00060043 CITBUIL ANG DMS IN PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
2011D5 FOREST AV BOB GERE MASONRY 00060043
OWNER'S NAME. APPLICATION SUR DATE
LEE FdN Q ET AL 480 CROSSLEES DR 06/07/2000
ZONE: SANITARY NO. CONTROL NO.
(408)972-1285
O O ARCIIIT[CT/ENGINF.ER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
H n IJ 1= L=J
i S N i LICENSED CONTRACTOR'S DECLARATION Job Description '
O Z_8 1 hneby affil ,hat 1 am licensed under provisions of Chapter 9(commencing - P
_� with Seaiun 7000 of nlnfthe Businessarta Professions COJe.unJ mylicenu
a —� isinfull force arta e,y�y
�� LittaeClass CMZ q . SQ� REPAIR CHIMNEY
5 Dare_p C:,nln,eur
I- ! d'� ARCllrn:cr's DEcm ITT Y
} I codef moo my plans shall Ie used as public rewords
i z n O Liccnwd Pmfeainwl `
le OWNER-BUILDER TI CLARATI0N
1 herehy altirm that 1 urn exemp,Gam the Cnnharou a License I,uw I.,use
(_=a following reason.(Section 70315,Business anti Professions Code:Any city or county
F C which requires a permit to construct,alter,improve,demolish,or repair any someone
�3Cse form to its issuance,also requires the applicant or such permit to rile a signed statement
22 ,hathe is linen•ca parasitism mine pronaoanf,e Cintmcto'e License Ww,ch.merySq. FL Floor Area Valuation
(eenuuencing.,In Section 7111N1)of Duot,inn 3 of the Business wed Pnrfc..ions Chair)
or that he is exempt therefrom and the basin oldie alleged exemption.Any violation ,
of Section 7031.5 by any applicant for a Permit.subjects the applicant to u civil penalty
of.,it tame than Five handled dollars(s5e0). A PN Number Occupancy Type
❑1,a%ownet of the property,or my employees with wages its then sole conmpemn:mlon,
will do the w„rk,and the saturnine is nm intended tar o1'R•red in,,sale risen.7(lia, 316330691 Mal
Required Inspections
Businr_ss and Prom,,ions C Jc:The Commit., License Law does nm 'a
apply an
owner of propeny Who builds or improves thereon,and who does such work him'] ,
or mmugh his own employees,presided thm such impomemems are not intended or 101 — FOUNDATION
offered for sale.It,however.the building or impm
roveenl is nNa within one year of
aonpfetlon,the owner.haimer will h:we the burden of proving that Inlaid lot blind or 31?_ — CHIMNEY REBRR R STRAPS
in,pn,se humorist,of&pled.
CI 1,as owner of the property,at exclusively contracting with licensed commctors to 5141 — FINAL PUBLIC WORKS
consumer the project(Sec 71141,Business and Professions Code'The Coalm.....
].'cense Low docs not apply loam owner of property who hulWs or lmpmves phaco,
and who u r rs,,,kir such projects with n eanuaemr(s) licensed pursount n,the
Contractor's License Law.
❑1 am exempt under See. ,B&P C for this reason
Owner Date /
WORKER'S CUMPENSAfIt1N DECLANA'1'I0N
I hereby affirm under penalty of perjury one of the following declarations:
k1 hove tad will maintain a Ccnifcae of Consent m sell-insure for Worker's - V
m pon'I onI as
provided fill by Section 37181 of the Ichor Code, for Ile. '
erlmounice of the work for%Inch this permit Is issued
❑1 have and will maintain Worker's Compensation Ism unee,as required by Section
370()of the Who Code,for the performance of the work for which this permit is
isxneJ.il�ly(�Wo�rker's Compensnrion Insurance copier and Py�licy num he yr v(y�
Currier:_�(LI I,j-1'1_Policy No.: —`-' — I /
CERTII'ICA ION OFFE%EMPI'[ON F M WORKERS'
COMPENSATION INSURANCE
(This section need nor he eumplcmd'f ire permit is Toone hundred dollars
SI Will less.)
