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01110108cITv of CUPE1k1'IN0 19 0 t IS �, I � I I' OR � WA k, M R WN I a "'Ar, NLA, o(lla(OP APN # Date: Fee Group BAPPLOTHER Building :Address:: '2.21-7 Owner's Name: S Lori Phone #: Bldg Permit sq. foot BUILDING Contractor: License #: MECHANICAL 51- Co -252 Contact: Phone #: BBOILER3 S3C(E�- & sn Applicant/Contractor: BBOILER4 E A5,, E MECHANICAL Building Permit Info: g Elect Plumb Mech Jo ascription: Residential: Ph nc c✓ee- 5o1.9,21vm Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: Architect/Engiineer: Valuation: Type of Construction:. Occupancy Group: Quantity Fee IID Fee Descari tion Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permit sq. foot BUILDING 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 BELEC 1000 Elec 600V <=1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Enerev BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 5 tA3 L.I 1 of 3 K 17.20 u1 O C �dE p¢ Z u oZ`—c ^F_n a p u C F --n Oe ,u i o X� tr � - u - Z > o- a3- CI'T'Y OF CUPERTINO CONTRACTOR INFORMATION: BUMMING DIVISION PERMIT BUH,DING ADDRESS: PERMIT NO. 22179 HAMMOND WAY 01110108 OWNER'S NAME: APPLICATION UB DATE TONI & LORI STELLIGA 11/26/2001 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH r1 F_ L-1 L.J LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busines;,and Professions Code, and my license PATIO COVER SCREEN & SOLARIUM. is in full foragtrid effect. �Cl License CI Lic. # Date Contractor ARCH_rmc-rS DECLARATION I understand my plans shall be used as public 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, $57000 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 ",� �tOrh29! that'he,iflicenspd pursuarl( to the provisions of the Contractors License Law (Chapter 9Valuation (comntegcing,with Section 7066) of Division 3 of the Businests and Professions Code) or that he is ezempl'therefrbm basis for ipt). Any � � -, 3;4� ' and the the alleyed'exern + violation of Section 703 L5 by any applicpnt for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). 101 AEN k)AT I ON - - Occupancy Type ❑ I, as owner of the property, or my employees with wages as their sole compensation, 102 — PIERS 10 3 — UFER Required Inspections, - will"do the work,'and the-stntcture 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 property Who builds or improves thereon, and who does such work himself 10 4 - REBAR _ or through his own employees. provided that such improvements are not intended or offered for safe: If, however, the building or impro4einent-s sold within one year of _ 1 0 5 - 'ANCHOR BOLTS completion, the owner -builder will have the burden of proving that he did not build or improve for purpose of sale.). 106 - SEWER & WATER 1 I,as owner of the property, -am exclusively contracting with licensed contractors to -2 02 - LUMBIN - t . UNDERFLOOR PLUMBING - nslruct the project (Sec. 7044, Business and Professions Code:) The Contractor's 203 — UNDERFLOOR MECHANICAL ' License 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 the2 04 — UNDERFLOOR --FRAME - - - --- -- - Contractor's License Law.. ° 1 am exem underSec. " B &'P C for this reason 205 — UNDERFLOOR, INSULATION Owner Dite'X -? 3 01 - ROUGH PLUMBING WORKER'S COM i ATIONDECLARATION 302 - TUB & OR SHOWER I hereby affirm under penplry of perjury one of the following declarations: 303 - ROUGH MECHANICAL ❑ I have and will maintain -a Certificate of Consent to self -insure for Worker's 304 - 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 ❑ 1 have and will maintain Worker's,C6mpensation• Insurance, as required by Section 306 — HOLDOWNt� S 3700 of the Labor Code, for the perf?rrnance of the work for which this pemtit is 307 - rl I ON INSULATION issued. My Workers Compensation Insurance carrier and Policy number are: J . :,�• ' „ '�;: 30'8'- _- SNEETROCK Carrier: r . , ..Policy Nb.: • •' CERTIFICATION OF EXEMPTION FROM. WORKERS' , t ".,. 3 O 9 .- EX'TERI OR . 