00080020CITY OF CUPERTINO
BUILDING DtvtSJOI4 PERMIT,
CONTRACTOR INFORMATION:
..
BUILDING A��LJ :rin1-II_ ST,
SI"II1LJ'
_
PERMITNO.00080020.
•z2 � 13AHL. S _
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OWNrat'SNthEU "`
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APPLICATIOfjl�llBrl{('Itli�(_(�(110
P. It rnp_ srl�ci'
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SANITARY NO. COST SOL NO.
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Z ARCHH ECOHNGINEER:
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BUILDING PERMIT INFO -
If )G E CT PLUMB MECII 1
l='I 'If
Z LI('I NSI DCONTRACIUIt S DI CI AItAI ION
9(
Job DCNcrI1i011 -
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I hereby affrm that I' d p lCl"II .c
uag'
withSa'ot71NN)),,fOchoa3ofthelt and Proles.'vv C.deandm,licer,
ADT}:I:
SQA T. - ,
1`[.11,1 OF', 41�) 1"
ix in full force and are".
1 iceae Clash Lic. p
H Dote Cmnmvn
ARCHITF.CI"S DECLARATION
S1 understood my plan. +hall be used as public records
,
s
OLi eased Professional
i OWNER-ftU1LDGR DGChARAf10N
vt1 hereby affirm than 1 am exempt foto the Contractor's License Law for the
ow
folling reason, (Section 7031.5, Business 6nit P nfecvions Cade: Any city nr county
_ which requires a permit to construct, alter, improve, demolish, or repair any structure
as prior in its issuance, also requires he applicant Ra mch lemon to lire. sign.d,iemment
0
Sq. Ft. Floor
Area
Va111'�ilafoo
- that he islicensed ph-airminthepe.,nmaanhecomrtnmrxLicense Law (Chapter 9
(commencing w hh Section 7000) of festoon 3 of the Basineas and Professions Code)
or Ilial he'w uven,pt there&.m and the basis for the alleged .,,iintlon. Any violuio.
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-,
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nfSection 7031.5 by any applicant for a permit sibiccst hcapplicanila a civil penally
nes mare tIttnt live modem dollar, ($5ap.
AP ]
9. �°(CJ:I, •: 1`%1(%1 "
- '
'
Occupancy Type
p Y YP
❑I,aowncenf the property, or on, omploycev will, wi,gr,., fair sole ..... i stition.
.
will do he wad, and the u,nemre is .al Intended or otlered 0n sale (Sec. 701
Bq,ine„and Profession, Cade: The contm.ror, liern,e Law duan no apply to an
, 1.I-•OURIi�FMief.
> ' '
r of pmli Who builds or improves thereon. and who does such work himself
_*pections
•'
or through his own employees. provided that +etch improvements are not intended or
102
I S
•:r .- IL'.ilsJ
.Rcm1 for sale. 1f, home.... the (wilding or impmmmere is .cold within one year of
.1.
rioulplefion, the wartar-Imilder all moeflic familiar or provin, final he did .6, build to
1Cd3
LIFER'
improve for pttrpasc of sale.).
-
C'4
REPAR
01.asra the property.amexclusively contracting with ficamedromm'cnmto
.1.
constructs the lowest (See. ]Illi. Business and Professions CNc:) The Contractor,1.05
"AIxlC1'•IUR BOLTS
License Law does not apply to an owner of property who hili Ids or improves thereon,
and who contracts for such projects with s cam Arar(s) licensed pursuant m he
:1 06
SF.WER� 1`L Wfl'T'h:Fi
'
Cnmrucv,r's License I....
❑ I all, csanpt under Sec. - ,11& I' C fon his aces..
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?fa'r_)'
- UNDERFLOOR h11_Lll'IBING
Owt'f
—WOItKEIR
3(%J3'
IJhlUfia"il'L_O(7Ft IIf::C:FIAI<I:CC:AL_
S COM'
^I ill swing
: '. 204
- UNDEi RFLOOR. •(-'RAI"IE:
I hcredcr penalty fpSA,i��ih oleclarmioin+:
era.;
'
uhIDERrI._CMR- IbhWl...AT:I IJ1'I ,
J have and will maintain a Certificate of C.n.enl a, sall'.Ir'i ra foe Workcr's
Con,parcmdun, ;is pinsided for by Section 3700 of the Labor Code, for the
L%1:I.
