02020105 CITY OF CUPERTINO
BUILDING DIVISION PER IT A& CONT" TOR•DWORMATIO+
BUILDING ADDRESS: PERMIT NO.
18600 BARNHART AVE . ROBERT BIRKMAIER 02020105
OWNER'S NAME: APPLICATION SUB DATE
ROBERT BIRKMAIER 02/26/2002
i �iONE: SANITARY NO, CONTROL NO.
WW�O O ARCHITECrrENGINEER: BUILDING PERMIT INFO
8't,ub BLDG ELECT PLUMB MECH
Brad
ID I-1
LICENSED
z y 2
1 hereby Ilim thou II ran licensed under p DECLARATION 9(commencing Job Description
:LEW provisions of Chapter REPAIR OVERHANG.
:LEW with Smiace,an efeci.isinn 3 o the Business and Pmfosions Cade.and my license
,x on< Licca ll force and ellen. I� I'��II /� t�
iN•U License Clnss Lic.g 1�R��IU" LE93
3 u N Data Commnur II V.'I
ARCHITECrs DECLARATION
.u O I ondersmad my pI.n,,h.1)he used as public recmd,
poo Licensed Professional MAR —0 12002
'yne OWNER-BUILDER DECLARATION
.-w 1 hemby,firm ma I am exempt from the Convacmr's License Law for the
GZQ
following reason.(Section 7031.5,Business and Professions Code:Any city or tummy BUILDING $
ISO which melons a perms to consultor,alms Impmm
re,demolish,or repair any swcmn 2 0
a.�3m _priemimissuaeq al,0 requires the applicantfor msapumiumi4uigmd smmmem. _ ,_ _,
that he is,licensed pmrsuenl to dm provisions of the Comment's License law(Chapter 9 Valuation
(commencing with Section]OW)of Division 3 of the Business pnd Profnssions Code) "( ; Cr3.:F1t3 4 ' -f'v
or Nat be is emmpi thciefmm and on basis for the alleged demptmA.My violation
-of Section]031.5 byarry applicam fm a permit sublttts the applicant ton civil penalry
tofnotMorethanivehundreddollars(s5W). 101PN��} DATION ' ' - Occupancy Type
❑1,as downer of mJac adpcvryrmy,or my employ,,,with rages offend their sole mom ec.71k n,
Busine she'wark,'and Um structure C not mmndcd oreLaw for,ale(Spey]Oras - -
owner ai dna erty Who ildae:Tw eves da m'a.License Law dopa nm apply.as 103 - UFER Required Inspections
owner of progeny Who builds or Improves at such,and who dos such work himself
or thiend or his own employees.provided that such improvements is sol within
hin intended e year or 104 - REBAR _
.compli for cele.B,however the building or improvement n sold he did one year of - . - - -
`omplaion,the owner-builder will have the bumph of proving that he did not build or 105 - ANCHOR BOLTS
reprove for purpose of sale.). 106 — SEWER & WATER
,p 1,as..a,of the pmpmn am exclusively contracting with licensed contractors to 202 — UNDERFLOOR *PLUMBING
comment the project(Sec.7064.Bus and Professions )Th
Cada:) Contractor's
License Law doe,not app?do as..at of progeny who wild,or i.pm,.dreon, 2 03 — UNDERFLOOR MECHANICAL
and.who contracts for such project:with a contranm(a)tiered pursuant no the
Contractor's License - -204 — UNDERFLOOR FRAME
law. - - - -
❑lamexempt under Sec.' ,B&PCfar this reason 205 — UNDERFLOOR INSULATION
°wA" ENS 301 — ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
I hereby affirm made,penany of perjury one of fln following declarations: 3 02 — TUB & OR SHOWER
303 — ROUGH MECHANICAL
C I�ve aha w'invnwidem a uyrcador Cons nl 10 aH Labor
for worker, 304 — ROUGH ELECTRICAL
Cam nncen o-he fed for b s<mmn 3]00 of Ne laver code, for the
peAormanee or me wmk for which this pemtid,is issued.
