02070172CITY OF CUPERTINO
BUILDING DIVISION pEI .�E.4NTRACTQRJNF0R11- 'ION
�'Z"'F96'FQMqCHO DEEP CLI DR POULSON CONSTRUCTION PERMIT n 2 n 7o 7 ,7,D
-ER DANIEL J 1907 COLONY ST
t PHONE: '(650) 965 -0914
0 ZO ARCHITECf1ENGWEER:
a
may
H y LICENSED CONTRACTOR'S DECLARATION
y o
(hereby affirm that f am licensed under provisions of Chapter 9lcommencing
F whit Section 7000) e of D' 'ion 3 of the Business and Professions Cade, and m 'tense
is in full force and efT G r
'(7
ad 6 License ass Lic. I+
3 a Date Cuntmcmr
�n ARCH Cr'S DECLA I N
, 1 understand my plans shall be used as public rernrds
Licensed Professional —
o OWNER- BUILDER DECLARATION
`= rn I hereby affirm that I am exempt from the Conuactor's License Law for the
Following mason. (Section 7031.5, business and Professions Code: Any city or county
❑ which requires a permit to construct. alter, improve, demolish, or repair any structure
0 prior to its issuance, also requires the applicant far such permit to file asigned statement
22 1fWt he Is licensed pursuant to the provisions of the Contractats License law (Chapter 9
(commencing with Section 709D) of Division 3 of the Business and Professions Cade)
or that he is exempt therefiani and the basis for the alleged exemption. Any violation
of Section 703 [5 by any applicant ray a permit subjects the applicant to a civil penalty
Of not more than five hundred dollars ($500).
❑ r, as ownerof 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 Contra:tnr s License Law does not apply to an
owner or property Who builds or improves thereon, and who does such work hitmelf
or through his own employees. provided that such improvements are not intended or
Offered for sale. If, however, the building or improvement is sold within one year of
eamp]etion, the owner- builder will have the burden of proving that he did not build or
(mprave for purpose of safe.).
Q 1, as owner of the property, am exclusively contracting with licensed contractors to
eanstruet the project (See, 7f144, Business and Professions Code:) The ContraeroPs
License Law does not apply to an owner or property who builds or improves human,
and who contracts for such projects with a controctor(s) ficensed pursuant to the
Cono"cines License Law.
111 am exempt under Sec, B & P C for this reason
owner — Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty orpedury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self -insure for Workeeg
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued,
❑ 1 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 permiL is
issued. My W 3rkees Compensation insurance carrier and Policy ber are:
�� ��
Carrier. Policy Na.:
ERTIFICATION OF EXEMPTION FROM WORKERS'
COMPFT•tSATiON INSURANCE
(this section need not be uompletcd if the permit is for one hundred dollars
100) Or ZatiL)
I certify that in the performance or the work for which this permit is ironed. I
a)w!I not employ any person in any manner so as to become subject' to the Workers'
Compensation Laws of California. Date
Applican
NOTICE t TO APPLICANT: If, o ter maEing this Certificate of Esempdun. you should
Obecame subject in the Workers Compensation provisions of the Labor Code, you must
Y forthwith comply with such provisions or this permit shalt be deemed revoked.
CONSTRUCTIONLENDINGAGENCY
=4 y 1 hereby affirm that there is a construction lending agency for the perfannanee
W F-t of the work for which this permit is issued (Sec. 3097, Civ. CJ
Lender's Name
z Lender's Address
C f ceyfify 0211 have mad this application and state thnt the above information is
�i correct. I agree to comply with all city and county ordinances and state laws mloling
L) to building construction, and hereby authorize representatives of this oily to enter upon
4 the above- mentioned property for inspection purposes.
y ps (We) agree to save, indemnify and keep harmfcss the City ofCupertina against
r�. CI] liabilities, judgments, costs and expenses which may in any way accrue against said
U City in consequenceq or the granting o�fA/J�is permit.
APPLf1L,ANT UNMRSTANDS ANVf)WfLL COMPLY WITHALL NON -POINT
4 ` i
Sign5ture ofApplieantlConmaetor. Date
HAZARDOUS MATERIA DISCLOSURE
Will the applicant or future building sec not store or handle hazardous material
as defined by the Cupertino Municipal Cads• hapter 9.12, and the Health and Safety
Code, Section 25532(x)?
❑ Yes ❑ No
Will the applicant or future building occupant use equipment or devices which
emit hazardaus air contaminants as defined by the Bay Area Air Quality Management
_ D tt,?