— ROUGH F'1_UMLiING' '
performance take work for which this pvimil is i„ucd'
„3(,13 2
-'; TUB OR SF3(JWk.R
❑ I have and will mountain Worker's Compensation Insurance, as required by Section
3700 of the Lahr Cade, far the pefierep sun of the work for which his permit is
:.303'
ROUGH MECHANICAL '
'
sued. MY Worker's Compensation lmdmnce carrier and Policy number are:
304
— ROUGH ELECTRICAL
Carrier. CPRI'IPICAI'[ON OP EXEh1MON FROM WORKERS' -
3fa5
"' FFIAML
COMPENSATION INSURANCE -
306
— FIOLDLIWNS _
(Thi, section need not be completed if me psamot In for one hundred dollars
(E I(Xl) aless.)
30
J.NJUL_nTION -
in
308
SFIEF..TROCA/
I ready na,t the perfarntance or me work for which mf, pernd i. issum,.1
nail n s ang,h,y any pa .... a in any onto par so is, In hear xubiwt ,, he W..sees
`
f%tri)
F::XT'F.Efi:I: CJL'i
Cnntpanxati.n Lava, of Calif omla. Dam
Applla'am
.
3.I0
IblT1::.1'7],OR 1._ATI-1.
NOI'ICE'IOAI•I•I.ICAN'I:It. after makii,mis CaniliculeolHscnm,ion. you should
'
• h.mnmsubjectortheWork,ACompenrau.nprovisionsoftheLnMaCodle,youroma
'forthwith
x.3.1,1.
P
-a)CI\nTCI-I COAT
�. eouply with such povl,l.m or this permit shell he deemed revoked.
31.:3
— ROOF 141clI'..'
: CONSTRUCTION LENDING AGENCY
' hkforwr,mhmher ,a.nn,d(Soc.fanding for the performance
` Cla.
-
— FINAL_ EI_ECTFiICAL. ENERGY
097,Ce.C.)
aepiNmr wnich,his permit is i.+ucd (sec. 31197, civ. CJ
i Lender, Noma
51`!12
— F.T.hIAI_ G'L_UI'IP:I:bIG FiNEFi[iY
LenJer'> Address
'
503
— FINAL I'IECHANICAL ENERGY'.
Ittnily lhatlhmr mad this applintion tradition lhnnhe aMwe inh,miation is
correct. 1 gyres to comply with all city and county ordinance, and xcity laws relating
1504
— F,T.NAI_ BUILDING ENERGY . ,
uhuWawe-mertsoned pr,aerhereby yforingmhorinem,nocnutive.v of this city to suer upon
me nM,(Wuremia, pcndemify
inspection purryues.
c t^.
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- .F'INraI_. E1...ErrR]:f::()L.
I. and the Cly of against
and keep hmay
(We) ggmc ,o .costs
hies,
'.'I�J�Y•
'- (l A«� T I:L:'.3 T -
and cape in true wino
which may in any why accrue nguln+l said
judgments. roses run i n ng of this
Ci,yincotNTUNDERS or ANDSANDWiILLCpermit.
City
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•.
'Issuedb '^ 7I!3�
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'� , F.Lhlnl... f:'LUI'IBING r
'—•� Date
SOURCEREGULTIONS,DSANDWILLCOMPLYWITHALLNONPOINT.
SOURCE REGULATIONS.
y:
- �-...,
signaaoactA,liratn(C.nmemor -,._[)are _
Re -roofs - :50Y7
.- F1 NAL GRADE
HAZARDOUS MATERIALS DISCLOSURE.
Will the applicant or future Wilding occupatn more it handle hmmam, mammal
Type of Roof i
YP 5: J. (J
,
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os defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
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Code. Section 25532a1?-
°Yee t�1\,
.'11.4
1-T.Nf•1L PURL c WGIti1Ls '•
All roofs shall be inspected
prior to any tooling material being installed.
Will the applicant or fuure.building mcupam use equipment or device,which
•mil
If it roof is installed without
first obtaining an inspection, I'agree to remove
ha,unbow nr conmminan¢ as defined by rhe Bay Arca Air Quality hMnageme,n
)ixrrlct?-
all new materials,for inspection.
