02020006 ...,.CITY®F caPM10N :C0NT➢BACTOR YNFOK PION
BUILDING DIVISION'. PE AT
BUB.DIN ADDRESS: PERMIT NO.
'106& WALLIN CT (LOT8) 02020006
OWNER'S NAME: APPLICATION SUB DATE
B..K. DEVELOPMENT CORP. 02/01/2002
� PHONE:. SANITARY NO. CONTROL NO.
O C Z ARCHrI'FCT/ENGiNEER: BUILDING PERMIT INFO
IU4O O BLDG ELECT PLUMB MECH
,y¢.Lu
a
ZLICENSED CONTRACTOR'S DECLARATION
0 z:0 I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
E w F; with Section 7000)of Division 3 of the Business and Professions Code,and my license NEW SINGLE FAMILY DWELLING.
�wW< LcenseCaforce and effect. (LIVING SPACE 3196 SQ FT.
cc C¢ License Class Lic.# 4• z
3 V.1, Dare ARCHITECT'S D CLContract°ARA'IION GARAGE 413 FT. )
F'^Oy ,: ,I understand my plans shall be used as public records
s ru'
M p O .licensed Professional
P.°'o OWNER-BUILDER DECLARATION
i hereby affirm that I am exempt from the Contractor's License Law for the
F"Z< following reason.(Section 7031.5,Business and Professions Code:Any city or county
f X—❑ which requires a permit to construct,alter,improve,demolish,or repair any structure
a 3°—° ..priorto,itsissuance,also requirestheapplicant for such permit to file a signed statement -
'[fianhel3 •tt{eprgvisrons of the Contractors License Law(Chapter9 ' $3 5 O O O
y ,Sq,,F Floor• e , �•:• uation
(commencing wht Segipn,10 of Division 3 of the$usihess•andPSofessions Code) _ _1 r �•, .=, i r S x5, ,i l�+1.' .t�.ib a`4 T'ti '
or that he Is ekem�t'thereftom�'nd the basis for the alfegdd,eeegiptjoo.Any violation
of Section-7031:5 by any applicant for(permit subjectsthe applicant to a civil penalty 3 6 21��1.1ll �, Occupancy Type
-of'n,of more than five hundred dollars $500. ;i'.'�'
❑I,as owner of the property,or my employees with wages as their sole compensation,
,willdiss'a work,-asions ode:The is not intended L or'ocense Law
doe sale*not apply
to ii, " - 1 O 1 — FOUNDATIMquired Inspections•"'
'Business`and Professions Code:The Contractor's License taw does not apply to an •-• : '
owner of property Who builds or improves thereon,and who does such work himself 102 — PIERS
or.through his own employees.provided that such improvements are not intended or _., -,- _ _•__ _ _ -
':offered-foi'sal6:If,however,rhetiuildingor"improGenientissoldwithin one yeazof
'completion,the owner-builder will have the burden of proving that he did not build or
'improve for purpose of sale.). 104 — REBAR I
.._ ...-...._.-._. ........... ..... .......
1]� .owner of the property,am exclusively contracting with licensed contractors to — AN HOR O T ' ,. ...'.,�'^-`•"
tenet the project(Sec.7044,Business and Professions Code:)The Contractor's 106 — SEWER & WATER '•�' '',"
License Law does not apply to an owner of property who builds or improves thereon, j
and wh°:contracts.fo such.'to c with,a contmctor(s)licensed pursuant.to.the. -202---" ""UNDERFLOOIR"PLUMBINC7"' '—
Contractor's Lic se ,
�' ❑[am...c d' ec;' `,'B&P.C,for this reason 2 03 - UNDERFLOOR'I MECHAN'I'CAL
;own e'` Date• - (� �y - 2 04 - UNDERFLOOR FRAME
i
K _S; ENS O DE LARATION 205 - UNDERFLOOR INSULATION
I he y a rim and penalty o perjury one of the following declarations: - 3 O 1 — ROUGH PLUMBING
- ✓- ❑ I have and Al maintain a'Certificate of Conseht oto self-insure for Worker's 302 — TUB & OR SHOWER
•Compensation, as provided-for by-Section 3700 of-the Labor-Code, for-the
- _ performance of the work far Whish this Qe7i[is issaea..;: 303 - ROUGH MECHANICAL
- 'o i naie'ana will maintain Workers ComPensatibri insurance,''as required by Secdpn 304 - ROUGH ELECTRICAL.
3700 bf,the Labor Code,for'the'performance of the work'.for which this permii'is 305 — FRAME
'issued:My Worker's Compensation Insurance carrier and Policy`numbcr are: '
'•.;: :;; ,1�:i. .,.-..... . ..,. .., .,,..
;wirier.._ „!' .::._(...
Policy t.+ a r
,!:.i CERTIFICATION OF EXEMPTIQN FROM WORKERSi' 30
'�J� sI'NS IYLiAT^I`ON'
r.
OM NSATIONINSURANCE" __..._..... ._ d,.._.-,,. -•--•--• - _.... ..
