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02050104WOO O m U Z y<a OZn` I-.2_uj �X�d a0 Xi e F F-�DQ urei�pc0c aXmlr. �?a fFo a OZ z� 0 �z UO wH OU W >" W Uz CITY OF CUPERTINO ' BUILDING DIVISION PE1%wiIT CUNTRACT R IN 4It r+ ' :4 T: BU RE1BAXLEY CT PERMIT 02 0 5 0 1 0 4 APPLICAO(BI UT 17A 0 0 2 PHONE: SANITARY NO. CONTROL NO. ARCH ITECTIFNGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing NEW SINGLE FAM P fto8I NG with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. 3692 SQ. FT. LIVING SPACE, 400 SQ. FT. GARA License Class Lic. p Date Contractor ARCHrEcrS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I 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 $393000 prior to its.issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 35606034.00 that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy p y Type not more man rive hundred dollars (asoo). 101 — FOUNDATION ❑ I, 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 We (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of 103 - UFER Required Inspections property who builds or improves thereon, and who doessuch work himself or through his own employees, provided that such improvements are riot intended or offered for sale. If, 104 - RE BAR however, the building or improvement is sold within one year of completion, the owner- 10 5 — ANCHOR BOLTS builder will have the burden of proving that he did not build or improve for purpose of sale.). 106 - SEWER & WATER 1. as owner of the property, am exclusively contracting with licensed contractors to 202 — UNDERFLOOR PLUMBING co struct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and 203 — UNDERFLOOR ME CHAN I CAL who contracts for such projects with acontractor(s)licensed pursuant tothe Contractor's 204 - UNDERFLOOR FRAME License Law. , ❑ I am der Sec., B & P C for this reason 205 — UNDERFLOOR INSULATION w er r7 / w// Dale Ir 301 — ROUGH PLUMBING WORKER'S COMPENSATION DEPCARATION Z302 — TUB & OR SHOWER I hereby affirm under penalty of perjury one of the following declarations: 303 — ROUGH ME CHAN I CAL ❑ I have and will maintain a Certificate of Consent to self -insure for worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 305 — FRAME ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 306 — HOLDOWNS 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: 307 — INSULATION Carrier: Policy Na: 308 — SHEETROCK CERTIFICATE OF EXEMPTION FROM WORKERS' 309 — EXTERIOR LATH COMPENSATION INSURANCE (-Chis section need not be completed if the permit is for one hundred dollars ($100) 310 - INTERIOR LATH or less.) 311 - SCRATCH COAT I certify that in the perfo once of the work for which this permit is issued, I shall not 313 — ROOF NAIL employ any Cah arnon i e anrle�s s to a subject to the Workers' Compensalion // 501 — FINAL ELECTRICAL ENERGY pnfiCa A LCA , after along is Certificate of Exemption, you should NOT C N6TT 502 - FINAL PLUMBING ENERGY become subject to the Workers Compensation provisions of the labor Code, you must 503 - FINAL ME CHAN I CAL ENERGY forthwith comply with such provisions or this permit shall be deemed revoked. 504 - FINAL BUILDING ENERGY CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of 505 - FINAL ELECTRICAL the work for which this permit is issued (See. 3097, Civ. C.) 506 — GAS TEST Lender's Name 507 - F I NAL PLUMBING Lender's Address I certify that I have read this application and state that the above information is 508 - F I NAL ME CHAN I CAL correct. I agree to comply with all city and county ordinances and state laws relating to 5 0 - FINAL GRADE r building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. 5 0 F I NA , PLANN I f (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs and expenses which may in any way accrue against said City 5 F N U LI WORKS ! J in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued bye'. 0 NAIL Date //p SOURCE ULATIONS. `�//—//� vla,41fi,tRe-roofs604 Type of Roof — OF IN— PROGRESS ' aturc of Applicant/Contractor Dite HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code. Section 25532(a)?All Yes roofs shall be inspected prior to any roofing material being installed. ❑ ff 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 hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑ Yes R<O I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534. I understand that if the building does not currently have a tenant, that it is my responsibility to no fy the occupant of the require which must m L prior t ante o a Certificate o ecu anty. Signature of Applicant Date ���� L� `� ` �/ �/� All roof coverings to be Class "B" or better 'Date Owncr or authorized agent uo0 (ZU n<� �? n( -Q i L. p14 yyggggH� iqC "zo u^v za zC G w� a UC wF y+ C ..4 0 U� M CITY OF CUPERTINO r x _.BUILDING DIVISION PERMIT � �N�`(�R�1 � ��R��TQ�t:'��'��+0" BUILDING ADDRESS: ALAN STOCKLMEIR PERMIT NO. OWNER'S