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02040125-FPciTr 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