02060007 OF
CI But DING DI ERTONPERMIT
NO CONTRACTOR INFORMATION: Y D k P u C4—, E, w
BUILDING ADDRESS: PERMIT NO.
10842 NORTHFIELD SQ THE BUILDING CO 02060007
2102 RADIO AVE 06/03/2002
( PHONE: SANITARY NO. CONTROL NO.
(408) 265-7500
aai O O ARCHITECUENGINEER: BUILDING PERMIT INFO
w C BLDG ELECT PLUMB MECH
c l-7 L' I CJ LJ
a' LICENSED CONTRACTOR'S DECLARATION Job Description
00 =0 1 hereby alfmh that I am licensed under provisions of Chapter 9(commencing
P_tW is
Section70W)ofDivision3ofdo,BusinessandProfession,Code.andtrylicense REPLACE DAMAGED WOOD MEMBERS/REPAIRS BETW
a, y in ran force and cRcet.
rez�a License Class uc.g PROPERTIES, 10832/10842 NORTHFIELD SQUARE
Dat` Cionarreor
ARCHITECTS DECLARATION BELONGING TO AVIVA SCHULTZ AND KOSTA ACHIN
,g 1 understand my plans shall he used as public recoNs ��
Y
u p O Licenxa Professional
o z OWNER-BUILDER DECLARATION
=a 1 herthy affirm that I am exempt from the Container's License tt�1� q
following...(Seen..7031.5.Business and Prorsiorts Code:Any=and O 20OZ
O which requires a pranor to constmn,alter,impress,demolish,or repair any suuaum.
u•7d 3 m.prior to its issuance.also requires the applicant for such perinit m fle a sigoed standoem. -
tyatpeiglicent<apursium)OtkporyvkianxormeconaactwsLlcenxL 9 a.,, q,.Ft. Foo Ar , I $ V luation
(eommenemg, ansFdian 7110b) r umesmm 3 of me Basin<ss'ana pI'{he ) (f 1,�( (3,..,� - ;q iy., -e.:�j v;1'n:�.;-).f�''i: 4 9 0 6
or mai lie is'exeinpt thererroldand the basis for the alleged cwempfoh plsl
-of section 703 LS by any applicant for a Permit subjects the applicant to a civil Penalty
-
ornm moredom five hundred dollars($500) 316.1 /U ff "'t. `-' Occupancy Type
D I,as owner of the property.or my employees with wages as their sole compensation.
will do the work,and the stmcture isnot intended or offered'for sale(See:7011;'
Business and Professions Code:The Contractor's License Law docs not apply to an 101 - FOUNDAT I&quired Inspections:
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 _,-- -,- _ 102 __ PIERS-
-offered'forsule.If,however.the building-or iinprovcmint is sold within one Yiur'of - ---- -
1ompletion the owner-builder will have the burden of proving that he did not build or 103 - UFER
`mproverorpurpoxar.vale.). 104REBAR
.-171 Ithe pmpenY Y '.g105
...- .- .__ _ .... .. .. ._._. __. a .... _ _ _ ... -__
em exclus el contract n `Js I<emsed c tracma to
o .t t theP jmt(see Iliad.Baon.. d Profession,Codie)ThContractor's
10 5 — ANCHOR BOLTS i t
- License Law does not apply to an owner or property who builds o improves thereon 106 — SEWER & WATER .L .
