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02070100CITY OF CUPERTINO C11rr_V__0LV__jCi1r TlDrL" rr-Tiv-0 APN # �tion Fee Dewd Fee Grou PERMIT APPLICATION FORM Building Address: Ale, APN # �tion Fee Dewd Fee Grou 1BAPPLOT Building Address: Ale, Owner's Name: CLM606 P() MAU kr_ Phone #: 1-7522-7 Contractor: , Lice#: -0- Contact: Hotel and Motel Phone #: v97 Applicant/Contractor: ukl14 Fax 7 7 7(? Building Permit Info: Bldg Elect Plumb Elec 600V > 1 OOOA ------ELECTRICAL Job Description: Residential: Elec Svcs 600V <= 200A Commerci4fPdM Mr -5 Sq.Ft. Floor Area: $/Sq.Ft.: Energy Add Multi Architect/Engineer: BeIgUT Valuation: Type of Construction: onim. Housing Mit. Fee -- Occupancy G A 7 -C, . C / (Y 0- Fee I �tion Fee Dewd Fee Grou 1BAPPLOT Construction Tax Con. Taxfor BQ Zone • Hotel and Motel Constax - Resi/Mobile I a mr-1 -Iam— ECTRICAL Elec 600V > 1 OOOA ------ELECTRICAL &Z aw= Elec Svcs 600V <= 200A ERGY _01 BENERGYADD Energy Add Multi BeIgUT Investigation fee N OW3111M•--- onim. Housing Mit. Fee -- BUILDING IGATR ,Res. Housin Mit Fee BUILDING 99MMIME MECHANICAL WIWI New Multi -family Res ELECTRICAL 'New Comm Electric ELECTRICAL FiNew Comm Mechanical I i 1 .51 1 3111 owl 0 -2 & I MIN QV MA mm -7 CITY OF CUPERTINO BUMI)ING DIVISION PERMIT BUILDING ADDRESS: 10200 N TANTAU AVE OWNER'S NAME! COMPAQ COMPUTER PHONE: p-- ARCHITECTIENGINEER: R 1z Y LICENSED CONTRACTOR'S DECLARATION Z I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Bu:Xis and Profe ��tlns Code' d y license is in full Tc and a I. - "o ,air is in full Tc and a 1. -7 A 2:3 a: 04 < LicenscC s Lic. # 7z 0 Lu U - F / , -1 'i - a on Co V Fj ­� A C ��Dl F­ CNITF d my an IEC undersi d m ens sh I r s r' us c� � 2 Licen stony V o OWNER -BUILDER DECLARATION I h eby affifirm that I am' exempt from the Contractor's License Law for the E: ?z following reason. (Section 7031.5, Business and Professions Code: Any, city or county r 2 = 0 which requires a permit to construe*, alter, improve, demolish, or repair any structure ru — prior to its issuance, also requires the applicant for such permit to file a signed statement 1IpIuej jsJ1i*d i,*pursu� requires pmAsiions of the Contractors license Law (Chapter 9 . am (conimcneingwith Section-70(ppi' Division 'i of the Bps' s and Professions Code) or thathe is exempt therefrom and the basis for the alleg. eximption. Any violation of Scrtlon7039',5 by aoyappMant for a permit subjects the applicant to a civil-penalry of not most than live hundred dollars ($500). 0 1, as owner of the property, or my employees with wages as their sole compensation, Wili'416 the work,and the structure is not ifitended of offered for gale (See, 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 or through his own employees, provide that such improvements are not intended or � 4- 4 n. ,offered fici 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 improve for purpose of sale.), 01, a, owner of. the property, am exclusively contracting with licensed contractors to 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, and who contracts for -such projects with a contractors) licensed pursuant, to the. Contractor's License Law. 01 am exempt under Sec: B & P C for this reason Owner Date 'WORKER'S COMPENSATION DECLARATION I hereby affirm nailer penalty of Perjury one of the following declarations: 0 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, -as provided for by Section 3700 of the Labor Code, for the perfbnmai nce of the work for which this permit is issued. 0 1 have and will mainiain'Workees Compensation Inspranct, as required by Section 3700 of the Labor ' Code, for the performance of the work for which this permit.is issued. My Worker's corn' In yrance carrier and P pfation (This section need not becornpleted if the permit is for one hundred dollars (5I00) of less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in int' of California. Date so as to become subject to the'Workers' Compensation Laws ate Applicant NOTICE TO APPLICANT: if. Ut-0 making _thisCcriif�oida . . of Exemption,'you should RZ become subject to Me Worker's Compensation#bvisions of the Labor Code, you must 0 forthwith comply with such provisions or this permit shall be deemed revoked. CoNsTRucnoN,LENDING AGENCY 1 hereby affirm that there is a,construttion lendiftigAgeitcy for the performance Of the work for which this permit .is istued:(Sec. 3097, Civ.'d.) UD z Leptler'sAddInt", I certify that I have read this application and state that the above information is ;T N4 E-4 torted. I agree to comply with all city'and county ordinances and state laws relating O.