08070068 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS: PERMIT NO.
21600 RAINBOW DR TBD — TO BE DE08070068
r"'NER'S NAME:
PERMIT ISSUE DATE
S A CONTROL NO.
ARCHlIECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
40p LICENSED CONTRACTOR'S DECLARATION Job Description
v affirm hereby arm that I am licensed under provisions of Chapter 9(commencing
Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is
H in full force and effect. NEW 2 ISTORY S FDWL 4, 21.9 .25 GARAGE 663 ' (VACANT
:12z License Class Lle•
jFe Date Contractor LOT) NC DEMO PERMIT NEEDED FOR FENCE/TENNIS COURT
ARCHITEC S DECLARATION
a REMOVAL .
< I understand my plans shall be used as public records
DWO
4 0 Licensed Professional
0 3 OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
a O following reason.(Section 7031.5,Business and Professions Calc:Any city or county
4.ff 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 Valuation
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area
y F$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $500000
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 rive hundred dollars(M). 36638012 . 00
❑I,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 ns Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of el P
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►J 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 docs 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.
❑1 am exempt under Sec. B&P C for this reason
,err (izyz?3 Date4 t p O
WORKER'S COMPENSATION DECLARATIO
I hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compcn-
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 arc:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need riot 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.I shall not
employ any person in any magocr�o u m b��c�tbject to the Workers'Compensation
Laws of Cslifo ia.Date 6/ / �f
Applicant es— �g r
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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z 2 CONSTRUCnON LENDING AGENCY
Fr►('e). I hereby affirm that there is a construction lending agency for the performance of
fx> the work for which this permit is issued(Sec.3097,Civ.Q
W Q Lender's Name
]z Lender's Address
1,0 1 certify that I have read this application and state that the above information is
LL"4 correct.I agree to comply with all city and county ordinances and state laws misting to
0 U building construction.and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes
t7 r (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
U Z in consequence of the granting of this permit. Date
►. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b):
Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
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
•le,Section 25532(a)? —/ All roofs shall be inspected prior to any roofing material being installed.
[3 Yes ANO
If a roof
Will the applicant or future building occupant use equipment or devices which
.s installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District? ,�.,�
❑Yes till
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 a tenant.that it is my responsibility to notify die occupant of the
requirements which must be met riot to issuance of a Certificate of Occupancy. Signature of Applicant Date
/ o,� 6�fag All roof coverings to be Class in"'or better
Owner or authorized agent Date
.7 C
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CITY OF CUPERTINO
BUiLDiNG DIViS10N PERMIT+'
BUILDING ADD ESS:
PERMIT NO.
2160 RAINBOW DR
TBD - TO BE DE
OWNER'S NAME:
PERMIT ISSUE DATE
2 0 9 9
:
S AiNt CONTROL NO.
ARCHrrWr/ENGTNEFR:
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 70DD) of Division 3 of the Business and Professions Code, and my license is
in full force and effete
NEW 2 STORY SFDWL 4,219.25 GARAGE 6 6 3 ' ( VACANT
DateC�`Gua CCoonuad r
.
LOT) NO DEMO PERMIT NEEDED FOR FENCE/TENNIS COURT
ARCHIECTS DECLARATION
1 understand my plans shall be used as public records
REMOVAL.
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby alTtrm that 1 am exempt from the Contractors License Law for th_
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 stnawre
prior 10 its issuance, also requires the applicant for such permit to file a signed statement
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
(commencing with Section 70D0) of Division 3 of the Business and Professions Code) or
5 0 0 0 0 0
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
36638012 .00
❑ L as owner of the property, or my employes with wages as their sole compensation,
Required Inspections
will do the wort, and the structure is not intended or offered for sale (Sec.70", Business
and Professions Code The Conaactmrs Liana_ Law does not apply toe an owner of
q P
property who builds or improves thereon, and who does such wort himself or through his
own employees, provided that such improvements are not intended or offered for sale, if,
however. the building or improvement is sold within one year of completiom the owner -
builder will have the burden of proving that he did not build or improve for purpose of
a
I. u awnei of the property, am exclusively contracting with Banned contractors to
constrect the proJen (Sec 7044. Business and Professions Codecw ) The Contrars U.
tense law does not apply toan owner of property who builds or Improves thereon, and,
who contracts for such pmjecm with a cone actors) licensed pursuant to the Contactors
License Law.
❑ I sin exempt
hereby affirm under penalty of perjury one of the following declarations
❑ 1 have and will maintain a CcNfiate of Consent to self -Insure for Workers Compen-
sadon, as provided for by Section 3700 of the Labor Code, for the performance of the
wort for which Ibis permit is issued.
❑ i have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the wort for which this permit is issued
'
My Workers Compensation bat u since carrier and Policy number am:
Carrier. Polley No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tnis section need not be completed if the permit is for one hundred dollars ($I00)
or ktss)
I unify that in the performance of the work for which this permit is Issued. 1 shall not
ernploy arty person In any mapocr�o u to me bJect m the Woritere Compensation
Laws of Califo
Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be domed invoked
I
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a bonstruction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Name
,
Lenders Address
I certify that I have read this application and state diet the above information is
correct. I agree to comply with all city and county ordinances and state laws misting to
building construction. and hereby authorize representatives of this city to coter upon the
above -mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
I liabilities, judgments, costs and expenses which may in any way accrue against said City
9��
consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WiTH ALL NON -POINT
Issued by: Date
SOURCE
Will th_ applicant or future building otxvpant atom 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
All roofs shall be inspected prior to any roofing material being installed.
❑ [gNo
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building star
pp ts g y pant use equipment y Mania cnt emit haraMnns air tmnre.ntn.n as defined b the BayAsia pie
all new materials for inspection.
Disnrict7
❑ Yes V4
I have read ate hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sadao 25505, 25533 and 255M.1 understand that if the building
does
�
CITY OF CUPERTINO BUILDING PERMIT`--- �/, I
BUILDING ADDRESS: 2160§RAINBOW DR
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor
Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, 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 provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I 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 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 accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature.
CONTRACTOR: TBD-TO
DATE ISSUED:06/302009
PHONE NO:
BUILDING PERMIT INFO: BLDG ff[I ELECT E PLUMB
MECH E]RESIDENTIAL ffl] COMMERCIAL E
JOB DESCRIPTION: NEW 2 STORY SFDWL 4,219.25 GARAGE 663' (VACANT
LOT) NO DEMO PERMIT NEEDED FOR FENCE/TENNIS COURT
REMOVAL. 01/12/10 REVSN MODFY SHEARWALL& MODFY DETAIL ON
MICROLAM FOR GIRDER
Sq. Ft Floor Area: I Valuation: $500000
APN Number: 36638012.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: _-- Date: 2
Date
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, 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 & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, 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 provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I 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 Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I 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 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 accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all
) > Dat(2_�_,\0 I Licensed Professional