00030208 CITY OF CUPERTINO PERMITNO.
BUILDING DIVISION PERMIT CONTRACTOR INFORMAATION: - O 3 a O
BUILDING ADDRESS' SANITARYNO, a APPLICATION SUBMITTAL DATE
vZ00o�0 R0021G11ESAVe (o h 6! /os4�9
OWNER'. NAME: p-T
// D,GG NIC CONTROL#
'HONE: LSz/6` da/l�f'S� -rX •779-27Z0 0 '
RCHITECHENGINEER BI)LDINO PHRMII"INFO
UE 5l��iK2. SOc
LICENSED CONTRACT'OR'S DECLARATION '
I haleby affirm Nat 1 am licensed under provisions of Chapter 9(commencing i' Job Description ,
m�W with Section 1000).()ivision 3ofdm Business Lid Pmfewiehs Codnd m
Chile,ay license is sere. `
in full forte and affect. '•j�/:�:• t:' /'•' v - .
u 3 a LicenaeClass Lia.« •:�f'afl//I 1G , GU/�tlDOie��C �L SLAC
E: De¢ Contractor /�f/V
C LL O g ARCHITECTS DECLARATION.
v�Y 1 underauod m 'Tall e all nd uud uwic scads ._ • -
o. 'casWRofe ER •. It ,
=w OWN DDECLARATION
1 he a .i thin l cxempl from Ne Contractors License Law for the
Y€o fellowin8 mal(Secarm 7031.5,Business W Prof ices Cade:Any city or county
WhICh IeQnIRs a pCnnll b LONW[I,eller.VliplOvt.delrpllxh.or Rpalf Ny tlm.
- Sq. Ft. Floor Areat gyp' �D, Valuation
pnatoits issuena,elan.qui.s Ne applicant fa ouch pcmdlto Ble aaignd awmrmnt I! S
Nes he is llunsed pursuanttoNa provisions of the Cona.tore Liunaz law(Chapla9 '
chat he
exempt and
or me alleged .aawon.Anyanacme)of A Numb ref - Occu ane 1I e
Natio is eacmpt thaafrom and cif basis(e Ne aBegM r'lici ce m Any violation of P. Y •J P -
Sation 10I n by tiny applicants for•pemdt sublas dm applicant m a civil pcNlry o� 1 {O
Dol come Nen five hundrtd dollars y employees
El LaaawNrk,the Cropeny,a my employav wiNwages fased. sal<C .Busatiod, - - Required Inspections
Will do New...Co Na he Cio inns intended,Law it l .61 1,.an owuess
and Nofwh ob Cade:The oyes th tom's.and w law does nil apply to if owns of
property who builds or improves t such i, le who does such work himself or through
1
his own emp)oymas.the provided Ilml such improvements tie no im r.f m plef<d for,usl -
owaJLhowevw Narmbuilding.,himproprovi.I,soldchiraneywrinarolelfar pme
owec,if her Will have dm buNen of proving Net M1e chiral build m improve for pw- -
poseofW ).
❑Luo of the property,afn exclusively convacting with:)The Cconowns'.
camwn the project not apply
toaA,Busowner
of cope property
who builds
ds or
The Contractors Li- - 'a
cense law d«e not apply je ts owner of#copes who sed p or improve conscious and ^
who U... r.lt for such projects wiNecontfecmrlq licensed pursuanuo Ne Cantraclors
Uanaz Law.
❑Tem exempt under5.. .B&PCfor Nis ruson
Owns - Dam
WORKER'S COMPENSATION DECLARATION - - 4
1 hereby eMo.under penalty of perjury oro of the following dermadmix - -
Ibav<albwillforbyS Smoot
37W of CONentr Code,
for the Worker's Compero • � -
tote I w provides!pe by Sation 3]00 of 0e Labor Cade,for the perfbrmar,u of the f ya
wet for which this pencil is orkie
❑1 love ad will maintain hi,co Y ran ca III,
Imurema,w rcquimd by Section
3100 of roc err Cotle,for the pertormence 0,in eek(nfwM1ICM1 Nis permil is iawd. - -
M Compeneetion 1 mane cam ollcy number tie:
s., ams cy No.:
CER CA F Pf ,'ROM WORKERS". -v� •�
COMPENSATION INSURANCE '
(This seal' nnad nandcomplemtl d'thc pcmdt i..(cocoa hundfed dmlms(5100) '
e
less.)
