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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