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07080244- PUB
aJ LL N � N $ > o a) v (UC: ami a a_ _0 E iv a) y y a- (U a a) f 3c ti d -o } a`y ay U O m Li L. 7�{ 0T 2 u U O LO '4� I F-J* —h It, t! 5"�.t'' `, � `L.! al o� Q vr) i v 0 m A w O 'n O 0 1 CC C D W Q O F O Q 0 c } W U --I .-I UO Q ' ~ N Z N U) MOOOL T N F- LO FF.{ A LLI : L" `z w a w O o _o W E CL 0 o N - g 2 U a ca H LO 3 A w 110 iv E L) Q =1 Q Ll U = al I Li a) p Q, W 0 a o xo U , 0 �, �d1 Icri Idl _ t� a i n n OL v a v O O O U Z j] O c pCZI � ? v II O o " O o Vi O LLI W LLI LI) _ _ 0 O O En O F- CD Z LL, al O -� O O ,� J i 0 z O 7 p MO 11 CD � N O N LL 0 W w M J LO u IL a CD U o r. 3. o a m a� N 0 -0 d x x� O iv d .. o ., o ¢i 0 ti CL "� 75 w -0 � x� a) u = E c xU 3 I- ar a i� > N o o s LO Q a CE 5 N a) a) m O I- _0 �C v L- 2 al ay W U QlCL - Z �y (U E E ,o 'a F- 2 U c c .4' ar E ti a� a E y v a`) a iv LO o Lu m` v a a� m m a� M 0- 2 Q w u D a_ O _� IL Lo c m < a- U U u E ay CITE'OF CUPERTINO �fI�7� BUILDING DIVISION PERMIT lY`1s�RtYJt�����.' BUILT2MEShEGNART RD VIA BUILDERS INC. P07080244 OWNER'S NAME: PERMIT ISSUE DATE , MIKE & KATHY YATES 4600 EL CAMINO REAL STE 209 09/21/2007 PHONE: (650) 948-1077 SANITARY NO, CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o p LICENSED CONTRACTOR'S DECLARATION Job Description U F- 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Z,) with Section 7000)of Division 3 of the Business and Professions Code,and my license is DEMOLITION, 1-STORY S FD I in full force and eff L �7(, License Clazs _Lic.# p Dale d 7 Contactor ARCHITECTS DECLARATION < I understand my plans shall he used as public records a.U tL Licensed Professional OWNER-BUILDER DECLARATION < I hereby affirm that 1 am exempt from the Contractor's License Law for the p 0 following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement E,< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter9 Sq.Ft.Floor Area Valuation (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $10000 R!!. 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 ofNumber Occupancy Type not more than five hundred dollars($500). 3 6 6 4 7 015:'l�U- ❑I,az 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.7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of Required inspections property who builds or improves thereon,and who does such work himself or through his own employers,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(milds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. C]I am exempt under Sec. ,B&P C for this reason 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'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 InsuranceG carrier and Poliky number are: S4i-Jkkc,6 Carier:C+.:DI'C55 G��jj R4QIYIl' Policy No.; WIX3 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc hundred dollars(SIOD) or less.) I certify that in the performance of the work for which this permit is issued,f shall not er,ploy,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 O forthwith comply with such provisions or this permit shall be deemed revoked. z`~ CONSTRUCTION LENDING AGENCY .r [-r r.. i hereby affirm that there is x construction lending agency for the performance of r'4 > the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Q+ Lender's Address U 0 I certify that 1 have read this application and state that the above information is - ►� correct.1 agree to comply with all city and county ordinances and state laws relating to rJ U building construction,and hereby aulhorim reprexntatives of this city to enter upon the U above-menuoncd property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against tiliabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. 2 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINTIssued by: Date I SOURCE REG LATIONS. L111 1-d— 9-of-cT Re-roofs Signature oflicant/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. C]Yes XNo 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 harardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes jfNu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcalth&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 nodfy the occupant of the requiremhush must be met prix lex issuance of a Certificate of Occupancy. Signature Of Applicant Date cn -766. Im `'°`�^�— 121-©-7 A11 roof coverings to be Class"B"or better Owner authorized actor Datc- CITY OF CUPERTINO �:� -7 o DEMO CUPEkTIN® PERMIT APPLICATION FORM APN# -70 � S� U U Date; Building Address: m CA Owner's Name: Phone#: Mk q08 -O5S3 - S3rI Contractor: License#: _ `l c �7P7 0.5 Contact: Phone #: 3onc,,.A&ti E �� - 0718 Applicant/Contractor: Building Permit Info: d b 113 o Description: Residential: igi�� Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: Architect/Engineer: Valuatio : Type of Construction: Occupancy�—ou Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILIDNG BSEISMICOM Seismic Commercial BUILIDNG BSEISMICRE Seismic Residential BUILIDNG BPLANCHK Plan Check Fee BUILIDNG BUSLIC Business License BUILIDNG Community Development 10300 Torre Avenue A ' ' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPE�TINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: Yom. s PHONE # 6Sp- as - a'?Yi 7 GENERAL CONTRACTOR: ;c, V, ,L FAX# 6sv - q qg- i I am not using any subcontractors: Signature Date Please c eck'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 caner/Contractor Signature Date