02040065tea
In
032
CITY OF CUPERTINO
BUILDING DIVISION
• - ' 1; ' -
CONTRACTOR' INFORMATION;
PERMIT
BUILDING ADDRESS:
PERMITNO.
10741 q BLANEY AV
JAHAN CONSTRUCTION
02040065
ONW'ER'S NAME:
APPLICATION SUB DATE
OVERTON MARY ANN
200 BURNETT AVE
04/15/2002•
ONE
SANITARY NO. CONTROL NO.
(408)782-3102
ARCHITECTIENGINEER:
I
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby.111m that Ism licensed under Pmvlelnne of CMpter 9 (commencing
j wi1hS<ratan)BOD)or0ivision)ofthe BusinessmdRofessiansCode.endmylicenu
Job Descri ti
I7
I&
I, in full forte
ADD 499 SQ. FT-.
LE®
and'e0e[t.
I Lice. Class r Lica ZO 0
Dau Contractor
1 ARCHITECT -S DECLARATION
FEB 0 4 2003
1 I understand Any plans shall be used as public Tec"ds
BUILDING
i Licensed Professional
OWNER -BUILDER DECLARATION
1 e1Rm thin xe
I am empt from the Contractor's Liana Law for the
G
following mason, (Sutton IDnstr Business and ow.Professionsdeli Code: Any city St county
whichitsharequires a pemtit to construct. alter, improve. demolish, or rtW it any Structure
$65000
-ginbiu iseynece, elbrequimtheappppllant for such permit file a Signed Statement
d01 kit licallied pdmuant mine 0ow-islons of the Convectors License Law (Chapter 9
------- �- -. ��.- -.-. _---------
Icommrne!"C1Y!'h-i'r;'fiTiVoigyf Division 7of thea mess Saud Pmressiom Cade
he
,.. .. .. ,NZ :-'S'^ '!S'�. V3IUBLlOn
1•` '1�� 1 ! t�{ •,�i(,,,
� t' 'r
or that LL exempt Ifieiefrom end the basis for Ne alRjed eaetnpdan. Any violation
ofSeNon' 313 by any Applicant for A permit subjects the 'spplicmntoxTMIpenahy-
lurnoa iidienlum Bae mocked doll*, (6300).
N {DATION •, •;� ' Occupancy Type
10
❑LuowiRo_Q heprogeny,"myemploycnwith xa¢es blero( on,
dIC 1[ Intended
-
'•
,w1ll.do N'nr�. and the a1NelYR n01 Bred
or offered fa L1IC ($a, Tllaa,
ad.7
' Bosinia'AnB'Profession. Code: The Convect": License Law does am apply to an
103 - - UFER Required Inspections-,"
owner of property Who builds or improv; thereon, and who does such work himself
,or thriphhs own employees pmvldedthat wch impmmmenu are rad.intended "_
offered for IS.l( hossww'. the, belldln t or immve
pmenl is Sold widtin one year of-
f
`c
omplynon. the owner-bailderwdl have the burden ofproving Inas hedd=build"
In
105 - ANCHOR BOLTS "
nAPmw f" purpose of sale.).
106 - SEWER & WATER
con:ubvhee.Mthe PmPSTIY. exclusively
---------------- ...------'--- — ------------'-- - ._.
202 - UNDERFLOOR PLUMBING
Ism
construct---
profession, WA:)Rdt'wtracmnm
the o a no (Sec. TOW, Business And Professions Code:) The Conten"'s
u"uelawdoeunor lyb an Owner builds
I'Li':. L't LIECr!
sJ. mjctzwofprogenywho "improvutherton,
.avd.wM.mmmcLL.l"wrh-PmpcLL.widl J.Caouan"(al.littnvd;uraSsw.b.tM-
conuanonLianseli
203 - UNDERFLOOR MECHANT'CAI':'"�'
-----'--2'0-4'---UNDERFLOOR--_FRAME -.._ .—.. ._....._.._.
❑_!X•.------_.--'---'-
lemptuMerS" $PCr"tbu Ruon
.,
....,
205 - UNDERFLOOR' INSULATION
°w"" v'—SoRREnSCOMPMZ,AnGNDE!_A"TION
301 - ROUGH PLUMBING
(hereby afllnn uMwPenalry.of perugo"a1—. lollawtn¢decunnmu--
302 - TUB & OR SHOWER
303 - ROUGH MECHANICAL
❑Ihive'eiid'aill"moinuini Cenifih�f of for Worker's
ComPo, flon: v.providd f" -by Section -3T00 -of' dx'Lab"-Code:'for' the
304 - ROUGH ELECTRICAL '
Pelfotnunee of the work,("; which this points is {abed,-.i„�
305 - FRAME
❑Ihow and will mentum worker a corApenealbn less., y raqutRd Ly.9ectiue
--
306 - HOLDOWNS
7700 of the'Labor Cade for the PenfprTrun of the wodt farwhich Ihtt Oct.![Is
iuued,My workersCahpenudpn he w
iinimucri"and Policy Aumbar
307 - INSULATION_
cam __ __ `PalkyN
_.
z syr
1 E%EMP7YON PROM -WOR l}
6 z 3 0 9 `I a EXTERI6R-LATH'
"P'fs(Thls
--•------
acct on'need not be'Mmpleiedifthe permitis for one hundred dollars;
"
311 - SCRATCH COAT
1 amfy that in the performSlte of the wink fo nen thLL perms It ;; ia. ed I
G,Il
� - .
