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02090097-F&TY OF CUPERTENG pp� CIT OF pp pp,� ?ERME 1L AP 1L ECA 1L 1LO IFOR1V'1L C�UPE��III�1® APN # 2-)( 002 Date: Building Address: D I `" d S �P—o �)L, Owner's Name: Phone M Contr to � \ 60�1-)�WG License #:� -�� Contaist� �` Cupertino Business License #: Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential /1 �° l) ;S Commercial ❑ Sq.Ft. Floor Area: $ /Sq.Ft.: Cost of Project: Occupancy Group �• Type of Construction: p Quantity Fee ID ]Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > L75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX BCONSTAXBQ BCONSTAXH Ind/Off/Comm/Quasi Con. Tax for BQ Zone Hotel and Motel BUILDING BUILDING BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC 1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL B EN ERGY Energy BUILDING BENERGYADD BINVESTIGA Energy Add Multi Investigation fee BUILDING BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 w U h z �anw, oz° -, 0i a kOav w30 r�o� atNt��ai Caa0 x°Cx w —y OZ z� a> LL Q �Z) Z UO_ O U Iti t� Uz CITY OF CUPERTINO BUILDING DIVISION ]PER . BUJJDJN5&DD69.AF FORD DR JENNECKY HOMES PERMIT N0.2 0 9 0 0 9 7 GwKAREmEDREXLER 1730 ROSSWOOD DR APPLICAT )!9sP11I"2002 PHONE: 4 O 8 314 - 9 2 9 7 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under previsions of Chapter 9 (commencing JT>iLOn with Section 70(10) of Division 3 of the Business and Professions Code, and my license is ADD 455 S Q . FT . , in full force and effect. License Class Lic. p ' Date Contractor ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER - BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the $120000 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 prior to its issuance, also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 39g2 Bt6n&J@ AM 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 penalty of pN N Occupancy Type p y yp not more than five hundred dollars (8500). 102 — PIERS ❑ 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 sale (Sec. 7044, Business Professions Code: The Contractor's License Law does apply to an owner of Required Inspections and not 104 - REBAR 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, 105 — ANCHOR BOLTS however, the building or improvement is sold within one year of completion, the owner- 106 — SEWER & WATER builder will have the burden of proving that he did not build or improve for propose of 5�' 202 UNDERFLOOR PLUMBING �5 `f, as owner of the property, am exclusively contracting with licensed contractors m 203 _ UNDERFLOOR MECHANICAL construct 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 204 - UNDERFLOOR FRAME who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's 205 — UNDERFLOOR INSULATION License Law. ❑ I am exempt under Sec. B & P C for this reason gee � AbV _ "0, � 6 tI 301 `Z- 302 - ROUGH PLUMBING - TUB & OR SHOWER ��" �V}�v'ORKER'S COMPENSATION DECLARAT 303 - ROUGH MECHANICAL 1 hereby affirm under penalty of perjury one of the following declarations: 304 — ROUGH ELECTRICAL ❑ [have and will maintain a Certificate of Consent to self- insure for Worker'sCompen- 3 O 5 — FRAME sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 306 — HOLDOWNS [] I have and will maintain Worker's Compensation Insurance, as required by Section 307 - INSULATION 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: 308 — SHEETROCK Carrier: Policy No.: 309 - EXTERIOR LATH ATE OF CERTIFICCOMPE 310 — INTERIOR LATH SATON INSURAANCEIORKERS' (This section need not be completed if the permit is for one hundred dollars ($100) 311 - SCRATCH COAT or less.) 313 - ROOF NAIL I certify that in the perf 'man -e of the work for which this permit is issued, I shall not 5 01 - FINAL ELECTRICAL ENERGY employ any perso in (rt nner so as to become b'eci to the Work ore a cation Laws of Californi Si.� - -yJnn ��+�Q�l r�� --�� p v 502 - FINAL PLUMBING ENERGY NOT, nt X4,11+ NOT O APPLICt I after making this Certificate of Exemption, you should 503 - FINAL MECHANICAL ENERGY become bjcct to the Worker's Compensation provisions of the Labor Code, you muss 504 - FINAL BUILDING ENERGY forthwith comply with such provisions or this permit shall he deemed revoked. 505 - FINAL ELECTRICAL CONSTRUCTION LENDING AGENCY 506 - GAS TEST 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.) 507 - FINAL PLUMBING Lender's 508 509 - FINAL MECHANICAL - FINAL GRADE Lender's Address I certify that 1 have read Ibis application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to 5 - FINAL PLANNING r building construction, and hereby authorize representatives of this city m enter upon the above - mentioned property for inspection purposes. 5 4 - F I NA4 PUBLIC WORKS (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 r in consequence of the granting of this permit, CANT UNDERSTANDS AN WILL COMPLY WITH ALL NON -POINT Issued by: lr Date E EG LATIONS G6 (r Re -roofs Type Roof re of Ap icant/Contractor Date HCod HAZARDOUS MATUTALS DISCLOS RE of Will the a )icant or future building occupant store or handle hazardous material ed by the upertino Municipal Code, Chapter 9.12, and the Health and Safely ection 25532(a)7 E] Yes Jo All roofs shall be inspected prior to any roofing material being installed. 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 u I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the cx:cupant of the requirements which must he met prior to issuance of a Certificate fOccupancy. Signature of Applicant Date roxlov 0G I it I 02 All roof coverings to be Class "B" or better Date wner or autho zed agent p ®CITY OFF CU EQI IIN ® CaTY GY CUPERTUiG OC2 0 f PERMIT APPUCATRON ]FORM APN # P rL — C) 'O — 0 10, Date. 0 q 0.