02080133W
'
OF
CI BOILDI
CONTRACTOR INFORMATION:
C DIIVIIISIONNOPERMIT
BUILDING ADDRESS:
PERMIT NO.
10554 N. BLANEY AVE
02080133
W
'A` W & AMY DRAKE
APPLICATION SUB DATE
08/23/2002
PHONE:
SANITARY NO. CONTROL NO.
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ARCHTTECUENOINEER: 1
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
Z—
Ihereby eFnnthat Iamlicensedunder provistomofChapter 9(commencing
BATHROOM REMODEL (HALL WAY)
3�
with Section 70m) of Division J of me Business and Professions Cade. and my license
re
is in full force and effect.
License Class Lic. M
to n �� 03
N
Data
3 a
Contractor
ARCHITECT'S DECLARATION
5
N�
I undersmnd my plans shall be usM v punlic records
MAR 0 6 20 03
pO
S R
Licensed Professional
OWNER-BUILDER DECLARATION
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1 hereby aFms than I am exempt (mm the Cosions Co License Lew for the
from
following mason. (Section 7071.5. Business otW Pmfessiom Code: Any city or county
1 LD1 NG $6000
•f ❑
which reclaims a permit l0 construct. alien Improve, demolish, or repair any sWCNR
_. __ - _,. ._._.-_ _ .. ._... __...
w r�.
a 3 —
pan t is nuance, ahs rcq the appbutmfor such paean to 0leeeignW sutement-
damn .l censed par:a.nl to d¢ pmvWons of thr Comrecior'a Littrvs Low IChager9
Secian]000)uf Division) me Businss.and Profession Cade)
t ph ,�Or,�A,���
,, tb 1.31$B C/S. a1•V 19.V"`• i ,h
i.9 �% s'
Valuation
(cam encng with of
or Nei he is exemptthkrtfrom and the buffs for thr ellkgeJ eaemyuon. Any vtolauon
t r. - - t - .i ;'.. Jxtia rl
- rdsectiutr]031.5 by any applicant for a pemduubjects me opPlicent to a civil penalty'
of not more then five hundred dollen (5500).
T,,
1 O 1 APN[ ,�V` T AT I ON
I ' Occupancy Type
°1, mowner of the patient, or my employees with wags as; their sale compensation,
102 —PIERS
-
103 UFER Required Inspections'
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will do me work, and the structure is not intended o, otremn for sale '(See:7oan,
Convector's License Law does not apply m an
Business end'Professlo us Code: Tie Convect
owner of property Who builds or improves thereon, and who does such work himself
104 - REBAR i
or through his own employees Provided that such improvements art not intended or
_ .- ,_ _. _... _...... _... _ ...._ ..-.
one ed for sale: If, however, the budding or improvement x sold within aide year of
�......
- '10 5 - ANCHOR BOLTS
completion, the owner-Wilder will have me When of proving that he did not build or
improverorpmpaseafxala.).
106 - SEWER & WATER
_... - --.... _, .. _ _. m. - - - —' _ -
�1. ns owner of the PmpenY•rem exclusively contracting with licensed commnonm
- ----202 - -UNDERFLOOR PLUMBING--...,. -
-
comtrvm the project IS.. 7044, Business and Profraeiaru Cade:) The Canvmnnr s
203 - UNDERFLOOR MECHANICAL
License Law does not apply to an owner of amprny who builds or improves therron,
n
_and whu.contracu for such projects with a comawma(s) liamm pursumtt to He
... _._ ._2.04'- ---UNDERFLOOR 'FRAME' . ..
Cmdonme. Liceme Low.
C3ame p nderSccB&PCforthisaamn
-
205 - UNDERFLOOR I'I'NSUEATION
erj°a
WO R' MPPATIONDECLARATION
301 - ROUGH PLUMBING
302 — TUB & OR SHOWER
Ihereby affirm under ,Penalty orprr;u,y.angathe following declarations:
303 - ROUGH MECHANICAL
° 1 haveandwill maintain a Certificate of Consent in selbimme for Worker's
304 - ROUGH ELECTRICAL
Compensation, m provided for by Section 3700 or the Labor Code• for the
305 - FRAME
performance of the work for which this permit m issued.,
'
° 1 have and will maintain Worker's Comprnsetion Insurance, as required by Section
306 - HOLDOWNS
'
37W of the Udom Cale, For N< performance of the work far which this pemm is
307 - INSULATION
issued My Wo rkels Comprnsafonlnsorem'e camrrand Pvley.numI care.
