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CITY OF CUPERTINO
,,CONTRAG70114VFO
RMA N:'•
BUILDING DIVISION ��
BUILDING ADDRESS:
PERMIT N0,
22600 ALPINE DR
PATRICK
HO
02050168
OWNER'S NAME:
APPLICATION SUB DATE
PATRICK HO
05/28/2002
PHONE:
SANITARY NO. CONTROL NO.
Z ARCHFIECTIENGINEER:
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
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i LICENSED CONTRACTOR'S DECLARATION
Job Description
O Thelcoltiffirm that l amliensed under provisions of Chapter!) (commencing
co with section 70Mof Division 3 of the Businss and Professions Code, and my license
REPAIR /REPLACE SIDING MATERIAL
-t is in full force and effect.
u LicanxeClnsx Lien
AND HAND
RAILS. 9=09MALE®
Date Contractor
i-n DECLARATION
ARCHITECT'S
1 undcrstane my plans shall be used as public records
AUG 17 2002
OLicensed Professional
OWNER - BUILDER DECLARATION
1 hereby affirm the, I am exempt from the Cormurmr's License law for the
>' following reason. (Section 70315. Business and Profession Code: My city or county
BUILDING
o a.hich requires a permit to construct. alter, improve, demolish, or repair any s,runum
c
m ..prior toim issuance, also requires she applic ant for such permit to file a signed sutement
r ,.,t -i; Sq.;Ft.FloorArea,.,_ -
�'
uation•
- thatp< i ;Iicaasedpurcrion7aWprovrsiision3 License
(commcnrin8 with Srcdon 700%Df Division 3 0! the Ugsmess antl Professions Code(
or that he is exempt tharefroni and the basis for the alhged exanpdm. Any violation
, _ _
' '
, .. , ... .. i
of Section 7031.5 by any ap,lican1 fora pemilsubjects me applicant to a civil penally
' or not more than five hundred dollars (s5W).
N 0 rtl 1 Ye Y
Occupancy Type
01. as owner of stn properly,., my employees with wages as their side compensation,
102
- PIERS Required Inspections
will do the win,.-and m< enamre is no, inemed or offered for sale (See. 7044.
Business and'Pefessions Code: The Contanoi s License Law does not apply to an
owner of property Who hills or improves thereon, and who does such work himself
that improvements intended
103
- UFER
or through his own employees. provided such se me or
' offered for scale. If, however, the Wilding or improvement is sold within one year of
10 4
..
RE BAR
completion, the ownenbuileer will have the burden of proving that he did not Wild or
-
improve farp.r,w, of sala).
105
- ANCHOR BOLTS _
° I, as owner a the properly. am u I lively contracting with licensed contranoe m
106
- SEWER & WATER
Lconstruct the project (Sec. 70w. Business and Professions Cm,:) The Conu "n"
icense law does not apply to an owner of property, who builds or improves thereon,
202
_
- UNDERFLOOR PLUMBING
and who, cc ccts cf�WUch proje,. with a.Imnanm(s) lice sed pursue, to the
203
- UNDERFLOOR MECHANICAL
yme pat fir Sec. B e P C for this e.x°n
owne Le yizlo�-
204
- UNDERFLOOR FRAME
205
- UNDERFLOOR INSULATION
ORKER'S h ENe TION DECLARATION
301
- ROUGH PLUMBING
Ihercby affirm under penalty ofpc do, ..of the following deelatimmm:
302
- TUB & OR SHOWER
0.1 have and will maintain a Certificate of Conan, to self -insue for Workers
3 03
- ROUGH MECHANICAL
Compensation, as provided for by Section 37M of he Labor Code, for the
performance of the work for which this permit is ixxum.
304
- ROUGH ELECTRICAL
° 1 have and will maintain Worker's Compensation Insurance, as requited by Section
305
- FRAME
37M of the Labor Coda, for the performance of the work for which this permit is
ssum. My Workers Compensation Insurance carrier and Policy number are:
306
— HOLDOWNS
Cuiice' ,fir r' 4 •' Policy No.:
_
,3 017 ..-
" '3 08 •
_ ... _ ... ..
„:INSULATION. r
_ - SHEE TROCK
.. • '.CERTIFICATION ONE FROM WORKERS,
TION. I10N
coMPENSnnoNw suRn "cE
309
EXTERIOR LATH
(Tots suction ram an, bat completed it the permit is for one hundred dollars
(s100)Dnes.)
310
— INTERIOR LATH
i cii t ry that in me pasta�+gq�p of the work for which this prim, is taxied, 1
311
- SCRATCH COAT
shell me amid py' anyhhnner to xa ym m the worker:'
313
- ROOF NAIL
compenxaeoy µ/e11 me LG�me
L O L
Ap haE f Y r� 1hT
501
502
- FINAL ELECTRICAL ENERGY
- FINAL PLUMBING ENERGY
N ETD P Ie :If, o @nmaki Nis eSiOns f the Esemption.youehould
Z b«Msubntwit mmi, hsofthdonnedCodc.yaumuxt
suchprrvoionsor,iis
C to theomplywith eehpro .ixonxonthiapm,xnauxeaemmevokd.
503
- FINAL MECHANICAL ENERGY
4 CONSTRUCTION LENDING AGENCY
504
- FINAL BUILDING ENERGY'
7 1 hereby affirm that there is a construction lending agency for me perfortaance
oI the work for which thie perron is issued (See 3097. Civ. C.)
505
- FINAL ELECTRICAL
(� Lender's Name
Z LenaarxAadaxx
506
-
- GAS TEST
II that I have rend this application and slam thanha above information is
507
- FINAL PLUMBING
apxxy
toms,. I ogee to comply with all city and county ordinance are state laws elating
relating
508
- FINAL MECHANICAL
C•)
(� to building construction. and hereby authorize rcprescntativcs of this city to toter upon
W the above - mentioned property for inspocum pur poses.
509
— FINAL GRADE
0. (We) agree m save, indemnify and keep harmless that City of Cupertino against
t,' liabilities, judgments, costs am espansas which may in any way accme against said
Z Ci,y in c equ ce of the gamin, Df this pcenit.
510 - FINALPLANNING
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y A PLI D RST NDSAND NI OMPLY WITH ALL NON'-: 01
to
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Issued:
F d C WORKS Date 6�
uR
M �� f .k
sign, o ApplicaMC°ntructo�r - -p — ate
HAZARDOUS MATERIALS DISCLOSURE
Re -roofs
Will the applicant or future Wilding occupant store or handle haardous material
Type of Roof
as definm by the Cupenien Mo.. I Cool Chapmr 9.12, and the Health and Safety
Cade,
Section 15532(e1?
°Ye No
All roofs shall
be inspected prior to any roofing material being installed.
Will ,be applicant °rfuture building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit hezartl°us air contaminants as defined by the Bay Area Air Quality Management
Diauiet?
all new materials
for inspection. Applicant understands and will comply with
°tics
all non -point
source regulations.
1 have read the hazardous materials equiremenu under Chapter 6.95 of the
California Health A Safety Code. Serious 25505. 25533 and 25534. 1 muleWand her
if the Wilding does not currently have a more, that it is my esponibility to notify the
occuyp�ant '�of a requirements which must be met prior a issuance of a/Certificate of
I Y&LA-6a' 'o
1�G Yy
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Signature of Applicant Dale
aMr l•� /
Dr amhonzed agent Dee
All roof coverings to be Class "B" or better
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