I. -and who contacts for such projects with a contescums)liccered.pursteml.m me 202 -._
UNDERFLOOR-PLUMBING-----
mmel
01oineaterpta kr,see
B&Pc for reason
203 - UNDERFLOOR MECHANICAL
owner Date 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
berehyarfmunder penalty orPrjo one onherouawinga«1a soma 205 - UNDERFLOOR INSULATION
301 - ROUGH PLUMBING
± D 1 have and will maintain is Certificate of Consent m xIf in...a Tor worker's 3 02 — TUB & OR SHOWER
m
Compensation, "s,Provided our by Section 3700 of the Labor Code, for the
= perfoanceofdeworkfarwnmhlnisp.itisis..ad.. 303 - ROUGH MECHANICAL
_ D 1 have and will maintain Worker s Compensation Insurance,as required by Section 304 - ROUGH ELECTRICAL
37W ofihe Labor Code:for the performance of the work for which this permit is
issued.My Worker's Compensation Insurance carrier and Policy number art: 305 - FRAME
306 .-" HOLDOWNSr ,. 5S
r l _,, CERTIFICATIONOFEXEM"IONFROM WORKERSI, - { 30,7- - INSULATION' I l R\ j
T CONIPENSAIIONINSURANCP __ _
I ora;inion need not be completed if the Permits for one hundred dollars -'3 0 8- -"•SHEETROCK- - -
pTWlorles" 309 - EXTERIOR LATH
1 nryina�nm Pcrr - "rte ii to;which m Permit v 1 .310.. __::INTERIOR-. LATH..'.' .... .. : ........ _._
"shall not employ any person in any manner so as to becomeabject to the Workers _ t
Core mxtionlow:ofcaliromia.Date 311 SCRATCH COAT
Apmmn, -3-13- - -ROOF -NAIL
I —
NCHICETOAPPLICAMI If.after mala grh' C•nl&mc fC prionuld
:you ahu ' i
Z necomesunjeetmmeWorker's camper.anonprevisionsoftheLzborCode.yenmust, 501 - FINAL ELECTRICAli ENERGY
Z Q forthwith comply with such pro.visions or this it.hall bo deemere
d ked.Z — ..-.... .:.. . . . . ..Perm .... .. .... .... 502 - -FINAL- PLUMBING- ENERGY- .. ...._ ...._.....-.,_ ... _....
'rn I'i'I^� '' CONSTRUCTION LENDING AGENCY
""Ihereby`art,.thatIV..isncoostmetionlenamgtinnigfotm<perrormama 503 - FINAL MECHANICAL ENERGY.
CG > 'the work for which this permit isissued(see.3097,Cls.C.) ."_,504 - FINAL. BUILDING._.ENERGY._..__ .. . . _.
�'❑ Isndei i Name'.._ _ _. .. ._. ...-. . .. _
5.Z Lendcr'; _AOdress 50S FINAL ELECTRICAL,,
_ U'O IcenifyihmIhave readthisapplications and run,flu,heabove information is 506 - GAS TEST
U+ [r 'correct.1 agree w comply withall city and county Ordinances and state laws relating 507 - FINAL PLUMBING
. 'CSU �m building conswction.and hereby authorize representatives ofthi.s city it)enter upon
>s rte the above-mentlooed property for inspection paHmxs. 508 - FINAL MECHANICAL
(.a.:6 (We)agree m snob,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in anyway accme against said 5 0 9 - FINAL
City in coroequence of he granting of,hi,Penmt. r)
APPLICANT UNUERSI}\NDS AND WILLCO\1PLY WITH ALL NUN-POINT IgSUe O '✓ F A NG Date
- SOURCE REGULATIo.vs.
Signature or AppfcanOComtrnnor. Date Re-rogfl6'� - FINAL BUILDING
t - HAZARDOUS MATERIALS DISCLOSURE "
Will the applicant or future bWlding occopant store or handle huatdoas material _.Type Type of Roof_ _. _ - -- _-_. ... ._,_,.... _ .. .. .,,...._.._..._ .
a:d f J by the M IP;I Cnde Chapter 9 12 rM1 HevI1M1 and S f tY _..• , h i"
Cod Section 25531+(2orr {. ) Y' +' sol
OyriI ONO I r.I,T'1 All,roofs,shall be ins ected rfor'to.any roofing.material being installed.__,
Will the ppl - t or future building mra,amuse cNe patent or dn,cer which - If a roof is installed without first obtaining an inspection,'P agree to remove
` thazardous air contaminants as defined by the Bay Area 'r Quality Management
• D r t all new materials for inspection. Applicant understands and will comply.with
❑res '— ON. all non-pointsourc®ulations. .
I have read the haardous materials aquimidents under Chapter 6.95 of the
California Health&Safety Cade,Suctions 25505,25533 and 25531.1 understand that -
if the building dons not currently have o enninthat it is my responsibility to notify the - r
'tq,,,am of the requirements which which must be met prior m issuance of a Certificate of
° P
Y. Signature of Applicant Date
owbe,or aamnriacd agent Date All roof coverings to be Class IT 11 or better
:.:'.:,; ' ,. ,.. .. .... ... .. .OFFICE .. _ .
OF
CI BUILD NG DIIVC1ISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10842 NORTHFIELD SQ 02060007
•' ' SANTTARY NO:-" CONTROL NO.