-
+
_
'308 '— SHEETROCK tea_
`,
Carver •j."t' + •�:•'PolicyNa.,,_.
•�;
�•p). �3.09..�- EXTERIOR-L�1TH`Y'.
RKE
NF
COMPENSATION
.,..INSURANCE - s'..,
i t R AT1 oamPelrerm
_........ 31�0-.;�---I'NTER-POR—LATH.. `._ .._.._ .__ ._ _ ... __ ..- _ —..,.. _.
prrni�smoan<e
r (This section need not W wdrtd dollars
3 11 - SCRATCH COAT
(S1000orless) i.
...,.313' • - ROOF
.. I cenify Nat to the perf tmance of the work for which this permit is' issued; 1,
501 - FINAL ELECTRI CAL' -ENERGY
shall not employ pnyperson �mYnna mer sa,as a lmct 10the Workers
l$cg
C mpensavan s Cel'fp �/�JVO`
A Ph ant
_ 502 -_FINAL. PLUMBING. ENERGY ._ .. .___....._. ._.
':ry ETon LICANT:ILaftermakingthisCenificamofExemption, you should
LI
503 - FINAL MECHANICAL ENERGY
Z
beeaadn e subject a the Workers Compensation pro t ions of the Labor Code, you anter
orthwuh comply with such provision, cir this permit shiall be created revokee
504 - FINAL, BUILDING. ENERGY.,,....--.-
• CONSTRUCTION LENDING AGENCY
-is
505 — FINAL ELECTRICAL
'Ihe y firm Himmf c .t t leading 'ag nq ter the performance
lof th sv kfur which thispc ['issurd 11 C)
506 - GAS TEST
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.tll9]Civ
'Lendr Nm
. _._ ... ...__ . _. ....
--. . -.507 -'-FINAL PLUMBING
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corrects Address ... ..
5080"', FINAL MECHANICAL
V'O
tee+.
,(certify that Phave reed this application and sten thauhe above information is
5 0 - I NAL G DE
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O j
correct. I agree to comply with all city and county ordinances and state Iowa relating
Ito Wusor-meing nnmed afthis rityto enter upon
ion
5 0 - INAL P NG
0.
prposenmrvrs
property for
the ubovo-mc gree to prvprny for inspection purposes.. ,
(We) mgree m. hm
and keepwhich saidnst
51 - NAL B RKS
h
(Zi
expendy
liabilities, judgment%• costs end expenses which may in any way eccrve against said
rents and may in say wee ancrueni rdist
City in corse uim of the grcar of this permit.
Qjii.
APPLICA. U:'ARpS'yTANOSnANDWWILLCOMPLYWITHALINOON-PONT
SOURCE
IRuATGII 8•c ).
Issued by Date
�i
nturt M ApplicanVComracmr.: " . .' ... Date -'..'
Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding occupant store or handle hawd us materiel
r
Type Of ROOF - —' "'•
°S ranted by. thecupenina Municipal Code, Chapter 9.12 and the Health end Safety
.. -. t ,
a �:
Code sero 255J2(ol :
°•
s
All roofs shall,be inspected prior_to.any roofing.material.being installed. __ ...___
" ;Will the applicant orfuture Wildingacupamuse equipmentmdeviaswhich
•emit
If a roof is installed without first obtaining an inspection,+'agree to.remove
hnzardons air emnmarrons as defined by the Bay Arca Air Quality Management
District^a�
all new materials for inspection. Applicant understands and will comply with,
°Yen., _ . -:- No -"
..
all'non=point s6iu*66 regulations..
-
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health& Safety Code. sections 8505.25533 and255M. l understand that
rfthebuildingdoesnotcurently hoveusnena mat it is my reeponsibilirymnoufy the
- _
ocrupant o101 rtquiremems which most be me PH., m issuance of a cri if¢ale of
Occupancy. ,'
,
-Signature, of Applicant Date,
All roof coverings to be Class "B" or better
Owrued agent Data
.. .. '..I. ._- .. -.._ . OFFICE - .. ... _ ..
CITY
OFgNc o ERTINO p T CONTRACTOR INFO ,TION:
BUILDING ADDRESS: PERMIT NO.
