03100157 CITY OF CUPERTINO �
BUILDING DIVISION - PERM _ � ""� 's"'T� ,� �
BUILDING ADDRESS: MCAULIFFE CONST PERMIT NO 3100157
OWNER'S NAME: 886 TALLMAN CT PERMIT ISSUE DATE
COLEMAN EUGENE M D F ES S 10/22/2003
NE: (408) 227-0343 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
loo LICENSED CONTRACTOR'S DECLARATION Job Descrlptiol�'
I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing r-1
��aR�
�i with Section? )of i aionJofthc eusinexs end Pro eCotlah and my license is - AftlCaaau.
in full fit
«e dP'o 3G SIDING/REPLACE WINDOWS
jn? License ars LI.
Dare Canuacros NOV 2 6 2003
ARCHITECTS
CC 1 an s C r
'yU 1
-off Licensed Professional BUILDINGS OWNER-BUILDER DECLARATION
aI 1 hereby affirm that I am exempt from the Contractor's License Low for the
p O following reason.(Section 11131.3,Business and Professions Code:Any city or county
S$ which requirm a permit to construct,alter,improve,demolish,or repairany.nructure $20000
Z y juror to its issuance.also requires the applicant for such permit o file a signed statement
< that he is licensed purmanLlnthe provisiomofthe CmdrocusrsLicense Law(Chapter 9 Sq.Ft. Floor Area Valuation
alt-$ (commencing with Section 7")of Division 3 of the Business and Professions Coda)or 35616005 . 00
..
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 APN Number Occupancy Type
not more Nan Bvs hundred dollars($500). .
❑L as owner of the property,or my employees with wages m theirsole cam pensation,
will do dee work,and the income is not intended or offered forsale(Sec.7044,Business
and Professions Code:The Contractor's License Law tlxs not apply m an owner of Required Inspections
property,who builds or improves thereon,and who does such work himself or through his
Own employees,provided that such improvements an not intended or offered for sale.if.
however,the building or improvement is sold within ane year of completion.the owner-
builder will haus Ne burden of proving that he did not build or improve for purpose of
sathJ.
❑1,as owner of the progeny,am exclusively contracting with licensed contractors to
comamct the project(Sec.7044,Business and Professions Cade:)The Contractor's Li.
cense law does not apply to an owner of properly who builds or improves thereon,and,
who commons for such projects with a tantracler(s)licensed pummunt to the Convector's
License Law.
0 1 me exempt under Be.. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following Occlusions:
I have and will maintain a Certificate of Cement to self insure for Worker's Coupon-
.."on,
ou pon-sation,as provided for by Section 3700 of the Labor Code,for the performance of the .
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Cada,for thc performance of the work for which this permit is Issued.
My Wo{ker's Cnmpensai oq ins ranee trier and Policy number
e\vI 1\'S o.:6n5nm�n4o,
CERTIFICATE EXEMPT] FROM WORKERS'
COMPENSATION INSURANCE
(This taction need not he emmpleted if the permit is mronc hundred dollma($100)
nr less.)
1 certify that in the performance of the work for which this permit is issued.I aging not
employ any roman in any manner sore to become subject to the Workers'Compensation '
Laws of California.Data
Applicant
NOTICE TO APPLICANT:if,after making this Ccnificme of Exemption,you should
become subject to the Workers Compensation provision,of the Labor Code,you most
�z forthwith comply with such provisions or this NonniI hall W deemed revoked.
OCONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
Y. r7 the work for which this permit is issued(Sec.3091,Civ.C.)
QLender's Name
z J.endar's Address
Q 1 certify that 1 have read this application and two that the shove infommtion is
Hcorrect.l agree or comply with all city and county ordinances and slate laws relating to
C.J building construction,and hereby authorise representatives of this city to enter upon the
Upi� above-mentioned property for inspection purposes.
(WC)agree to save,indemnify,and keep harmless the City of Cupertino against
fn PPLI
,judgmcros.cosu.ad'expenses which may in any way accrua againstsaid City
;J7 ucncc of
grantin of this pc iv
r�^^.• NT UNDERST SAN ILL COMPLY WITH ALL NON-POINT Issued by: Dale
11 R If ATION
�ro Z2• 09 Re-roofs
Signalurc cf Applum"Commou" Dam
HAZARDOUS MA LS DISCLOSURE Type of Roof
Will the applicant or future building oceupantslore or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 255320)? All roofs shall be inspected prior to any roofing material being installed.
❑Yat 4 N
Will the applicant or future building occoperm use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
lit havardous air contaminants m coined by the Bay Area Air Quality Management all new materials for inspection.
jistrin7 �/
❑Yes LqN.