'LATH"; COMPENSATION INSURANCE 310' =' '1NTER"IOR• LATH l (`[his section need not be completed if the permit is for one hundred dollars 311 -- SCRATCH COAT (S 100) or less.) ' ' I certify that in the performance of the work for which this permit is issued, I 313 — 'ROOF NAIL--- 5fi Il not employ any person in any manner so as to become subject io the Workers' 501 — FINAL ELE CTRI CALENERGY Compensation Laws of California. Date ' Applicant 502 — 503 - FINAL PLUMBING.ENERGY FINAL MECHANICAL ENERGY NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply witfi such provisions or this permit shag be deemed revoked. 5.04 - F I NAL _ BUILDING ENERGY . 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 permit is issued (Sec. 3097, Civ. C.) 506 - GAS TEST Lenders Name Lender's Address 507 — _ FINAL PLUMBING I certify that I have read this application and state that the above information is 508 — F I NAL MECHAN I CAL Cottee[. I agree to comply with all city and county ordinances and.state laws relating 509 - F I NAL GRADE to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes.51 O - F I NAL PLANNING (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against Said 514 - FINAL PUBJJC WORKS City in consequence of the 'ranting of this permit. APPLICANT ; 'D NDS AND WILL COMPLY WITH ALL NQS-POLNT V Issued by: Date %SSignaturree4KAA(pplicant/Co'nnimctor � Date Re -roofs • HAZARDOUS MATERIALS DISCLOSURE ' ' Will the applicant or future building occupant store or handle haiardous material Type of as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety .Roof , Code, Section 25532(x)1 • ' ❑Yes' ONO ' All roots 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? all new materials for inspection. Applicant understands. and will comply with ❑ Yes ❑ N° 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 cu endy have a tenant, that it is my responsibility to notify the occupant of the re a tits which must be met prior to issuance of a Certific- of ccup 7 'uth°rizea Signature of Applicant Date All roof coverings to be Class r`B" or better Owner agent Date OFFICE I y�t CITY J nut OF c DIVIiSiONNO CONTRACTOR INFORMATION: PERMIT BUILDING ADDRESS: PERMIT NO. 22179 HAMMOND WAY 01110108 OWNER'S NAME: ONI & LORI STELLIGA APPLI TION UB DATE 11%262001 ` PHONE: SANITARY NO. CONTROL NO. 0 ARCHITELT/ENGINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION o that I non licensed under visionsof Chapter 9 Job Description j with Section ebony )ofDiilion3 sion.Cde,andmmecense efect. on3 Of 11, Busi:pandPmPossions Cade. end my license PATIO COVER SCREEN & SOLARIUM. r sin full forev J effect. gfund License CLMi' Lic.M . # n Caere ARCHITECT'S DECLARATION I undersmnd my plans shall be used as public mcoNs ed its public / Ucenud Profustowl OWNER BUILDER m theConumON I hereby a(Sectffion ,hat 1 am aempt from the C License Law for the an following re"soa (Semon ]U315, Business and usions oil o Code: Any city or county. j O O o which requims a perm, alma imp demolish, vet de or repair any structure 7 O Tier to its issuance. also regatta dm applicant for such permith, m ui=the -Fmet License - Provisions ow (Chapter9 a he Contract., or ,a, ncing,with Sedtim] )of DivisionJof the Businesyr� and Fault...Code) or that ti i nemPYtherefuniand a••A,.slr1, I a1) Y Valuation 3'4 ,t3tO J. 1�,U'Ci v y, rid-,,., the basis for the olle ll'c4emiabod. y violation -of Section 4031-.5 by any appliam for a permit subjects the applicant to a civil penalty - .I nm more ntanr a hundred douam (s511o). �t�a,,���,, ^ 101 AEN P'7L' 1VYJATI ON i r--�... ,� - �- Occupancy Type ❑1 nenfNepropenyormy employees with wages as their sole compensation _ , will do she work and the'euocture Is not Intended -or offered for sale (See: 701 1- Bo nes➢ "nil Pmfe,sions Cade The Contractor a License law does not apply to an 103 - UFER Required lnspeeuons ^�''' ' T•: owner of property Wimholds o improves thereon, and whod such work himself a th o gl h' employees, Provided that such improvements are nor mended or - 104 - REBAR i oA<rrA7 I If'h - e e ,n tu,idin - - gerimproWroem la ,m' onerea: of 'cbinpleeon the owner -builder will have the burden of proving that he did not build or __._. .... .. .. ........ — _.._.- 105 - ANCHOR- BOLTS )':�` - c r c.. ••, improve forpmpas<ofsale.). s, 106 - SEWER & WATER -- - -- - ...