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02040125ciTr of CUPEkTNO (CET Y OF (CUF EII TEND 0Z0�6o12�S- APN # Fee ID ]Fee Description Date: BAPPLOTHER Other Appliances MECHANICAL Build in Address: BBOILER1 Boiler <= 100,000 Btu MECHANICAL BBOILER2 Owner's Name: MECHANICAL Phone #: r MECHANICAL ( Contractor: _ MECHANICAL License #: Boiler > 1.75M Btu MECHANICAL BCONSTAX Contact: BUILDING Phone #: Ind/Off/Comm/Quasi BUILDING f(=11 O9> �� = G S Applicant/Contractor: BUILDING Fax #: - c- — — Building Permit Info: —� (Plumb Bldg Elect ech o escription: � � Residential: ELECTRICAL Commercial: Sq.Ft. Floor Area: Elec Svcs 600V <= 200A ELECTRICAL $ /Sq.Ft.: MOO Energy BUILDING Architect/Engineer: Energy Add Multi BUILDING aluation: Type o Construction: Investigation fee BUILDING BMITIGATC .ai BUILDING Quantity Fee ID ]Fee Description Fee Giroen BAPPLOTHER Other Appliances MECHANICAL BBOILER1 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 BIEN ERG Y . Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING 1 of 3 -K e6l, 3 tCrt OFOF_ FLU U F Z ur 8 w z z_e y f � 0 V ¢ �OaU p y Y � ia¢p Oa, u0 = �i 1-7 w ti1�m a3— d ® z z �z U C W � U z t= CITY OF CUPERTINO Tf� �^ CONTRACTOR �NF( �VaW,. BUILDING DMSION P RMI BUILDING ADDRESS: PERMIT NO. 18650 RUNO COURT 02040125 OWNER'S NAME: APPLICATION SUB DATE MORRIS MANDEL 04/23/2002 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ry ru � u LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busine and Professions Code, and my license is in full force "d a t. NEW WINDOWS /PLUMB I NG ELECT . License Clasa' Li . N Daft Contra r i' PI•ECT'S DEC 1 understand my plans shall be used as publ c records Licensed Professional OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the 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 $24000 prior to its issuance, also requires the applicant for such permit to file a signed statement . . - S "lQ r•AT a - - -.3 Valuation that he is,licansed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing Section 7000) of Division 3 of the Busyness and Professions Code) with or that he is exempt therefrom and the basis for the alleged exemption. Any violation . " of Secuon 7031.5 by any-applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 10 &A N- I DAT I ON Occupancy Type ❑ I, 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 Contractor's License Law does not apply to an - 103 - - - - - - - - UFER Required Inspections owner of 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 104 — REBAR offered (&'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 10 5 — ANCHOR BOLTS ' ' improve for purpose of sale.). 106 - SEWER & WATER O 1, as owner of the property, am exclusively contracting with licensed contractors to 202 - UNDERFLOOR PLUMBING construct the project (Sec. 7044, Business and Professions Code) The Contractor's License Law does not apply to an owner of property who builds or improves thereon, 203 — UNDERFLOOR MECHANICAL and who eoutracts for such projects with a contractor(s) licensed pursuantio the Contractor's License Law. 2 04 — UNDERFLOOR FRAME - - - ❑ 1 am exempt under Sec. , B & P C for this reason 205 - UNDERFLOOR INSULATION Owner ' Date 301 — ROUGH PLUMBING WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER I hereby affirm under penalty of perjury one of the following declarations: 303 — ROUGH MECHANICAL ❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker's 