NAME: PERMIT ISS A SANITARY N . CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. k REVISION ONLY Date Contractor ORIGINAL PERMIT #02050104 ARCHITECTS DECLARATION 1 understand my plans shall be used u public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 70313, Business and Professions Code: Any city or county which requires a permit to concoct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to Glc a signed statement that he is licensed pursuant to the provisions M the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy 7� not more than five hundred dollars ($500). P y TJ Pe ❑ L as owner of the property, or my employees with wages as their sok compensation, 35606034.00 will do the work and the structure is not intended or offered foraak (Sec. 7044, Business and Professions Code: The Contractors License Law docs not apply to an owner of Required Inspections property who builds or improves thereon, and who does such work himself or through his 101 - FOUNDATION own employees, provided that such improvements are not intended or offered for sale, If, 102 — PIERS 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 Wild or improve for purpose of 103 - UFER ask.). 104 - REBAR ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's LI- 105 — ANCHOR BOLTS. cense Law does not apply to an owner of property who Wilds or improves themon, and. 1 O 6 SEWER WATER who contracts for such projects with a contraemr(s) licensed pursuant m the Contractor's — & License Law, 202 - UNDERFLOOR PLUMBING ❑ 1 am exempt undo Sec , B & P C for this reason 203 - UNDERFLOOR MECHANICAL Owner Date WORKER'S COMPENSATION DECLARATION 204 - UNDERFLOOR FRAME 1 hereby of ince under penalty of perjury one of the following declarations: 205 - UNDERFLOOR INSULATION ❑ 1 have and will maintain a Certificate of Consent to self -insure for WorkeeaCompen- 301 — ROUGH PLUMBING cation, ss provided for by Section 3700 of the Labor Code, for the performance of the 302 - TUB & OR SHOWER work for which this permit is issued ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 303 - ROUGH MECHANICAL 3700 of the Labor code, for the performance of the work for which this permit is issued. 304 — ROUGH ELECTRICAL My Workers Compensation Insurance carrier and Policy number are: 3 05 — FRAME Carrier. Policy No.: CERTIFICATE OFEXEMPTIONFROM WORKERS' 306 - HOLDOWNS COMPENSATION INSURANCE 307 - INSULATION (This section need not be completed lithe permit is for one hundmd dollars ($100) 308 - S HE E TRO C K or less) 1 certify that in the performance of the work for which this permit is issued, 1 shall no 3 09 - EXTERIOR LATH employ any person in any manner so as to become subject to the workers' Compensation 310 — INTERIOR LATH Laws of California. Date Applicant 311 313 - SCRATCH COAT — ROOF NAIL NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must ' forthwith comply with such provisions or this permit shall be deemed revoked. 501 — F I NAL ELECTRICAL ENERGY CONSTRUCTION LENDING AGENCY 502 - F I NAL PLUMBING ENERGY 1 hereby affirm that there is a consmxtion lending agency for the performance of ' 503 - FINAL MECHANICAL ENERGY the work for which this permit Is issued (Sec. 3097, Civ, C.) j L.endcesName 504 - FINAL BUILDING ENERGY Lender's Address 505 - FINAL ELECTRICAL j 1 certify that 1 have read this application and state that the above information is coned I agree to comply with all city and county ordinances and state laws relating to 506 - GAS TEST building construction, and hereby authorise representatives of this city to enter upon the FIN PLUMB G above-mentioned property for inspection purposes. (We,) agree to save, indemnify and keep harmless the City of Cupertino against j Ilabilitlu, judgments, costs and expenses which may in any way accrue against said City O 8 F I L in consequence of the granting of this permit. 5 FING APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: 5446 Date SOURCE REGULATIONS. Re -roofs 514 692 Type ofR�o NAL PUBLIC WORKS — ROOF PLYWOOD NAIL Signature of Applicant/Contractor Dam HAZARDOUS MATMALS DISCLOSURE 3 - ROOF BATTENS Will the applicant or future Wilding occupant store or handle harerdous material as defined by tate Cupertino Municipal Codd. Chapter 9.12, and the Health and Safety Code, 6014 - ROOF IN -PROGRESS Yes ❑ No All roofs shalbe f inspecte prior to any roe log material being installed. 0Yes25532(e)? ❑ 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 cmll herardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? 0 Yes ❑ No 1 have read the hamrdous materials requirements underChapier6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that lithe W ik ing does not currently have a tenant, that it is my responsibility to notify the occupant or the requirements which must be met prior m issuance of a Certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class "B" or better