Toy any Inti in the mymannoceof Na warkfa which Nis the Wikers.C,l.hdl - •.
not employ any Califon in any manner so w m become xubjea to the Workers.Compen-
stamnLnwsofCelifomie.Dam
Applicant sere r ? sere
NOTICE TO APPLICANT:If,after making this Ccs ificam of Exemption,you should f,
become Subject to the Workers Compensation provisions of me Leber Coda.you most
Forthwith comply with such provisions or this permit shall be dermad mvoked. _
CONSTRUGDON LENDING AGENCY
Q - I hereby about dla there its construction lending agency fonts perfnmwce of
the work Ins which this permit is ismed(Sac.3041.Co,,CJ 1 • '
U date Name
Under.Address
I cenify that I have mad this application and sum that Ne above info nalion is -
�+ car<cl,i agrca to Comply With all city end coumy odimnus and xmm laws Main". -
z building cotimuction,end hereby station.repream w.alibis city to emcrupon the - -
,t� C) above-mentioned property for inspection mr oazs. •' '
R H (We)agree to save,indemnify and kap homilies Ne City of Cupertino elitist -
O U Imbiliuet.jalgments,costs and expenses which may in any way secfue against said City
W in<onazquence of the granting of this permit,
_ L APPLICANT UNDERSTANDS AND WILL COMPLY,WITH AIA.NON-POINT
SOU ;REG UId'TIONS.
V '
' law.til App'enUComr.mr Data t'
HAZARDO TERIALSDISCLOSURB
Will appliont or future building occurrent aha or M1andle hkeefdom mawid Re-roofs _
u defined b he Coto Municipal C pmr 9,I;and the Health and Safny - -
oda'act,..
iia 3 T e of Roof.
< nus xa)1 YP ,
❑Yw
All roofs' shall be inspected prior to an roofing material bein
Will the applicant or future building occupant nae egoipmem of davicaa which P P y $ ,g, I
emit hsvfdous air conleminmu es definnd Bay Arca Ab Quality Management installed,•If a roof is installed without-first obtaining an inspection .
am"' I a ree to remove all new materials inspection. Applicant
❑Y<s g
Ihave mad de loo mmua m.�.ls res iammus, hole,Chapter 6,95 afro,.Cdnd
,- un, rands and will comply with all non point source regulations.
(oma Hee
Zed
Cade,sections 25505,75533 and 25510.1 understand that if the _
Ful din anacofren)y have.let."that itis my responsibility bnolify the occupant42
irtmenu whic�wmafl tpne to is nee oh Ceaificae of OCLupency.
'gnature of pplica Date _
......thori edam Dam
All roof coverings to be Class"B"or better
OFFICE'•.,
CITY OF CUPERTINO `' a wSy'�aPi,3 R t a"`e *sI�ta amt r PERMUTNO.
BUILDING DIVISIONpERD jpNTRACTOR INFORM;� '(ON
t '. :�2?Sski'L�Y..i8t�3+k�'TSY:3+*.Y.Ff.P=..ril.•i,` .=?'t..e r. t� _
BUILDING ADDRESS: I
1 SANITARY NO. APPLICATION SUBMITTAL DAT
OWNER'S NAME: I -
_ 'I,i .�'�• Il.. -:Jr v / NIC CONTROLN
RCHITECTIENGINEER f, 44SITPPrti{;itai.e"�-BULDTNO PFRMfTWPO i{!iSY.`4 N:!�
O.0 0z
YJ e •
NOTES • .._.. �� ------�—
i= Job Description
y�
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ao�
C3a
Sq. Ft. Floor Area Valuation
APN Number Occupancy Type
Required Inspections
w Iw
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oFc >
4
.7 z Z
UO
0 E
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� a
rn •
Q z /;/A_'�L`
Re-roofs
Type of Root'
All roofs shall be inspected prior to any roofing material being
installed. If a roof is installed without first obtaining an inspection
I a ree to remove all new materialsospseP
understands and will comply
ithall onpoint oucregulations.