3 04 — ROUGH ELECTRICAL Compensation; as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 305 — FRAME ❑ I have and will maintain W6rker s Compensation Insurance, as required by Section 306 — HOLDOWNS 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: 307 — INSULATION Carver. policy No.: 3 0 8 1 - - SHEETROCK . CERTIFICATION OF EXEMPTION FROM WORMS, 309- - 3 EXTERIOR LATH O COMPENSATIONINSURANCE' _ _ _ ___ �S_ :3'1 V — fir rT 11V TER I OR LATH (This section need not be completed if the permit is for one hundred dollars ($100) or less.) 311 — ' SCRATCH COAT I certify that in the perfoyann,, of the work for which this pemdt is issued, l 'shall 313 — ROOF- NAIL- not employ any person In nner 0 s to e�; fit to the Workers' S O l FINAL ELECTRI CAL ENERGY Compehs on La�v s of C ifp i PP � A' 1' �� 502 — 5 0 3 - FINAL PLUMBING ENERGY FINAL MECHANICAL ENERGY ,ems NOTI O APId� v�T: If, or making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must pen-nit comply with such provisions or this petit shall be deemed revoked. 504 — FINAL BUILDING ENERGt CONSTRUCTION LENDING AGENCY 505 — FINAL ELECTRICAL I hereby affirm that there is a construction lending agency for the performance of the work for which this permh is issued (Sec. 3097, Civ. C.) 506 - GAS TEST Lenders Name Lender's Address ' i- 507 - FINAL PLUMBING I certify that I have read this application and state that the above information is 508 - FINAL MECHANICAL correct. I agree to comply with all city and county ordinances and state laws relating 509 — FINAL GRADE e to building construction, and hereby authorize representati ves of this city to enter upon the above - mentioned property for inspection purposes. , 5 10 — FINAL PLANNING (We) agree to save, indemnify and keep harmless the City of Cupertino against li liabilities, judgments, costs and expenses which may in any way accrue against said 514 — FINAL PU IC WORKS City in consequence of the granting of this permit. APPLICANT UNM RSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date S UL s;bAjWpIfCan ntr ctor Date Re -roofs y HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material Type of Roof as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? �'N ❑Yes All. _ , All_roofs shall be inspected prior to any roofing. material being installed. 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 District? XNo all new materials for inspection. Applicant understands and will comply with ❑Yes all non -point source regulations. I have read the hazardous materials requirements under Chapter 6.95 of the California Health & 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 requirements which must be met prior to-issuance of a Certificate of Occupancy. Signature of Applicant Date O All roof coverings to be Class `B" or better own age t e or OFFICE CITY ILDING DPESIONNO PERMIT CONTRACTOR INFORMATION: ' BUILDING ADDRESS: PERMIT NO 18650 RUNO COURT 02040125 WNER'S NAME: E APPLICATION SUB DATE '40 RIS MANDEL 'NA 04/23/2002 HONE: JAN rsoo9 L JJ SANITARY NO. CONTROL NO, ARCHITECDENGINEER; BUILDING PERMIT INFO 1 'L MG BLDG ELECT PLUMB MECH i LICENSED CONTRACTOR'S DECLARATION 1 hereby afrm that I am ]icenud under provisions of Chapter 9 (commencing Job Description °at with Section 7")ofoivision3oftheBusme and Form... on, Code. and my license in fun (.resod a t. NEW WINDOWS /PLUMBING /ELECT. Uis License Clasr_� Li . S to firian shall be u a g I understand my plans shall be used as puhlrc records DLicensed Professional OWNER BUILDER DECLARATION - 1 hereby affirm that 1 am exempt from the Contractor's License Low for the a following reason. (Section 7031.5, Business and Professions Code: Any city or county ❑ which requires a p .I. m,m swct, almr, improve, demolish, an repair any structure 2 4 Q 0 O & prior to its issuance..]