00100055 CITY OF CUPERTINO
BUILDING DIVISION PERMIT C0NTRACT08$•DdF0RMJtSJ0NMl.IC WORKS '
` '[No '
BUILDING ADDRESS: � , PER.W . ,
OWNER'S NAME APPLICATION SUB DATE
101122 ADELHEID .Cl' ' . • 001002155
` SANITARY NO CONTROL NO.
PHONE x. OHLER PETER C AND LYNNE D, 10/06/2000•
ARCII TECI'/ENGINEER BUILDING P17RMIT INFO'
.too . r �. BLDG ELECT I'LUMB 'MECIi
z •
yn LICENSED CONTRACIDR'S DECLARATION Job Description
DND l herch,larn Etal am Lvcmed under Inns of Cad info - ,
pawl+ p tcammm�cmg .
F_:w xnh Sectinn9ptofOrvisron)nflhe HU+meswnA Pmfn.inns Cale,anJ mylicenu
n full 6rec and etlem.
Liner se Cla.. .Lm.# ` - -
3 a H Dams - 'Cantmcmr
ARCHITECT'S DECLARATION
n. °5
f T,inde,slif ndm sitd
yFire. ihea..d.rolahlbetce.ad, NEW STAIRWAY
yM .
a i p p 4cenwJ Pmfenaowl \ '
oBe OWNER-BUILDER DECLARATION
1 nereny,aidein ism I inn eBusin Business A the Cantma9a o e Ali,,Law for the !/
.-C Z a which re rea+on sector word to 7031 ru 5.Bu,inn,and 1'adesaoli h,or Any my s county
Sip 'loch ,I,ole a pemw ur comweL aher,improve,demolish, file repay any amnuro
3$ thmileawu...0In i,un ttotherhos,,uw,ofbeCchpenniuotilenmgnedCapter9 �9 ,
thmhnclan with to me par olnauz NeUllBonnets neLarnwLawfe.Cartel Sq. Ft. Floor Area G Valuation
(c that be is l with Section or 7")ad a hall, 9 of ILe Coc,and ina Any Cod,)
or he is exempl therefrom ana rM1e has'fo'r ine allege)exempfima Any nohmon Q '
of Sermon 7011,5 by nay app,n l[for o Forma vibjcctn Iha appbaanl to a civil pvalfy
ofnotalfin�Bae lurched dau at.(S500) - APN Number
/ cwpancyType
❑La.rw,near,tk. all nrureI sloyeeswin,waroe,ffsala, (Set.afnn,
well do the xnrk.and the.ve: Foe a net nor is la e nlhmd far anl,apply 91N4;
ownerof and arty Who Cliche:or a Contractor thereon,,.unit'o do s such nor apply to an Re aired Inspections
mwoe,nr property was hnaa.or imptnae.merenn,um who Jae.>aah xnrk himself 357090227. -0 ,
fhrnagla hry awn umpfuye,s."'widul That such linprmvdinant+•f a rim infeoded or -
offefcd for safe If,hnwema the huddmgpr Imprnvemem is sold wham one yen,al ,
completion,the owner-builder will bloc the burden of proving that he did rim mild or
prnveforprimn.enrade,) 1.01 — FOUNDATION
as owner of the property,am eaclmively commchng wall licensed romranms in 102 PIERS
(swt Zi Fns,I(Sec,71144,if...cas and Ptofesorn Code'.)The Contractor',
Ineen+!I..dons"on uppfy m ai nwnei of properly who I,a rid, a hnprnve,amrcnn. 1.0.b '" UFE R
and who contracts for such pagece with a eoutwOotfs)licensed pursuant to the '
CnntractineaUcen+ol.aw'. 104 — REBAR
❑Iameaempt older sew � B&PCrrmi,raa.nf ` .105 ='ANCHOR BOLTS -
wuxxu� cnlPF snf'fn�yS:wRnTIDV
406 SEWER 8. WATER
202 — UNDERFLOOR PLUMBING
Ihereny urBrm ender penalty of per3ury one of the following declarations r_ '
Cl 1 have and wal amahtun a Ccaiucale of Consent fa .elf...am for Winter's
20? y UNDERFLOOR MECI IAN I CAI
Cnatpcnsmiint a, pm,-ided tin by S,chnn.371)0 nl Inc Lanni Coda far the
performance of the work for wh¢h this peron rs fs,ued 204 UNDERFLOOR FRAME
'05 — UNDERFLOOR' INSULATION
r Cl I have,ad will maimilin WarAm's Can upaununn inwnince,isle yuunl by 9ccuon t 2
