06050089CITY OF CUPERTINO T' Tt�a,�y
�xs=ar�
- "j�"I��y�^`"
IR
BUILDING DIVISION PERMIT
dl..®��pv"^'l�O
BUILDING ADDRESS:
PALISADE BUILDERS INC
PERMIT No. 06050089
19501 STEVE
OWNER'S NAME:
PERMIT ISSUE DATE
MENLO EQUITIES
909 ALMA STREET
rj6/o9/2no6
NE:
SANITARY NO. CONTROL NO.
Ir
(650)470-4700
ARCHITEC (ENGINEER:
-
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
n o 0 0
LICENSED CONTRACTOR'S DECLARATION
IOL DCSCi1pI1On
1 hereby affirm Nat 1 am licensed under provide. of Chapter 9 (commencing
with Sic ]IXk3)ofondsian Sof Ido, Business and Professium Codc, and my lice...
nlnnfn.ea.derr«t.
REVISION-CANTILEVOR.AROUND BLDG
Lhamm Class Lim.#
Dam Commum
RFI FOR PLANTING NEW TREE-ORIG #04090240
ARCHITECT'S DECLARATION
NO NEW PERMIT
nd my plans shall he u.d as public rords
1 understand ec
( Licensed Pmressional
OWNER -BUILDER DECLARATION
1 hreaso .(Sere the 11. exempt from Nc Contractor's Liccn. Law for the
i mason. (Section BI31.5. Business and Code: My city m county
my
ere. dedone
which a re conswcL a@r, impmw, erre eery swnum
1 which t
squires
,also h permit i a sig
Of for sucContrarmiva ril nM 1.2 N sammem
primer its ceased W the the
Sq. FL Floor Area
Valuation
nt provisions
pursuant
sli<ensedpursuam7")orDvsio3NeheBuinessaddProlLAw(Chap¢r9
tthat curn
(commcnring rith Sauon]0003 of Division lnf dtc Business add Profeaiatu Code) or
$0
that he is eumpt therefrom and the basis for the alleged exemption. Any violation of
APN Number
Occupancy e
P Y TYP
Section ]031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more Nan Ove hundred dollars (S5ML
❑ 1.uowtterof J¢property,termycmploycuwithwagsuNeG.lecampeu don,
Required Inspections
will do the work and the strumum is not intended or offered forsale (Sec. ]ON, But.
and Profndou Code: The Contractors License Law docs twI apply m an owner of
property who builds orimproves Narcan, and who daessuch 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. Ne owner -
builder will have the, burden of proving that M did not build ter improve for purpose of
anlc.)
❑ 1. as awns of a property, . Business exclusively cofessio g with licensed .tract rs i.
centre Ne project (pec. too14, Code) The Li-
(\
a who Wilds es theme,
no(apply Pr m an owner of property whe builds or impmvn thereon. and.
chrofand property
cone Law cdoesontracts for
for such projects with a cantrecmr(s) licensed pursuant m One Contractors
whence
Lacts
License Law.
am
i] 1 ore evempt undo Sec 0 3 P C for this ..on
V
Owner Dam
\
WORKER'S COMPENSATION DECLARATION
01 I hereby affirm under penalty of perjury one of the following declaalions:
hire and will maintain. Ccnificaa of Gmsu m to self -intim for W.ftesComfort.
setmo, u provided for by Section 3700 of the Inbar Cede, fee use poofarmance of dte
work for which this permit is issued.
❑ I have and will maintain Workers Compensation Insurance, as required by Section
3700 of Ne Labor Cole, for Ne performance of the wart for which this permit is issued
My Workers Compensation Laurance artier and Policy number are:
Camcr: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ibissection need net beeemplewd if the permit is formic hundred doll= (5100)
or loss.)