. acquires theapplicam f.,mch pcmduo 6leasigrad,ummens _ (homes] .withSean7")provisions ot the Contractors (commencing In Secs n 7(X10 fin as 3.(the Business al and Code) S yG �p11y •�`aj�,- `T3`II�LSLV•J8'&6ai, t" q I A n5 J J!(J:U Sh,' et.'Sn t f u a R, Valuation .,, .,,her he a un. Any vi b ii fi and the basis for the alleged affirm on. Any violation -of Section 003 LS by any applicam for a permit subjects the npplicnm u. a civil penalsy- 31.5 any lof not more than five hundred donarscs5W). 10. N�DATION P. "''" Occupancy Type ❑ 1, as owner of the property, or my employees with wages as their sole compensation, 102 PIRRR "wlll"do the' work;' and he munme is not intended or offered for sale (Sec. ]0.M, - Bubiiress and Professions Cade: The Conuactoi a License law does not apply to an 103 - UFER Required Inspections". - owner of property Who builds or improves thereon, end who dues such work himself or through his own cmployccs. provided that such improvements arc not intended or 104__-_._ REBAR.__ 'offered for sale If, ho a building p mint i sold w tnin one year of Completion, the owner-builder will have the burden f proving that h did not bold or _ .... ._.__._ 105 - ANCHOR BOLTS ' improve forp.,nsc nfsala.). 106 - SEWER & WATER . f]Lmownec ofthe n,om exclusive] non iaM, one - 2 02 - UNDERFLOOR PLUMBING canswn he p,ojenprs�, Business Profession, n, Cocenudcommcmreto r.reaalona cede:) The comma.r'a License Lava does nor apply to an owner of progeny who Wilda or improves thereon. 203 - UNDERFLOOR MECHANICAL' " and who contracu.foc.such Pool acts with a comacm,(s) licensed pmamat.to the Contractors License Law, _ _ —. ___. 204 - -` UNDERFLOOR .-_----.-.--_-.- e of ❑lemexempr under sec. ;B &PC for this mason 205 - UNDERFLOOR INSULATION ° net. Data 301 - ROUGH PLUMBING WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER I hereby aM. order amyy afpdrjdryoa ,ofinermmw�Irgdecmmtions: 303 ROUGH MECHANICAL O 1 have and will maintain . CcniOcme of Consem'to self -insure for Worker's Compensation, —at- provided for by Section 3700 of the Labor Code, for the _ 3 04 ROUGH ELECTRICAL _ 'performance of the work for which this pa out is issued. 305 - FRAME ❑ ] h d 'B ma Worker's Compensation In urarice required by Section 3 06 - HOLDOWNS 3]00 of the Labor Code f the perfor a of th work fo' which his Permit is issed Myw- ker'sC tnl an nInsura amerand Po]'y b on: ;', . 307 - INSULATION Carrier- policy Na. 3,0,8.1, ISHEETROCK,.. CERTIFICATION OF -'-'" S -' " Lie.' yl'3O9t "',EXTERIOR`'-LATH' COMPENSATION INSURANCE" S 3I O p= .INTERIOR `LATH— - - - =':. C'r mles union need not he c.mplcied if the permit is for one hundred dollars (slBO>,a�lps..) „ nr] :';•:; I o; 311 - SCRATCH COAT ' 1 ntfy thutain the pc forma or me work for which R p 't a e I "stillnrempluLyawanypesnt more n _... -'313``_ ROOF" "NAIL - -�, ate ,t�' m th'Wakm. 501 - FINAL ELECTRICAlir`ENERGY AppltPC_s)ft i x-'�L -- - 502 - - -- FINAL -PLUMBING ENERGY - 503 — FINAL MECHANICAL ENERGY NOTIC�£IQ7,'t.