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02100101r R t .CITY OF �z Fee 1tion E_ E 1 Other Appliances L-10 PICK= •Ind/Off/Comm/Quasi1 Owner's_ Name: E_ #1 •E� �* • Contractor: W-A-Xgm�� Licbnse #: Contact: (! Mr' fit lii.TRICAL • f..:. iWAM ► Applicant/Contractor: ELECTRICAL ii _ 600V <= 200A Ddildi4i;�t Info: i. ilect lu. =Mech Residential: !Commercial: Comm. • w TMit. Fee_____1�1 I Architect/Engirieer: Res. HousinR1 Valuation: New Multi-FamilyRe§ 1:1 013m,32100, New Multi-familyRes Type of Construction: mike Fee 1tion E_ E 1 Other Appliances Construction Tax PICK= •Ind/Off/Comm/Quasi1 #1 i I Con. Tax for AQ Zone W-A-Xgm�� Hotel and Motel !ii fit lii.TRICAL s it fit iii , ELECTRICAL ii _ 600V <= 200A ELECTRICAL Energy Add Multi Comm. • w TMit. Fee_____1�1 Res. HousinR1 Ii i' New Multi-FamilyRe§ 1:1 013m,32100, New Multi-familyRes 04 Z ma,® OZ - 0,4 -5 Ag:,F J Hw< X 0,U rid UJ 10 04 E. - CITY OF CUPERTINO BUILDING DIVISION PEk,irtlT NF BUIL IV12A2*ESRICHWOOD DR CLEAR OAK DESIGNS PERMIT NO2100101 OwfR9f@H.,EN BERGER 1723 B ROGERS AVE APPL1CATTVYt94TY 2 0 02 PHONE: (408)436-5448 SANITARY NO, CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH L_J LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing ADD J 132 SQ.FT.Y.,,1TffW REMODEL with Section 7000) of Division 3 of the Rival d Professions Code, and my license is in full. nd of 57an arc Lic.# a License 9 Pd --+,P Con tra ... ''j ARCHITECT'S D@CL,ARATtON I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the $50000 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 3Sil91affl(2JVA1al@ Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and thetbasis for the alleged exemption. Any violation of 1 UAPNN6t'b6NL)A:yIONOccupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). 102 PIERS C] 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 Code: The Contractor's License Law does to 1: F E F Required Inspections and Professions not apply an owner of 104 REBAR 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, 105 - ANCHOR DOLTS however, the building or improvement is sold within one year of completion, the owner - 106 - SEWER & WATER builder will have the burden of proving that he did not build or improve for purpose of sale.). 202 - UNDERFLOOR PLUMBING 6 1, as owner of the property, am exclusively contracting with licensed contractors to *no construct the project (Sec. 7044, Business and Professions Code:) Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and 204 - UNDERFLOOR FRAME who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. 205 - UNDERFLOOR INSULATION E] I am exempt under Sec. B & P C for this reason 301 - ROUGH PLUMBING Date — 'ON 302 - TUB & OR SHOWER WORKER'S COMPENSATION DECLA 303 - ROUGH MECHANICAL lowing I o ng declarations: I hereby affirm under penalty of perjury one of the f lowi 304 - ROUGH ELECTRICAL (3 ]have and will maintain a Certificate of Consent to self -insure for WorkeesCompen- 305 FRAME sation, as provided for by Section 3700 of the Labor Code, for the performance of the - work for which this permit is issued. 306 - HOLDOWNS C] I have and will maintain Worker's Compensation Insurance, as required by Section 307 - INSULATION 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: No.: 0 `:�7 308 - SHE ETROCK artier: olicy -1 CERTIFICATE OF EXEMPTION FROM WOPI(ERS' COMPENSATION INSURANCE 309 310 - EXTERIOR LATH - INTERIOR LATH (This section need not be completed ifthe permit is forone hundred dollars ($100) 311 - SCRATCH COAT or less,) 1 313 - ROOF NAIL I certify that in the pert Cc of the work for which this permit is issued, I shall not 501 - FINAL ELECTRICAL ENERGY employ any person in net so as to become subject to the Workers' Compensation Laws of California. Dar 502 - FINAL PLUMBING ENERGY Applicapt, N 0 APPLICANT: If, after making this Certificate of Exemption, you should N 503 - FINAL MECHANICAL ENERGY #Cbject to the Worker's Compensation provisions of the Labor Code, you must 504 - FINAL BUILDING ENERGY "wi, comply comply with such provisions or this permit shall he deemed revoked. 