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10030012CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10556 LA.RRY WAY CONTRACTOR: TBD -TO BE DETERMINED PERMIT NO: 10030012 OWNER'S NAME: PHONE NO: LICENSED CONTRACTOR'S DECLARATION r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Ys, Lic. # ] a f % r r r MECH RESIDENTIAL COMMERCIA Contractor � provisions of Chapter 9 JOB DESCRIPTION: ADD ATTACHED 20X30 IN-LAW QUARTERS(6005 ) (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I 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 performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $90000 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 31602026.2NDUNIT Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STAR D to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities, judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with RE -ROOFS: ❑ OWNER -BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed. If a rool is installed without first obtaining an inspection, I agree to remove all new materia for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with Licensed contractors to ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of th 1 have and will maintain a Certificate of Consent to self -insure for Worker's California Health & Safety Code, Sections 25505, 25533, and 25534. I will n aintain Compensation, as provided for by Section 3700 of the Labor Code, for the compliance with the Cupertino Municipal Code, Chapter 9.12 and the Healt i & performance of the work for which this permit is issued. Safety Code, Section 25532(a) should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance, as provided for by Additionally, should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code, for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. I certify that in the performance of the work for which this permit is issued,l shall not employ any person in any manner so as to become subject to the Worker's :0/ b become subject to the Worker's Compensation provisions of the Labor Code, l must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that -there is a construction lending agency for the performance oi work's APPLICANT CERTIFICATION for which this permit is issued (Sec. 3097, Civ C.) 1 certify that I have read this application and state that the above information is Lender's Name correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit. Additionally, the applicant understands and will comply I understand my plans shall be used as public records. with all /Z-0 le v CITY OF CUPERTINO BUILDING PERSION # BUILDING ADDRESS: 10556 LARRY WAY CONTRACTOR: MICHAEL WAWlE RMIT N 030012 CONSTRUCTION OWNER'S NAME: SANTA CLARA, CA 95050 PHONE NO: (408) 615-8004', ❑ LICENSED CONTRACTOR'S DECLARATION I— I— r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lie. # MECH RESIDENTIAL r COMMERCIAL. Contractor Date I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: ADD ATTACHED 20X30 IN-LAW QUARTERS(6009.Q) (commencing with Section 7000) of Division 3 of the Business & Professions 7/27/10- REV#1- NEW CAL & ROOF SHEER WALL-REV#I ISS'D 8/5/10 Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I 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 performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $90000 l have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 31602026.2NDUNIT Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply :7 Issued by,—� Date j < with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is 34- OWNER -BUILDER DECLARATION installed without first obtaining an inspection, I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: Signature of Applicant: Date: 1, as owner of 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 & Professions Code) ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). HAZARDOUS MATERIALS DISCLOSURE 1 hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 of the declarations: California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will 41aintain I have and will maintain a Certificate of Consent to self -insure for Worker's compliance with the Cupertino Municipal Code, Chapter 9.12 and the Heath & Compensation, as provided for by Section 3700 of the Labor Code, for the Safety Code, Section 25532(a) should I store or handle hazardous material. performance of the work for which this permit is issued. Additionally, should I use equipment or devices which emit hazardous air I have and will maintain Worker's Compensation Insurance, as provided for by contaminants as defined by the Bay Area Air Quality Management District I will Section 3700 of the Labor Code, for the performance of the work for which this maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Sections 25505, 25533, and 25534. 1 certify that in the performance of the work for which this permit is issued, I sha not employ any person in any manner so as to become subject to the Worker's Date: Compensation laws of California. If, after making this certificate of exemption, l become subject to the Worker's Compensation provisions of the Labor Code, I mu CONSTRUCTION LENDING AGENCY forthwith comply with such provisions or this permit shall be deemed revok I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) APPLICANT CERTIFICATION Lender's Name I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating Lender's Address to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all / Licensed Professional 9.18. Signature Date r' 0 CITY OF CUPERTINO BUILDING PERMIT - ---- MAXE 1C)�2�-� BUILDING ADDRESS: 10556 LARRY WAY CONTRACTOR: MICHAEL MCKINZIE PERMIT NO: 10030012 CONSTRUCTION OWNER'S NAME: ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I 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 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, wil I do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licen tractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I 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 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, 1 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemeqrev9ked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, he applicant understands and will comply with all non -point source regulation per Cupertino Municipal Code, Section 9.18. �_ 1_6 3575 THE ALAMEDA SANTA CLARA, CA 95050 DATE ISSUED:06/14/2010 PHONE NO: (408) 615-8004 BUILDING PERMIT INFO: BLDG r— ELECT I— PLUMBir MECH r— RESIDENTIAL r— COMMERA r— JOB DESCRIPTION: ADD ATTACHED 20X30 IN-LAW QUARTERS(600 Q) 10/26/10 - REV#2 - WOOD DECK/COMPOSITE 17X17 & 6V-1-f7 for kf, t\ OU Sq. Ft Floor Area: Valuation: $90000 APN Number: 31602026.2NDUNIT Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARVED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued b �-----Date: ,-'e RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of tt California Health & Safety Code, Sections 25505, 25533, and 25534. I will aintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Secti s 25 05, 25533, and 25534. : CONSTRUCT11 LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed Professio