Applicant understands,and will comply with
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all non-point'source regulations. -
1 have read the lima d.us materials renal m arts under Chupier 6.95..f rhe'
California Ileahh & SalMy Code, Sections 25505, 25533 unit 25534. end entonJ that
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iftheM1uilAingJoc, not curendy have atenant, that hia my responsibility to notify the
' -
”"t ant or Ibe requie.ment, which mal be met prior to issuance of. Cenifiratc of
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"
a`y'" '�- - .) �- 1'
Signature of Applicant ., '. Date
All roof coverings [o be Class or better'
Owner nr autbnnlal in en, Oma
OFFICE
i
CITY OG CUPERTINO
CONTRACTOR INFORMATION:
-sof{.DUNa ISIOv PERMIT
BUILDING ADDRESS'
PERMIT NO.
22342 BAHL ST
GRIDLEY
COMPANY
01060151
OWNER'S NAME:
MCSHANE THOMAS J AND BIRUTA S
19 S 3RD
ST
APPLICATION SUB DATE
06/26/2001
PHONE:
SANITARY NO. CONTROL NO.
(408)374-0900
Z ARCHITECT/ENGINEER;
BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
pO
V
L_J 1� LJ L-1
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that I am licensed under provisions of Chapmr 9 (commercing
we with Setion7011)1of Division 3oftbeBusiness dadProfessi�nsCodsandtry lic<nse
MS BATH &BED REMODEL.
isiafnBfm""my ffct.
sc LiaenseGlaes _ Lie g
`U
Ftp -ALED
Da¢ Contrxtor
(n
ARCHITECT'S DECLARAN
g1 understand my plans shall be used as public records
SEPXP 2001
o LicensedPmfet,maid
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Conuucmr's License Law for the
a following reason. lSerra.7031.5. Business eadProfession,Code A,any ormumy
BUILDING $76000
which omtdras a Mmail m cnnnmct, 11i,,, imm cnl ish, repair any gmum
pm. dmm t
m Pri , its .s - cc, a1so4 l 'PPI- tf - hl mta iflsignedsutc,nn.
- that be I<nsed puo trod 'p ,sio of the Contrition .License La'ICle,urY
h.[ r�ppC /j r�ais t`_- Valuation
'v' p-11
�'OF`�t5..,1J
(cornmecng with Section 7") of Division 3 fthe Busine and Pof ions Codd
or that rte is excmpf therefrom and hhe boas for the alleged exempion. Any violation
- -32S@ 1
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty
rf or more than E ve hundred dollars x500).
101A N� bATION
Occupancy Type.
❑I, as owner of the progeny, or my employee with wages as their sole compensation,
103 -
Required Inspections'' `
UFER 9 p '
will do the winds, ad the structure is not intended or offered for sale (Sec. 70sL
Business'and Professions Code: The Contractor's License Law does not apply to an
owner of property Who builds at improves thereon, and who does such work himself
104 -
REBAR
or through his own employees. provided that such improvements are not intended or
ob impm"` year
',offered for sale. IL however, the buildingimprovement is sold within one r
105 -
..... - _- .. _ ...
ANCHOR BOLTS '
the owner-noilder will have 0e burden of proving that he ata nm Huila or
iompletion,
mprove for g.,,,a or salol.
106_ -
SEWER & WATER
__
- oLar°wmrnnhep°P=rty.ameael��"elrcmm�ctingwnhTia. Oedeommamrsm
202 -
UNDERFLOOR PLUMBING '•, '1 •; ,'
construct the pmjea (Sec. 7041, Business aM Pmfcsi.as Code) The Conlmcmr's
2 0 3 -
UNDERFLOOR MECHANICAL*' '
n
License Law does m apply to do owner of property who builds or impmvas the...
and vht,abolfacts f«such prujecta. with .. ewxrectMsl.lic<rheed.-pa.an, mane
--_ ..204 ='
UNDERFLOOR--FRAME--_...._... _.. _-.___.... .._._._._.___.
Contractors License Law.. , .,
-_, ,or this moon,
❑ Adm exempt ander SecP C f
205 -
h
UNDERFLOOR`INSULATION
Owner' " Gum:301
-
ROUGH PLUMBING
" WORKER'S COMPENSATION DECLARATION
302 -
TUB & OR SHOWER
lhereby afrmhnaeerp<payyafatj�iy,appnnherannwingdeaamtian::
303 -
ROUGH MECHANICAL
j olnaae`and'wiumaintei,acertri,ineofCronn[m.e1r-insure for Worker's
304 -
ROUGH ELECTRICAL
Compegsahon, as provided for by Section 37W of the Labor Code, for the
permrmanecof,he work, f°r wn�en thug Permit is �,sard...