1 ramify that in the performance of the work fm which this permit is issued,l
shall not employ any person in any manner u as to become subject to the Worker:
Compensation Lows of California.Date
Applinun .•,
NOTICE TO APPLICANT:If,all"making this Cenificae mf Exemption,you should
-Z became subject m the Workers Compensation provisions of the Labor Code,you must
,ZQ 0 forthwith comply will such provisions mild,permit shall be deemed revoked.
^F CONSTRUCT ION LENDING AGENCY
a I hereby aflion that there is a commotion lending agency for the performance
of the work for which this permit is i...ad(Sec.3097.Civ.C.)
tY Q
Larder's Name
Z lander'&Addm,x
U 1 certify that I hmerwd Ods upplica,ion and state that the uM1nvc Inrormmion is
kin E.r corer.1 agree mm comply with all city and county renounces and&tote laws relating -
(� to building eomtrrion.and hereby authorize mprem
seatives ofthis city inciter upon
the amaze-hicadi rid property for inspection purposes. +
(We)agree minor,indemnity and keep harmless the City of CoNitimn against
Fr 0 liahilitics,judgment,,costs.and circuses which may In any way acerae against said
U y Airy in consequence of the grunting of this rennin.
APP LICANTUar.of he rota AND WILL COMPLY WITH ALL NON POINT
SOURCF F,tIA o' Issued Date
/��o_rL
Signut Applicum/ tract Dam Re-roots
II LARI MATEItIAI,S DISCLOSURE
Pill me applicant or m nauaing perapant nmme tar nanme nammdman ria an Type of Roo
adefinedby,he Cupertino 1unicipal Calc,Chager 9.12.and the Heahh enA Safety
Cale.Section 25531(.)?
El Yef No All roofs shall be inspected prior to any roofing material being installed.
Wi 11 the applicant or farm building occuramt use equipnan,or devices which If a roof is installed without first obtaining in inspection, I agree to remove
emil hazardous air contaminants as defined by the Bay Arc.Air Quality Management
District? �{ all new materials for inspection. Applicant understands and will comply with
❑Yes XNo. all non-point source regulations.
I have read the hazardous nnoerias all irements under Cramer 6,95 of the
Cadmium.Hinflih-&Safety Cola Sections 25505,25533 and 3534.1 amderstama,hat
if the building does not currently have a tenant,that it is my mcNnsibi]imy to nodfy the
mcmpam of the requirements which must be met prior to issuance of a Certificate of
Occupancy. ,
�QQ Signature of Applicant. Date
Al
ow - thmrizea en, I roof coverings to be Class"B" or better
I
OFFICE
CITBUIL ANG DMS IN PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
2011D5 FOREST AV BOB GERE MASONRY 00060043
OWNER'S NAME. APPLICATION SUR DATE
LEE FdN Q ET AL 480 CROSSLEES DR 06/07/2000
ZONE: SANITARY NO. CONTROL NO.
(408)972-1285
O O ARCIIIT[CT/ENGINF.ER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
H n IJ 1= L=J
i S N i LICENSED CONTRACTOR'S DECLARATION Job Description '
O Z_8 1 hneby affil ,hat 1 am licensed under provisions of Chapter 9(commencing - P
_� with Seaiun 7000 of nlnfthe Businessarta Professions COJe.unJ mylicenu
a —� isinfull force arta e,y�y
�� LittaeClass CMZ q . SQ� REPAIR CHIMNEY
5 Dare_p C:,nln,eur
I- ! d'� ARCllrn:cr's DEcm ITT Y
} I codef moo my plans shall Ie used as public rewords
i z n O Liccnwd Pmfeainwl `
le OWNER-BUILDER TI CLARATI0N
1 herehy altirm that 1 urn exemp,Gam the Cnnharou a License I,uw I.,use
(_=a following reason.(Section 70315,Business anti Professions Code:Any city or county
F C which requires a permit to construct,alter,improve,demolish,or repair any someone
�3Cse form to its issuance,also requires the applicant or such permit to rile a signed statement
22 ,hathe is linen•ca parasitism mine pronaoanf,e Cintmcto'e License Ww,ch.merySq. FL Floor Area Valuation
(eenuuencing.,In Section 7111N1)of Duot,inn 3 of the Business wed Pnrfc..ions Chair)
or that he is exempt therefrom and the basin oldie alleged exemption.Any violation ,
of Section 7031.5 by any applicant for a Permit.subjects the applicant to u civil penalty
of.,it tame than Five handled dollars(s5e0). A PN Number Occupancy Type
❑1,a%ownet of the property,or my employees with wages its then sole conmpemn:mlon,
will do the w„rk,and the saturnine is nm intended tar o1'R•red in,,sale risen.7(lia, 316330691 Mal
Required Inspections
Businr_ss and Prom,,ions C Jc:The Commit., License Law does nm 'a
apply an
owner of propeny Who builds or improves thereon,and who does such work him'] ,
or mmugh his own employees,presided thm such impomemems are not intended or 101 — FOUNDATION
offered for sale.It,however.the building or impm
roveenl is nNa within one year of
aonpfetlon,the owner.haimer will h:we the burden of proving that Inlaid lot blind or 31?_ — CHIMNEY REBRR R STRAPS
in,pn,se humorist,of&pled.
