08100184 CITY OF CUPERTINO ..�R'�-•�gwgw+a, Mwr q' .tcc - -
BUILDING DIVISION PERMIT 'CONTR'AC,TQ
R�INF'URiVIt1'CION.;
BUILDING ADDRESS:, PERMIT NO.
11510 WELL LE
OWNER'S NAME: CATHA PERMIT ISSUE DATE
A CONTROL NO.
TT T
ARCHTIECOENGINEER: Bt11LDING PERMITINFO
!' BLDG ELECT PLUMB MECH
u o o LICENSED CONTRACTOR'S DECLARATION
i� 1 kmby,Rem Nes 1 sm Iimnsed under provisions of Chapter 9(commencing Job Description
withScdon70W)of DivisJof dm Buunex aM Pra(rssiom Calc,aM mYlice u
+I„ infell form andertcs.1or - REPLC SIDNG(MASONITE) W/NEW HARDI-PLNK ,SIDING
jRz Lieenn Glu+_ _
Dow—
W . .._...-....:.:=:.irECT'S DEC -. -
I n."d my pl...hall k oed u public me.,&
s
'G Licmed professional
ay3 OWNER-BUILDERmDECLARATION
1 krtby.(Sect that 1 1. tempt from then ConuaetCc :Any c Law for the
no followingmoon.(Section RIJIS.Business p Rofevfons Cu do:Any city or county
$ which in IIs f a peonit m mnswct,duns,improve,h permit k ore a sig ed tatairstrecm
Prior to iuiuuanm.alwtequims sk applicant for suchpermitLcerri sLaw(Chtemcnt
< (that be commencing
licensed pServant7000)provisions 0)r th0)Cflusintoe'.send Prrelaw(Ckpter9 Sq.Ft.Floor Area Valuation
x o (commencing with Sation]000)a(Division Soflk Busincssad Profrwov Code)or
r3— this he u exrmpt therefrom and tk buds for the alleged exemption.My violathon of 7
Section 7031.5 by any appii.t for a Permit mbjcmt than applicants In a civil penakY of APN Number Occupancy T
nos moa than It.humlrtd dollars(5500). P y y(�
❑I.uawner oftk pvpdty,mmy uoployev with waguutkir cele eompevathon, 36651038 . 00
will do tin:work.andetene ContracartWteded Law clotorula(Sec.]061.hams,of
arta Prorewov Cock The Contrxwrs License law does cele apply ff rt rwner or Required Inspections
P'oWsywMbup «impays+ himn.+nd wno=noiin worthimselrmthmadehu
rwarem.t ycs provided that rns improved wit tee not ear o c orledon.forssle.lt.
6 filcher ill Wilding esdesOfpmvttWmid withinto Searormprovefrthe posaer-
sae.). will kw the Wrdcn Of proving that k did rot build or improve far purpose of
axle.).
❑L u owner of the saopert,ons elusively consisting wish licensed conuanms to
construct the project(Be—7044.Business add Professions Code:)The CresxtNs U.
ceue Law deo not apply to an owmr of property who Wilds or Improves thereon,and.
who mnuast+for.uch pri jecu with a conuastor(U licensed pumoant in Uc Conuacsors
KIM
law.
,lam excin one ,a$PCforthsosrwn
owner. — Date
RK� SCO Pf1aSAT10N OECI.sRAT10N
1 kmby ren muter pewty of perjury oro of tk foflonMog declarWmss
k1 ham and will nisnoth a Certificate df Covera le elf-iuurt fur Workrs Compen-
tien,u provided for by section 3700 of the Labor Code,for the erfomaanm of the
work for which this permit is isawd.
❑1 baw and will maiouin Workers Compensation Ieuuunm,u required by sawn
3700 ofthe labor Code.for 0te pcdoorisrrs ofthe work forwhich this permit Or issued. '
My Worker,('m,.,rnutim Ioivopse artier and policy number
Cartier._ 01ry No.:..
_....vttJ..r:..._-_.--..ON FRGS.
