02020050 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: APPLICATION SUB DATE
WIES DAVID L AND JOYCE G TRUST 5602 CROYDON AVE 02/13/2002
HONE: SANITARY NO. CONTROL NO.
(408) 978-7500
co,,O ARCHITECTIENGINEER: BUILDING PERbfIT INFO
U G BLDG ELECT PLUMB MECH
van III
h
LICENSED CONT'RACTOR'S DECLARATION
H C
]hereby afI tha 1 am 1ic<nttd under Prorisiuns of Chapmr 9(commencing Job Description
w f_m Acll- fm-nll�
reaffirmJor@eB n smmit ne sin Cde Mame
yyf t �L° BATHROOM REMODELLING
p0 U ¢.p yGam r FINN ,E®
u O< T'S DE A 10
so I I undimmed my plans shall be used as pubic recons 4�i
LS a o Licensed Professional i7
OWNER-BUILDER DECLARATION
so so I hereby of Dat that I am exempt from the Concom ur's License Law for the MAR 11 2002
C�< fillowingreaso..holun]1U1.5.Haloes,and Professions Calc Any city or county
E xo which requires a Permit to commuc6 alar,improve.demolish,or repair any structure O O 0
aim _prior to its issuance,also acclaims the applicant for such parnat to file a signed statement.mh)th¢at"he'fe !cmeedded pp t nhueernehfro'nthploProvisions
isi s salone
thContractors
iLem ai Law n y(Chapter
tio9n ' v " ' - ' s'
`'r
(commercial, ith Sect 7000) f Division 3 of the Business and Professions Cod) i ''1 f-11 FI,FIOor Area,,
"l t
Sca
-of not mo 7031.5 iv any hundred
doll fm a permit subjects the applicam m z civil pmalty-
mrnalmate than five n°nares aanar,.(sstro). APN Number Occupancy Type
❑I,a, at,ohne property.or my employee,wan wages as their spm cam tion. 101 - FOUNDATION `
.'will do the work,:and the urucmre;s at intended or'offered'for sale IS..v7Ula, - --- -
tB°:mm,.6dCane:
'PmRu,iun, The Comment's License Law does nut apply m an Required Inspecti UPS -
owae
r nr pman,Who build,or unp ave,nnemaa..and who daw such work himself 103 - UFER
_or through his own employees.Provided that such inniumemems are not intended m -1'04- REBAR -'-' ;---- -
nlTc d t .ale If h tfi building - - r ....- . .._._. . . _-........ ..
g p e);n: Id tdi nc year or b
opo f n , owner builder will have the burden of proving thin heed not bund or 105 — ANCHOR BOLTS
Imp
improve rot puryou of sola),
'�r:'_:'.-'•�'� -,':',' ❑L_ac_.l_,a.w_tracrmt_neot_ap.p_
ly..t.o_an'_.ow-.-ner op_ropIe.rt..y who Wl ._vi.s N.areao_n_,
. ----- -106--
WATER- _
- ...-_._....__—,_--------
property,amY 6nrmnnns,thuproject(Sec.]fat,B.,ime"fandI'mfesios CWea)To,Cummno', - PLUMBING
PLUMBI
and.who contracts such Projects.with e a<na,) iaensedpi°aman203°°Ira"ne .;"n,,Law' ._ UNDERFLOORICAL
❑I am exempt under S . &P C forths rtaon 204 — UNDERFLOOR_FRAME_
r a — NDERFLOOR _INSUOwneData 205 LATION ..