I certify the in the performance of the work for which this Permit is isued. I shell not
employ any person in any manner. as m become subject to the Workers Compensation
Laws or California. Dam
Applicant
NOTICE TO APPLICANT: If, altar making this Cenifcam or Exemption, you should
became subject to the Worker's Compertsatimn provisions or the Labor Code, you must
foMwith comply with such provisions or Nu permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby a1Brm that there is p conswnien lending agency for the performan¢ of
the work for which Nu permit is issued (Sec. 3097, Civ, C.)
Lender's Name
Lenders Addacss
1 certify Nat 1 have mad this application and state Nat the above information is
comet, I agree to comply with all city and county ordinances and stale laws misting to
building construction, and hereby amhorrre repraena6vcs of this city to enter upon the
ahovm-memidgm propertyoat or inspection purpoharmless
4 (We) agree Ire save, indemnify and keep h less Ne City of Cupertino against
es. ts,the craving expcmcsmit. may in any way same against mid City
inqunce or
mf granting of this permit.
A
APPLICANT UNDERSTANDS
' APPLICANT UNDERSTANDS ANO WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGUL.AT \
Re -roofs
Type of Roof
ignammplantt{{{ ohuacmr Dam
AZAROOUS MATERIALS DISCLOSURE
Will Ned pliant orfumm building occupantsmvv
re of handle hardrusmerud
as defined Wits,
Ne Cupertino Municipal Cade. Chapter 9.13, and the Health and Safety
Code. seNa. zssu(.)]
❑rte �Dfd
All roofs shall be inspected prior to an roofing material bei.
P P Y g being installed.
OrWill Ne applicant or future building occupant use, equipment or devices which
Oricn
If a roof is installed without first obtaining an inspection, I agree to remove
hanNnu air crnaminamts u defined by the Bay Area Air Quality Management
all new materials for inspection.
❑Yes ON.
I haw read Ne harsom., materials ac,immera under Chapmr595 orthe Califor-
nia Health h SafelyCode. Savors 25505, 25533 smI 5534,1 understood IhxtifNe building
Docs not cuncmly haw, a ¢rant, that it is my rapmuibility to notify the occupant of the
mqu Khmhh�bemIptjgrIHi emoraC-SomaCcccpmcy.
�� �E
Signature of Applicant Date
All roof coverings to be Class "B" or better
0-6c, r mon.ndegept, ❑ue
Z. :
<C
:pC
.zi
0 2
Z C
CITY OF CUPERTINO
ONTRACTQR�INFO RMATIQN
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PALISADE BUILDERS INC
PERMRN0.06050059
19501 STEVENS
OWNER'S NAME:
PERMIT ISSUE DATE
MENLO EQUITIES
909 ALMA STREET
06/09/2006
NE:
SANITARY NO. CONTROL NO.
(650)470-4700
ARCHITECT/ NGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm Nal 1 am licensed under provisions Of Chapter 9 (commencing
with Section 7") of Divialon Sof de Busiess and Professions Code.and my licence u
in full force and effect.
REVISION-CANTILEVOR BLDG
License Class `J
Dam CaMvacmr
.AROUND
RFI FOR PLANTING NEW TREE-ORIG 404090240
ARCHITECTS DECLARATION
NO NEW PERMIT
1 undersand my plans shall he used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby alum that I am Caceopt from tM Convazlofs License law for One,following
eman. (Secdoa 7031.5. Business and uns ny ProfeasiCade: Acity or.unty
which ¢quirts a permit to construct, alcor, improve, demolish. or repair any structure
! prior to its issuance, also inquires the applicant forsuch permit to Glc a signed statement
Conuacmrs Liccnm Law 9
Sq. Ft. Floor Area
Valuation
Nat he is licensed pursuant to the provisions of the (Chapter
(commencing with section 7000) of Division 3 or Ne Business and Professions Code) or
0
1 Nat he u exempt therefore roand the basis for the alleged exemption. Any vloladon of
APN Number
Occupancy e
P Y IYP
Section 9031.5 by arty applicant fa a permit subjects the applicanuo a civil penally of
not more than five hundred dollars (5500).