Q' - ARCHITECTIENGINEER: BUILDING PERMIT INFO
w BLDG ELECT PLUMB MECH
a i-
�?y .
LICENSED CONTRACTOR'S DECLARATION Job Description
QZ=p 1 hereby aRrm that I am licensee under pro s of C Me 9lcommencing I3
nser "'a'""'mn3nnneBn,me.uanne �UnaCwe..namyran� REPLACE DAMAGED WOOD MEMBERS
a Y I
,in full f and affect.
�o�aO_ I
Ls
ik w -+ 1son
nrandplan,
C ntmcmr �jn2�
FS-a u.r" e h _,
W a! I ARCHITECTtS DECL rtmNs t..... -
K 4 ^'Y.PIn chall.M1e used Pu ^' FIN /\ 9 EV - 1, aI •s
w 6 pp -Licensed Professional••`•- -
OWNER-BUILDER DECLARATION
e m 1 hereby affam that 1 um exempt from the Contractor's License Law for the JUN 1 0 200
F z a following reason.(Section 7031.5•Business and Professions Coda Any city Or county" $4900
E x 0 which requires a permit,o construct.sorer,improve,demolish,or repair any strucone
at 3 .prior to its iso„anca also requires the applicant for such Permit o file a signed sm¢menr
that he is licenced pursuon,to the pro,toons of the Contractors Licence Low(Chapter 9 r S Valuation
(commencing with Scribm,76001 of Division 3 of the Business and Professions Code) '♦,ilw iia 1.b-3 /l•)I /4hWs+��^=�+ �'I�,^'
or that We ii exempt Narefroriaand the basis for the allege)eiemplon.Any violation
Of Section 7031.5 by any vpplicanl far v Permit subjects he aPplia.m m v civil penalty
-of unbmnrcman Five hundred dollars(S500), 101A - V6 bATION :.'.t ,,: Occupancy Type
C 1.as owner f,ha property,or in,employ«s with wages as their rale curn,roa ion.
-will'dn[hc work'and the
- employees.
sne no"nOrhffared onot(Sec T
402 PIERS—
ss and Professions Code:ThCommaor's License law e not apply o an
103 - UFER Required Inspections
..be,of property wM1 Wilds Of e tb .andwh d ssuh k himself
of though hPI yeprovided th t such improvements0.4-
'••�-••'
t t year or 104- r.-. REBAR _. .�.__..
Offeredfo3t the
a tM1 bhav ge burden
e i s IJ lh one year of t p"t"'
j s , .,
anmplet nn,me ownar wiener morn have me bureen ar Pmvmg that oras not mous or 105 - ANCHOR BOLTS- - '
improve for purpose of aate.l 106 - SEWER & WATER
1_; a owner frha -- — _-,
_
consumerhe pr,act(Se)OSJ Bus vas ly d Pm&camns Code:)sno C.mmanrs 2 02 - UNDERFLOOR PLUMBING . ,' l'•
w due not apply to an owner of pmpeny who wilds or improver thereon 203 - UNDERFLOOR MECHANICAL `
..i.Ce who conuacis for.such prujects,with.a eanuacmHs)licensed porsuant.m.Ne _.. _.- .._.. .. _...__.__ __...-_._ .....-_......._-.-
lampos Licenxlnw. .,. ,y, _ .. . -__ _..204 -.._UNDERFLOOR:FRAME-
0
- - mptuneerSic. - '':B&PCIOrthismasoq 205 - UNDERFLOOR INSULATION
Data .I:" 3O1 - ROUGH PLUMBING
WORKER'SCOSIPENSATI ONDECLARATION
I hereby affinst underpenalty rpc3 rt'One. fN following nge 1 tong 302 - TUB & OR SHOWER
303 - ROUGH MECHANICAL!':w.
Ori ha a a siiW le c nteof cWorker's 304 - ROUGH ELECTRICAL
TCon pens i o nio,idea I r by Sen on 3700 f he Labor Code, for the
perfunnan«none wink for which this remit is Is.\ued:-
305 - FRAME
❑I have and will mainiori Warker's C64sparratio t Insurance.as requiree by Section 3 06 - HOLDOWNS
37M of the Labor Corfor the' Perform f thework for which this permit is
issued.M¢y�Worker's C P . t I nr one c,and Put icy Ours, a 307 - INSULATION
wntrV�/rPF1_ 'Po1 tr
I'SHEETROCK r
TONMwORKFRS
COMPENSATION INSURANCE EXTERIORA. H
_INTERIOR LATH
-.-.._- ---------------
3
'u{r
.-
.-._._
_ .„--,.
