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02120076CITY OF CUPERTINO=ria shy y - ms r:d3' BUILDING DIVISION PERMIT CONTRAGTORaINFORMATION.I BUILDING ADDRESS: SUNSTONE CONST INC PERMIFNO. 22271 KENDLE ST WR'S NAME 176 GILMAN AVE APPLICATION SUB DATE ERNER WILLIAM L AND ANN K TRU 12/18/2002 PHONE 408 379-0592 SANITARY NO. CONTROL NO, ARCHI'IEC IENGINIiIiR: BUILDING PERMIT INFO BLDG ELECT PLUMB MECII 0 0 0 0 LICENSED GONIRd under provisions of CON 1 herby off rat that I am licensed under provisions of Chapter H (commencing fob Description p with Section 70K08 of Div'si 3of the Burin s and Professions Code, and my two. is °0� in mu force and efficL FOUNDATION UNDER PINNING Liccnu Clam Li.ai Da Contrsamr 1� 1 / / FINALnE® RCHITECTS D RA (� �T 1 understand my plums Shull be used e. p tic records JAN 2 2 2003 I.i.aced Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Commc7nrs License Law for the following maaun. (Section 7831.5. Business and Pndcssioas Code: Any city nr countyBUILDING which acquires a permit to construct, alter, improve, demolish, or repair any awemm Pont to its issuance, also requires the applicant for such permiuo file a signed statement thatbe is licensed pursuant o the provisions of the Controcmrs License Law (Chapter 9 Sq. Ft. Floor Area $9U41 Cation (commencing with Section 7100) of Division 30 the Buvimc, and Pnd'cstrous Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of be Occupancy Type Section 7831.5 by any applicant for a permit subjects the applicant to a civil penalty of not mom than five hundred dollars (25110). ❑ 1. as owner of the pmpeny, or my employees with wages as their side compensation, eq Ulred Inspections will do Ne work, and the structure is not intended or offered for We (Sec. 70,14. Burrow and Pmrwions Code: The Comrecors Liana law does not apply to an owner of 10 2 — PIERS Property who builds or improves thereon, and who does such work himselfor through his own employees, provided that such improvementa are not intended or offered forsale.IL 103 — UFER however, the building or improvement is sold within one year of completion, the owner - 104 REBAR builder will have the burden of proving Nat he did not build or improve for purpose of - 581CJ' 105 - ANCHOR BOLTS 0 1, as owner of the prupeny, am exclusively contracting with Licensed contractors to 106 - SEWER & WATER construct the project (SCC. 7BW, Business and Professions CWe:) lac Contractors LI- censeLaw does hot apply tuenrusher of property who Wilds orimprovesthereon. add 202 - UNDERFLOOR PLUMBING who contracts forsuch projects with a conmennis) licensed pursuant to the Contractor's La Lived.21)3 w. — UNDERFLOOR MECHANICAL I am exempt under Sec. ,B& P C for this reason 204 - UNDERFLOOR FRAME ' Date 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING I hereby affirm under Penalty of perjury one of the following declarations: 302 — TUB & OR SHOWER ❑ IMvx end will maintains Ceni(¢ete of Consemmsdhinsure fm Worker'v Compere Wind, as provided for by Section 3780 of the Ichor Code. for the performance or the 3 03 - ROUGH MECHANICAL work 304 - ROUGH ELECTRICAL Ir,�/1 have and will maintain Worker's Compensution Insurance, as required by Section 3 0 5 - FRAME 37(111 of the Labor Code, for the performance of the work for which this permit is issued. My or cis qNor cion lnsnl'.tnee carrier and Policy number ate: 306 — HOLDOWNS Canner `Slott -}Vnd Pat Nn. " ZroZ 307 - INSULATION CERTIFICATEOFEXW40 R SWORKERS' COMPENSATION IN NCE 308 - SHEETROCK (ThiaaeedemneednmWenmplemdif,W .it isfmmnehundred dollars (sulm 309 - EXTERIOR LATH "rIC9a) 310 - INTERIOR LATH 1 cenify that in the perloromace of the work for which this Permit is issued, 1 shall out 311 — COAT employ any Person in any manner so as to become subjectto the Workers' Compensation .SCRATCH Laws of California. Date 313 - ROOF NAIL Applicant 501 - FINAL ELECTRICAL ENERGY NOTICE TO APPLICANT. If. after making this Certificate of Emniption, you shouW become subject to the Workers Compensation provisions of the Labor Code. you must 502 - FINAL PLUMBING ENERGY fonhwiN comply with such provisions or this refund shall be deemed revoked. 503 - FINAL MECHANICAL ENERGY CONS rRUCPION LENDING AGENCY I hereby ufrrm the there is a couuotrtion lending agency for the pedbrman. of 504 — FINAL BUILDING ENERGY The work for which this Permit is issued (Sec. 3017, Civ. C.) Lender's Name 505 - 506 - FINAL ELECTRICAL GAS TEST Lender's Address I cenify Out I have this application sura that the above information is 507 - FINAL PLUMBING correct.correct.lagree to comply withith all city and countyy o ordinances and stem laws Writing to building emestrue iom, and hereby amhorim representatives of this city m enter upon the 5" 5 FINAL MECHANICAL above mentioned property for inspection purposes, 5 9 — F I N (We) agree In save, indemnify and keep harmless the City of Cupcninn against liabilities,judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT 5 Issued by51 N G WORKS Dale Ov SOUS REGULOXIGUNS.' Type of Roof 41"Re-roofs nature of ApplicanUCummetor me HAZARDOUS MATERIALS DISCLOSU Will the applicant nr future building oa:cupaat sore nr handle havallous maredal s defined by the CuNnino Municipal Code, Chapter 9.12, and the 1{calth and Safety e. Section s 25532tayf ❑Yes PC No All roofs shall be inspected