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08030155CITY OF CUPERTINO77 1 "' _` <�61. BUILDING DIVISION PERMIT, ERMIT x1 :,.::• But ,RFs PERMIT NO. 10�DU N STELLING RD WEST BUILDERS, INC. 08030155 OWNER'S NAME: PERMIT ISSUE DATE VSII,A CALIFORNIA LIMTD 1608 4TH ST STE 120 07/09/2008 PHGNE-� TTTL�17 C'`U T Tl SANITARY NO. CONTROL NO. (510) 525-9378 ARCHITECT/ENGINEER. BUADING PERMrrnsmo BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that T am ficensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is DEMO OF LANDSCAPE , C ONC RETE , PAVING ,CAR PORTS , in full force and effect License Class LIc.0 i3a2S �QiS /I REC/LEASING. Date contraGm�T&A, Pr, Y� ARCHITECT'S DECLARATION I understand my plata shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby al irm that 1 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 prior to its issuance, also requires the appfiam for such permit to file a signed statement he is licensed to the Contractors License Low (Chapter 9 Sq. Ft. Floor Area Valuation that porauant provisions of the Section 7000) Division 3 the Business Profession Code) $17225 (commencing with of of and or that he u exempt therefrom and the basis for the ancged exemption. Any vlotlatlon of 3 2 6 0 9 0 5 6. 4B Number Occupancy Type p y Section 7031.5 by arty applicant for a permit subjects the applicant to a coil penalty of�p� not more than five hundred dollars (S-SM0). 0 L as owner of the property, or my employers with wages u their sok compensation. Required Inspections e will do the work. and the SUUCt= is not intended or offered for sale (Sec. 7044, Business Law donot apply to an owner of and Professions Code The Contractor's Ln nsicense Q p property who builds or improves thereon, and who does such wort himself 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 completion, the owner - builder win have the budea of proving that he did not build or improve for purpose of axle.). 0 I. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Profession Cod--) The Comractork U cause Law does Got apply to an owner of property who builds or improves thereon, and , who contracts for such projects with a contractor(s) licensed pursuant to the Conuactor'a Litxase LAW. 0 1 am exempt under See. . B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjory one of tate following declarations 0 1 have and will maintain a Certificate of Consent to self -insure for Workers Compen- sation. as provided for by Section 3700 of the Labor Code, for the performancc of the work for which this permit is Issued. 0 1 have and will maintain Workers Compensation lasurancr, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued My Worker's Compensation In An^' carrier and Policy number are: Carrier. 4i rDtTC l UA)1) Polley No.: -7S610IR0) F CERTIFICATE OF EXEMPTION FROM WORKERS* COMPENSATION INSURANCE This section need not be completed if the permit is for one hundred dollars ($100) or las.) I serf trot in the performance of the work for which this permit is issued 1 shall not employ arty person in any manncr so as to become subject to Ude Wortdra' Compermation . Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provision of the Labor Code, you must forthwith comply with such provision or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sm 3097, Civ. C.) ' Lenders Name , Lenders Address 1 certify that 1 have read this application and stare that the above information is correct I agree to comply with all City and county onfinances and state laws misting to building contr ction, and hereby authorvt representatives of this city to enter upon the above-mentioned property for inspection purposes (We) agree to save, indemnify and keep harrnkss the City of Cupertino against Liabilities. Judgments. costs and expenses which may in any way accrue against said City . in consequence of the granting of this permit. APPLICANT UNDERSTAND N WILL O P Y WITH ALL NON -POINT Issued by: Date SOURCE 1tEGULA770N, l �_� �v Re -roofs Type of Roof Signature of Applian✓Conuamor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant car future building occupant store or handle hazardous materia as defined by Ude Cupertino Municipal Cade. Chapter 9.12, and the Heath and Safety Code. Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yea ,Q] No / \ If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hasardon air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District] ❑Yes 11�;No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code. Section 25505.25533 and 25534.1 understand that if the building does not currently a tenant. that It is my responsibility to notify the occupant of the requirements which m t mat of a caurcao of Occupancy- Signature of Applicant Date �_&P) All roof coverings to be Class '%4'' or better ' Owner or authorized agent Date BMLD(NG DIVISION PERMIT BUILOWG ADDRESS: 10870 N STELLING RD TAEST BUILDERS, INC. ]WNER'S NAME VSII,A CALIFORNIA LIMTD 1608 4TH ST STE 120 P .TTL�D C'UT Tl (510) 525-9378 ARCffMCT%FNGWEER: PHONE rr: Cd DC ❑ Eluilt-Up Roof m us;: ❑ 10T'CHENN REMODEL rj n�i PLANNING 77-3308 x > GAS TEST Q FOUNDATION/PIERS/Hn.S. J FIRE - CALL (408) 378-4010 a � UFER GROUND � Wy PAD/SET BACK -CERT Y l GARAGE KKOPREGUNTTE r� J Z MECHANICAL 00 ENERGY Z UNDERGROUND/SLAB` F `a UNDERGROUND PLUMBING UNDERGROUND ELECTRICAL UNDERFLOOR PLUMBING ' UNDERFLOOR FRAMING VENTS UNDERFLOOR INSULATION ROOF SHEAXWDIAPHRAGM PLUMBING TUBS & SHOWER PAN MECHANICAL ELECTRICAL/POOL BOND FRAMING/SI'AMME. EGRESS INSULATIONIVENTILATION EXTERIOR SFEAR/HOLD DOWN INTERIOR SHEAR114OLD DOWN SHEEIROCKISHEEZROCK SHEAR SHOWER LATH SCRATCH COAT SEWER/WATER TEMPORARY APPROVALS OCCUPANCY MQ77U22 e C7A-Ilf'aFm Qy- I ,E , P. XIUp4�EAOLT&(hday, at least 24 hours before required inspection. Job address and Permit Number are needed when requesting an inspection. RFI MMIMAL COMMERCIAL GrHU ❑ YES Ir yes . I undersand dm a Can A mof utanbiy is mquimcl. ❑ NO loidal - LC.>t.D. s 6 0 9 0 5 9- ; I IING ROOF COVERING Number of existing co•erings. To be removed To be reined Z �O ❑ Eluilt-Up Roof ❑ SFDWL ❑ 10T'CHENN REMODEL ? r j PLANNING 77-3308 x > GAS TEST Q GRADE (P.W.777-3354) Z FIRE - CALL (408) 378-4010 J -+ T. HANDICAP U ELECTRICAL p PLUMB ING _ r� J Z MECHANICAL ENERGY VISUAL FINAL ONLY PRE-QyS?ECTION: INSF TEAR OFF INSPECTION: TYPE OF ROOF COVERING - rtulArt ru. 3030155 kEnar L -51M DAT. 7/09/2008 Wff AKY NO. CONTROL NO. BUILDING PEtM171724 D SLOG ELWr PLUMB MECH $17295 COAIl4IERCIAL ❑ N9W BLDG/ADDITION ❑ DEMOLITION ❑ TENANT r' ❑ FOOD SERVICE IMPROVEMENT ❑ OTHER EXISTING: PROPOSHD- ❑ Built -Up Roaf ❑ Eluilt-Up Roof ❑ SFDWL ❑ 10T'CHENN REMODEL ❑ ADDITION ❑ PLUMBING R.E-PIPE ❑ MULTI -UNCI' ❑ ST UCI'URAL Cl Other (Specify) MODERCA37ON ❑ INTERIOR ❑ CHIMNEY REPAIR MMOVIDAENT ❑ SwWAWG POOLS ❑ BATH REMODUAEPAIR ❑ DEMOLMON ❑ OTI-EER $17295 COAIl4IERCIAL ❑ N9W BLDG/ADDITION ❑ DEMOLITION ❑ TENANT r' ❑ FOOD SERVICE IMPROVEMENT ❑ OTHER EXISTING: PROPOSHD- ❑ Built -Up Roaf ❑ Eluilt-Up Roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shaloss ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles Cl Other (Specify) ❑'Other (Specify) NO FINAL INSPECTIONS Pro -id. I.C.B.O. Report No, _ UNTIL ALL REQUIRED BUSINESSPravide Mfgr. Installadon Spea INSPECTION SPECIAL INSPECTION REQUIRED DATE ThsP s CUPERTINO SANITARY DISTRICT Closed circuit video Inspection of property One cleanout, point of connection and street lateral required prior to passing FINAL CITY PLUMBING INSPECTION. Cad the District (408-253-7071) for an appointment IMPORTANT When a permit has expired,.a charge totaling one-half the fees to obtain a new permit must be paid to reactivate the permit. If a permit has been expired for more than one year, a charge totaling the full fees to obtain a new permit must be paid to reactivate the permit. OF OCCUPANCY PLYWOOD: DATE INSP. DATE BATTENS: IN -PROGRESS: INSP. FINAL DATE INS?. DATE INSP. DATE - lNS?. DATE NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION 03/07/2008 15:22 FAX 408 777 3333 CITY CUPERTINO ' MIAQ He a CITY OF CUPERTINO DEMO CUPERTINO PERMIT APPLICATION FORM Ig 001/005 6,3i71e) 0,eD3 O/�� APN# 32 (0 — oc� Fee ID Date: 3 O g Building Address: 6Og—!bg.^ Permit Type Mailing Address (if different from building address): IDEMORES lC Oo SNV-f-f - l60/ S�v-, Owner's Name: c, C�.lt �,,� , Phone: (l Seismic Residential o c-13 Contractor: Phone; 51 C> 5.2 — A3� j (,�•Gs - �,�1iac�� B Fax: 5ta 525-0555 Contractor License #: (6-a.5 1BSEISMICOM Q�pqtno Business License #; TPD B Contact: Phone: 1 t�-"'� �o..�Mo rc,•��Eo . Fax: 1BUSLIC Residential 91 Sq Footage Commercial ❑ Sq Footage Job Description- `` i c. ul CSG �C Valuation: F71 22S. Attach Green. Building Checklist to demo playas. Quantity' Fee ID Fee Description Fee Group Permit Type IDEMORES Demo -Residential B ISFDWL-DEM IBSEISMICRE Seismic Residential B IDEMOCOM Dema -Commercial B WONMIL-DEM 1BSEISMICOM Seismic Commercial B 1BUSLIC Business License B F1 CITY OF CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS:l0'5-70 Kcd� PERMITD OWNER'S NAME: PHONE # le 5O "131 -34 6-1 GENERAL CONTRACTOR FAX # U 991-23b5-7 I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date UIA� Vlw'n` ontractor Signature Date 60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal eet Rock e UIA� Vlw'n` ontractor Signature Date