3'1'3="`ROOF"'"IzTAT 1;7- ,yTR-
rbtempl yany,person tv auny manner so Io be pine rvb"t to the workejs
Ccapensa to i o Cehfom R ` ' '
� CAL
501 FINAL ELEC
- I '"ENERGY
IN077CETO P afar ma ng thu euo
-502 ---FINAL FINAL PLUMBING ENERGY -
aempl on You sbould
bed ante shbJea eWorkera rape ore ofthe labor Code, yoo must
•• .:'1
503 - FINAL MECHANICAL ENERGY
ishme or
(anhwth camPly wlth such prov sloes or his gamut shall be dam d moked.
_._._504-----FI-NAL--BUILDLNG -ENERG1__.__. .__
CONSTRUCTION LENDYNG AGENCY e
-" lhmby erYmi Thal them Is's cepstrocign lendlq 'epncy f"me
y
T
SOS - FINAL ELEOJTRI�.'�iL_q�,(.., ,y
perfdmminic'
m
w"kfar which thu pemlt'sisiucd (Sea JOPT, Civ, C)
ism..3%7: N._
._bonne
Leider'e Nem" -a». .-,_...l ,.,,,:�";..
_.__-____..5.0.6__=_..GAS _TEST_.._ ,
.._._. _ .. .._..... ..____._....._._._..—.-_.—'
Lenders Add6:! ''s-
"'
_..__..._
507 - FINAL PLUMBING
ty...r."�- •"�
•, d cent( That I hon Rad -Nis application end aunt that obdve infonneilon is
,
508 - FINAL MECHANICAL
eoiiecl 1 agrtA M comply with all c'ty and courtly ardlu"eeAnd sate lawrRhting
ro bre ldm¢ coA', im on and hertby a llmnee mpTcc ntli of Jus chy to enter upon
the aboemembned,proptrry forinsPicdon Puryoses
IWe)agru Indemnity keep
509 - FINAL GRADE
510 - FINAL PLANN NG
t and yurmleelth¢Qry o(Cu`peNnoilams
'
nave,
liamhnq Judgmequ, c"LL end a penso Nergh may m any way accrv5p¢umtuid
)}C�ipty 10 rollfa uenh drthe (fdplmg a(dlif peITTUI
514 r- F INA PU C - I
SouCEREuL4`Itdto�f?�Y.%l.?+'AI-L nGIPD1";:r'.':
Issued by Date
—
SlynatuR fAppIicSWCdAtmclIW k r. In o R 1`; .t
•rat - HAZARDbUS MATERIALS DISCLOSURE
Re -roofs D Ll
'type
r willthe applicant" future WBdmgocvpnt,mactwhandlehtrndo"mem�l
by Cupertino
of Roof. _
as Qaflned the Mumcfpai Code chapter 9.12: and the HNth aM Ssfery
Gdda Seclbn 233J21„ .,r�,r-,I. ,1I - ,
orae use , %
'. .t�,_t` �•r AP;R��:1,5..2002
,r xn �i
s� M ,F
pll roofs.shall a inspected.prior.to.any ng.matenal,being installed......W
M•, Will theappheSnt"fumrebuddln "cupwuseequPromA,devlcc, which
nth hSUMous elr eontamba.ls aid' b! th Bry Asea Nr Quillry Mine{amens
yiemn f,
If a roof is ins alledlwithout first obtaining rains ecnoti I a ee.tolrelnove
g p
all new maters 1®p ecflnn A._,_,D.p.l_ t 1
.
n ❑Yes A 1 : -
t,
rel't.'
nderstands ani will cam
.._.. .. _ p y. with_ —.
' - Fl ,1 �t`- ^',,
all non -points r e r :; I...