prior to an roofing material beim Installed. P P Y g g If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or ffuu'ture building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District' ❑Yes Ib No I have mad the hamolous materials requirements under Chap crti 95 el the Culifor. Nu health & Safety Coda, Sections25505, 25533 and 25534.1 ostens and Nat if the building docs not eumently have a tenant, that it is my responsibility to notify the occupant of the reyuirem uwhichnaas, r m piminissuancenfaCenineme cY.O^ Signature of Applicant Date !te t- (Owner All roof coverings to be Class "B" or better uraetlumorcd agent Date �( CETY DIS CUPERTffND CITY OF PERMffT L'i11C 1C UCA 1L 1LDN FORM CUPS NO L9 �- � ? & P 79 AP #' Date: Yee Gircu Building Address: Other Appliances Owner's Name: �� ` I I , I� e� l� vl Phone #: Construction Tax Contractor: OVIC Com_ �i c3�t .�- d1C • License #: ��AR Contact: Phone #: q08, ApplicanContractor: �UVt aC1�.ItiN Fax #: . 37q ZIM Buildi g errmit Info: Bldg Elect Plumb BCONSTAXR Mech Jo_Rob scription: sidential: �W�ti Ove o ✓ je- o v,\ n 8 q Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: BELEC 1001 Architect/Engineer: �C � .� e�'i U i a► Valua on: .�� Type of Construction: l Occupan B EN ERGY Quantity Fee IID Yee DescH an®nn Yee Gircu 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 BELEC 1000 Elec 600V <=1000A ELECTRICAL BELEC 1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL B EN ERGY Energy 13UR LI(DI NG 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 of 3 �7z.E-C- BUILDING DIVISION BUILDING ADDRESS: SUNSTONE CONST INC PERMITNO. 22271 KENDLE ST 02120076 OWNER'S NAME: 176 GI LMAN AVE APPLICATION SUB DATE WERNER WILLIAM L AND ANN K TRU 12/18/2002 PHONE: (408)379-0592 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: wO p LICENSED CONTRACTOR'S DECLARATION s U P 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing Z< w with Section 7000) of Div'si 3 of the Busin sand Professions Code, and my license is =4411 5-7 y in full force andeffe Z) z License Class Li . A O Z —Da 14 VA 9 Contractor = ~ O RCHITECTS DbWRAT40N -u 1 understand my plans shall be use p lie records XOaU LS 3 n, �Licensed Professional F = 0.1 OWNER -BUILDER DECLARATION iy�'u <x 1 hereby affirm that 1 am exempt from the Contractors License Law for the m p O following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair my structure 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 q(commencing with Section 70(10) of Division 3 of the Business and Professions Codc) or a 3 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 not more than five hundred dollars (S500). ❑ 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. 7074, Business and Professions Code: The Contmctora License taw 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.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractors 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. ❑ 1 am exempt under Sec. , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a Certificate of Consent to self-insum for Worker's Compen- sation, as provided for by Section 3700 of the tabor Code, for the performance of the work for which this permit is issued. if i have and will maintain Worker's Compensation Insurance, as required by Scction 7 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's o pensa= Insufnnce cam and Policy number are: Carrier -i d Policy Nor c CERTIFICATE OF EXEMPTIO WORKERS' COMPENSATION IN NCE (This section need not becompleted if Ore permit is forone hundred dollars ($100) or less.) 1 certify that in the performance of the work for which this permit is issued. 1 shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become suhject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constmction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lenders Name Lender's Address 1 certify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city ED enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, toss and expenses which may in any way accrue againstsaid City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Vature of Applicant/Contractor IF D61c — HAZARDOUS MATERIALS DISCLOS 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)? ❑ Yes ;A No 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 District? ❑ Yes XNo 1 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 docs not currently have a tenant, that it is my responsibility to notify the occupant of the require s which rrruet-4e.m p 'or to issuance of a Certificate cy. Z 7 � 777L �/n Z Owner or BUILDING PERMIT INFO BLDG ELECT PLUMB Job Description FOUNDATION UNDER PINNING Sq. Ft. 102 - PIERS Required Inspections 9 YQ@ation Occupancy Type 103 - UFER 104 - REBAR 105 - ANCHOR BOLTS 106 - SEWER & YIATER 202 - UNDERFLOOR PLUMBING 203 - UNDERFLOOR MECHANICAL 204 - UNDERFLOOR FRAME 205 - UNDERFLOOR INSULATION 301 - ROUGH PLUMBING 302 - TUB & OR SHOWER 303 - ROUGH MECHANICAL 304 - ROUGH ELECTRICAL 305 - FRAME 306 - HOLDOWNS 307 - INSULATION 308 - SHEETROCK 309 - EXTERIOR LATH 310 - INTERIOR LATH 3.11 - SCRATCH COAT 313 - ROOF NAIL 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 5 FINAL MECHANICAL 509 - FIN 5 N G Issued by51 - WORKS Date / Type of Roof 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 all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better