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08020113- PUB U_ o o a)IL a_ O m U LL. a_ Q = U �� O cn z Q 3 +o as v 0 v O o Q LO o °i o o rk w — �t o 0 0 CD u LID 07 H a 0 i a H F W A C:4 p a w w 0W U Q P Q 0 p ` 1 QQ a w U F O U M 0 qz cc O C=O Z %DCC Z O w NOL ~ (O W A C\j _ O V wC=O H wZD- O o Q > a ILCO E = U a W H n N U M Li CL OL E K z 0 �o Lo p 11 U7 ao � = 0 . _0 u a =1 — ZD a u lei a) A d OL y u" xQ O V H Q) z v u < ani iii a) n a n a Z n a� O O O w J Ul co O L is OL za z J o IL U_ p Z w -_� v CO 0 o Q � > $ C 0 0 0 0 w j w [L f N N CD O Qy T O U7 � _ N U N M Z > _ V ~ d _ CD N i — M J ZD N O O U O p — — st Q Q .r p C Q7 O N 9] 9] N OLx •V ip a Q O _ L as xv" a .E (D N aJ z OL o v a N o E .� ' U > w a' o o s in o n ZZ ° o 0 o p '� (D o N +3 baa % a O v U E cCl a,, w a� �o o O n a� a`7 a� a`7 IL O Q to U O IL O a_ Ck _ N ,C CITY OF CUPERTINO BUILDING DIVISION PLs' W]' BUILDING ADDRESS: PERMIT NO. 21837 TERRACE DR PERKO CONSTRUCTION 08020113 OWNER'S NAME: PERMIT ISSUE DATE JU ROBERT 1 254 NAMES RD 03/12/2008 PHONE: SANITARY NO. CONTROL NO. (831) 818-0072 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O p LICENSED CONTRACTOR'S DECLARATION u 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description Z with Section 7000)of Division3oftheBusinessandProfessionsCode,andmylicenseis REVISE FNDTN & SUBFLR DETAIL-ORIG#07040080 y in full force and effect n Z License Class Lie.0 F„w Dare Contractor ARCHITECT'S DECLARATION < 1 understand my plans shall be used as public records aV a F" Licensed Professional 0 y OWNER-BUIL-DER DECLARATION j< 1 hereby affirm that I am exempt from the Contractor's License Law for the ❑O following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct.alter,improve,demolish,nr repair any structure Z prior to its issuance,also requires the applicant for such permit to file a signed statement _ that he is licensed pursuant to the pmvisions of the Conuaclor's License Law(Chapter9 Sq.Ft.Floor Area Valuation t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $0 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 penalty of3 5 617 0 2 0 °��Number Occu anC Type not more than five hundred dollars($500). P Y YP ❑1,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(Sec.7044,Business and Professions Code:The Contacutes License Law dors 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- builderJvilt have the burden of proving that he did not build or improve for purpose of salla.` 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 co dhetor(s)licensed pursuant to the Contractor's License Law. ❑I am eze t d _ ,B&P C for is mason Owner Dam K WORKER' 0 PENSATION DECLARATION 1 hereby affirm on natty of perjury one of the following declarations: ❑1 have and will maintain a Cenifhcam of Consent to self-insure for Workefs 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 are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc hundred dollars(5100) or Icss) I certify that in the perfonnanc of the work r which this n is issued,I shall not employ any person in any ne so as csub'ect t e Workers'Compensation Laws of California.Dam1-7 Applicant NOTICE TO APPUCA :If,after making ream of Exemption,you should - become subject to the Worker's Compcnss' n is of the Labor Code,you must z forthwith comply with such provisions th' rmit shall be deemed revoked. y O CONSTRUCTION LENDING AGENCY •r►- I hereby affirm that there is a constructinn lending agency for the performance of 14> the work for which this permit is issued(Sec.3097,Civ.C.) 0 Lender's Name Z L.endces Address C) 1 certify that 1 have read this application and state that the above information is - L correct 1 agree to comply with all city and county ordinances and state laws relating to VU building construction,and hereby authorize representatives of this city to enter upon the N ahove-mentioned property for inspection purposes. y(� (We)agree to save,indemnify and keep harmless the City of Cupertino against y liabilities,judgments,costs and expenses which may in any way accrue against said City z in consequence o granting of this permil. APPLICANT RST ND _.WILL PLY WITH41. N-P INT Issued by: Date ',1 2 Z� SOURCERE 0 / ( 4, Re-roofs Signature of ApplicanUContraetor Dam HAZARD S ATERIALS DISCLOSURE Type of Roof Will We applicant or Tut wilding occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code.Scction25532(a)? Yes All roofs shall be inspected prior to any roofing material being installed. ❑ Will the applicant r o 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 defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes u 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 an 534.1 understand that if the building dors not currently ve a mean that itis my 'bilily to notify the occupant of the requirements w 'h ust be issu f a C.,rc o Oceupan Signature of Applicant Date Owner or auth rizcd agent Dare g A]1 roof coverings to be Class" `or better ' 3 CITY OF CUPERTINO CUPEkTINO REVISION/DEFERRED PERMIT APPLICATION FORM APN Date: a � Original Permit #: 070 � n ® 80 Building Address: Z 1 g 3 -7 1e- r 0 c e ©y CLA 0 , CA 9,�-01 Mailing Address (if different from building address): Owner's Name: Phone #: O � ®� 3l 6 . zI Contractor: Phone: (8 3 f ) 08' 0072— C h r►, s P,0-Y ® Fax: Contractor License Cupertino Business License #: C� C7 1 Contact: Phone: CT°0 �) -3/ 1 .8 P,C) / Fax: Building Permit Info: Bldg ` Elect ❑ Plumb ❑ Mech ❑ Residential Commercial ❑ Job Description: R-e v j `f O Lr ho' R f-;0 ij ckh l g14 b 1/0 01 Type of Construction (Usage Class): * Occupancy Type: 1 FR, I IFR ❑ 11, 111, V-IHR ❑ 11, 111, 1V V-N [ - (L Valuation (cost of project): Project Size: Standard Large ❑ Major ❑ Valuation: CRY OF CUPERTINO CITY OF REVISION/DEFERRED CUPf(�1'INO PERMIT APPLICATION FORM FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft 1REVCOMNEW Revision Commercial New B 1* 1REVCOMTI Revision Tenant Improvement B 1* TI 1REVSFDWL Revision SFDWL B 1R3SFDW / 1REVRESADD Revision Addition B 1R3SFDADD 1REVRESREM Revision Remodel B 1R3SFDREM 1DEFINSP Deferred Submittal not R-3 B 1* Inspection 1DEF'PLNCK Deferred Submittal not R-3 Plan B 1* OR Check 1* TI 1DEFR3PLNCK Deferred submittal R-3 Plan Chk B 1R3SFDW 1R3SFDADD 1R3SFDREM 2 of'3