❑Yes ❑ No
1 have read the hazardous materials requirements under Chapter 6.95 or the
California Health & Safety Code, Sections 25505, 25533 and 25534, f understand that
if the building does notcurrently have a tenant, that it is my responsibility to not ft' the
occupant of du requirements Vich must be roc[ prior to issuance Oft. Certificate of
Or an[nnrizCd agent
Uata
APPLICATION SUB DATE
_07/26/2002
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
Job Description
REPLACE EXISTING DECK
1 FIALED
DEC 19 20OZ
BUILDING $12600
KNIZINI-W50 "I,
101 ,yr"I'IDW iTION
1 1117 — 1DTL70C
103
- UFER Required Inspections
104
- REBAR
105
-- ANCHOR BOLTS
106
- SEWER & WATER
202
- UNDERFLOOR PLUMBING
203
- UNDERFLOOR MECHANICAL
204
- UNDERFLOOR FRAME
205
- UNDERFLOOR INSULATION
301
- ROUGH PLUMBING
302
-- TUB & OR SHOWER
303
- ROUGH MECHANICAL
304
- ROUGH ELECTRICAL
305
- FRAME
306
- HOLDOWNS
307 --
INSULATION
308
- SHEETROCK
309 -
EXTERIOR LATH
310 -
INTERIOR LATH
311 -
SCRATCH COAT
313 -
ROOF NAIL
501 -
FINAL ELECTRICAL ENERGY
502 -
FINAL PLUMBING ENERGY
503 -
FINAL MECHANICAL ENERGY
504 -
FINAL BUILDING ENERGY
505 -
FINAL ELECTRICAL
506 -
GAS TEST
507 -
FINAL PLUMBING
508 -
FINAL MECHANICAL
509 -
FINAL GRADE
510 -
FINAL PLANNING
514 -
FINAL PURT TC3, wnPv.q
Issued by:
Re -room
Type of Roof
Date
All roofs shall be inspected prior to any roofing material being installed.
If a roof 's installed without first obtaining an inspection, I agree to remove
all new materials for inspection. Applicant understands and will comply with
all non -point source regulations,
Signature of Applicant Date
All roof coverings to be Class "B" or better
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CITY OF CUPERTINO G
G-O� NTRA C�T R, t INT cEs w O Rx V ATI
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BUILDING DIVISION PERMIT
PERMIT NO.
T'n'!DPDDr&NCHO DEEP CLI DR P
POULSON CONSTRUCTION 0
02070172
APPLICATION SUB DATE
Bv1Tff2'ITT,ER DANIEL J 1
1907 C
COLONY ST 0
07/26/2002
SANITARY NO CONTROL NO.
PHONE: (
(650) 965 -0914
BUILDING PERMIT INFO
ARCHITECVENGINEER: B
BLDG ELECT PLUMB MF.CH
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LICENSED CONTRACTOR'S DECLARATION J
Job Description
I herehyaffimi thatIan lismsesimax,provkhrmuf Chager9 mormmcncing R
REPLACE EXISTING �C�L�®
with Seem, 70i I
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P_o1
onipass
anagement Group, Inc.
July 1 S, 2002
Melinda Laudy
Poulsen Construction, Inc.
1907 Colony Street
Mt. View, CA 94043
Dear Melinda,
The Board of Directors at Rancho Deep Cliff has reviewed your proposal to replace the deck and
wall for owner Ilan Schettler at 22456 Rancho Deep Cliff Drive in Cupertino.
Paulsen Construction has the Associations permission to proceed with the construction per your
bid dated Apri125, 2002 on Quote 42, #3 and #4.
It is our understanding that because you have contracted directly with the Schettler's, they are
currently responsible for the full amount of the proposal, however per the Association the
Schettler's are only responsible for items 2, 3 and 4. The Association is responsible for and will
pay for Quote ##1 of the proposal, which is for the wall on the patio, ,.
As the Rancho Deep Cliff HOA is responsible for the wall we would like a separate contract for
the work that wiii be done under Quote #1 in the - amount of $7,729.00. The contract and -the
billing should be sent to Rancho Deep Cliff HOA clo Compass Management Group, Xnc. 20
Great Oaks Blvd. Suite 224, San Jose, CA 95119, Attn: Lyle Peddicord - Association Manager.
Wo understand that painting for the wall is not included in any of the quotes referenced alcove
and will be bid by Poulsen Construction' as a separate item if the Association wishes.
If there is any question, please feel free to contact me at 40$.226.3300; we look forward to
working with you.
-Lyle Peddicord
Association Manager
Rancho,Deep Cliff
20 Crcat Oaks Folilevard, Suite 220 San Jose. California 451_1_9
408.226.3300 I°AX408.226 -3406~ www- gacompats.cnuI
07/19/2002 FRY 09.37 rTr /R7< un 02:51 RAM
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