02070062 CITY OF CUPERTINO � $'S!'*�+e'�y_<�'��� 4yy��-" y1 �`7�, � s �`{"�
BUILDING DIVISION PERMIT Nrl..R271• � R INF QiAll� NRQN�'
.,,,,ban ., .?'des �
BUILDINGADD.PSS; PERMIT NO.
225 1 RICARDO RD. LOT 4 02070062
:'S NAME: 10413 TORRE AVE . - PERMITISSUEDATE
IVIOSHE MENDELSEN 02/27/2003
PHONE: (408) 781- 7620 SANITARY NO. CONTROL NO. .
ARCHITELTIENGINEER: BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
o o LICENSED CONTRACTOR'S DECLARATION ,,,���22y,,,rrr�����a O O O O
(� 1 ion? )farm that 1 am trate under provisions of,Curb. 9(commencing �� ���
z1
with Sarceand10nrDlvhlon3o(dtcBuainessandProfeuiomCode,mtlmylicemcis SFDWL LIVING SP
in full forte end effect
��Z Datc Clans lb.
q Dam Ca.vactor GARAGE 562 SQ F
qpp ARCHITECTS DECLARATION aI
y y Iunderstand my pl)ns.hall he used u public records DEC o}f' LOO4
3� Licensed pndessional
OWNER-BUILDER and
PDECLARATION BUILDING( ■I ®� ■
+� S 1 berchy affirm that I am exempt from the Contractor's License Law for the {D�U '`V,
Sio following mason. (anion ]1131.5,Buatheumal vet dcroli Code:Any city or county
$' which requires u permit m trim i t,altea improve,formch rune e mi n m mash any moment
b,jy that be prior miuiuvaacaluantto to theisions o beCorretor'sule ,Law(signed sutemcm
gga (commiscttmedpurstion7N)ofDiviovofofINBuinessalmnuctaw(Corner 9ode)or Sq.Ft.Floor Area Valuation
(commencing exempt
Nsereirom andth Division nftWegedc mpton.nd Any
Code)or .$445000
Net he Is 31.5 b therefrom and the burs for to)lieges,exemWm,Any it penalty
of
Semon than five
)ray red dollars
for(a permit mbJecu be applmmt m a civil prnalry of PaA pp��*nTi 1,
not mom Nen rave hundred dal W.(g3o�. 3 D O V 1NaIpI�eT 0 0 Occupancy Type
01,As ofdte pvpmy,ormyemploycet with wguulheirmle eompematlon. DOV U 1
will do IN work,and rite structure is not Intended maffered for tale(See.7044,Business ,p�,.,...�{
And Profession,Cods:The Coroaclor',License Law does not apply m m owner of 101 - FOUND�P41UI 1@d Inspections
property who builds or improves,thereon,and whodoeuuch weds himulror through his _. :...,._102 - PIERS ., .. _ _ -_ __. ......_.. .... _--•..-__
own employtos,provided than such Improvemenu are not Intended at offered for sale.IL
however,she building or improvement it sold within one year or completion,the owner. 103 - UFER I
builder will have rite burden of proving Nu he did not Wild m improve for purpose or 10 4 - REBAR
.I.J. ,
❑h ea owner of the property,am exclusively contracting with Demand contractors m 105 - ANCHOR BOLTS . .. L.