-. ,', 3.0.8......1 ;:SH 1 'ROCK-
•' `'(This section heed not be'comple(ed if the permit is for one hundred dollars _ + •,`' ' ' '' + •`•11, `'"�i •,
•(sioo)orless.) 309 �EX 'ERIOR LATH
I certify,thai in a pe '' F tgh 'l or which this permitis issued;I•shall no[employ iso ina anaeo become subject to the Workers' 311 - SCRATCH COAT'ComC
_. .313_ --..RO.OF_..NAIL...... - - -..___.._.. -
p,a ter a hpermitishall a deem dt3ov Yea 5noaia 5 0 2 FINAL PLUMB I_NG..._ENERGX.... .__.. __ ...
• ICE TO' I A q4p '
X .- tome subject to R a ees Com sation'piov+shons of the Labor Code,you must
- Y
ryy� �• 501 FINAL ELECTRICALENERGY
• ••
q. ed. _
..�hereb`affirm that their is a tons .._. .... _ ._...... __.__._._. ..._...... _�
® � 'forthwith complyith h rovisi s or this errmt shall be deemed revoked.
�H.� •'••„
CONSTRUCTION LErroixGnceNCY " ; �. -- 503 - FINAL MECHANICAL ENERGY*,--`:`-`,.'-,'.-''' ' •
a„ y, quctiori lending agency for itis erfotmanb,e , — -
. •ra 'of tie work for which this permfi is'i'ss5ed(Sec.3097,Crv.C.) ,. P' .` 504 FINAL BUILDING ENERGY
Lender's'Address .....,_ .._ :._.. _. .. .. .— INAL -E
7.
CTR ICAZt- _. .
.:� .,. , :. : 506 - GAS TEST ,
I certify that I have read this application andstate that the above information is
'c6irecCd agree.to gotpply with al)city'and county nrdinanges and state laws relating 507 - FINAL PLUMBING
U :to building construction,and hereby auth6ri2c representatives of this city to enter upon 508 - FINAL MECHANICAL,
Ey.fthe above-mentioned propzR for inspegtion purposes.
'(wej agree o'sav,'•rod rfy and keep harmless the City of Cupertino against _ = '
_ r.y M liabilities,'jug tis,c is a e ses which may in any way accrue against said 509 FINALMRADCity in co se a 'e d e g t of this ii '' , S1O '� F AG
APPL IC CI E T COMPLY WITH 4LL N0 -P N �0
sou s G OZ Issue t Date
ignatureof pli Contract ' " " .,D e' r' Re-r��2�- ROOF PLYWOOD NAIL
RD S'IvtATPRIALS.DISCLOS `''`
applicant or buildino'pccu an_i store or dle haiirdous material R
d .Ty-pe.g�aof.".... OOF BATTENS_._.. . _........... .:.�...
'as defned. y th0. upertin upicip ,code,chapter-9.12,and the Health and Safety '604,-
C —t.,ROO�'i`.:I N_PROGRE'S S
ode$ection355 2 a?•' -;�
,
•Lj.Yes ,, All,ro.pfs,shah-be'in*sp,ected..pri6r to... ny_6 ing'material-being i>Zstalled, _.,
•Will the,•Uplieant'or,future bui ding occupant use equipment or devices which If a roof is installed without first obtaining an inspeetibri'-I'agree to.remove
emit hazardous air tontaminants a efined by the Bay Area Air Quality Management
District? ' all new materials ori spe t n__.AppI' t understands.and will,comply_with
o Yes - ❑No • ' - -a11 non= hint
I have read the ba do u er+als 'q uiremerits�ugdei Chapier 6.95 of the
Cal-rforitia Watdi Safe Codogs 505,25533 and 25534:1 understand that
ifthebuildingil _ of rren ate t,thatifis my responsibility to notify the' - /-Ldz
occupant of" ir' encs' mhi be'rtietprior to issuapceOf;a'Cer[ificlate of l
°"apa, Signature of p • ant ate
_ All of coverings to be Class "B" or better'
caner or aum ed g r. D to, ,,
1
Q CITY OF CUPERTINO
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ncu
NEW SINGLE FAMILY DWELLING a 2- 0
Z ��
PERTINO
APN# 26-12o Date: Z 1 ) OL,
il
Building Address:
Owner's Name: ,, ,� Phone#: (qL7&)E3-73 _ -�
Contractor: ��. �lhC. License#: 3_7 O 1 H q
Contact: . � ��. Phone #: �LAOO 0 7� _8,7.7q
Applicant/Contractor:
Building Permit Info:
Bldg -" Elect--- Plumb Mech
Job Description:
Residential: I/ Commercial:
Sq.Ft.Floor Area: 0� L, j $/Sq.Ft.:
L� `n
Architect/Engineer: (,\ � c,, cx v1 Valuation: zG,,
l
Type of Construction: Occupancy Group:
Qty.if
Applicable Fee ID Fee Description Fee Group
BCONSTAX Construction Tax BUILIDNG
BENERGY Energy BUILIDNG
BMTTIGAT Housing Mitigation.Fee BUILIDNG
BNEWSF&2F Square Fee BUILIDNG
BNUSFD Square Fee BUILIDNG
BPERMFEE Bldg Permit Fees BUILIDNG
k BPCANCHK. Plan Check Fee AUILIDNG
BSEISMICRE Seismic Fee Res BUILIDNG
BSF&2FAM Square Fee BUILIDNG
EPERMITFEE Elect Permit Issuance ELECTRICAL
k MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMTTFEE Plumbing Permit Issuance PLUMBING
BSWIM Swimming Pool BUILIDNG
fir",
BUSLIC Business License BUILIDNG
- � 7 20