Signature of Applicant Date
All roof coverings to be Class"B"or better
APPLICANT'S P fi ?I+^ C07Y
CITY OF CUPERTINO
HUJLnINc DIVISION PERMIT CONTRACTOR INFORMATION:
r01
12D(Tbfb"T�ODRIGUES BLDG PERMIT NO. 00030208
n"FBILTMORE APARTMENTS APP6Ir3A/o3Ndu)"fbb0
ONE: - - SANITARY NO. - CONTROL NO.
1. t
fizZrARCI=4JT=NG1NEER: BUILDING PERMIT INPO
ce
00 RI.DG ELECT PLUME NIiECH
y 2 LICENSED CONTRACTOR'S DECLARATION
Ilion 7000)of
thallan of
Business
p lid Pronsoens Code,a commencing WINDOW/DECK/FE
/FE�Ptlon
i N o CK//7E
der Seenon](g10)of Division3uilbe dminess and Professions Code.and myliceae
in full ford,and effect.
i z a License Clam Lic.a /
Date Commuter
I Ez 6 nRCHITECfe DECLARATION V
I.Pro... my plans shall he mea an public records / -
:LL�E
i O G Licensed Professional
O
'°' OWNER-BUILDER m Ce Cont ON
��-• 1 hereby aRrm Ina 1 am exempt from the Conti eAnyLicense Low for he
1`-/l
r=_4, laicism,rea.smISecdo"]031x,Ra.me.sanaPmres.mn.a,ae:Anyalymdoumy $90500
which act,tim,a pemiil to cmcmat,alter,improve,demolish 4,r mpmr any.wcwre
z
m poor oits tssuancca.wrt no filcasignW sutemcm --- - -- - - - - -
a3o
(commencing ms«tiav7000lp�ru�.ion3ortheumner, iesm,la tchaprorY :3WIh310Q8AQ1 . ., ; f .Valuation..
(cor.mencamwim Sectam t,me rmees,m� emr . ._...
g wi end Professions Cade)
or that he is exempt therefrom and the basis for the alleged exemption.Any l penalty
-id Salton 7031.5 iv any hundred
applicant for a permit subjects the applicant m a civil penalty ,
stood more man fine nunarea sonars fs50o). lO1PAF NS'QG)$IDATION Occupancy Type
01......mof the pmpeny.aron,employees with wages as their sole compensation, 102 - PIERS
will do the work:and the•swcmre,is not intended or'affected'for sale(Sec:7044. _
Business and Profession.Code:no Contmcunis License Law doses not apply m an Required Inspections
owns
r of prop.ny Who bands or impmms thereon,dad who does such work himself 104 - REBAR
or through his own employees,provided that such improvements arc not intended or
10 5 - ANCHOR BOLTS
offered for Bale.If.however,the Wildi"g or improsona nt Is sola x'imin one I..,or .'
ve
completion,the ox nenbuimer will have the burden of proving that he did not Wild or .• .. . .. .. . ...... . ..•
imp...cforpnmoseof.alo), 106 - SEWER & WATER
❑Las owner othe'propcnr.am exclusively coneractiug with licensed convaaora to 202 -- UNDERFLOOR-PLUMBING
onsnuct the pmjmt(sec.7044,Puniness and probe...an,codec The Commcmrs 2 03 - UNDERFLOOR MECHANICAL
License Law docs not apply to an owner of property who builds lir Improves thereon.
and who.contracts for wen projects with a connactmts)licensed pursuant to the .2 04 . - .UNDERFLOOR_ FRAME
"canards,°ret I.Inc.,.Law., - 205 - UNDERFLOOR . INSULATION
°I am cxcmm under Sec. .B ad Y C for his reason
owk� Date 301 - ROUGH PLUMBING
'
WORKER'5COMPENSATION DECLARATION - 302 - TUB & OR SHOWER
I hereby affirm under penalty at Nuury on of following declarations: 3 03 - ROUGH MECHANICAL
r� l hard and will maintain a Certificate m1 consent 10 alt-insure for warker's 3 04 - ROUGH ELECTRICAL
y compensation, as provided for by Section 37W of the Labor code, for the 305 - FRAME
perfonnuma,of the work far which this .it is issued.