CI 1,as owner of the property,at exclusively contracting with licensed commctors to 5141 — FINAL PUBLIC WORKS
consumer the project(Sec 71141,Business and Professions Code'The Coalm.....
].'cense Low docs not apply loam owner of property who hulWs or lmpmves phaco,
and who u r rs,,,kir such projects with n eanuaemr(s) licensed pursount n,the
Contractor's License Law.
❑1 am exempt under See. ,B&P C for this reason
Owner Date /
WORKER'S CUMPENSAfIt1N DECLANA'1'I0N
I hereby affirm under penalty of perjury one of the following declarations:
k1 hove tad will maintain a Ccnifcae of Consent m sell-insure for Worker's - V
m pon'I onI as
provided fill by Section 37181 of the Ichor Code, for Ile. '
erlmounice of the work for%Inch this permit Is issued
❑1 have and will maintain Worker's Compensation Ism unee,as required by Section
370()of the Who Code,for the performance of the work for which this permit is
isxneJ.il�ly(�Wo�rker's Compensnrion Insurance copier and Py�licy num he yr v(y�
Currier:_�(LI I,j-1'1_Policy No.: —`-' — I /
CERTII'ICA ION OFFE%EMPI'[ON F M WORKERS'
COMPENSATION INSURANCE
(This section need nor he eumplcmd'f ire permit is Toone hundred dollars
SI Will less.)
1 ramify that in the performance of the work fm which this permit is issued,l
shall not employ any person in any manner u as to become subject to the Worker:
Compensation Lows of California.Date
Applinun .•,
NOTICE TO APPLICANT:If,all"making this Cenificae mf Exemption,you should
-Z became subject m the Workers Compensation provisions of the Labor Code,you must
,ZQ 0 forthwith comply will such provisions mild,permit shall be deemed revoked.
^F CONSTRUCT ION LENDING AGENCY
a I hereby aflion that there is a commotion lending agency for the performance
of the work for which this permit is i...ad(Sec.3097.Civ.C.)
tY Q
Larder's Name
Z lander'&Addm,x
U 1 certify that I hmerwd Ods upplica,ion and state that the uM1nvc Inrormmion is
kin E.r corer.1 agree mm comply with all city and county renounces and&tote laws relating -
(� to building eomtrrion.and hereby authorize mprem
seatives ofthis city inciter upon
the amaze-hicadi rid property for inspection purposes. +
(We)agree minor,indemnity and keep harmless the City of CoNitimn against
Fr 0 liahilitics,judgment,,costs.and circuses which may In any way acerae against said
U y Airy in consequence of the grunting of this rennin.
APP LICANTUar.of he rota AND WILL COMPLY WITH ALL NON POINT
SOURCF F,tIA o' Issued Date
/��o_rL
Signut Applicum/ tract Dam Re-roots
II LARI MATEItIAI,S DISCLOSURE
Pill me applicant or m nauaing perapant nmme tar nanme nammdman ria an Type of Roo
adefinedby,he Cupertino 1unicipal Calc,Chager 9.12.and the Heahh enA Safety
Cale.Section 25531(.)?
El Yef No All roofs shall be inspected prior to any roofing material being installed.
