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04030130CITY OF CUPERTINO ,gym T+°'°�' INFORMATION•, BUILDING DIVISION PERMIT ',CONTRACTOR 4R BUILDING ADDRESS: RICHARD TAYLOR PERMITNO04030I30 OW NER'S NAME: PERMIT ISSUE DATE RICHARD TAYLOR 0 ONE: SANITARY NO. CONTROL N0. ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Jb Description oesc p o mencing 1 hereby Mo. Nat 1 am licensed under provisios nof Chapter 9 (cm wit Section 700)of Division 3afthe Busmeuand Profcssioru Code, and my license is m in full NEW GAS LINE TO FIRPLACE ��Qj�4y7Jy License Class Lic. A Dale Conuacmr ARCHITECTS DECLARATION MAR 2 6 2004 1 undcmmnd my plans shall k used as public records II.pl11 11��®�L�I/'� MOLDING ■ NG Licensed Professional OWNER-BUILDER DECLARATION I krehy of im tat I am exempt from to Conuacroes License Law for the u.vWa following recon. (Section 7031.5. Business and Processions Code: Any city ser county which requires a permit to convect, alter, improve, demolish, or repair any structure poor m its issuance. also require 0m applicant for such Permit to file a signed statement FL Floor Area Valuation tatk or licensed pursuant o the pmvisiou of she Common's License Law (Chapter 9 Sq. (commencing wit Section ]000) of Division 3 or to Business and I'mressiou Code) or Net k is exempt draefmm and the buss for the alleged exemption. Any violation of 3 2 &413a0iMer0 0 Occupancy Type Section 1031.5 by airy applicant for a permit Subjects to applicant to a civil penalty of not moss tan five hundred doll.. (SSW). ❑ 1.umneroftepmpcny,ormyemployeuwitwaguuteirsolecompensulan, Required Inspections will do thewmk and testrumum is not intended proffered image (Sea 7N, Business and Professions Code: The Cnnuanors License Law door am, .pply to an owner of prepcnywha WildsotimpmseSthcrean..ndwhnd..uch .,it Mansell., trough his own amployeor, provided that such improvements art not intended oroBered forsa e. If, however. to building or improvement is sold within one ycu of completion, the owner- builder will have to burden of proving that k did not Wild or improve for purpose or sale I. ❑ 1, as owner of the propony, am exclusively convecting wit licensed convenors 10 construct to project (Sec.1034, Business and Profusions Code:) Tk Contractor's U. ' ccnx Law dose not apply m an owner of properly who Wilds or improves thereon, and who contracts for such projects wit a convactor(s) licensed pursuant an om Contractor. License L w. mpt er Sec. .B&PC for this recon ate jjV'6'WORKERSCO a PENSATION ECLARATION I hereby aRrm under penalty of perjury one of wing dechusalimus, 1 have and will maintain a Corticate ofCanscnuo Mow for WarkcrSCompcn- Sarum, ss provided for by Section 370 of the labor Cade, for the performance of she work for which tis permit is issued. Q 1 have and will maintain worker. Compensation I===. as attired by section 310(fof to Labor Code, for to performanu of to work for which out permit is issued. My Workers Compensation Insurance carrier and Policy number am: Curne,Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not beeompleted ink Permit is forone hundred dollars ($LO(d) or mss.) I cerdry to, in the peoformanec or the work for which tis Permit is issued, I shall not rs employ anypersoy¢dpy maneLSp asmb me�s�ubj�kl e_Workcti Compcasation' L Laws of Calil DYC -` �.� ^�� n Applicant J4C ��..Yw.�� 0M— NOT E TO PAP LICANT: If, after makmg this Cemficate of emptor. you .ha1W Ecco e s hjeet m to Worker's Competuuion pmvisions of the IaMr Code, you must fo omply wit such provisions or tis Permit shall k deemed revoked. CONSTRUCTION LENDING AGENCY I kreby aQirm tat there is a construction lending agetcy for to perfsrmam:e of the work fur which tis permit is issued (S . 3091, Co. C.) Lcnd.es Name Under', Add. I cenify that I have mad fair application and sate that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to Wilding convection, and hereby authorise represen tisv ofthis city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and knit harmless to City of Cupertino against j Ii.oLidu,judgmenu, costa and eapenxes which may in any way amus against said City in consequence of to granting of tis permit A UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT `J Issued by: Dale SOU E GULATIO . Re-roofs Type of Roof Bs aturc of AMI canvContaclor am HAZARDOUS MATERALS DISCLOSURE Will the applicant Or future building occupant store or handle hevudou material as defined by to Cupertino Municipal Code. Chapter 9. 12. and to Healt and Safety e. zss3z25532a)?� ( ode.[IYes All roofs shall be inspected prior to any roofing material being installed. ❑ gSiNn � If a roof is installed without first obtaining an inspection, I agree to remove Will the appGcart or rfukm Wilding occupant SSC equipment at devices which it harsrdous air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection. Disvia? ❑Yeses I have mad to Int ordo.. mamdals requirements under Chaper6.95 mitt, Califor. nia lmalt& Safety Code. Sections 25505.25533 and 25534.1 undamsertd thatirtc Wilding rtcntly hart a tenant tar it u my responsibility to notify onemttupant or ftrequire.. ts chmass Wm poi n ..reamer aparmg Signature of Applicant Dale All roof coverings to be Class "13" or better wrerormohm odagent Datc_� ❑C Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS Z18c�MAO1 � l►a P1�MIT # OWNER'S NAME: v"\ l4 q Lc1 PHONE #40% -S''A (.A4 GENERAL CONTRACTOR: FAX # I am not using any subcontractors.,_��..��c�.� IJ�m,4A _ \ \' 3 - 2 4— Signature J Date Please check applicable subcontractors and complete the following information: Owner/Contractor Signature Date 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 • • 4W CITY OF CUPEIZ,TINO CITY OF CUPERTINO REPIPE/SEWERS/MAIN SERVICE ° 03 013 D PERMIT APPLICATION FORM APN #3 2 6 �4•- 63 Plumbing Permit Issuance Date: Building Address z 1 8 ci l o �2-t-rc Re i e of Fixtures Owner's Name:�J ��KacZo 4. Phone #: 4o-3 ZE2 CD`l4l Contractors Phone: ✓v ScLF- BUILDING License #: Contact: Scti Phone: , 2s 2 cq�41 Cupertino Business License #: Building Permit Info: Bldg ❑ Elect ❑ Plumb Job Description: O -(5-- Residential Commercial ❑ Sewage Disposal Cost of Project: B SLIC Qt Appl• able Fee ID Fee De.,rrintinn FPP r:rnnn PPERMrrFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPERMFEE Bldg. Permit Fees BUILDING BPFIXTURE Pbl . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING B SLIC Business License BUILDING q� 2�67%/