OLDOWNS
°1 have and will am elhin W'orker's Compcnsirion Insurance,as required by Salton 3 0 7 - I 3 0 6 - INSULATION ON
3700 of the Labor Code,for the performance of the work for which this permit Is NSULATI
issued,MyWorker,Compensation Insurance dimer and Policy number are
308 - SHEETROCK
Poli,CERTIFICATION•OF EXEMPTION
FROM woRKcds309 - •EXTERIOR LATH
-COMPENSATION INSURANCE
,. ---.._ . _. .3.1.0--: INTERIOR..LATH--- - .... —.-:------- --- ------..._ _
(This section old at be completed it he permit is far one hundred dollars 311 - 'SCRATCH COAT
(51000arlean.),,. , . 313 ,..- ROOF .NAIL . , ..,.. _
i&gd that in nmalae
ep<To -fthewe*forwhichthisPenm61:'issued.l 501 - FINAL ELECTRICAL' 'ENERGY'
.,hall not employ any person in any manner so as 10 become subject to the Worked
Compensation Laws fCmifaoda.Date• 502 - FINAL PLUMBING ENERGY
ApplicantNmICETOAPPLICANTIf.ahet making thisCenircamofEsemption.yournomd � 503 FINAL MECHANICAL' ENERGY
Z become subject to the workers Compensation provisions of the Labor Code.you must
Q Q forthwith comply with such provisions or this Permit.shall be deemed revoked. 504 - FINAL BUILDING ENERGY
'CONSTRUCTION 1.ENDING AGENCY 505 - FINAli ELECTRICAL -
^' I hereby affirm that there ins a consumerism lending agency for the rcdormaince 506 - GAS TEST
f� u of the work for which this permit is issued(Sec.3097.Ov.C.)
o: q Lenper'rNamti 507 -
FINAL PLUMBING'
oz LendersAddres.• 508 - FINAL MECHANICAL'
.WoQ l degree that Ihave mad tins city
applicationandstate that the nIntlaws orating is 509 - FINAL GRADE
0 U In Wildiagree ng
contoction,awith III cityand countyordinancessand orate lawsser upon
O U m above-eonotn;edpmpcnherebyaaehmiareposenmtmeooftntsmtywemetppon 510 - FINAL PLANNING
.r f6 rhe ubsvumcgree 1.oned do,r:nd forinspectionand kepharmle
F o eWe)agmets,avetaand xpennswhichran)inywayacruenaoatsaid 514 - FINAL PUBLIC WORKS
�' City arcs,judgments,tens and expanses which m_ay.,many way accrue against said
V:Z City to ANT UNDERSTANDS
4,r the NDSA D this Permit.
''APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b r Date
SOURCE REGULATIONS. - Y'
Signature of ApplicarUComemom Date Re-roofs
„ . . HA9ARDOUS MATERIALS DISCLOSURE
Weill the..piprtanr or future baddmg mortar,shire or handle haaraoan muttmal ..Type of.Roof . . ... .. - ..,. -
as defined by me Cupcnino Municipal Code.Chapter 9.12.and the Health and Safety
Code,Scaion 25532(.)?
°Yos °N --- All-roofs.shall.be ins ected" riot to,any roofing material beim
g.installed. _.. .
Will the applicant orfumrcbuilding occupant use equipment ordevices which If a roof is installed without first obtaining an inspection, I'agree to remove
m11 ha=dous air contaminants m defined by the Bay Arm Air Quality Management
I...lot? . ❑No all new materials for inspection. Applicant understa_nds and will comply with,
_
k . all non-point source regulations.'
1 have read the hwaNnus materials requiremdnts under Chapter 6.95 of the
'California Health A Safety Code.Sections 25505,25533 and 25534.1 undemand thea
find building does not currently have a tenant.that it is my responsibibry to notify the
ochpam of the requircmams Which mon he net prior res issuance of is Certificate of
°""R'"`e' - - - Signature of Applicant Date
own«mamnod:ed ageht - Date All roof coverings to be Class"B" or better
OFFICE ._ . . ..