Wi 11 the applicant or farm building occuramt use equipnan,or devices which If a roof is installed without first obtaining in inspection, I agree to remove
emil hazardous air contaminants as defined by the Bay Arc.Air Quality Management
District? �{ all new materials for inspection. Applicant understands and will comply with
❑Yes XNo. all non-point source regulations.
I have read the hazardous nnoerias all irements under Cramer 6,95 of the
Cadmium.Hinflih-&Safety Cola Sections 25505,25533 and 3534.1 amderstama,hat
if the building does not currently have a tenant,that it is my mcNnsibi]imy to nodfy the
mcmpam of the requirements which must be met prior to issuance of a Certificate of
Occupancy. ,
�QQ Signature of Applicant. Date
Al
ow - thmrizea en, I roof coverings to be Class"B" or better
I
OFFICE
CITY OF CUPERTINO PFRMrr No.
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
004o� O
BUIWING ADDRESS: / - ,,
Z n I O� ✓�S� `m — �ph L l �/t C SANITARY NO. APPLICATIONS MnTAL DT'FE
OK'NGR'S NAM1f Ii��� / /✓Ip (f
N/C CO.Y1130L
C:
. PHONOO
ARCH
TfECr/ENGINE[R � / �' • ! ��/T BOILING PERMRINIU + y `;
�00
C
U d
7 LIC4ISF CONfRAC11ORS DeCLARATION
z - 1l�etyarmpN,LIamlieemedoo�poor arcn.pm9f=amnemug Job Description
wiNS voe]000)ofDivivon 3oflW Bud®.ad Rofessiam Code,aE wry lssueu
Fxi Nrw ferea.m arm.
tM6 LaaCT.v R g,723rF? 8 Rem":&( �Ci tcltPh GtKe( 3 �gE �iraoveu
IAse Catvma y
C LL O S ARCHr1ECI's ce oN
tlufl u.ml to publk 11 v.m
Ks�a
PMea mal
A'a OW NER.BIIBDER Dt 0,c ATION .
i=2 M 1 bvcby afire Nan 1 Im eemp form Ne eizi near. -My c Law no Nc
f D ro oSilumi.(Secllat ]O)IS,Biuim..od Au.� i tuck Amy can a marry
ansa. $ which mryiru.ymndo to mmwn.w1k i t for ro denld'Wit a rtpw.%.rmmue
phase 11--1'also
ntto cies uK.�be a fa.�ngtena'. 9g�etbapmee Sq. Ft. Floor Area ?0 Valuation
dantWuIlopr.d�tosixa Division
Sof Coeoacleas Lil L.a'(Chapmr Z (f 1J J j
(Codolt see.nom ttSsJ.on anti)dDliuo m3 dNe Bwixu udon, c 'vu Cadc)v
daL h.i,nIJ1 b Nm applicants
anal de wi.a Ing m Re e.gmpean.Any l peream d APN Number Occupancy Type
SCNm]O31�by any apPBoafaapamRmbjecu Ne applk.0 loacivil Peary of — 3 >— �6 St,h )
na ripe Oua fl.e Wtdcd dollar(5500). ^
❑I.uIdlWpapmlr.amrNw%m�m..R,..mor.gle�IgPm..am, Required Inspectiordt
w10 do lbew and the egl Iluglaled a offend fa sale ISec.]pLf,B.
and Plofusiam code:The Cowaria'.Lrsme lav don ea api 19 an ower d
piopmy vW W iMs or inlpra.a Ihvmn,and wW does.acb w hinnsH a Neopn
his own emPI y provided Nn R ioWrvrnlwu sae not inteMed a oRaed for
ale.If,how .Ilse wilding or wipoossoicn,L sold v thin one year al covgkoae.Ne
ovrcs-0 Wer vl hale IW Wide d pvvly ILt W diad mbuild sing efape-
❑I,a 1 ft c oi the See. ,,B gaclu aoci cwvacuy wuh:)meed c o-I&s U.[1 1,. NC plaj h(prix et t y,.BYY W..ad R atraanMi Cade:)The calPCml!u.
cmuetaw sine.m�apply m an ave d popery wW bolds a impove tbono ,and
wW coovaro fa rub poj.w .convaetor(s)IrwN pelmet In Ne cnna .
