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02100191 (2) CITY OF CUPERTINO BUILDING DIVISION PE C17 INFOR =ION: 'Agra„ .. Bultl)(510-APOESLAS ONDAS CT PERMIT N02100191 iYAK NNFE:TH TAKEMOTO APPLICATIPV�UTY 2 0 0 2 NE: SANITARY NO. CONTROL NO. ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MF.CH 0 0 0 0 0x10 20 LICENSED CONTRACTOR'S DECIARAI'ION bDescri [IOD e4 U- 1 herchy affirm that I am licensed under Provisions Of Chapter 9(commencing REPLACE WI NDOV1ISn P with Section full force nda'f)of Division tof the Ousincss end Prmfcuiomawe,and my license is G y LiceireClass and �® �Zg z Licen.•e class Lic.x -0 Dam Connector =�rJ` ARCIIITIiCPS DECLARATION NOV 2 5 2002 I understand my plana shall he used as public records Oyu LLO� Licensed Professional g OWNER-BUILDERcreantfor. heconrmu BUIL[ u�<q 1 hereby af0rm that 1 em caempr from me Commnnrs License law fm he 0 m-00 following mason.(Section 7131.5,Business and Professions Cine:Any city or county a'�$y which nyuices a permit to construct,alter,improve.demolish,air repair any structure I-Zro ro prior to its issuance,also requites the applicant for such Permit o rile a signed statement £ Nat he is licensed pursuant toMepitokions(if the Contractor's Licenselaw(Chaplet 9 3�q9&QIFIo"t39A@9 Valuation y�O (commencing with Section 7000)of Division 3 of the Business and Professions asde)'n Cy $ that he is mempt merefsom and Ne basis for the alleged ascription.Any violation of IISection 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of pN N Occupancy YP Type not mare than five hundred dollars($50)(1). 102 PIERS owner of the prupeny,or my employ..with wages as their suis compearalion, will do the work,and the muctum is nm inended moffered for..Ir(Sec.7W,Business 3:93 UFER and Professions code:The Commences[.I...Law docs not apply to an owner of 104 - REBAR Required Inspections prupenywh t buildsor improves thereon,and who d.nsuch work himself or through his Own employees,provided that such impmwmenrs am not intended or offered for aide.If. 105 - ANCHOR BOLTS however,the holding or improvement is sola within one year of completion,the owner. lO6 — SEWER & WATER builder will have the burden of proving that he did not build or improve hu purpose of arts.) 202 - UNDERFLOOR PLUMBING as Owner of me property,am exclusively contracting with licensed contractors to 203 - UNDERFLOOR MECHANICAL construct Ne project(Sec.70/ 1.Business and Promassions Cade)The contractor's Li. cense law does not apply to an owner of property who builds or improvea themon.end 204 - UNDERFLOOR FRAME LiceneLaws for such pmjecuwnheumtrecmHU Become pursuant me cnmracmr's' 205 — UNDERFLOOR INSULATION 0 l oro crerpt under Sec. a S P C far his rcamn 301 - ROUGH PLUMBING woo j&(/ �pGL/ atel0 Z 302 - TUB & OR SHOWER ORKER'S Osvl � PENSATION DECUNICATION 303 - ROUGH MECHANICAL I hereby alarm under Penalty of perjury one of the following decimations' 304 - ROUGH ELECTRICAL ❑l have and will maintain a Cenifcam of Consent to sclf-mom for Workers Compere 3O5 - FRAME salmn,Us provided for by Section 3701)of the Labor Gam,for Ibe Performance of the work for which Nis permit is issued. 306 — HOLDOWNS ❑1 have end will maintain Wufkert;Compcnsstion Insurance,.m,aired by Section 307 - INSULATION 3700 of the WMsr Code,for the Performance of the work for which this Permit is issued. My Worker's CnmPenssawn Insurance carrier and Policy number are: 308 - SHEETROCK conic': Policy No.: 309 - EXTERIOR LATH CERTIFICATE OF FEMPTION FROM WORKERS' COMPENSATION INSURANCE 310 - INTERIOR LATH (Thu section need not the completed iffse permit is forone hundreddollars(Sl4)) 311 - .SCRATCH COAT mlest) 313 - ROOF NAIL a I certify that m the perrnrmane sf the work for which this permit is issued.i Nall not 501 - FINAL ELECTRICAL ENERGY ' employ any fiction in anyan . mso Us In -ac�Oyi to the Worken'Compensation lif Tom Laws or Car/ 502 - FINAL PLUMBING ENERGY APPI'1cayys NOI'1{aEJTO APPLICANT': 's Compensation this Gerhim Of of Exemption,you YOU UhMulJ 503 - FINAL MECHANICAL ENERGY bcc _ hjentotheWnhchCompensationpmvisiumofthelnhmCOJe,youmoa 504 - FINAL BUILDING ENERGY 0Ofrthwith comply with such provisions atthis Norinshanw hedeemedmkm. 