*U to building consLnuetion, arid hereby authorize reprcsimattives of this city to enter upon >14_W the above-mentionedproperty for inspection purposes. AO (We-) egret tosave, 146M'nify'and keep harmless the City otapirtinc, against liabilities, judgments, costs and expenses which may in any way accrue against said z City ih consequence ofthe granting of this permit. AAJklM VNZaSTAN"P$ ANI) N\TILCUMPLYPNITH Aft NoNipomr' HAZARi5QU9 MATERIALS DISCLOSURE, tht appEca»t or foturt $ Gldhigooca' as defined by the CupetrIno Mumcipat a. Chapter 9A 2and the Health and Safety I Code;" Section as ,will the applicant or future building cupant equipment or device, which Quality _ Distrilet! Management emit hazardous air contaminants as 8efi yAAii 0 Nes 0. i'hav , e .'read the. haaardous'inaterials requirements under 'Chaplef 64S' ei the California Health & Safety 'C(ide,'Sections 25505,25533 and 25534,-1 understand that if the building does� nat currently haven tenam-that it is my responsibility to notify the of the , , which I 'be' ' kerecipire entsw c must 'met Phot t6isihianbe ofa Certificate of pl�rup cy., U A Z,Zid Zmw�:� Date rl" R * *1 3 0 AP" &(�UGH 501 - FINAL ""02070100 APPLICAT16VtIY" 2002 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH L___J r_ _) L ."i Job Description $18000 Valuation Issued by: 9 Re -roofs Type of. Roof All roofs shall be inspected prior to any roofing. material being installed, If a roof is installed vVithout first obtaining an inspection, I agree to rdinove all new materials for inspection. Applicant understands and will comply with all non -point source regulations. of Applicant Dat ' e All roof coverinRs to be Class "B" or better Cat 0C �G 'ZW sv= nFu ix F7 ;Oyu i3 OQ �o. IFO y3� CITYOF O Nc DIVISION Y'FRI�YYT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT N "'n"62070100 10200 N TANTAU AVE D COMPAE' COMPUTER APPLICAT16V$ ap97Ey2OO2 1 / / LONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INTO BLDG ELECT PLUMB MECH u C=1 L'7 LJ LICENSED CONTRACTOR'S DECLARATION Job Description p I hereby affirm that l am licensed under provisions of Chapter 9 (commencing GENERATORS Division of the Busipfsanup re", ns Code. v�eany license With lull re in full and a t. ,%l LiccnmCm Lic.k crena er r G ` A CHITECT' DEC undent a my Jam sh. us a. is Liccn roar" OWNER -BUILDER DECLARATION 1 M1f cby ar(m that 1 am exempt from the Contractor's License Law for the following maven. (Section 7031.5, Business and Profasionx Code: Any city or county $18000 which requires a permit to ronsuvm, alter, improve, demolish, or repair my structure norronlicemdptikwm -p it 4. PP Permit file asigrcd...Otment. - ------ r, .....,.._,3,W FO BIBdr A(01.: •f f--• -` :: ". Valuation- theiheislianiedpdisuennaihepitinvonsofOeComrvcmr sLittnse law (Chapter . (so ess Professiom Cade) -ii ,0Q0) and ithievirefrommvnA the forhtc alleged 'e In p g aemp., n. .. Fti.>. �. - s--�•' . y. ... x_v..Saat�.v.. is. ci l,emaan '-of Seton 90313 by v hundred doll for o pemdt wbjcns Ne vpplicmr ro a civilycnelry nfndtmemrhanlivehnamaenn.rt(sspo). 30�PNNaQHE3H ELECTRICAL:'•rT.' Occupancy Type °Lasa,.arnfrhapmpny.Ormyemployeawith wages nuheirset, ompeouni.a.; 501 - FINAL ELECTRICAL ENERGY will do the work. -and the stmhmm is not intended nrnffered for sale (Sec: ]044;' 505 FINAL r Business and Professions Code: The Contractor's License Law does no apply to an _ :r. 1 (1 OIl$ • ' " ' - 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 --- -offered for sale If, how th Wilding a improvement is sold within one year of - a a. I �t 'complet an, the owner -Wilder wilt have the buten of proving that he did not build or - improve for puryose of sale.). _.