O I, u ownerr of the property, a my employees with wages as the"v sok campensomm.
Required Inspections
will on the work and dusvuaum u not intended or afemA far ale (Sec. 1044, Bud.
Cam License Law does
and Pnefessiou Cade The xc o x ooh apply to . Ower Of
property who bunds orimproves thereon. and whodausuch werkhimselfor Wough his
own employees, provided Natsuch improvements Meet intended aoffemd furnace. If.
however, the building or improvement is sold within ane year of completion, the owner,
builder will have the bard. of pawing Nat he did om build or improve for papom of
talo.).
- Q, ^ \.
1, as owner of the property un exclusively convudng with licensed ¢outran m
ca atruct the project (Sec. 7044. Business; and professions Code:) The Commodes V.
V (�
cense law does Out apply m in ouxr of property who builds or improves then.n, and .
who cmdacts for such projects with a conuacands) thersed pursuant ad the Convector's
License law.
❑ I am exempt under See B k P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury tee of the following declan0ons:
❑ I ham and will maintain a Culifiamof Conacnt as self -insure far WorkcfsCompen-
ad., u provided for by Section 37M of the latter Code. for the performance, of Ne
wort for which this permit is issued.
❑ 1 have and will meimain Worker's Compensation Issuance, az mgmovd by Scedon
3700 of Ne lather Code. for Ne performance of the work for which this pemnil is issued.
My Worker Compensation War.. artier and Policy number are:
Carrier,Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu sec bms land Out bu completed if the permit is fmonc hundred dollars ($I00)
ter less.)
I certify that in the performance of the work for which this Permit is issued. ) shall not
cmplcy any persen in my manneras as on become, subject to de Workers' Compensation
Laws or California. Dae
Applicam
NOTICE TO APPLICANT: If. after malting this Ccrtinate of Exemption. you should
become subject m Ne Workers Compensation Provisions of the Labor Code, you crop
faMwith Comply with such provision or Our permit shall be doemed revoked.
I
j CONSTRUCTION LENDING AGENCY
1 hereby affirm Nat Here is a conswctinn lending agency for the performance of
Oc work for which this permit u issucd (See. 3097, Civ, C.)
lendeh Name
Lattices Add.
I certify Nat 1 have reed this appRcadm and waste that the above ittrwor en u
cam M I agree a comply with all city and county ordinances and sam laws relating to
building conauunion, and hereby authodm reprammatives of this tiny to enter upon de
abbvememioned property for inspection .
I.rpte
(Wer) agree to save, indemnify and krcp harmless Ne City of CuPcnino against
cram and Oxpcnsesmit. may in any way carve against aid City
which m
incoideajose or th,
or IND
APPLICANThe Aranting
WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE RECUTA s ^
�a
`^!/
Re -roofs
Type of Roof
ignmum lion dnZO prem
AZARDOUS MATERIALS DISCLOSURE
Willplica¢ a fuwre Wilding ecup.lsrort or basic haurdm
ous nunah
az defied b Cupertino Municipal Code. Chapter 9.12, and the HcaIN and Safety
coca. Borden25532(.)?❑y. ONg
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding dexpam use cquipm.t Or dwi.s which
If a roof is installed without first obtaining an inspection, I agree to remove
mit huardom air Com minana u &rjmd by the Bay Area Air Quality Management
all new materials for inspection.
District,
1]Ya ONO
I law maJ the haaNnus maternismquiremcn s under Chapter6.95 Of thc Called,
nia Hesith k Safety Cada SaCtiass 13505,25533 and 25534.1 undersand thlifthe building
does not Carmody hot a tenant, that it u my rome cubility m OMiry the aTap.l Or the
rtyvim whichmuvbcmd tufa-reamara=
Signature of Applicant Date
/ b
All roof coverings to be Class "B" or better
ow c, or mth.rimd Date