�t PN�tPI' If a cr makingthis fir! iCam of Exemption you should nedomesubject mtheWorker'. Compe nsationprovisionsof the Labor Code. youmust- fonhsrid, comp]y with iucn provisions m this pcm al shall be deemed revoked. . -- -- 504 - - -- FINAL- BUILDING ENERGX.- °P' em ioLENDINGAGENCY' i 'CONSTRUCTION ' afiich this them is a lending for the performance .r- 505 - FINAL ELECTRICAL of work a slued (ninn s. C.) orthe rkfo'hchth.Permit ' slued (b 3o9zciwe) " _.,�..c:.. 506 - GAS TEST- a- Lenderstheme ..... _ - .e.:..: _..: Leriyere Addfess'" ,.._._...,_...._. ... -... „..) 50 - FINAL. PLUMBING;- n I certify that 1 have this is above haws application any stemances 508 — FINAL MECHANICAL Ilion 'cones. 1 agree to comply a with all city and county ordinances end smac laws relating ply with city a :to oropany rebysuthorimrtposenmtives of skis city menmr upon' 509 - FINAL GRADE e advive- meconstruction, tioned the aW(Wayitianeo inspection andikepharmles ( g eto'se a ndem ph harmless the C iyofC oag'nn. 510 — FINAL PLANNING ] Ctly liabilities j egmnce eon and pnaea which on., n any y g m.. gta, p pansca ma y, Cisy inconsequence of th gr t "g fin p 514 - FINAL P C WORKS ,.•g -� , "APPEICANT 'DIRITANDSANDWILL COMpLYWITH ALL NON- POINT, ' 501RCF RE(c - N �� Issued by: Date p,te HAZARDOUSMATERIAIS DISCLOSURE Re -roofs ''•� Wll the aypficam ft- W'Iding ac pant store or hnaudn smat -N: .,Type of Roof. Municipal Code Chapter 9 12 any the Health end Safe,, .Code, f Section cby 25532(a), _ e , v. oY a �t I I All roofs shall be Inspected, prior to any roofing material. being Installed, iJ ] theapp[ p t f i b Id' g pare sc equ p ht reevtcea I, '•m t hazard. air concomitants as defined by the Bay Arxiim r Quality Management if a roof is installed without first obtaining n ins ection,1a ree to remove g P g Din et- ❑Y all new materials for inspection Applicant understands and will comply with a ., x, ., N�' ,_ all non- poinfsource'regulahons 7 I Bove Q the hem dos maarials iegmrcments under Chaper 6.95'of the 'Cahfornia Health & Safety Code: Sections 25505, 25533 and 25534. ] understand that if thcbut doe f & snot currently have a tenant; that it is my responsibility to ratify the -' "' " -' "' - ""'—' " "" "' -'— - -- -— - -- - _. _ ._.. o.f ' occupant of rtie,rtquircmems which must be' t poor m its ence of a Cenificudbf ` "ap `yi ' �' n Signature of Applicant Date All roof coverings to be Class "B" or better D4, or '>., esem,• _. '__....:...._...._,.__. -.._ - OFFICE - . 1 1 a a 2@,Q CLEAN LA �Mull oviax S-Rb� 00 °O° W CLEM Tx III, APR 2 3 2002 00 00 0 _ In•, goal �o �a o Q�as 0 Tmac ^S I�IIi�J is up, i. C-JD�� E 01-15, 0 o° o� a . o bo FF;�. 11, 0 9 o °Lg gad �Oo G�4 00 00 00 0 0 00 oviax S-Rb� 00 °O° W CLEM Tx III, APR 2 3 2002 00 00 0 _ In•, goal �o �a o Q�as 0 Tmac ^S I�IIi�J is up, i. C-JD�� E 01-15, �1 . , .• �=Hullstl!lfl ;� glavow -aw mm� In �is RHO PRIP BSS §Will all 'I i gx as x t y eta_ z x #t t ca�a � ~ RE 4 1 m € i 4 s P� 1 1 � ti m all IN �x -* 6 g 6 tY_ ( . Q' Q 4 1 m € i 4 s P� Li z � Q O Q U; xs � l C lu � I 0 m r f 1 1 � ti m all IN �x -* 6 g 6 tY_ . Q' Q Li z � Q O Q U; xs � l C lu � I 0 m r f 1 1 � ti m all IN �x -* 6 g 6 I i Q � h U— W Izz 8U jig Ei t 2, 2 T - is IS TH HI 4A 2 i z SH Awl I z I — Flan 5H wa €S5 FRI 2L 73 sw`o. H 0 1 1 t ;PI - �E I __ § _ _t6t.. - . FH4! .......... �i =� �6 _ ,x 41 mC ifl-Vi t ;PI - �E I __ § _ _t6t.. - . FH4! .......... �i =� �6 _ ,x 41