01070083 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:.
BUILDING ADDRESS. PERMIT NO,
20655 ACADIA CT PAI NAI Y AND HELEN 01070083
OWNER'S NAME. APPLICATION SUB DALE
PAI NAI Y AND HELEN 07/18/2001
PHONE, I SANITARY NO CONTROL NO
w C C ARCHITECT/ENGINEER: BUILDING PERMIT INFO
s BLDG ELECT PLUMB MECH
L J CJ L _I I-1
y z LICENSED CONTRACTOR'S DECLARAnON Job Description
Z_,� 1 hereby affirm Nat I am licensed under provisions of Chapter 9(comme eng
P_z 0 i:�'�,u`foRe�a)=rc i'at°n3oftnaBnst«aranaer°rea.tmt.cnee.anamrman=e REMODEL.
95 o i a g1emecla- conv am ADD WINDOW, NEW BATHROOM &
3 a[- ARCHITECT'S DECLARATION NEW LUNDRY.
L"4 O< 1 understand my plans shall be,used as public records
uc w, FINAL
e. O Licensed Professional E.
K OWNER-BUILDER DECLARATION E
D
m I hereby affirm that I am exempt form the Contractor's Umense Law fw the
a=t-o a (SemmmI03I5.Bu&mxxa and PmfesssomC Ay c'ry or cur ry f which requires a permit o conserver,char,tmprove,demolish,or repair any srrucmre J C n
90 O.p -
,amf w its issuance,also rqu"es the applicant for sucn parent m file a signed soueme0t. I
thatk'sh«n_dpurcignr totlle pronsioru of as COmtixwls License law(CTapar9 ,_,__ S Ft:Floor ea-
Or tt ei lie rngxxm Secmm�[0001"(Division 3 of the Easiness amd t6.Any vi Cade) L.4; i i; ',..�9�; )� . a _j'i t z��'r O nation
w mai he rs ere pt therefrom aril the base for the l Burin hem d Peci Any is Co k) L Z y"'-
-of Section 1031 5 by any applicant for a occur subjects the applicam to a civil pmah,
Tor Our more than fve himered dollars(SSWj. 326`M66� I111�5� ccupancy Type
❑I,as owns of the pmperry,or my employees with wages as their sole compensation, -
-will do the work;and the Structure'is'nor intended or offered for sale(Sec.701t,- -- -Business and Professwms Code The Comaetora License Iaw does lent apply m an 101 - FOUNDAT�$yTired Inspections'' "
cer of property Who budds w improves t rearm,and who does such work himself I
w 102 PIERS
of through soh own employees.provided env such 1amentrx sod are not oeidea or
-offerea for sale IF.however,Ne l Once of diipoofpsov n solo within nor year of ----- - - -- -"--''--"- --' , - - ---- - --- - - -------
103 UFER _
coinPkuon,the owner-budder will Have the butdrn of q°vm8 that M dim nor build w -
'mptove for purpose of sale) REBAR _
_ing . 104----_ _
net of the proper y,am excluswely d professions ns with olicensed
,)The conowrs m 10 5 - ANCHOR BOLTS
_= - incense doe project(Sec.7011,ovorea o and Pro who b Code)The Contractor's - " -
- -
License Law aces not apply w an owns of property who bwlds w'erynovcs thereon, 106 - SEWER & WATER '-
' _and who commas[,-for such projects with_.ccomments)licensed purs"vu to die. -__ _
Contactors License ., '- _ 202--- "UNDERFLOOR "PLUMBING' -----_ '---- �----- -" ----
�Im37�1 un ' ° - ' B&PC,fwtn'sreawn 203 - UNDERFLOOR-'MECHAN-ICAL
-_= 2 04 - UN DERFLOOR FRAME
oRxE SCOMPENSATIONDECLARATION 205 - UNDERFLOOR INSULATION
hereby'afrin under am dry of perjury,one of me fmhnwng tleclarvimis: 301 = ROUGH PLUMBING
° I have and:.it['rnzu6tmn a certificate of Coasem'm self-Insure for workers
Compensationras provided for by-Section 3]00 of the Libor for fire 3 02 TUB & OR SHOWER
peirnrmmiee of the wn,k for wman woe petnn is hssuea
303 ROUGH MECHANICAL
--_ ❑I have and will"aincrm workers compensation Ins...nie,as cei m ed by section 304 - ROUGH ELECTRICAL
3I00 of the Labor Code:for the perfo'mance of the work for whmch this permit's
reandMywnerscompencat'°nmmanuyarnera,aPoloyaunmerK. 305 - FRAME
I -policy No
69..;- 10ERTUTCATI F M KE
ONO ,EXEPIIONFROMWORRS fINSUULATIONfi
e' COMPEslSATIONIMURANC'E'' '
-- ----'308-=—SHEETROCK'---- -'-7:
°'-`(Thi xniori need rot be complaed if the pemut is fw pile hundred!dollars -
tsloojnrlers) ,„r.... . . :::... . .. .... 309 - EXTERIOR LATH � '
'. ''.famvrr.IAlintneperfo'mincenfthe,pn'kfwwhshtNSpawrii;ssueal -"`INTERIOR'. �LATH;v..._,.,:`--_-- --- -- °--..° . _- - --
4 =
&O net ac 1 an s ro u�m sun r o me woe tern 311 - SCRATCH COAT'
s employ y Orion person m any m fee
NOTICETOAPPLICANT`If.aft mak'ngtPCertificateof Exemmon,y,must 313- ROOF NAIL- ----- --1 -.___. __. -- .. _ ..... .... .... ...