,
u. lirya e'ead dna M1eaaidous�mmonals regbreinmta under Chapter 6.95�bf the
allfomla ealth d:5af Coda SeNont 255 233] 2777e
Jthe bulldln doe: not c`ryprantty MR nenant. t%M1
¢ my ruponsipl6ry to ltmlfy?0,
.-„,,
Pt7antl
occ Jpan, of the m9!tiR'mehe
nu htah mutt he met d td Issuance of a Ceetflate of
,. Y,t .p_.•,
1��
_..Signature of Applicant._.. -.__. ...... ... .Date_: _
All roof coverings to be Class. B or better ”
owner A ormidAgen ! D e ,
:
., _ ----
.....:vc .TiS::: •t':;:,
CITY OF
CUPERTINO
CITY OF CUPERTINO o Z ° S
PERMIT APPLICATION FORM
APN # 30
.3/
O q ?
Date:
Building Address:
07g3 S: 13 L,a,vZ A ee .
Other Appliances
Owner's Name:
/i'l —, 0 V
"i2 a
Phone #:
Contractor: � s
�o-�s��'
License #:
Contact:
CB �✓5�'
Phone #: 0z
Applicant/Contractor:
�T� s��
�6o✓S✓ o
Fax #:
,aiulding Permit Info:
Bld
lu
ec
o Description:
Residential:
BBOILER5
Commercial:
Sq.Ft. Floor Area:
BCONSTAX
$/Sq.Ft.:
Architect/Engineer:
BCONSTAX
Valuation:
Type of Construction:
BCONSTAXBQ
Occupancy Group:
Quantity Fee ID
Fee Description
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
MSiTILDING
BBOILERI
Boiler <= 100,000 Btu
MECHANICAL
BBOILER2
Boiler > 100K to 500K Btu
MECHANICAL
BBOILER3
Boiler > 500K to 1M Btu
MECHANICAL
BBOILER4
Boiler> 1M to 1.75 M Btu
MECHANICAL
BBOILER5
Boiler > 1.75M Btu
MECHANICAL
BCONSTAX
Construction Tax
BUILDING
BCONSTAX
Ind/Off/Comm/Quasi
BUILDING
BCONSTAXBQ
Con. Tax for BQ Zone
BUILDING
BCONSTAXH
Hotel and Motel
BUILDING
BCONSTAXR
Constax — Resi/Mobile
BUILDING
BELEC1000
Elec 600V <= 1000A
ELECTRICAL
BELEC1001
Elec 600V > 1000A
ELECTRICAL
/ BELEC200
Elec Svcs 600V <='200A
ELECTRICAL
BENERGY
Energy
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
BINVESTIGA
Investigation fee
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
BUILDING
BUMDING DIVISION_ PERNUT ` CONTRACTOR INFORMATION:
BUILDING ADDRESS:
OWWER'S NAME:
OVERTON MARY ANN
PHONE:
p � zz ARCHITECT/ENGINEER:
kC U
_�
�<=
:Dt LICENSED CONTRACTOR'S DECLARATION
zW Z
_ C I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
rn with Section 7000) of Division 3 of the Business and Professions Code. and my license
Y M _ is in full force and effect.
z�< License Class Lie. M Z O l
0,C) Date Contractor
o < / ARCHITECT'S DECLARATI
rn I understand my plans shall be used as public records
e: p O Licensed Professional
o cc OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
F Z_ q following reason. (Section 70313, Business and Professions Code -.Any city or county
E F fl which requires a permit to construct, alter, improve, demolish, or repair any structure
prior"to its issuance, also requires the applicam for such permit to rilea signed statementtlfat 6GiR)ict9sFd puowin[.tcr h 06uvksions of the Contractor's License Law (Chapter 9
(commencjn$widt$eeysopr7000) 9f Division 3 of the Business and Prefessions Code)
or tharhe rs exempt therefrom and the basis for the alleged exemption_ Any violation
-of Section -M31-:5 by, any appl!tan( for a permitsubjectsihrapplicant to &-civil penalty
bf not ioore:llian five hundred dol (S500).
❑ I, as owner of the property, or my employees with wages as their sole compensation,
wsll . io, the Work, incl thi stricture is nn_ intended or 65ered for sale -(Sec. 76R,
Business and Professions Code: The Contractor's 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 employ_ee_s.. provided that such. improvements are not irt-!ended or
offered for sale. ft, however, the building or improvement is sold within one year of
'compaction, the owner -builder will have the burden of proving that he did not build or
improve for purpose of sale.).
as owner 'o( tbt pfoperty, am exclusively contracting with licensed contractors to
_ construct she project (See. 7044, Business and Professions Code:) The Contractor's
License Law does not apply to an owner of property who builds or improves thereon,
and -who. contracts for: suclt.projects with a.contractor(s) ficensd-putsuant.to the
' Contactors License Laws ..
❑ I am exempt under Sec." B & P C. for this recon
owner 'Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm -under prsuhy,of perjury.one of d>e following declarations: -
} ❑ I have and Will main(alri 'a Certificate of Conseni to self -insure for Workers
/I - ;( Compensation, -as provided for by Section -3700 of the tabor- Code, for the
- peliormance df the work for which this pemdt,is issued.