COMPENSATION INSURANCe
(This ream cW not kcompked iftk permit is forone hundred collars($1013)
orless)
1 certify Out in tiro perfmmace of the work r which this permit u intend.I sl not
employ anyperson in any 10 me+ tet to the Worker'Compensation
Lawa of Cahr.rrds D
Applicant
NOTICE TO APP:UC If,after making this Certificate of Exemption,you should
become mbjas m th hrY3 Compensation Pmvidons of the labor Code you mus '
0Z foMwithcomply yBl such pmvisi0v Or this permit shall k deemed revoked.
y0 CONMUCTION LENDING AGENCY
[--� 1 krthY,Rem that Nem I..cmusoetinn lending apoc,for the performamx of
IYr? Ne work for which this permit is isec
ucd(S .309'7,Civ.C)
W p Lender.Name
CL
z Lender.Adams, '
V0F L certify than I haw mad this application and auto that the thaw information is
UL U correct.1 agree to comply with all city and county ordinances and stem Iowa misting in
0 Wilding construction.and hembyanthodro repmamuuvesor this city wenteruprn the
r w aWve-mcntirnd Property for inspection purples
gy (We)ag.in ssw.idemnif1 and keep hatmlev the City or Cupertino against
iFw VS liabilitiu,judgments.cols and eapensu which may in any way am ,lost said City
(„)Z in consequence of the granung of this permit �T
^ APPLICANT UNDERSTANDS ANrVW1rCCOMPLY WITH At' Kr.'" ^INT Issued by: (7�d Dale
SOURCE udz,n. ^we,
Re-roofs
sugar,..-...,a•..atNconuacu.. —T �:-_-
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wil One applicant or forum Wilding occupant tom orhandle huca dons mawrial
as,defined]by the Cupenin0 Municipal Code.Chapter 9.12 and the Health and safety
Code.Scotian 25532(0)?
❑Tns /y All roofs shall be inspected prior to any roofing material being installed.
7T hYe
Will Uac applivns or futtue Wildin6 aavWnt tic cquipmenl or dcvim which If a roof is installed without first obtaining an inspection,I agree to remove
it havvMv air conumiamsu u dcftnetl b Bay Ams Al,Quality Management all new materials for inspection.
cR
❑Ya ❑ u
I haw real the hvaNaumato mquimmenuun4rChapter6.95.1"0thCalife'-
nuHealth&SaloyGede.SeWass 255(15.25533 and 25534.1 udstwnd that ifth0)Wilding -
does not currently haw a taunt.that It is my responsibility On mmiry alae oseup.nt of the
mgoirr nlewhrhtravkmetaa, ••uatRT'hesCmsricrh.rrkmpau -. Signature of Applicant Date
Owner or uthoeheo qm.
All roof coverings to be Class'W'or better
Data
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . .. 36651038 . 00
DATE ISSUED. . . . . . . : 10/29/2008
RECEIPT # . . . . . . . . . : BS000006487
REFERENCE ID # . . . : 08100184
SITE ADDRESS . . . . . : 11510 WELL SPRING CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . . "
OWNER . . . . . . . . . . . . : GATLEY CHRISTOPHER J AND CATHA
ADDRESS . . . . . . . . . . : 11510 WELL SPRING CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5136
RECEIVED FROM . . . . : CHRISTOPHER GATLEY
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : GATLEY CHRISTOPHER J AND CATHA
ADDRESS . : . . . . . . . . : 11510 WELL SPRING CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5136
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- - ----- ------ ------ ---------- -- -- ----------
1BSEISMICR VALUATION 7, 500 . 00 0. 80 0 . 00 0 . 80 0 . 00
1SIDEOTHER SQ FEET 1, 600 . 00 919 . 00 0 . 00 919 . 00 0 . 00
---------- ------ --------- ----------
TOTAL PERMIT 919 . 80 0 . 00 919 . 80 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
------ --------------- ------------ --
CREDIT CARD 919 . 80 MC
---------------
TOTAL RECEIPT 919 . 80
•
CITY OF CUPERTINO
CITY OF
• CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN #� / / � `v� �. U � Date: jo 2 0
Building Address:
Mailing Address (if different from building address):
Owner' Name: Phone #:
� e/S r `/os YY( 3Y,2-3
Contractor: Phone:
`la 5/70Y
Fax: G
Contractor License#:
Cupertino Business License#:
Contact: Phone: V
e Fax:
Residential F1
QCommercial
Job Description:
Building Permit Info:
Bldg M— Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B &–
Valuation: Square Footage:
-� o
Project Size: Express ❑ Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable, include in plan set& the sheet index.
• Points Achieved:
For help, contact Build it Green at www.buflditgreen.org
Revised 10/20/08