no aw y/
I mo u uMv Sen. B tO P C,flw'tlri.yrus-m V -
OwnerT.
linoWORKER'SCOM of'tnj TON aCLARAt10N
I hmebY afire oMer peaty d pmJllry goe d ds following dalvanioe: `�
❑I here W will mmnUm.Cauflurg dCoean m.eU.inwug fa Wohglacal�e-
utiol. r pori t Tor by Sg ia- JI00 d do tabor Code.fa Ne pvfavugcg of We
work ra wfiicn Ni.prep is erwi, -
❑1 lu.e.gd rill Ieivwn w«ter.Cwppe.aWn Imlmrc<.m lequ'ud by Secooe _
My dIhlabor Code,fa the Pulaournnd Nc wvlk nuwort Nup�eu Bhared.
MYWoiters Canlpeoutim Inruuec rartim.I Polk:numba.m
Cannv. Policy RO
CERfQ'IC OM OF NIMN ATIO UNN FROM WORICFJIS'
CVMPFI.'SAITON INSURANCE
(This.ectioa geed not W eoliplmcd if IW pmmt a faoee hind ddW($100) '
a kat
Ioy any pe in the p,non adinewk neobje is the w aiaad,I shill
oa gmpl%anY pron in any menner.a..l0 beNne"anRvt m Ne WaMn'Car� .
Alma ur.d Cwfmvi..Dec
Applicanar
NOTICE TO APPLICANT:If,atm nuking Nis Caoflu¢th exvnpim.yen rtaWd
bombe anr*ttoent y tl Watds Caepcnr this povi.:wu d IW Lebo code,you oma
raNwiN comply wiN.vch provHim.a Ni.primp.bB W deemed mvokd.
CONMUCITON LBT.DING AOE
O p Ibeiby�Nor dem u.canurucllae lenNng mommy fa Ne pmfam.raed -
Z Ne wait fm which Nu pamr u iuued(Ss 3()9],Civ.C)
t:. lassie/e Name
CYi ? Lmdcr.Addimn
W A I mllfy Nu I have rod Nu.pplicaran ioe anal mote Nbe.bove inram.um Is
d a.I.guom
e Io cply aiN all cuM roo
r amy mNuaea and v.•lavg t
,relatino
7 Z care
WBdiy cwemvooa,and hereby awhoos mpmseutivn of Nu city meoee,opn Ne
V Q abovo-mgniad". Y for Iupembn,epees.
(K•e).pee to a.te,iodeamify anal nap bannlean the City of Cupeoiro.punt
O () nadlitiu,jdgeema,ev.0 wd capms wtib may in any way anme siaiw uitl City
S m gagre9agam d Ce gwdog or Rd.permiL
_ APPLICANT UNDERSTANDS AND WI U,COMPLY WITH A LL NON-POINT
V Z 6URCF. .GUTATION&
mere dA /
n,
pplicanvCowama ane
B
HAl.ARDOl1S MAIERIAIS DLSCLOSURE
WIIIW appkannafmlue Wilding¢ulpntnagan..elg haaotd mbnrial Re-roofs
as deflect by Ne Copmtitw Ms.ei vl Code•Chapm 9.1;mod Ne Health and Sorely
Code. 25532(.)' Type of Roof
El Yes
Will dle.wicmtarfuxe Wiwi,occident sae mp,ipme,Im dgvigm whish All roofs shall be inspected prior to any roofing, material being
g thaot aakennonsmanta..defladbythe B,a, r AuQuwtyManalpmem installed. If a roof is installed without first obtaining an inspection
❑Ye
LAVI� I a vee to remove all new materials for inspection. Applicant
INvg mead Ng h.mdou mnmWlegWmnevavdm Ch.pm 695dlbecali- understands and will comply with all non point source regulations.
(arch NeIN R Safety Cade,5 W i]5503.U533 and 25536.1 wdvemd Nal if de
WiMmg dm pal cu.na]y eic.eupl,dm h is In,2+Ponobinq to &y be..pw
d which Imm W InI n ismotsre ar. M
0 Signature of Applicant Date
ng.m.wtat»aa year Dare
All roof coverings to be Class"B"or better
OFFICE