❑ I have and will: maintasn.Woiker's Compensaiion Insurance, M iequired by Section
3'oq of the Labor Code. for the perfprnwnce of tht; work for which this permit is
issued. My Worker i Corhpeirsaddn Insurance carriez and Policy;
Policy
No.: , •. ,
.
CERTIFI CATION'OF EXEMP'nON FRQMWOkXEEPS'
Qghff ENSAT) ON'INSURANCE
(rhes section need not be completed if the permit is for one hundred dollars
( (S 100) or )ass.)
` I certify that in the performance of the work Ifor which this, pennii ii, issued, -I
j shall not employ any person in any mannei•so' to and sub'ect to the•Wor�cers
Comp .. ' Laws of Califo ate
Applicant 6 _
y NOTICE TO P I , after malyng,thrs:C scare of xempliori, you should
1 become subjectTZrTe Worker's Compensation provisions of the Labor Code, you must
Q forthwith comply with such provisions or this permit shall be deemed revoked.
0[
,r te. I CCINSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction leddini agency for the .performs nce
W Lender s
Of the work for Nameicli this permit is issued (Sec. J097, Civ. C-) . . ....... . ... _ .. ..
lir
a Lender's Addreu.
a z!! ,
V 0 I l cenify that I have read this application and state that the above information is
correm. l agree to comply with all city and county,ordinancespnd.state laws-rclating
to building construction, and hereby authorize 4eprescntatives of this city to enter upon
the above-mentioned property forjnspection purposes.. .,
(Wei agred to save, indemnify and keep hannlesd the City of Cupenin.b against
to ¢ liabilities, judgments, costs and expenses whigh may in any way acctue, against said
V sZr i City in consequence of the granting of this permit. - '
I4 APPLICAS7 CNDERSTA-�-DS A��D %VILL COMPLY \%I H ALL ?'0\-P0�\`T':
`1 SOt72CE REGGLATIOXS.
I Signature of Appileant/Contraetor ..Date
III HA7ARDOUS IMATERLALS DISCLOSURE .
Will the applicant or future building occupant store or handle hazardous material
t asdefined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(x)?, -
❑ Yes ifo
Will the applicant or future building occupant use equipment or devices which
emit hazardous air comarnihants as de ed b)• the Bay Area Air Quality Management
District?
❑ Yes No
I have. read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety" Code, Sections 25505:25533 'and25534. 1 understand that
l if the building does not currentlyy.have a tenant- that tit is my responsibility to notify the
` occupadt of the requirements which must be ince priorto issuance of a Certificate of
cc upancy,
.
zed agent 4 Date.
CONSTRUCTION
200 BURNETT AVE
(408) 782-3102
ADD 499 SQ.FT.
PERMIT NO.
02040065
APPLICATION SUB DATE
04/15/2002
SANITARY NO. CONTROL NO.
BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
II c-) L 1 U
Job Description
��y q� $65000
:. 3-� Th; F400 rp-a Valuation -- - -
101- N'RftDATI ON Occupancy Type
103
- UFERv Required Inspections -
nspections_._10.4._-._
_10.4
REBAR__..._-__._.....
105
- ANCHOR BOLTS
106
- SEWER & WATER
202
- UNDERFLOOR PLUMBING
203
- UNDERFLOOR MECHANICAL`'
_ .. _.._..2..04_
- UNDERFLOOR- FRAME ..._.....-... _.
205
- UNDERFLOOR'INSULATION
301
- ROUGH PLUMBING
302
- TUB & OR SHOWER
303
- ROUGH MECHANICAL
304
- ROUGH ELECTRICAL
305
- FRAME _
306
- HOLDOWNS
307
- INSULATION
3 Q. SH81J.TROCK. ..
B09
�<
- EXTERIOR LATH
3-1 0
_ NTERIOR' _LATH _ -
- SCRATCH COAT
_.._. 3.1.3...___
ROOF- -NAIL. L.__.. I..._ -...._ .....:__._.:... __ ...... -
501
- FINAL ELECTRICAL ENERGY
502
--FINAL PLUMBING ENERGY
503
- FINAL MECHANICAL ENERGY
- -504
- FINAL -BUILDING ENERGY,_
505
- FINAL ELECTRICAL
506.-
GAS TEST,
507
- FINAL PLUMBING
508
- FINAL MECHANICAL
509
510
- FINAL GRADE
- FINAL PLANNNG
514 - F I NAL,., PU$�- C ,�i
Issued by:
Re -roofs
Type of Roof
All.. roofs shall
If a roof is ins
all new materi
- all non -point
D APR 1 5 2002
e inspected prior to any
lied without first obtaining
Date " 1 -i,.S
g material being installed. .
inspection, I agree to remove
derstands and will. comply.with.
Signature of Applicant Date
All roof coverings to be Class "B" or.better
OFFICE