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01080045I" MM CITY OF CUPERTINO BUILDING DIVISION PERM �v �L.��•77.l7<,��:. �..�p:��f tl.O RACTOR, NIFOlNM BUILDING ADDRESS: LIANG LEE PERMIT NO. 10708 S TANTAU AVE 02120099 OWNER'S NAME: 24010 PRINCESS ELENA CT APPLICATION SUB DATE (650)917-9666 SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing vith Section 7000) of Division 3 of the Business and Professions Code, and my license is n full force and effect. .icense Class Lic. p )ate Contractor ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records .icensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the ollowing reason. (Section 7031.5, Business and Professions Codc: Any city or county ,which requires a permit to construct, alter, improve, demolish, or repair any structure 3rior to its issuance, also requires the applicant for such permit to file a signed statement hat he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 ;commencing with Section 7000) of Division 3 of the Business and Professions Code) or hat 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 not more than five hundred dollars (S500). ❑ 1. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (See. 7044, Business and Professions Code: The Contractors License Law does not apply to an 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 offered 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 improve for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon. and who contracts for such projects with a conLractor(s) licensed pursuant to the Contractor's License Law. ❑ I am exempt under Sec. . B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Workers Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forone hundred dollars ($100) or less.) 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lendcr's Name L.ender's Address 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction. and hereby authorize representatives of this city to enter upon the ahove-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in anywayaccrue againsisaid City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULATIONS. Signature of Applicant/Contractor Dale HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safely Code, Section 25532(a)? ❑ Yes ❑ No Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? Cl Yes No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Certificate of Occupancy. Owner or Date Job Description REVISION --IN HOUSE USE ONLY NO NEW PERMIT ISSUED, ORIG. 01080045 Sq. Ft. Floor Area Valuation $333000 APN Number Occupancy Type 37537003.00 101 - FOUNDAfft*ed Inspections 102 - PIERS 103 - UFER 104 - REBAR 105 - ANCHOR BOLTS 106 - SEWER & WATER 202 - UNDERFLOOR PLUMBING 203 - UNDERFLOOR MECHANICAL 204 - UNDERFLOOR FRAME 205 - UNDERFLOOR INSULATION 301 - ROUGH PLUMBING 302 - TUB & OR SHOWER 303 - ROUGH MECHANICAL 304 - ROUGH ELECTRICAL 305 - FRAME 306 - HOLDOWNS 307 - INSULATION 308 - SHEETROCK 309 - EXTERIOR LATH 310 - INTERIOR LATH 311 - SCRATCH COAT 313 - ROOF NAIL 501 - FINAL ELECTRICAL ENERGY 502 - FINAL PLUMBING ENERGY 503 - FINAL MECHANICAL ENERG 504 - FINAL BUILDING ENERG 505 - FINAL ELECTRICAL 506 - GAS TEST 5FINAL PLUMBING U FIN PC L Re -roofs 602 -(_�OF PLYWOOD NAIL Type of Rgief3 - ROOF BATTENS 604 - ROOF IN -PROGRESS All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better zed Z y00 W. W .7y 2 J 3yU �O.4 0C �za EEC 0 z z° W? .7 z UC LT. o tF, �v U r - CITY OF CUPERTINO DIVISION 4...... BUILDING PE PERMIT NO. BUILDING ADDRESS: OWNE A PERMIT ISS PHON SANITARY OL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing Job Description with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License ClassLie.N REVISED TRUSS/ROOF—=IN HOUSE USE ONLY Dare Contractor ARCHITECT'S DECLARATION NO NEW PERMIT, ORIG. #01080045 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professinns Code) or 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 CCU anC Type not more than five hundred dollars (5500) P y ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law docs not apply to an owner of Required Inspections property who builds or improves thereon, and who does such work himselforthrough his 101 — FOUNDATION 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, the owner- 102 — PIERS builder will have the burden of proving that he did not build or improve for purpose of sale.). 103 — UFER ❑ I, as owner of the property, am exclusively contracting with licensed contractors to 104 — REBAR construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li. 10 5 — ANCHOR BOLTS cense Law docs not apply to an owner of property who builds or improves thereon, and, who contracts for such projects with a conlractor(s) licensed pursuant to the Contractors 106 — SEWER & WATER License Law. ❑1amexempt under Sec. B & P C for this mason 202 — UNDERFLOOR PLUMBING Owner Date 203 — UNDERFLOOR MECHANICAL WORKER'S COMPENSATION DECLARATION 204 — UNDERFLOOR FRAME I hereby affirm under penalty of perjury one of the following declarations: 205 — UNDERFLOOR INSULATION 01 have and will maintain a Certificate of Consent toself4rsurefor Worker's compen- 301 — ROUGH PLUMBING sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 302 — TUB & OR SHOWER Q 1 have and will maintain Workers Compensation Insurance, as required by Section 303 — ROUGH MECHANICAL 3700 of the Labor code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: 304 — ROUGH ELECTRICAL Cartier: Policy No.: 305 — FRAME CERTIFICATEOFFJ(EMPTIONFROM WORKERS' 306 — HOEDOWNS COMPENSATION INSURANCE (This section need not becompleted if the permit Is for one hundred dollars ($I00) 307 — INSULATION or less.) 308 — SHEETROCK 1 certify drat in the performance of the work for which this permit is issued, I shall not 309 — EXTERIOR LATH employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date 310 — INTERIOR LATH Applies"` 311 — SCRATCH COAT NOTICE TO APPLICANT: If. otter making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Cndc, you must 313 - ROOF NAIL forthwith comply with such provisions or this permit shall be deemed revoked. 501 — FINAL ELECTRICAL ENERGY CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) 503 — F I NAL ME C HAN I CAL ENERGY Lender's Name Lender's Address 504 — FINAL BUILDING ENERGY 1 certify that 1 have read this application and state that the above information is 505 — FINAL ELECTRICAL correct. I agree to comply with all city and county ordinances and slate laws relating to 5 6 — GAS TEST building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. O F I � L P agree to save, indemnify and keep harmless the City of Cupertino against0 8 — F I AL liabilities, judgments, costs and expenses which may in any way accrue against said City :*NG(We) in consequence of the granting of this permit. 5 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. — Re -roofs 514 Type of RoW 2 INAL PUBLIC WORKS — ROOF PLYWOOD NAIL Signature ofApplicen✓Contracmr Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handic haym4ous material 603 — ROOF BATTENS as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(x)? All roofs skfl to BII p (�(�� insp&QLq$riW & 9AQ%&erial being installed. ❑Yes QNo If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes [3 No 1 have read the hazardous materials requirements undcrChapier6.95 of the Califor- nia Health bcSafetyCode, Sections 25505,25533 and 25534.1understand thatifthe building does not currently have a tenant that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class "B" or better Owner or suthorimd agent Date PUG -03-2001 1431 PL.-. DE ANZR AREA 3 Pacific bas and Electric Company 1 City of Cupertino 10300 Torre Ave. Cupertino, Ca 95014 To Whom It May Concem: Subject: Removal of Gas and/or Electric Facilities P. 01/01 10900 North Blaney Avenue Cupertino, CA 95014 The glass and electric facilities h ve been removed and/ora andoned at rtnt) on If you have any further questions, please contact me at (408) 725-2024. Sincerely, C Gwynneth Hoist Service Planning TOTAL P.01