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09070012�OZo Z� n�H v�Z eea ?yU U. f- ny= OC Y. K$� yz`a FFC 41 i 0C z� CO H W� L1. UC wF 0� ,+ C ►F-t G U� CITY OF CUPERTINO DIVISION PERMIT BUILDING BUILDING ADDRESS: PERMIT NO. 11177 PAL OS VERDES DR GLOBAL CONSTRUCTI Q9070 12 `tER'S NAME: PERMIT ISSUE DATE .rON A O. CONTROL NO. (408)20: -2129 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prof c sto s Code, and my license is in full force and effect. RMDL KTC'HN (10 0 SQ) , BATH (8 0 SQ) , FLOORING , STAIR License lass Lac. # Date Contractor RAILING, RMV 1 CLOSET IN UPSTAIRS, ADD WALL IN ARCHI CTS DECLARATION MSTR I understand my plans shall be used as public records BTH , REPLC WATER HEATER Licensed Professional OWNER - BUILDER DECLARATION 1 hereby affirm that I 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 consuucl. alter. improve, demolish, or repair any structure Sq. Ft. Floor Area Valuation prior to its issuance, also requires the applicant for such permit to rile a signed statement Law 9 that he is licensed pursuant to the provisions of the Contractors License (Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 6 6 0 0 0 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 Occupancy Type not more than five hundred dollars (5500). 3561700".00 ❑ I, as owner of the property, or my employees with wages as their sole compensation, Required Inspections q P will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Commutes 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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's u. cense Law does not apply to an owner of property who builds or improves thereon, and. who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. 01. exempt under Sec B & P C for this reason •er Dale WORKER'S MPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's 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 for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant I 11 NOTICE TO APPLICANT'. If, a r ng hs Cenifrcatc 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. a CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of y the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender'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 miating to " building concoction, and hereby authorise representatives of this city to enter upon the above - 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 any way accrue against said City in of this consequence of the granting permit. " APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. �jltL /u�1ou Re -roofs T of R Hof Type Signature of Applicanr/Contractor ate MATERIALS DISCLOSURE HAZARDOUS Will the applicant or future building occupant store or handle hazardous material as deftned by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety te, Section 25532(a)? All roofs :;hall be inspected prior to any roofing material being installed. ❑ Yes V. If a roof i:; 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 m iterials for inspection. District? ❑ Yes1u I 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 altenant, that it is my responsibility to notify the occupant of the requirements which met prier to issuance ofa Certificate of Occupancy. Signature :)f Applicant Date All roof coverings to be Class'" or better Owner or authorized agdlnt Date ' Cn of CUPEI�TINO CITY OF CUPERTINO ADDITION /REMODEL PERMIT APPLICATION FORM 0�070 c�5 � A APN # Date: 7/ / Is a 2" d unit being added? Yes ❑ No If yes, please fill out the permit application for 2"d unit. Building Address: I %l 77 U�Pir �S Y e -Y n y } 9 Mailing Address (if different from building address): Owner's Name: 'j "'J Phone # 0 - 99 Contractor: G� /� Phone #: (� p� -� � � �l— p �--V 5 t-c G Fax #: Contractor License #: J �T Cupertino Business License (o °7 5 Contact: Phone #: �z000 — 3 % / -' �26pd i&& ,rL Fax #: Building Permit Info: Bldg. ©/ Elect. E� Plumb. Mech. Hillside ❑ Job Description: Addition -What is being added ?(Be Specific): n_0 What is being renpd.,eled (not including addition)? �, f-{ �;, _-9 Remodel Includes Re -Roof: Yes No If yes list numb._ er of squares Remodel Includes Structural: Yes ❑ No Do you have the pre - application planning approval? Yes ❑ No ❑ If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached 1­ Remodel: Kitchen . Bath ther Type of Construction (Usage Class): Occupancy Type: 1 -A, 1 -B ❑ II/III/V -A ❑ II/III B, IV -HT, V -B LD Valuation: # ZI �u'p �� �,0 0 0 �% Please check this box if the project is a / % second -story addition ❑ Project Size: Express [0.,,9tandard ❑ Large ❑ Major ❑ Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, Green Building Points Achieved: include in plan set & the sheet index. ** *For Office Use Only * ** Over - the - Counter ❑ Revised 06/10/09 ' Parcel Numb �P . ��� — o D / 0 �O . Assessor's P Number: Name of owner. Project address. ;Pa-�os Contact person. 41 emu, A- LZ/h- Phone. Fax. —(l T �l /. �-- 02 Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y SHEET Is privacy protection planting required for the project? _�� N On what floor(s) is work being done? Brief description of work. r itiw�v Code editions: 2008 CBC �- N)2008 CFC 2008 CPC - N)2008 NEC Hi'" P RvG Effective 1/1/08 ;N ACCURDANCEW a CUMnNo CODE AM - N) 2008 CMC- N) N) )A qft 9t of plans _r; . �,,,c:�lcations MUS�`� � ' � � • ,,ones and it is U11 8 on the iawi� to make _,;., ;� or alteration ermission fron. A SW pe;tino. Ca ne building Dept., in of thi �a specttications the stamp 6 mit or to be ar be held t�� G= � �roo: PPS the violation of any l� nrn,nArirA :',r onv rity Plan Review Process Work Book Page -B- Revised 1/1/08 "_:,I CITY Of CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777 -3228 Fax (408) 777 -3333 Building Department JOB ADDRESS: 11/77 pA pS PERMIT # " BUSINESS .NAME BUSINESS LICENSE # OWNER'S NAME: PHONE # —• GENERAL CONTRACT L��2 FAX # - - - t < I am not using any subcontractors: T 8 p• Signature Date PIPacP rherk annlirable svbrontrartors and complete the followinz information: 4�2m- Owner/ Contractor Signature Date ►M SUBCONTRACTOR BUSINESS .NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 4�2m- Owner/ Contractor Signature Date ►M P- CA at�� 401 arse Ivew Ye c cSS il (f-7,RL4 fY O-t Aj -- c y e �- h 1Z CRIVU, E) UL 0 2 2009 Como> 11 C07) 2 n "y . L,)-; I - _ ,t/ew �6�►��# h �n t '. 1-),7 T �. 1 0 " - -- Tu h f /9el-h oiAk �^ CIOS i MGS�� Kf S-,, IL Vc rt. watt. I I ' Fil O v Aft' ") Hau Rcti� I 11 -. ,- I 0 v m RECEIVED JUL 0 2 2009 BY: v T: I air JUL 0 2 2009 13Y'-------' C:))-