3700 of the Lahor Code,for the performance of me work tar which this pent l is 301 — ROUGH PLUMBING
r.+ded My Workers Carl ...I a Insurance carrier and Policy mintier are:
Carr,, policy No ' 302 — TUB- R' OR SHOWER
CERTIFICATIONOr EXEMPTION FROM WORKERS' 303 — ROUGH MECHANICAL
COMPENSATION INSURANCE
f flaw section need not becmopletedd the pernhis far iae hundred dolar 304 ROUGH ELECTRICAL
Tslnn,anev.) 305 — FRAME
I wady mat at fur'pi.......a,ce of me wmh m,wldd,this Pa i,dt i,i,saaa.l 2,06 — HOLDOWNS
shall not employ airy person in any manner+o as ur hecome subject to the Workers'
Cnmpen,uiluiiawooralifornia.fare ' 307 — INSULATION "
APFLarinI
NOTICE TO APP LICANT:ILaftennakagiltos Ccnficae-t Usluep or,1.l1wwld ,}171B SHEET ROCK
p'Qhecomc,ubyee,to the Worker,Cofnpensauon prnvnwn,or the Lahr Cnle,y nu must
mnnwimcnntpfywrmwchprovi.inn.arrniopemrashelfhedecmed«vnked. 309 —' EXTERIOR LATH ,
F CONSTRUCT ION LENDING AGENCY .3 — INTERIOR LATH
I hereby anion that there is a construction lending agency for the pertomtance
a ? or the work bar whl eh Ill opet rranI. .aaeJ(Scc3nn,CiwC.) n .51, 1. — SCRATCH COATI
' y p Lendc,,Nano
Len /vE�s,J 313 — ROOF .NAIL
.7 der's Address -
U o Ice,mytlratuw�areaawt,apphcaain,amintmeu,akill towernf in, CD , 501 — 'FINAL ELECTRICAL ENERGY' `
Ls, (�. correct 1 agree fo comply with.11 city and county ordmann•,and sate law+mlaang ,(� n —
O U r o building conwmction,and hereby aumorizerepewrrtativeso f this city to enter upon •502 FINAL PLUMBING ENERGY
meiaMr(W,ti,maned'pse,aiidlif,andknphe...e 503 —` FINAL MECHANICAL_ ENE'RGY-
'�' y (We)agnemsaoClen, mniryaul on to h..nc,. the City of Gpremhn ugein+r
N babiline,, dgilents,ow,and enpenwc which may in any,wo,liscrue against+aid 504 —•' FINAL BI TJ_D T NG ENERGY
V .Zi Cuyin cnnwyucncc ofthe gmnhng oftfii+permit �r�•�-p
•SOURCANT UN ERSTANDS AND WILL COMPLY WITH ALL NON-POINT ISS y: 505 — FINAL_ ELE=TCQale.:
Sagmuum of A,ke,fiVCmatacmr Dote - Re-roofs r
HAZARDOUS MATERIALS DISCLOSURE.
Will the applicant at future building ncvvpant store or handle har.Wtw.material Type of Roof
u,denncd by plc Cupertino Mumeipal Cdda,Chapwr 9 12,and the Health and Safety,) •.
Code,Section 25332(a)7 ..
❑Ye, oyn , _ All roofs shall bedi0f'ncted(1Q'lJbto�i5lpoting material being installed.
wal me,pphrnn,nr wairu na,laing,iccaipant ii.,,,l,iiniaantn,de.are.wbid, . ,,,If a roof is installG]ZFyitheu[FfiSyt�phtailp Hiy� tion, [ agree to remove
inn hJlprdnl a fur cnntnminanl,as JehneJ by the pay Area Mr Qualify Alenagmnem
oistacl9 all new materials ft6lspcctp PNApply�tOp{t<cjptgtEALand will comply with
°Y"• °"° all non-point sou ulat
I have rceJ the hmurdous mammal.regmrcmems under Chapter 695 dr metl�g' `Y'NAL GRADE
California Health&Safety Cole,Sect ions 255BA23533anJ'_533i lundernand that 510 — .FINAL PLANNING
-
I the bnddmg Joax not aurre naly hdvc a lcndnt Thal it in nay raprymsibJity to nnlJy ahc
occ...a nl the rcymrerac as which mull he amt poor In issuance of u Cenilirne of T. 1 h — I? p l/l�- [siivtrttr WQf1l1/_
�. .t .
Signature of Applicant • Date,
�ZO; eage„f All ro of coverings to be Class "B;'or better