- -- Buildiri Ad7s, ( 410 4 Alf Owner's Phone #: 1 "0' Contractoi License #: Contact: Phone #: Applicant/Contrac�or: Fax #: Buildin Permit Info: Bld //Elect Plumb Mech Description: Residential: Commercial: Sq.Ft. Floor ea: tk.v C- t� �� :N ' VS, $ /Sq.Ft.: - Architec ineef: Valuation: 4 °S 1 � I-N 1 Tpe of Conspetion: P Occupancy G oup: .A V,Q �C ve, d1' ova + S9 , BUILDING Quantity Fee M Fee Descrilgdon Fee Giroulp BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax – Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL B EN ERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi - Family Res MECHANICAL BNEWMULTI New Multi-family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING 1 of3 ZA P 00 — Lau O aZU n¢a may L " O C �0, no �Za CFO a�g i 7 Z z° W� ?. Q UO L14 F 0 F p^ U r. CITY OF CUPERTINO BUILDING DIVISION P]F][gMI BUILDING ADDRESS: JENNECKY HOMES PERMITNO. OWNER'SNAME: KARL F, MARV,8,D4 T)REXI.Eg 1730 ROSSWOOD DR APPLICATIO PHONE: (408)314 -9297 SANITARY NO. CONTROL NO. ARCHITEC (ENGINEER: BUILDING PERMITINFo BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing p with Section 7011(1) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic.k IN —HOUSE ONLY REVISION Date Contractor ORIGINAL PERMIT 02090097 ARCHITECTS DECLARATION 1 understand my plans shall be used as 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 7031.5, Business and Professions Code: Any city or county which requires a permit to consVUCL, alter, Improve, demolish, or repair any struclum 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 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 OCCu anC T e not more than five hundred dollars ($500). P Y YP ❑ I, as owner of the property, or my employees with wages as their sole compensation, 36206020.00 will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of Reqwired 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 build or improve for purpose of 103 - UFER sale. . 104 - REBAR ❑ 1, as ne the property, am c lusively contracting with licensed convectors to co tract to' ( 7 •Bus ss and fessions Code:) The Contractor's Li. 105 — ANCHOR BOLTS. cc La n t I I an caner props who builds or improves thereon, and 106 SEWER who ntra s c w ac r lot )licensed pursuant to the Contractors — & WATER Lieen Law. � 202 - UNDERFLOOR PLUMBING ❑ I am zero tiler , B & 203 - UNDERFLOOR MECHANICAL w ORKERT COMPENSA i ECLAR D "tior;: 204 - UNDERFLOOR FRAME 1 hereby affirm under penalty of perjury the ollowing 205 — UNDERFLOOR INSULATION ❑ I have and will maintain a Certificate of Consen le f -insure for Workers Compen- 301 - ROUGH PLUMBING ration, as provided for by Section 3700 of the La bo Code, for the performance of the 302 - TUB & OR SHOWER work for which this permit is issued. 303 — ROUGH MECHANICAL ❑ I 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. 304 - ROUGH ELECTRICAL My workers compensation Insurance carrier and Policy number am: 305 - FRAME Carrier: Policy No.: CE ATE ZEMPTION FROM WORKERS' 306 — HOLDOWNS M ENS ION INSURA E 307 - INSULATION (This section edn ted th pe ' is onehu red dollars ($100) 308 - SHEETROCK or less.) I certify that in the to ante h wor w 'ch p it's i ued, l shall not 309 - EXTERIOR 'LATH employanyperso in m ncrs s cc su ' alt he lot cr Compensation 310 - INTERIOR LATH Laws of Californt . ate Applicant 311 313 — SCRATCH COAT - ROOF NAIL N CE TO APPLICANT: If, after making this Certificate of Exe p ou should been jest to the Worker's Compensation provisions of the La e, you muss fo Ilh comply with such provisions or this permit shall be deemed ed. 501 - FINAL ELECTRICAL ENERGY CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY 1 hereby affirm that there is a construction lending agency for the performance of 503 — FINAL MECHANICAL ENERGY the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name 504 505 -- FINAL BUILDING ENERGY - FINAL ELECTRICAL - Lender's Address 1 certify that I have read this application and state that the above information is cort 1. I agree to c wiN all city and county ordinances and crate laws relating to 5 0 6 — GAS TEST buildin onrwet n, an reby authorise msentativcs of this city to enter upon the 'octet fo 'spec' S. FIbiffING PLUMB G above -roc roperly npu ( me to sa inde ify ke less a City of Cupertino against 'abilities, d en ,cos nd nsc ich an wayaccrueagainslsaidCity Q $ 5 F I AL 3/(6 i •onsequ c L grand h per A IC A STAN D W Y ITH ALL ON- INT Issued by: 5 Date SOU E REG TI S. Re -roofs 514 Type of Roof NAL PUBLIC WORKS ure o plic U actor arc HAZARDOUS MATERIALS DIS R Will the applicant or future building occupant st ous material \9.12, as defined by the Cupertino Municipal Code, Chapter c Health and Safety Code, Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑ Yes If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or fu re wild; g occupant use equipment or devices which h azardous air contamina • deftn by the Bay Area Air Quality Management all new materials for inspection. islric s o I a ad ha t us atcri req men and Chapter 6.95 of the Califor- ni Health ctyC c, '0 5505. 53 d25 4.1 derstandthnifthebuilding d not cu hav a ant, Ih it is y r nsih 'ty i ofirytheaccup4mortlit requ mcnls hmust etprio of an a 'fie ofOccup y. Signature of Applicant Date 3 11 All roof coverings to be Class "B" or better cr ors thorircd agent D