A hcane_._. _.
Z becomesubedlotheW.1ker'IC'm rnumum mtsof the LatinCost, 501 - FINAL ELECTRICAL ENERGY
O O forthwith", -,-- comply wan such pmvisi°nil or this pa,me snag rte deemed re-
o.-I - - - .5 0 2-_.-_. F INAL_ PLUMB ING_ 'ENERGY
FZ•: t'-��:'-""�:-,-_'::,.CONSTRUCTION LENDING AGENCY. _
1 hereby afro that there is'a conswctmn[coding.genq for the pertom'aoce 5 0 3 FINAL MECHANICAL ENER
GY`
A.a Of me work for wmrhthis pi,A nisi,med(See 3o9z Cie e), 5,04_ -,_FINAL._BUILDING ENERGY- _
:M - Lenders Nance'_..._..._ .....____.,.w�__ . _.. , . __ _
n aesAaares• 505 - FINAL ELECTRICAL .
u o 506 - GAS TEST
iI ced'(y chat I have read a 11 apps non s, sma that the above laws l,,�s
`w. o ref' i name.n nm;nph.w, an eii,aqa commis°a:nanee,one same i.nvs rela,:ng
507 - FINAL PLUMBING
s v-V twbwldu'gtt.ro'nictiw,ernveny nmthon>e repr.eniame.of tM1ti nrymnnerupon'
`�W :rte above-mnmtinn d prop nv fnr'n,p a'mn pa omits.,
508 - FINAL MECHANICAL
-6 Iwe)agree m save.mdeiminify and k«p lb re.,In the Gry of cupemno agvvv
- m 1i.b:bnes.rvdnmemm, ana expenses wn�cn may ten ary way creme agamsr said 509 - FINAL GRADE
U yC'ry m consequent the¢rwhng of this permit
fskPPLICA.NT R�TT'y,'��SANDWILLCOMFLYWITHALLNON-POINT 10 t•FTS,NA LP TING Date
Op ATI h0 �j' � t ��� Issued }I Q- .e(J
- sdefwedb th'�drtno Municipal budding cc Cpm,.DISCLOSURE
" •D�- /
_ = , f W'BYe I for DOU buPisldwn'aI stns O URE hazardous matenal. TRe-roofs
f
_
., np er 9 12.and the Health and Safety - YPe of Roof
coaeaauonzss32rgl
:•ore, �, exa`;,'!� , :: _`'�'-" . _ . _-_All roofs shall be inspected prior-to any-roofing material being-installed.
w u
he applicant or form budder. p t use equipment or devices Which, If a roof is installed without first obtaining a 'ins ection, I agree to remove error restrictions azr conearriuments ❑fed by me Bay Area Air Quality M age t
i Di m r - - _ all new materials for inspection._Applicant understands and will_ comply with
°NO all non-point source regulations. - -
.I have teal the ha md°us materials r quirements under Chapter 695 of the
California Health&Safety Coda sections 25505.15533 and 25531.1 understand that
'f'hehuildIne axs ay have a tenan4thatn is my ies,snsmbihty to notify the - -- -"- "' - -- -- --'- - - --- -
o«0pavt of the mer whmh must be met prior m issuance of a Camli,ate of - -
:.
__ .-- - - —(air / _ to
Signature of Applicant Da
�d All roof coverings to be Class"B"or better
r Sn�orizea a¢en[ �' : Date -
OFFICE