— ---....._.... .: Laaat ooject(Seny.amusinesstydProfe ,,gwhnlmensedoanmacmrs to. _..._... ------ 202 ....-.._"UNDERFLOOR--PLUMBING..__ TI 't'•. the Contractor's Anse the present (Se )041, Business and Refusionsilds or The improves hemon, Lic<ae.cmLaw d«,not apply teennwnecaf propenywho bmlcentednpmvea.m.th. 203 - UNDERFLOOR MECHANICAL ..rod who.coLicent. for. aucb.pmjec6. with.a contractors) bcensed.pusuam.to.the. Cnnuacto,'s 1, cense Law . _._...... UNDERFLOOR --FRAME '-----"-^-------------- ----- ❑1 menem ttder$ec B&PCfor this ou,on 205 - UNDERFLOOR':INSULATION ° ""v%}.7y, D..a ? G f7Z' 301 - ROUGH PLUMBING , ,,;; ,_I WORKLR S COh ATl . DECLARATION .. ...... .._. ... _ e,''.I 3 02 - TUB & OR SHOWER hercb firm under ... ra ve�ahy,arpedurydneennernilowinge<aamtmn:: 303 - ROUGH MECHANICAL E❑ 1 have ad wiil'mainthin'. &C medic of Consent 'to'selrimurc for Work<r's 304 - ROUGH ELECTRICAL Compensation, or provided for -by Section 3]1)0 of thr Labor Cale,- for he perfondmcedf the work f111%or which tnrs pemdt i, hae�._ 305 - FRAME ❑ l have enJ will tett nWorkcr iCompcn tlobrin3urmc,e; neuimd by Section 306 - HOLDOWNS 3100 m the Labor Code, for the peyf9mance'of the work for which this pemii,'is ' issued My Work es Compensation 1 sun e< me d Policy number rc 3 07 - INSULATION p d Cart QP Y't,1 t.ntl'ItYN „• duty No •._ S'I-EETROCK_-_.. .....,.-..-,- :.<-..-„.,................ 3O'8' ! ': CORTIflCA 00N OP EX N'FRO MIWORKERS 1. 6. „ 13'09 ” r • EXTERIORL='r^ COMPENSATION INSURANCE t v - •- _ R ,__—_ _ — 310', INTERIOR' LATH f1h's t on n rA i he ipleum rth perm t is f hand ed dollars t • ' st Ct •' (ato0).rl,) 311 - SCRATCH COAT '. _ ' I etfy tht nthe pet mu a hhe work for -h ch this pc",i issued, I � 313" 'ROOF :NAIL=: xnml t mPI y :any pe on nny a s, m 1ov.m beet to dne Workers ' 5 01 - FINAL ELIEOTRI CAL`�'ENERGY' - C pe m a Or I Cdifo Date App' 502..= ...FINAL--PLUMBING...ENERGY . ,, r,, , 503 - FINAL MECHANICAL `ENERGY bee c,TO PILIr el furmaA grot C n,B em of Esemp, do you no st beco uhteei,otheWorkersC^mpcnauonPmo ,mnsoftheLaburC&le,yoummi Firm .. 9e l-; . -- an,orm pem,h,nahxe marc kee. _ . 5.04_-_-.-_FINAL.-.BUI,LD.ING cONSTRUCION LENDING AGENCY 1 n rcor whim, th tpe rt fi c est ',"`m nd'n agency fo the perf.on.ove, gg _ENERGY_. _- . 505 - FINAL ELECTRICAL •" 1 of Ue work for bleb th perm t t ssucd IS 309] C,v. C) ' ,.• ,. ... .. 5 0 6 - GAS TEST uL_'.._ Lend A14 , _.. _.. ._. _... _._ 507 - FINAL PLUMBING. ,�•, I n,fy,tha�lha ercad,hts apphcauon and state,hauhe nhuve infurmm,un is 508 - FINAL MECHANICAL" correct: 1 "gree to comply with all city and coumy,ordinnnca andpme laws relating m building constnleri n and hruby authorizei p entahve of this t enter upon 509 - FINAL GRADE _city th o'mentioned prpertf sp5cuo"Prposcs 'I 51O - FINAL PLANNING (N) ,gree m u e d mn fy vnd lep h nl i,he 6ty of Cuperi 6Against liabilities. I dgsnants eat. we pmu whch y many y cmc"g";nvl said 514 - FINAL PUB C WORKS Cityy n co s q once f tM1r gm ng of thl p t. APpLfCAN7 'D - S NOS AND WILL COMPLY, WITH ALL N 4;POINT''" RICH re Issued by: t.6-r;l,rt-� Date S ignut. ApvlidauvUrinruetm' ..•:. .Dune °- HA2ARDOU,S MATERIALS PISCLOSURP ',,.,' Re -roofs / : rwlimeappliemr.hniteMhlmgaccpa,,td<arnaadlnarvwa,matertal.._Typeof-Roof.........,...._........._.--_-. asdfndbythCupen _..-..:...... M cplCal Chapter 91 admHealtha dSlry-- ..tom.---._. :.,_.__.._...- Cod �cYu 1553 (a) Lf -win ih. It:�tt All roofs shall b@ mspected,pnor,to. any roofing, material being installed. rn vplc mo r w ba lay g pant me of .p u rdevices which 'emit hazard contaminants0 defined by theBay ArcaA Quality Management _ If a roof is installed wOhout first obtaining anlins ection; is Tee to `remove �s p g Districts.m^ r all new materials for inspection. Applicant understands and will comply with �_ - - p _ - -- - all non point source regu under Chapter fi.95 of the IY5543,�155J3a- Llitycoolfet�ode❑Secotiu, nd 35534 1 understand thataes net cu entlynnveotewmahvt i, is my rcspons b,lny,o nnufy@e re ms which muni bpiior m issuanceof a Ceiftcme of ..'7Signatureof Applicant Date.;aw All roof coverings to be Class "B" or better gent d:..., Dnt< . OFFICE. '- . - .. __ . _ ---- .... 1. ...