02090192 CITY OF CUPERTINO 3 � u.
BUILDINGDIVISION PERMIT CONTRACTOR INFORMATION -%
Bu1Lp?q(�ugESBARRANCA DR TINA Sa' SCOTT BREHMER PERMrrN®2090192
4M- .NNEI& SCOTT BREHMER A"PLICAT0191YB44 2002
"ONE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINF.ER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MICH
0 0 0 0
wOp
LICENSED CONTRACNR'SDECons of hap
s I hereby affirm that I am licensed under provisions of Chapter Y(commencing
<iU wOnSectionTBg)nfDivision3ofdeBusinessandProfessln.CoJc.andmylicenseis REVISION (ADD '� RAF 'RP HOUSE USE ONLY
F« inmllorm nae(leet. ORIGINAL #02070067 , NO NEW PERMIT ISSUED
ofLJZ License Class Llc.p
Fm Dale Contractor
ARCHITLC'S DECLARATION ra
I understand my plans mall M used as Public rccnNs \\
upa0
tis n a.C F_ Licensed Prnlc.sinal
Z to OWNER-BUILDER DECLARATION eaM y I hereby.(hero that I amm exempt from the Contractors Code:1.iecme Law lou the
in OO billwhich requiresa ermi(Sectne monstr Business and ve.de inlih, Any coy mcmmre \\l
a�$(v which inquires a permit to construe,alter,improve,demolish, file
repair ed statement 5 0
Fly
prior it i¢mnephomalso uc to ft the
ovisio so for Such pertor'sL rma Laa, soammem
IxC thmnecatinnudpursmntmthupmviviomofthe OftheBusines'sndreactionChodMrY Sq. Ft. Floor Area Valuation
n F
heindicatingis exemptn Section 7(ow)of Division the
the aged ess and on.Any
vi Gwlc)lir
y��
that he is exempt therefrom and Ne Luis for the alleged exemption.Any violation of 32601007 . 00
Section 7031.5 by any applicant for a permit subjects he applicant to a civil penalty of APN Number
not mere than rive hundred dollars(s500). Occupancy Type
101 - FOUNDATION
1.as owner of the pro perty,mmyemployees with wages r their Sete compensation,
will dothewores ands he Corti is noes tendedLicense
unaffected does I.,apply We(See](13d,B at,of —
PIERS anJ Professions Code:The Conomcmrs Limine Law does not apply to an owner is 103 - UFER Required Inspections
property who builds or improves thereon,and who arc not
work himself edthmugn his
man employee,thccs,ping or improvements within
ne intendedwmnRcrcd for sato If, 104 — REBAR
howeWilder u,the building or den orvcment is sold within one year or completion,purpose
pose of
builder will have one burden of proving that he did not buil)lir improve for purpose of 105 - ANCHOR BOLTS
sath.). 106 - SEWER & WATER
❑I,as owner of the Pmpeny,am exclusively contracting with licensed contractors to 2 0 2 - UNDERFLOOR PLUMBING
construct the project(See.trod,Business and Professions Code:)The Contractor's Li-
censelawdoesnooapplymanownerofpropertywnoWildsorimprovesWoon,and 203 - UNDERFLOOR MECHANICAL
LicenseLawtsfor such prnic whnacnnuanorts)Eccn dpursaammmecnvaaor 204 — UNDERFLOOR FRAME
I am exempt under Sec. ,B&P C for this reason 205 - UNDERFLOOR INSULATION
ncr Date—
301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
Inereby amrm under jai of perjury one or me rmlrwmg eenmminns' 303 — ROUGH MECHANICAL
137M
Ihave andwillifor by naCmin 37 c of be
escltfarcforWurkcr'sdeofhi-
on,az pmviJCJ for by Seniors atm of me IaMu Code,fm tM pcRonnance of the 304 - ROUGH ELECTRICAL
k for which this permit is issued. 305 - FRAME
I have and will maintain Worker's Compemaoion Insurance,as required by Section 3 0 6 - HOEDOWNS
of the Labor Code,for the performnecn(Ne work for whichthis permit is issued.Worker's Compemation Insurance carrier and Policy number are: 307 — INSULATION
Carrier: Policy No: 308 - SHEETROCK
CERTIFICATE
COMPENSATION IINSURANCE
ON FROM ORKERS' 309 — EXTERIOR LATH
rrhis.sccdon field not M aomNeteu iffe remit is formol hundred dollars(Shot 310 - INTERIOR LATH
or rifyless.) 311 - SCRATCH COAT
employ
mater the performance of as work roll which his the W is issued.I encu nm 3 13 — ROOF NAIL
employ any baron in any manner m as m Meume subject m the Wmkcri Compensation
Laws o(Cab retain.Dam
Applicant 501 - FINAL ELECTRICAL ENERGY
NOTICE TO APPLICANT.11,of ter making this Ccnilicam of Exemption,you should 502 - FINAL PLUMBING ENERGY
become officer to the Worker's Can ne oration provisions of the Labor Code,You must
O Z fmlow ORcomply win such provionmmthis permiI hall he deemed revoked, 503 - FINAL MECHANICAL ENERGY
? CONSTRUCTION LENDING AGENCY 504 - FINAL BUILDING ENERGY
F• = Ihereby affirm matthucisaenmwebnnlending agency for the Performance of 505 - FINAL ELECTRICAL
C > the work for which his permit is issued(sec.3lylt.CO,C.)
506 — GAS TEST
tt] 0 Lender's Name
:D z LeaderAddress 507 - FINAL PLUMBING
U O 1 eenify that I have mad this application and cute that the above information is 508 - FINAL MECHANICAL
F^ correct.l agree but comply with all city and county ordinances and suite laws relating to
O
U building construction.and hereby auburn,representativesofthiscitymenterfromthe 5 FINAL GRADE
9
1 above mentioned property((it inspection purposes,
(We)time to save,indemnify and keep harmless the City of Cupcnino agai oat 1 0 FIN I G
h
liabilities,judgments,costs and expenses which may in any way accmcagainst said City 5 N LI WORKS
U in eonscslucnce of the grantingof this permit
'—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date `-�•/
SOURCE REGULATIONS.
Re-roofs
Signature of APplicnHAZA DO Dam
HAZARDOUS MATERIALS DISCLOSUREhandl Type of Roof
Will the applicant or future building te,Chan store or handle IbaNum material
debneJ io the Cupertino Municipal Code,Chapter 9.Q,and the Ilcalm and Safety
Mc,section 25532(a)?
❑Yes ON. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant in future building occupant roc equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emir htmrduus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
El Yes 0 N
I have real me hamrJnus ma¢rials requirements under Chapter 695 of the Cali foo-
nit Health is SafetySatins
Coda, 25F15,25533 and 25tk
,534.1 unmtund men if me wild.,
dices caw currently have a meant Nut it cr my m,ptmslhllity to nobly me eecupnn of me
requirements which must M met prim to issuance of a Cenmetm of Occupancy. Signature Of Applicant Date
Comernramhori d mm Date All roof coverings to be Class "B" or better
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