505 FINAL ELECTRICAL CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of 506 GAS TEST the work for which this permit is issued (See. 3097, Civ. C.) 507 FINAL PLUMBING Lender's Name 508 FINAL MECHANICAL Lender's Address I certify that I have read this application and state that the above information is 509 FINAL GRADE 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 S, FIN L PLANNING above-mentioned property for inspection purposes. F I N RILE (We) agree to save, indemnify and keep harmIcss the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON -POINT Issued by Date SOU C eREGULATIONS. c� lh,Lxj Re -roofs Type of Roof ignature ofApplicant/Contractor Date HAZARDOUS MATERIAL W?CrSURE 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 Safety Code, Section 25532(a)7 . Yes 'J!!�No All roofs shall be inspected prior to any roofing material being installed. El 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? C) Yes KNo I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Heafth& Safety Code, Sections 25505,25533 and 25534, 1 understand that if the building does not currently have tenant, that itis my responsibility to notify the occupant of the be to issuance Ccrtfficamof`Oc��cy rcq-w, is which must met prior of Signature of Applicant Date &'% , , bankL 9_642 4/2,7p - All roof coverings to be Class "B" or better I, 113ate— Owner or authorized agent oma, 00 w V an <c. ozn b �OyU w3w� t_gog E, is � ac a ^Z0 a3— CITY OF CUPEW11NOn „, , BUILDING DIVISION PERMIT . CONTRACTOR INFORMATION: Bwl1)02A2I@EsRICHW00D DR CLEAR OAK DESIGNS PERMTTN02100101 owrRPTeHEN BERGER 1723 B ROGERS AVE APPLlCAr11VYB194Ty 2002 ZONE 408)436-5448 SANITARY NO. CONTROL NO. ARC111ECTIGNCINEER: BUILDING PERMIT INTO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION 66�Dp � I hereby at that l am named under pmvidom of chapter 9 anmmeneins ADD 132 SQ.FT.I%K1?l:jpp��ri�jjrREMODEL with section 700(P of Division 3 of Inc Bm ipesys a Prom dons Gwc and an, license is inl ull Jct lass LC— Lic.X ki ice; n -Z— conte records CDJ AlXARATION r�(.4'h I my shall W usedas FINALE® understand plans pontic DEC 2 6 2002 Licensed Pmressional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Cummanr's License Law far, the $50000 following reason. (Section 703 L5, Business and Professions Code: Anti oily or county which requires a permit to vonmrun, alter, improve, demolish, or repair any structure pdnno Its Broome, also mquirex the applicam br such permit to rile a xi,ard xOmmem that he is licensed pursuant to the provisions of the commems License Law (Chapter 9 3YR9fEISlB(2)3A@D Valuation (commencing with Section 7000) or Dlvis nn S of the Business and Prolessions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of PNN Occupancy Type Section 7131.5 by any applicant for a permit subjects me applicant to a civil penalty id not more than five hundred dollars WOOL 102 - PIERS ❑ I,mownerofthepropeny.urmyemployceswithwagesu Neirsolecompensation, Required Inspections will do the work, and Or structure, is not intended or offered for sale (Sea 70,&4. Business and Promssions Code: The Contractor's License law does not apply to an owner of 104 - REBAR property who builds ur improves Jmreon, and who doessuch work himself or mrough his own employees, provided lhatsuch improvements are not intended or offered for side. If. 105 — ANCHOR BOLTS however. the building or improvement is said wimin one year of completion. Oc owner- 106 — SEWER & WATER builder will have the burden of pmving mal he did not mild kir improve for purpnw of sale.). 