31'0”
section neeJ'no,w comported if the Penni,is for one hundred dollars - - - I
rsluo) l:
311 - SCRATCH COAT
1'cen ft'that in the performance ofth kfor wM1rhmx t '. a:till .,...- -- 313'- -"'ROOFNAI,L—
, r ,.-„ t,-,.:i. , ..
",hwlnu mployan,pa ym toWomi ObicntoNeworkeR 501 - FINAL ELECTRICAL ENERGY
Applc t • - l , '.t ... '.. _-- - -_..50.2..- -F-INAL PLUMBING:,ENERGY._. --
Co pe t taw,'ofCalifornia.'D to ”
NOTICE TOAPPLICANT Ifaftimaking th Ccnificite of Examp,ion .,should d 1,
betsubjectt mew ke C 'pe rat provisions(iftheLaborCode you most 503 - FINAL MECHANICAL ENERGY
O 0 forth di ply with such p .or thisPermit hall b<Jeemed revoked
z _.. _.
504 .. - - FINAL BUILDING -ENERGY - --
CONSTRUCTION LENDING AGENCY '
505 - FINAL ELECTRICAL
1 hereby hick th t N ra t lee g g cy f the lie fora c
C ? 6rm kmr nmthis p mitis d(s<a )097 c c) - GAS GAS TEST .
(sl a . lid N - - -__... .. .. _. .._..-._
Z t.ende Addrc ' -; 507 - FINAL PLUMBING .- ,,, [,
U.O lttnfythat lWin rcall this application andstate that the above information s 508 - FINAL MECHANICAL
cbrInti,lagione to comply.with all city and countyordinances and.ttel reb' g 509 - FINAL GRADE
ran Id g t t dhere by a01lo p taive 1 N'.JOY m tater upon
, p.3 7 the awve mcnnpnee pmpi In,molecular Purposes. 510 - FINAL PLANNING
[r (We)pgrcz
to. e nide nify and keep h Men pthe City of Cupertno'against
`h "tialult,ties.I dgn Pls,costsand expense L h mpY' ry y 9 hist said 514 - FINAL C WORKS`
U z Chen y ce f m gram ng ollh p R
,hPPLICANTUNDER.STpNDS'AN'D W '0: '�p 'WITH ALCN N:POINT'' r(
SOURCE REras. ' 't'� >GIssued by: Date
�Ibinjbla of Applicam/Comrcmr t• ",;Umar;', Re-roofs /
HAZ\RDO MATERIALS DISCLOSURE
wB me ppl a m r t molding« p t,t m r handle n and . m t tiI Type of Roof. .
tuft pd beth Cpertn Mu cP ICJ CI pt 912JN HbM1 old Sale,
Code,Sect o 25SJ3fa1
s
❑Y
I t T , _• - All roofs sha
It,be Inspected priorto',any roofing,material-being,mstalled.
,I:! mme;ppl t rfuture re ouildi g Pamuceeq pate to J ices which If a roof is in611ed'without first obtaining an inspectiofi','Ijagree to remove
e t M1 b " cot t
s ticfirw by th Bay Area Ail costly M.... cm
Di t t all new materials for inspection. Applicant understands and will comply with
C °YNuall non-point source regulations.
I ha a read the hazallou
ma
'2
'regd ms under Chapter 6,95 of,he
•--� Cal fomta tleulth&SP&y Code Sections 3550, 5 3 and 25534I understand that
-if,hebuildmg does not currently have u lent .tha Is my responsibility m notify the --
coerpam or the requ rdm ni which si m prior to issuance of a Certificate of
Oc uPancY, ._ . .. . .._.. ..
03 0 Signature of Applicant Date
_ ..
Z.
« Pr aomodrae 1 Data, All roof coverings to be Class"B" or better
,:..'.".a .;.,cd:.:,I - .,'_� ' .'- _ _ -... •., - ..,,r_. ..- - - OFFICE.. . . _ - ....... .. . . ... . - -. - . ._ .