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09020025 CITY OF CUPERTINO BUILDING DIVISION PERMITL� RQRI�1 � IN. PERMIT NO. BUILDING ADDRESS: 10358 GLENVIEW AVE DP CONST TI PERMIT ISSUE DATE OWNER'S NAME: A CONTROL NO. 'ONE: (408) 605-2232 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 Z cc a LICENSED CONTRACTOR'S DECLARATION Job Description U I hereby affirm that I am licensed under provisions of Chapter 9(commencing z with Section 7000)of Division 3 of the Business and Professions Code,and my license is COPPER RE—PIPE e,y in full force and effect. 9 1j 3 t 22 z License Class �•X Date hn y /7�Contraclor _ T TARLJirrEcrs DECLARATION I understand my plans shall be used as public records �yU O yLicensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the .20 following reason.(Section 7031.5,Business and Professions Code:Any city or county ym 0! which requires a permit to construct.alter,improve,demolish,or repair any structure _ prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq % (commencing with Section 7000)of Division 3 of the Business and Professions Codc)or y that he is exempt thomfrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number not more than eve hundred dollars(M). 3 6 9110� 3 . 00 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 oroffered for sale(Sec.7044,Business Required Inspections and Professions Code:The Conuactoes License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, 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 build or improve for purpose of sale.). 1,as Owner of the property,am exclusively contracting with licensed contractors to tract 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. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑amW exemptRK�S B&P C for this n Ow �(fo?XPENSAnON Dale L U,3 ECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- .-.ton,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation insurance,as required by Section 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: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (•Ibis section need not be completed if the permit is far oris hundred dollars($100) or less) 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 Wo rs'Com nation Laws of Califomia.DYe Applic11025 ant YLi n NOTICE TO A f, r making tbiertificatc of Excntpdon,ybu smduld become subject to the Worker's Compensation provisions of the Labor Code,you must Z forthwith comply with such provision or this permit shall be deemed revoked. Z 0-4 CONSTRUCTION LENDING AGENCY E~.t►�-. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name IZ, Lender's Address I certify that 1 have read this application and state that the above information is LUL sorest.I agree to comply with all city and county ordinances and state laws relating to 0V building construction,and hereby authorize representatives of this city to enter upon the s W above-mcndoned property for inspection purpose a (We)agree to save,indemnify and keep harmless the City of Cupertino against H In liabilities,judgments,costs and expenses which may in any way accrue against said City L.", V Z in consequence of the granting of this permit bate APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: so U ONS. C� Re-roof; y � — tgn u of plicae onRDO Date T of Roof HAZARDOUS MATERIALS DISCLOSURE Type 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 roofs shall be inspected prior to any roofing material being installed. ❑Yes C?(No Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove L hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. ,trict? / GYes 0o 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Section 25505,25533 and 25534.1 understand that if the building does not currently have a tenant.that it is my responsibility to notify the occupant of the require mcDUOnEd'a9c . 5 met prior two ian aance of Certificate ofOc Signatui a of Applicant Date r All roof coverings to be Class'V'or better r own or 0 Date Community Development - 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 ClT1f Of Fax(408)777-3333 ';UPEkTINO Buildi:n De artment JOB ADDRESS: 103 �1 �L-L=nI��1�f A-V _ PERMIT # CA OWNER'S NAME: M D S l2 JU j V`.7 PHONE # q-D - 3 -7 3 GENERAL CONTRACTOR: �,D (� FAX # I am not using any subcontractors: Si: nature Date ; Please check applicable subcontractors and complete the followinginformation: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO v�� - REPIPE/SEWJER/MAIN SERVICE CUPERTINO PERMIT APPLICATION FORM Building Address: _ 1D35R CLL-"71/VlhJ 4 V E Owner's Name: Phone#: M LO Ff A-ti �S/2 N /LIA SA7-IJ 2P3-7 4 -3 Contractor: -DA v,/ Phone#: `7/L f --&/4—�7 2 64 Fax#: Contact: P C - o4 Phone#: RDs 4-P FQ Wo tom, tk l 5A,vq Tom. Fax #: Contractor License#: 3q 2 -31 Cupertino Business License#: Job Description: �� ✓�` / Residential Commercial ❑ Valuation: V ,SPO 49 Project Size: Express0---Standard F1 Major Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set& the sheet index. Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitar3 sewer 1BPREPIPE Commercial r,;-pipe per fixture P 1CPRP 1 PGASCOM Commercial C►as Piping System P 1-4 Outlets 1BCBSC Cal Bldg StanJards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CUPERTINO -K ` REPIPE/SEWERiMAIN SERVICE CUPEt�TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICR Seismic Residential P 1PRSEWER Residential buildin; P 1RPSS sewer/sanitary sewer 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P YGPWS or ittr vv., 1 PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P / 1BPWATER Install/alter Water ripe P 1 BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets 1BPGAS Gas Piping System 5+ Outlets P 1PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Buildirt Department De artment JOB ADDRESS: yPERMIT # 49UiC ` �v- �', o Cd � Vn (nV Q 2aS4- IL OWNER'S NAME: CJIeri 411il k-c W ` eu:s/e ' PHONE # q v S� - Y 4 6 _/f - GENERAL CONTRACTOR: ijc. .- tea. > 0n:�:tjFAX # I am not using any subcontractors: Sig�lature Date Please check applicable subcontractors and compfete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date