__...._-..._ pm_—__....__... .__..___.___ __. _-___io .. _. ntraaonm _CT. *a; owner ofthePmpanriam eadmivdy romr&mssions laR`.'r-•'I'P a:!'s^ - -- eon&waaw Code:) (appl904a, Busies andertywhons Code:)Thews therom,or's p LC! ....:'P does no property who hilae ..cams law ares not apply m an owner rM1er.,he ...: F� seimproves th a comrecmr(q licensed pvrtuanom.rhe.. _ und who.'. .-_. ................._._.... ...._ ......__....._.__.- Lie us.far_auch.projats.with 01 mi ofs L cende,S - ❑leme rept under, Sec � �' '-� f c•BAPCf th m '. �•`�' � i`.;'.! ' 4oa« !iil. 2. 4 7002 i've", WORKER'S COMPENSATION DECLARATION I hcmby from under penalty of pe rjury'oirc of the following declwtions: BUILDING ° 1 have send will maimnin a Certificate of Conieni m re f-insum for Worker's ' Compeusai-as provided for -by Seaian 3700 of the Labor Code, for Ne perfonnintt of the work for which tMx permit is issued. ° 1 have and will mvinivo worker'e Conn ensodori Insurance, o requited by, Section 3]00 f the LaborCod ( the performance of the work for which thispemue is issued. My W k fs Co yuet o I enc c e d Po7jcy�s ... . rY s r CERTIFICATION F FXEMP FAOM WORKERS x - •- , .... .,r.'.., .: COMPENSATION 1NSURANC'E'"7!r',;-, ..-.: :. .. ,n, ..___... ., __ ... _ ,_.._.�_.__.. _.� _. .._ .....__ _�_ ..... _..... _. '.��.C_b V-`l\•�. Cit l•. r' ro: .f .. completed ed (fliia section need not tie �compkied if the pcnnit is for on hundred dellen 1"" .•' i3' ll &0 in theperformance of thek for which this perm t -s issued- I ,not - r "llail employ any pciso-arty manna m biome subject to fee Workcri �' l' ' .•l'. Compensation laws of C&lifcurem. Dam 14 . NOTICE TO APPLICANT:If. aper making this Cenifiale of Exemption. you should become subject the Worker's Compensation' provisions of the Labor Cade, you must fonh6'ith comply with such provisions or this permit shall be deemed revoked. ' 1 I'�rCONSTRUCTION LENDINGAGENCY Y B S y 1rkf &Rim@ai Werttiscs6"d'(Edah Icidin 'imi•for the performance of the k for h¢h th s permu s ssue0 (Sic 3097Cr C) - - Lender',Aadress"`"- •and •the . I certify that I have mad this application slate that above information is torreR_ 1 agree to comply with all city und ordinances and state laws relating county to building mnsWetion, and hereby emhboxe rtpiesemativei b( this city to enter upon the movo-mcntioned pmpery for inspection purposes.,- r. I (We) ngree'so save; indemnify and keep harm!eas the City of Coperiiao against liabilities, judgments, costs dna expenses which may in any way &carve again said City in consequence of the jimong of this part' ' "' ' "" " "' ' r. SPP UNUERSTAN ISAN WIL C .1PLY 7TNALLNON.P Issued by: Date I i"t ip ,Dec" r' Re -roofs HAZARDOUS MATERIALS OSCLOSORE '- 11 N C cam m Tamm hal a• pa t tons handle an team _ . - Type of Roof........._._ Health cdef m by sheCupen ao Mu repel c Chapter 911 rid the Health d S&( l Safe,, ,, Cine 25532(&) nJ ,It S •A1 1 .. , '. - �. • , . I _. 0!1 ' .t .- r' .. s o'.; °Yes I ,jn k All.roofs shall be Inspected prior. to any roofing.material being, installed.__. ...... _ Will th ,app( canto Tut m h Id ng e p t_ q .pm t d r whish ..if boardo s are nmminante as def y the Bey A A Qu 1 ty M gem t If a roof is installed without first obtaining an inspection 1 agree to7femove Distnaall new materials for inspection. Applicant understands and will comply with all new byes",1..1 _ I. Ilha erreaE'Nih ;adous'meienils requirements under Chapter 6.95'ol the , Celifomin Ha.ltM1 & Sef b Code: Sections 25505; 25533 end 25534: 1 mommnd that . _ .-if arts building dx> ria cunendy have it <nagcth...... my tappndbiley to reatify the _. _. .. _ •,'., _ of W, rcgore ''ants which must be mei prior to Issuance of & Certificate of y "' .- Signature of Applicant Date . All roof coverings to be Class "B" or better' _ ea agent Dare k.,. :_.. F..,.,: ...a..e. ..... __. ... .._ ... .._. _.:.... ._._. .....__. OFFICE .. _ ....._......