505 - FINAL ELECTRICAL CONSTRUCTION LENDING AGENCY t=t14 Iherchyaffirm Oil there in..narostionlending agency Rome permrnme,if 506 - GAS TEST fY, > the wok far which Mi.permitisissued(See.3097,Cn.C.) 507 - FINAL PLUMBING W " laml Name z TOOr'sAdd. 508 - FINAL MECHANICAL U p I Certify mat 1 hate read this application and sate that the above infmmmion is 509 - FINAL GRADE W (~ concn.I agree to comply with all city and county ordinances and rare laws mlating m building construction,said hereby eumodaeepresenmtines of mix City to enter upon the 5 FINAL PLANNING above mentioned poi for inspection purposes. a (we)agrte hs save,indemnify and keep harmless the City of Cupertino against 14 - FIN BL I C W RKS rFi V) liabilities judgments,costs and expenses which may in any way mems against aid City VZ in commixice of the granting of this permit. 1 6/34 o / APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date (� SOURCE REGULATIONS, Ll11177 � a� }O��OZ Re-roofs lam, a of Fp rcam/Cummcmr Dat HAZARDOUS MAT17RIALS DISCLOSURE Type of Roof Will the applicant or future building awcupent storeair handle hazardous material ss defined by the Cupertino Municipal Code,Chapter 9.12,and the Ilahh end Safety Code.Section s zss3nan All roofs shall be inspected prior to an roofing material bei" Installed. E]yes )4 No P P Y g g Will the npplicamor future building occupant um equipment air devices which If a roof is installed without first obtaining an inspection,l agree to remove emir hasarmus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? rrss�� ❑Yes I(I No 1 have rad :the hlmdOU.-s materials mquimmenn under Chapter 6 95 of the Califnr. nit Heald&Safely Code,Scciam,25505,25533 and 25534.1umkrsmnA mal Ume building does not currently have.tenant,Man ii is my mspmxi hit ity In nattily the ..pan,of Me requirements which must to mapdnran iamamc of.CcrtilicaIaenpanej.' Signature of Applicant Date 7 rt(�LlT10'{0 /0a0� OwuthnrtreJ"gem All roof coverings to be Class "B" or better Dom G�d3 2�c3 2x3 6x4 , • 3 3"x3 a #1 kIT � d 4 x� 000V- G-J X r 1 1 • APPROVED 1N ACct3RDAN CURfMn TN CITY 6 IV Q 6�xii 1 AND INANCE� 0 T F OCT , j 6 K3 SIGNCD This set or ' ns and' pec"dications Mll i. 1( be.kept he job at all times ul to mand it is I n lawfake any changes or alfieratir ns v on same without written /I the building Dept., rmis�an fr.m The stampingof G AFP of thiln am OEM Col-IR I is �u +m of to be n 6�x8!`Dooe 'p MC16,11C.8%tion of ! -` an Y 'aeRritt "v C. si. r 18tazence or State taw. 3 XI; (N!Ai N �l 6x6* ,4T(2I U !t) x6TE,x`s 4x6T" : 964xaol? poop- -Z 6 �,P%], • CITY OF CUPERTIN� Y � cuPI CITY PERMIT APPLICATION FORM I A2 3 ate: .10130 02^ Building Address: las ©hdas C©�r7` O er's Name: Phone#: %P�,n e T 293 --8s&9 Contractor: License#: SL co!j. 'uc 75/4 09 Contact;_ , Phone#: //moi Reh is 400 - 67I— 9822 -Applicant/Contractor: Fax#: uildi g P it Info: Bldg Elect Plumb Mech Job cription: Residential: X lq—(e W/�C ow!� ; Commercial: Sq.Ft.Floor Area:' $/Sq.Ft.: Architect/Engineer: Valuation: �b ype of Construction: Occupancy Gr up: uanti Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances 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<= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A 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 BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BNEWMULTI New Multi-family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING Iof3 7 oZ