305 -
FRAME
Khave and willtrain 'ric Worker's Compensation Insurance, ai mi,ai'ned by Section
3 06 -
HOLDOWNS
0 of the Labor Code, for the Performance of the work for which this permit is
307 -
INSULATION
issued. My Workers Compensation lnmrance carrier and Policy number are: -
_
caver: roliey
308,,;-
SHEETROCK
N°,
' "c'aY ATl oE%EMPTf06W,OMWOR Rs4
' • '309`-
;ERTERIORi LATH'
" COMPENSATION INSURANCE
__---310�:,i=-ii INTERIOR_LATH - c.hr.,q __._..
t
(Thu scc'on nese n t be complaetl ,f the perms, is f r one hundred dollars
311 -
SCRATCH. COAT
l0ol nr lais.l
S"'.",
-„
i: Ic n, mN rI eifine kfoi whch tin-penn,is issuN,l
----313 -"ROOF'
NAIL", ., ... - ...
f I .
t em ry r dy eredm he- tab tato the Workers'
§hall mend
501
- FINAL ELECTRICAL ENERGY
-ApPlpcnspto C f i' -" . _
..... 502--
- -FINAL PLUMBING ENERGY'- - - -- -'- -
NOTTCETOAPLe NT f ,mrk,gmevenreale prop.ynenhanld
503
- FINAL MECHANICAL ENERGY
eLa
the Workers CnmPehi db pods ora ole Labor Code yen run
become subjection;
foithwirh comply with such provisions or phis permit Snell be deemed revokW.
ply ._ .-.
504 -
FINAL ..BUILDING- ENERGY.. --.--.-.- -- ----
_ . _ _.._. _._ ....., ....
"CONSTRUCTION LENDINGAGENCY ".' ""
505
- FINAL ELECTRICAL:.
I hereby affirm that th - on r et on leadm agency f theperformance
of the okfohich lM permit �. ...n urs 31N7 Liv c, -
506
- - r
- TEST.
ALed eNm -._. _.;, ...... _._�... .. .. _.._......
I< d A Idrc s'h�
_
507
,GAS--...-.... __.. ._. . _...
- FINAL P.LUMBING,.,,
z
'..l certify that lbave read anis application end Male that rhe above in(omution is
508
- FINAL MECHANICAL
ammaL I a me to comply with all city and county ordinances and gam laws mating
509
- FINAL GRADE
mbuilain onatn,tidn eadhchcby authorise represehtatives of this ashy to enter upon
GUs7 Neabr(WmniignIasaven !yandkephamala _ .,
ons
510
- FINAL PLANNING
L (W ice tib ssvc' Yanak hihamayintany way CupertinoiPi sit
elf
cc Rabaidm. °g hmna, ria ,ae.wmm may in any way accrue against said
514
- FINAL PUBLIC WORKS
YGly n ee t `n to pe 'I � •' ,
APPLICA lER' y A t VLLCOMPLYN'ITHIALI'NON-POINT'
IssUedb y'
Date
SOURCE) 1 ❑ ._ -tel e (
CC�ate
Re-roofs
- Signature lie can nr' -
,
'.. HAZARDOUS MATERIALS DISCLOSURE" - "
11 the applicant or future buildinj°ccawat store rthandle hazardous matenal
Type of Roof
.__..._.._.....-__...-_.__............... ...
adf dth Cpcn M cplCod Ch Per9.12 dmHealth an Safety
by,
C
.
..,xi'..
d'S t2 ',.. ,..
255321.,
❑Y Ns
All,roofs shall.b
,t .".
e prior.to any roofing material..bemg installed.
inspected
.. ..
2 Will the applicant or future building occ prim use equipment devices which
If a roof is installed without first obtaining an inspection, I-agree�to'remove
.m t ha lido air contraction n as eared by hh Bay Am d Quality Management'
D ,rsn
oY .' "°.
all new materials for inspection. and
P -Applicant
P g understands and will comply with
all non-point source regulation .,
_
1 on mad ins It x tnuie I r q it mento oder Chapmr 695. of the'!
California e""&Soler e. tom 25505; 2553)and 255?4.l understand that
- - - - -
" if the builds es note a iyh a tanantithatili.emy responsibility to notify the;
- - -
- -
c
occupnbt o 1 n hi t be met prior to issuadce of a Cenificzm of
Signature of Applicant
Date
i"---'„
All roof coverings to be Class B" or'better
ow area agent D(
OFFICE
JUN 2 6 2001
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JUN 2 6 2001
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REVISION
DATE...
SHEET
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