202 — UNDERFLOOR PLUMBING 1, as owner of tho property, am exclusively contnaing with licensed contractors m 2 03 — UNDERFLOOR MECHANICAL construct the project (See. (Wq Business and Professions Code) The Contractor's Li- censm Law does not apply to an owner of property who Wilds or improwen themon. and . 204 — UNDERFLOOR FRAME who contracts for such projects with a coavannro) licensed pursuant n the Contractor's 205 - UNDERFLOOR INSULATION License Law. ❑ l am exempt under Sec. . B A, P C for this reason 301 - ROUGH PLUMBING r Date 302 - TUB & OR SHOWER WORKER'S COMPENSATION DECL ON 303 - ROUGH MECHANICAL Ihereby ttenunderPenaltyofperuryoneofthefolowinga«larahots: m 304 - ROUGH ELECTRICAL ❑ Inavc area win maimaina Ccnmcam otcunwnun wlunsrrm sur wmkcr's compere- 305 — FRAME cation, as provided for by Section 3700 of the lahnr Code, lot the pemmor . of the work for which this permBis issued. 306 — HOLDOWNS 1 have and will maintain Workers Compcnution Insurance, as required by Section 307 — INSULATION 3700 of Or, Llvtr Cade, for me prdormance of the work for which this permit is issued. My worker's Compensation Insurance carrier Policy numbmam: 308 — SHEETROCK �a7nd surer :�i(f�166�Nhe,No.;'1(a7 (O� 309 - EXTERIOR LATH CERTIFICAA E OF EXEMPTION FROM WORKERS' 310 — INTERIOR LATH COMPENSATION INSURANCE (rniswcoonmcalmotccompmcdinlnpermaisfurunehandreadunarstvan 311 — SCRATCH COAT kir less.) 313 — ROOF NAIL he a which thisis issued. IcenRy n,Pe.cporn try 501 — FINAL ELECTRICAL ENERGY nets astosuijecttothemoikirssCompensanm employ an.'in ince rima m become is the Workers Compensation on Lawaurcahrurni..Dal 502 503 — FINAL PLUMBING ENERGY — FINAL MECHANICAL ENERGY nnntiaa' n Id N O APPLICANT: If, after making this Cenilicam of Exemption, you a Liu ubjecrtotheWorkeraCnmprnmaonprovisionsofthelabname,youmusl Ovvith 504 — FINAL BUILDING ENERGY comply with such pemisiau or Ilia peuntl ah,I) M Jeem d revoked. 505 — FINAL ELECTRICAL CONare is a f10N LENDING ng ager Y urereny anirm that there isacunmmction lendmgagencr bu the performance or 506 — GAS TEST the work for which this permit is Barred (See. 3097, Cie C.) 507 — FINAL PLUMBING Lenders N. 508 — FINAL MECHANICAL UniteAddress I certify mat I have iced this application and state that the shove ws emming is 509 — FINAL GRADE �' A cumin. 1 at Lia comply with all city mJ county and store laws ,dating at 5 FINAL PLANNING (� `— ntativ sof e building cunstm0ion.and hc¢hyamhodvcrcprcumativcsofmiscity mcn¢rugrndte asovc mentioned property for inspection purposes. 14 N4 FIN C W RKS (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 xaad City in consequence of the of this permit. / �7V/ granting APPLICANT UNDERSTANDS AND COMPLY WITH ALL t ON -POINT Issued by: Dale SOUGQUI.ATIONs.�nt_k.�J.C.Lk/f-s.{ti. �iolM� RC -roofs Type of Roof �.WILL tgnauto of ApplicanJCnmrumr Date IIAZARDOUS MATIiR1A1. 1 SURF. Will mea fumes building arupant Wore or handle h with and u JcnneJ by the Cupertino Municipal Code, Chapter 9.12, and the Ilcallh and gaiety Cupertino Code, 255111417 .No All roofs shall be inspected prior to any roofing material being installed. OYm 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 CMA hasardnus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Nattiest Cl Yea KNo I have mad me hwardaus materials requirements kinder Chapter 6 95 of the Califon nia llcuth S Salcty Cede. Secume,25505.25533 and 25511.1 understand thst tithe building arcs t curtently Haut n Nn'vnt, ma it is mY rusrymsiM1illty m notify Inc rav' pant of the mqad�c,Nw6tswhichmuslbnmetpriortoisetameofaccmfixamof0c�Y Signature of Applicant Date A Lau_ Q� : n All roof coverings to be Class "B" or better Owner kir authnriacJ ugcm