I have mad theh xzohms materials requirements under Chapter of the C,lifon
me afery Code,Sceuons 25505.25533 and 25534.1 undersand Nat ifthe building
docs t Core 1,have a Icosm that yis y responsibility to notify the cecupmt of Nc
reyui cnlswh'hMust bcMCI p Inti egraeemhm napmcr. Signature of Applicant Date
All roof coverings to be Class '13"or better
Own act
Or
send Omc
*ITY OF CUPERTINO*
CUPEf�TINO PERMIT APPLICATION FORM
N #
�
Building Address:
110q1 SaAN an asa
Owper's Name: P on25�- 3 b5b
ce v
Contractor: License#:
tha vl; g88�3Z
Ctact: Cupertino Business License#:
13CN% KC 0b 22.1 , 0343
Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
escription-
Residential t AL vlw wwJ.v+5 Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: �-D �' Occupancy Group ��
Type of Constructio :
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 1 OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILERS Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax-Resi/Mobile BUILDING
BELEC1000 Elec 600V <= IOOOA ELECTRICAL
BELEC1001 Elec 600V > IOOOA ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
1of3 L4W � s�,
OCT 2 zo _3 OFFICE COPY
B a
(4*
Ar-P o tU
IN ACCORD E WIT f THE ITV
• / 0 J N �+
SIGN
CTbbi hikeet on theis ansecifiratiOns job at alltim s and Its un,
I i to make any changes or altoroHons
om same without written permission from
the;building Dept., City of Cupertino,
Ihe,stamping.of this plan and specifiatbns
SHALL.NOT be held to perms or to
(J oppft oflf I&vio ad of ® �s
Rl� 0all woocQ Sio( l rs i este `-
•
CITY OF CUPERTINO '
{n
BUILDING DIVISION PERMIT -,CONTRACTOR
BUILDING ADDRESS: MCAULIFFE CONST PERMIT NCO 3100157
1 7
•R'S NAME: 886 TALLMAN CT PERMITI.SSUEOATE
COLEMAN EUGENE M D FRANCE S 10/22/2003
NE' (408) 227-0343 SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+o0 LICENSED CONTRACTOR'S DECLARATION job Description
hereby affirm that I am licensed under provisions of Chapter 9(commencing
U with Section] )nf i ren Sof the Busirm and Pruf�ssinnsC deh and my noun.is j�, /�
'.ordn mmnm ren x' 154$ 3t, SIDING/REPLACE WINDOWS �IIIVFI�E®
a Z License LI.
s l„ Date Contractor
4a< I a ARCHITECTS - NOV 2 6 2003
>yU
ii y Licensed Profcsaional
S OWNER-BUILDER DECLARATION BUILDING
C a q 1 hcrchy affirm then 1 1. exempt from IW Contractor's Co e:Any
Law for the
p O following mason.Nonni,
I ](131.5, r.Business and ire.Professions Code:Any city or county
3$ poorM1 r to its iss s a gamut re conswcl,aper,improve.h permit t or repair any structure $20000
-iy thathess issuanceursuant to ths@eapplicant
sof for such permit micenle se aw(E.Il ant
:Z< (earn maningwiIpSectio7")of Diviomnf the C,awnesand License (GM1HPICr9 Sq.Ft. Floor Area Valuation
ZFp (commencing with Section)t]W7nlDivision3nf the Business and Pmfcssinna Cnd 0 35616005 . 00
a then he is exempt therefrom and the basis for the alleged exemption.Any vinlaGon of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than Eva hundred dollars(5500).
0 1,as owner of she property,or my employees with wages as their sole compensation.
will do the work,and the structure is nolinsended or offered for sale(Sec.7044,Business
and Promotions Code:The Contractor's License Law does not apply in an owner of Required Inspections
property who builds orimprovea themon,and who does such work himself or through his
own employees,provided that such improvements are not insured oreffered 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 improv,for purpose of
sale.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
conswcl the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
cense Law does not apply to an owner of progeny who Wilda or improves Neuron,said,
who contracts for sub projects with a contractor(s)licensed pursuant to the Convector's
License Law.
❑I am exempt under Sec. ,B&P C for this reason
Data
i' 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 m self-insure for Wark,r'sCumpcn-
sxtion,as provided for by Section 3]00 of the Lather Code,for He performance of the
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation insurance,es required by Section
3700 of the Labor Code,for Ne performance,of the work for which this permit is Issued,
My Wo "I Cnmpensa' Ins mnce niu and Policy numberare: IeQt_
e n o.:6tShWtn
CERTIFICATE 00 EXEMPTIOM WORKERS'
COMPENSATION INSURANCE
rrhissection need not W completed if IM permit is for one hundred dollars($100)
IevJ
I certify Nat in the pi rro comm.of the work for which his permit is issued.l shell not
employ any person in any manner x as to become subject o the Workers'Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:IL after making this Cenificau of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
�z forthwith comply with such provisions or this Permit shall Ise deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a constrvninn lending agency for performance of
La the work fur which this permit is issued(Sec.3097,Civ.C.)
Sl Q Lender's Name
7 z Lender's Address
;J 1 certify Nat 1 have read this application and Stam that the above informadan is
LH correct,l agree to comply with all city and county ordinances and state laws calming to
�(J building consvuction,and hereby suthorim representatives of this city to enter upon th,
„ above-mentioned property for inspecdon purposes.
(We)agree to save,indemnify and keep harmless Ne City of Cupertino against
~(/) R Iq,judg.ems,cmiamdcxpenams which may in anyway accom against mid City
J7 i con ueneeahhegramin of Ihia pe il. /
r7 A PLI NT ENDERS S AN ILL COMPLY WITH ALL NON-POINT Issued by: Date «l
S URC U ATIONSI
. D# Re-roofs
' Signammof Applicanl/Contractor Dam
HAZARDOUS MA LS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle haurdous material
efined by the Cupenino Municipal Code.Chapter 9.12,and the Health and Safely
S,nion 25532(a)?
r]Year Na All roofs shall'be inspected prior to any roofing material being installed.
Will Nn applicant or future building occupant tau equip cat or Devices which If a roof is installed without first obtaining an inspection,I agree to remove
7mq.i
avardous air contaminants as refined by the Bay Area Air Quality Management all new materials for inspection.
" CK
N.
Yes LgNu
1 have mail Ne hasardous materials requirements under Chapter 6.95 of the Califon
^s$aRry Code,Smuum2,,d5,25533an,.534.1 unJcrslmld thaifNc Wilding
tcume ly have a tenant,that iI y msponsibility m mmly the rccu,.fof the
cnmwh hmuslbemclp tricor.ccrtinmetn �,cgpancy. Signature of Applicant Date
L., tiz, 9 t'oat mind agent — Dale All roof coverings to be Class "B" or better