q O M z O O z a U 0 a = U cn O o Z O N OC Z o O cna a A o CE CD - ' E a- o uEi a LLI N LLI rm a.a. cr) = m ❑ = U 2 H W f U Cr LO ..j _ LD 3: 47 U Q O = O Q U Idl v U- 7 Q c ro r s` xo U z vJ v Idl IC91 ISI v a a a a a� O O Ou CD CD n WaCD v Id► O U Lo o J m o w Cl J Q w c a a m z o L�� LL 8 �ti w L. w Li � a .M v o -, c c v,' o 0 m F- F- w a- m N N N U ti 0 p Q 10 u w o U 1 U N w O Q O M J 00 a Q Q w cvi CD U o 0 o U aoC p v f o c c v v `v (D x v o x -0 a O IC -0 dfu CL �E- 2xa x� u L.L ~ xE a .N O F= Dxv Z a) U j w v O m t LO o a � z v v v p J v +o v 2 v a x v o n v Q 3 v a v a v a I a O U U .a N v w '= v 20 o a 8 .r 8 w x� � U � Q O U � a- o � �L a`- � p_ tl Vi m � Q � U U U � •� � L,� _ ar CI'T'Y OF CUPERTINO BUILDING DIVISION PER BUILDING ADDRESS: ^ ��1 _ ®�� ^ PERMIT N�oi ®1 � OWNER'S NAME:, ,��]1 T ,I/",i YV \I PERMIT DATE s f, m► �enchor bvv nem ► -6 ` o1 PHONE: SANITARY 90. CONTROL NO. . 2,5 - q1 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o a LICENSED CONTRACTOR'S DECLARATION t P I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description 5 Z Lu ith Section 70')0)of Division 3 of the Business and Professions Code,and my license is �� { q�� ^-,y�� O�� 1,•y,1, y°. in full force and effect. \P /V/, /�Vlj\�Y/'(`�J. `//,�`1�� +N*/ ? License Class Lic.i! ❑ Date Contractor �p �v� �� to ARCHITECTS DECLARATION //� T rv]i V M 66V// a a 1 understand my plans shall be used as public records �yV 4 WO r„ Licensed Professional OWNER-BUILDER DECLARATION y<� 1 hereby affirm that I am exempt from the Contractors License Law for the p 0 following reason.(Section 7031.5,Business and Professions Code:Any city or county K which requires a permit to construct,alter,improve,demolish,or repair any structure —w 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 Contractors License Law(Chapter 9 Sq.Ft. Floor Area Valuation xt—m (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). ❑1,as owner of the property,or my employees with wages as their sole compensation, 'Ile yNr will do the work,and the structure is not intended or offered forsalc(Sec.7044,Business ns Required Inspections and Professions Code:The Contractor's License Law docs not apply to an owner of q P 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.). ®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 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. 1 am exempt under Sec. ,B&P C for this reason .. Owner J' _ Date 01A 1 WORKER'S COMPENSATION DECLARATION 1 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'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 carrier and Policy number arc: 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 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY C/] 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.) aQ Lender's Name , a Z Lender's Address U C) I certify that I have read this application and state that the above information is Li. .� correct.I agree to comply with all city and county ordinances and state laws relating to - Ubuilding conswetion,and hereby authorize representatives of this city to enter upon the Gla ahove-mentioned property,for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against NC/3 liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. �-" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date — SOURCE REGUL T NS. III tb7 Re-roofs Signature of Applicant/Comractor 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. [I Yes All roofs shall be inspected prior to any roofing material being installed. ❑Ycs [�No 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 No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Heakh&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the rcquiremen s whisIt must be met prior to issuance of a CeruGcatc f Occupancy. Signature of Applicant Date ��/v f�;1 7 All roof coverings to be Class "B" or better Owner or authorized aecm Daic *CITOF CUPERTIN(e d r0I g� � CITY OF E'PERMIT APPLICATION FOM CUPS TINO APN# /}_ Date: Building Address: Co(o/t� Man �Address (if different from building address): Owner's Name: �J�/� gCNco,,g/t,/ Phone #: Nva' 2 7 q -7 Contractor: 5 ia/�� a C-1v C Hug License #: Contact: S I}�}� P EwCfMR it/ Phone: ;oq)2s"7-q?6.1 Cupertino Business License#: Fax: Building Permit Info: J TR�i A �o✓l= G1LovvD 0t/I_pJJ/➢ S bq & /?CA/4 ' Bldg ® Elect lR Plumb 0 Mech ❑ Job Description: Residential ❑ Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Q,S° Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ 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 BELEC 1000 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 • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: 10�79 1'1-01eAW,1pY court- PERMIT# cv kA-F� Cid -d Q 7g OWNER'S NAME: PHONE # 406002,S-7- 0178-/ GENERAL'CONTRACTOR: Q FAX # I am not using any subcontractors: IJIII07 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 f3 Owner/Contractor Signature Date