305 — FRAME
a
❑1 have and will maintain Workers Compmrsedion beurance,'a required by Section 306 — HOEDOWNS
3700 of the labor Cod,for the ppRormantt of the work for which this parvo is
' issued.My Workers Compensation Insurance csame,and Polity number art: " -
307 — INSULATION
' curaera t : -a+t I F a PpicrNa 3 08 "=;.SHEE'�'ROCK
'1 CERTIFICATION OF EXEMPTION FROM WORKBRS '- k (�•. t R 1 + `
COMPENSATION INSURANCE'. ' L " .. .'.... .._...... ..._.-3O9 `— `EXTERIOR"• LATH a
3I 0'l'.'—_, --INTERIOR"LATH _..._.. ... ..... ,._ .
"(Thai secilon eeae nod bepo�ap4ied;nwerm
pitshundred one nared do[]. 311 — SCRATCH COAT ,
(SIM)or less)
Iccalrrmt�n am parr - onsWeak
f nen to x -t ed1 ., 313 ROOF NAIL',... ' 1 .. ..
,,heli t ploy any person any so as e s e t io th Workers "
Aompery 0r r0 .�" a. °oG,Y�o ' 501 _ FINAL ELECTRICALIENERGY
P° 502 FINAL PLUMBING ENERGY
NOTICE PPLICANT If eft making nfc t ofE pt on.you sho Itl' - -
Z Wov.aubjaItotheWorker,Compen...bnProvision,oftheraborCode,youmain 503 — FINAL MECHANICAL ENERGY
O forthwith comply with such provision or this permit shalt the dermal revoked. FINAL' BUILDING ENERGj' .
`e coNSemisacoNLEN�wcgGENCY 505 - FINAL ELECTRICAL
1 hereby wire this there ass construction W7,C agency for the perfermmce
w,r ofnewekforwhichJJspermitisissucd(Scc.3lN],Civ.C.) "' 506_ .,- GAS TEST a
z 'Linder',Name ... .. . . . .. ..
q;zmeraAddress 507 — FINAL PLUMBING
U O Icertify that l have read m
this appliation and than sheaW,a infomudion is 508 — FINAL MECHANICAL
'comer.I agree to comply with ail city and mommy eminences and dam laws.]ming
to building consuunioWmal herebyauthorise representatives of Nis ciryto a..,upon 509 — FINAL GRADE
r� the above-mendionadPropertyfor ins inspection i" W , a puWrote 510 — FINAL PLANNING
re 6 y ( q agree do save,indemnify and Aspic hamNess the City of cruenino'agsna
W liabilities,judluence cosh and expenses which may in any way accrue against said 514 — FINA P I C WORKS
V 1Z City in consequence Of she granting of reit pckmir, "' - n
PLICANr UNTJERSTAN SAND WB.L'COMPLY WTfH ALL NON-POIIJr' 1
- G 's. o,Z Issued by: Date
Signamr<pf ApPlicen Convenor pa
',HALiRD0USb1ATERIAIS Dsoon so
Re-roofs
�WJI Jrieppiant oi,hmrt wilding bcmapm+atort or handle heaerdoux ma¢ris .Type.Of Roof
as Qeincd br the Cupc�tiso Municipal Code,Chapmr 9.13,and the HW N and safety "- _ .. . . ._...
C e,'S cton 25S32(n)?". d: ... t s - tv r
-:•'- i _ - All rood's.shall be Inspected prior to any roofing material being.installed.
`ot.l Will airc mndorfurore building ed oc gam u.egmpm mordevices which If a roof is installed without fust obtaining an inspection,'I agree to remove
:1h Will the avconummantsasdcOnetl VY me areszgtr Qualifye ises mem
'ham" all new materials for inspection. Applicant understands and wi11 com ] with
❑Yes
PP..,. ._ - -- P .
p ,
all'non'point source regulations:- _. :..j;�;,; -
"1 have read the Seery
Onous miions 2 505. 5533 a underChapter Understand
f she
California ing Health s of ear Calc.Section ant.chat
it is y n 2553,,,1 understand Jus
if Ne wilting docs not tumemlj have a meant,shat it is my responsibility to notify tw
WPrccmcnts which muat w roes prior.issuance of Ccniff.is of
Signature of ApplicantDa e
gem .trey ... .
Date
All roof coverings[o be Class"B" or better
..OFFICE_. __ . . . .. . __ ._.... ... _ ..