construct the project(Sec.7040,Business and Profculons Code:)The Contractor's LI-
comeLawdoesnotapplytoanownerof property who Wilda or improves themon,and, 106 - SEWER & WATER
1� conmrl4for Such proJecBMNacontractor(»licensed pursuantmNeComrattor'. 202 - UNDERFLOOR PLUMBING
Cmenx rsw, -
a¢mIvneerSee ,BA PC for this n 203 - UNDERFLOOR MECHANICAL
t l�D. 2204 - UNDERFLOOR FRAME
v� woRKeR'sc MPFNSA HDEc ATN 205 - UNDERFLOOR INSULATION
IhembyaRrmunderPenallyofperjury ane of the to owing eaiuWon,: 301 - ROUGH PLUMBING ')
❑Ibaw and willmeinuine CartiaceteofConuntmrelf-Imam forWarkers Camprn- 302 - TUB & OR SHOWER 'ry
.alio.,u Section provided for by Seon 37of the Labor Code,for the Performance of the
work for which this permit 1.issued. 303 - ROUGH MECHANICAL 1
304 - ROUGH ELECTRICAL
My
❑1 have and will maimar.Worker's Compensation u on Insurance, required by section y
3700 of Ne Mbar Cod0. Ror
for Nepemmesorwork forwhichNi.permit Is Issued. r
My workers sati
Cnmpenan Insurance carrier)rted Peary number are: 305 - FRAME !I;
Caere- Policy No.: .306 - HOLDOWNS IMI
CERTIFICATE OF EXEMPTION FROM WORKERS' - 3O7 - INSULATION i
COMPENSATION INSURANCE
(MIAmotion need not W completed the Permit 1.rte one hundred dollars 308 - SHEETROCK
,,ries.) 309 - EXTERIOR LATH
I certify them in�Ibpcpc}f]n menee of Ne work for whish Nb pnsnrt is rusted.I.hell not 310 - INTERIOR LATH
employ anyR r manncrmum Wamc subject mthe Wortrn'Compematlen �
uw.arealu ma�a`le 311 - SCRATCH COAT
ppm ant i �'-Z,I 313 - ROOF NAIL- SIJ
ETO APL A If,a reeking Is c acem of Exemption,you should
come tubJectmNe Woher'a Compcwtlon provitiom of Ne lshnr Cndc.you must 501 - FINAL ELECTRICAL ENERGY
,`� forNwiNtomply wiN,ah pmvisiom mNis permit Na116e damW revoked.
0 502 - FINAL PLUMBING ENERGY
CONS.I..,0NLENDINGAGENCY 503 FINAL MECHANICAL ENERGY
E�^ Ihemhy aliitm that NemUCTIO ter ENDIendiACEN ryforNe performena of
the work for which this penis isimued(Sec.3097,Civ.C.) 504 - FINAL BUILDING ENERGY
ILl lendres Ham.
jZ Lander'sAddress 505 - FINAL ELECTRICAL
U 0 1 cenrfy Net 1 haw read 1N,application and sum that the aWw Information Is 506 - GAS TEST
Ig.P cO.em.I agree m comply with all city and county ordinances and amid law,relating to '] - - FINAL PLUMBING
0 building convection,and hereby AuNotlye representatives of this city to enter upon Ne
W shove.meri oned property,for Impaction purpose. O - F I%wi—I—Date
I CAL
fk. (We)Agate m saw,indemnify and kap harmless No City of Cupertino against
Tag
liabilities,Judgments.cosu and expeose,which may inmyway gameagaimtmid City 9 FI'in consequence of the granting of this Forth. SAPPLICANT UNDERSTANDS AND WILL COMPLY WI A L NON-POINT Issued by:
S CE REGULATIONS. ,A\ `
`f\ ���///��- Re-roofs 602 OOF PLYWOOD NAIL
S%
u of tic HAZARDOUS MATERIALS DISCLOSURE ractor Date Type of R0610 3 — ROOF BATTENS
Will the applicant or forum building occupant store or hanmr haymdou,materiel 604 - ROOF IN-PROGRESS
red by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Section25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Yos
Will the applicant or future holding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haxamous air coniaminanu as defined by the Bay Arca Air Quality Management all new materials for inspection. I�
District?
❑Yes ®ago
I haw&s ki Nwc,&hazardous mamd5.2553als .dm 5 4,1.nder Chesson aof No Califon Y
blaHnt hSarctyhowa toetlom2550S 2myomdmia Iunrk or excuo sof thng
e
docs not cr hi haw t tenant.p it h su me.f a cEty GI' occupant of rime
roquidIfo which muuWmn p'rmiuumcc ofa CcniOcat, mrmtr. Signature of Applicant Date
Owlt T /� ,
.4&amhe,ed agent a, f All roof coverings to be Class"B"or better