—
'
_
WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
- i - Ihereby affirm under penalty ofatj°ryone othe following declarations: 302 - TUB & OR SHOWER
I Dere.ad will m imain a certificate of consent to self-insum for worker's 303 - ROUGH MECHANICAL
". .ama<nspraa, ax,Provided for by Section 37W of the Inbar Cade,-for me 304 - ROUGH ELECTRICAL
- jarrmmaace of tndwork brow hich this pepfi is issued. 305 - FRAME
- ❑1 haJ2and will maimain worker's Compensation Induraoce.-as required by Section 306 — HOEDOWNS
3]00 of theLabor Cod f th Performanc f d work'f which tM1 s perm t
p,na Mrw ke„Compensator,]it,ara<e”arric1
2 307. INSULATION.,.
aro
l CERTTFlCATONOFL%EMviNFlQ , 2 ? p�30'8� !- t;SHEET'ROCKa ,t, ° . -
COMPENSATIONINSURANCE J / 3.0.9_.._ EXTERIOR.-LATH ---------
for
%•'' (rn t n need not be completed of the perm is for one hundm liars 310.1' :'INTERIOR LATH
311_ SCRATCH COAT
1 if that rm x -a a°ftp work b' to pe t ' s a - - 3 ROOF NAIL"
Com W Yo� Toris
y pan a 6b d p t� It 31 -
�kers ;.i,,-,. -`_
A , it T.
501 FINAL ELECTRICAL ENERGY
P ANT If rt _pas tntc�f - Ex pian -arae - — 502 - - FINAL PLUMBING ENERGY -- -" ---'
0 (0 lonhw th mmply i;u suchep visionsCom nas pro nst] th xp re Cml you must '
P pe 't shellbcd eereakca. 503 — FINAL MECHANICAL ENERGY
Ind,by trrta ._ . _ _ ---' 504 -FINAL--BUILDING 'ENERGY
'� '1 " CONSTRUCTION LENDING AGENCY " -- "-' '-
a-> that then is a consuucito I dngegency for the performance 505 — FINAL ELECTRICAL'•l"' r
.w ofthe k(c which this pant issued(S '3097 Civ.C) ` -- '
:6Nam .. ._ ..
a 506 --GAS TEST-- . _
p_Z ae Adg _., 507 — FINAL PLUMBING"'
G 1<geetocom a stn city
aott stun lobo r Inn, 508 - FINAL MECHANICAL
p. Sat, t I g t comply m all<�ty and county omnnsa<e:and ane meds entreating 0-U to buildingconxtmmibn:and hereby emfionu rtpresenmtivcs of this<irytacnmr upon 509 — FINAL GRADE
Yp ret the zba t ed prep rtY r r_ pc Iia purpo
n d Iw) g a s.cos tlmnfr ilk ph l any ayacc 'roams 510 - FINAL PLANNING
Z luyne jdg ala,cA tri p,o xis h y enYx
U.Z ci�� q fm g i g nniapc t Y s"`� aie 514 - NA WORKS I b L
APP C NTU ERs7yaNDS'Ah WILL COMPLYNTfHA[.0 N� DINT Issued by: Dale
S t REr Ly'ig4S,
SiIII
i ^ o< pprcchn—oc�at�m<^n-r-` ter' Re-roofs
" HAZARDOUS ATERIAfS DISCLOSURE ..
as
tied Will't
applicantprfLure dregottvp tst&e&handlehaaardoumaledrl -„ ,Type of Roof_ .
as def n d by th C pen o Municipal Cod Chapter9 U d th Health lth and Wary
-
Cotre S q n 2553 1 ! -
,; T .♦ t i to 1fi ILA .i_Yl
El yes I . kI )1 ON _ t I.. dx Ft.�' i
All roofs shall.be inspected poor to any roofing material being,msta_lled.
.'Will the aPprwm tamed bulking occupby
Bay Armoipmento devices whivh If a roof is insialled'without first obtaining an inspection A agree.Io remove
Di'emit hazardous c'ntam n t defined by the B y Arw'A Q alry Management
°,""'pY�.. ,oNo all new materials for inspection Applicant understands and will comply with
all non-point'source regulations _
r.,1 h a the hazard m renals mqu rc cots under Chapmr 695 of the
Cal f m a Health&Safety Cade Sections 25505.25533 and 2553, 1 understand that
if the bis ldi o drum,am currently h ve moan, thin t y map° 'b l'IY to not f I
«Clip nt of th' quirem t h' h' uit be et D t aaua f en fie a of
' - Signature of Applicant _ Date
-'^ w"° °'^ eP age t +, OV. Da All roof coverings to be Class "B”or better
OFFICE--