10554 N. BLANEY AVE 02080133
APPLICATION SUB DATE
AM MkW & AMY DRAKE 08/23/2002
V
HONE: SANITARY NO. CONTROL NO.
O O ARCHTTECT/ENGfNEER: 4 BUILDING PERMIT INFO
F BLDG ELECT PLUMB MECH
m ZLICENSED CONTRACTOR'S DECLARATION
Z I hereby afMn that1 am licensed under provisions of Chsphar 9 (commencing
(: with Section 70110) of Division 3 of the Business W Pmfeuiou Code. W my liceeu
Lyy5 is in full forte and affect.
QS License Clear Lic. N
KKKi Dau Contractor
ARCHITECT'S DECLARATION
5 1 understad my plans shall IN need as public records
Rp Licensed Professional
(i OWNER -BUILDER m the CaATION
m I hereby affirm at 1 ern exempt Term the Centracm o License law for the
C ? following rtamn. (Section 7031.3. Business ed Pm, de ons Code: My city stcounty
A G which requires seem. re uirswtt deer, improve, demolish, or repair any xtrenu s,
3$ primuiuiuuanegdm requires tovinceanf far Con permit Lennox Law
Wth5es licensed Sectiont6theofDiiauoftk Ce Business
Liceruelawon,(Chapter Coe)
(commencing em t thm n am and t e Division o th, Bed ca ap PmfAny A Code) » j .
or that is 31.5 b my cep li end or basis forube dlkged eumant to Any violation
of not mo ]031.3 iv any applicant for a permit the applicant m e civil peulty
.of not more than five hundred dollen ($500).
❑ 1, u owner of du property, ur my employees wit wages u their sole compensation,
'will do to work, and to structure is am intended 'or offered for uIn sec. 7044.'
Business ad Profession, Code: The Comncmr's License law does not apply to an
owner of property Who Wilds m improves tenon, and who does such woks himself
or through his own employees. provided that such improvements sac not intended or
1 ' offered for We. If, however, the building or improvement u mid within one year of
p completion• to owner -Wilder will haves to burden of proving that he did not Wild m
improve for purpose of sale.).
I, u owner of the property, am exclusively contracting wit licensed commemm to
onswct to project (Sec. 7044, Business and Profession Code:) The Comacmr's
License Lew does not apply to an owner of property who Wilds or improves tenon,
.,ad who com ucu. for such projau wit a emtncmg.) lieemd pursuant to.rhe
Contractor'. License Law.
Olsme p Met C. .B k PCfmtismamn
ppww�� 4�/dl�j}
iffier WO R' MPPATION DECLARATION
I hereby aRrm under penalty of perjury one of to fallowing daclatations:
❑ 1 have and will mdmain a Certificate of Consent to self -insure for Worker's
Compensation, u provided for by Sermon 37M of to Leber Code, for to
performance of to work for which this pmdt is issued.
❑ 1 have sed will maintain Worker's Compensation Insurance, u required by Section
37W of the tabor Code, for to Performance of to work for which this permit is
issued. My Weakens Compensation Insurance carrier and Policy number art:
Policy No: ».. .. .. 1 .
1; : CERTIFICATION OF EXEMPTION FROM WOR S'
COMPENSATION, INSURANCE'"'' `
" ''(Thir sict.m need not be completed if to permit is for one hundred dollen
j (gloB)orless)
1 •I eertify nut in to peffokmantt of to work for which this perntit is issued, I
-dull not employ ynYgenon in anmr ye�e�p,�cgne subject to to Worsen'
• Coll noteion Jews nom
Gf �1O0`
Appli cot art _�,
bm6=— E TO ct LICANDkI gaffer makingti this C Wiecme ofExemption,Eidedyou should
breQme subject m to such pr Compevision rti is permit shall
of to labor Code, you must
Q O foMwith comply with such provisions or this permit shill be d«md revoked.
CONSTRUCTION LENDING AGENCY
1 herebyfor affirm tot tcrt is s remembering Sc:
0017, C agency fm to per(oamana
'of to work For which this permit is issued (Sec: 309], Civ. C.7
W Q 'Lender', Name ., ..... ... ..' . .. . .
Fes^ .L Iandir'r Adduu .
.w 1 eanifY tet 1 have read this application arta sun tat to above infortmuon is
cmrect. 1 yue to comply wit all city and county ordinencef and sun laws reining
- u Wilding construction. sod hereby mutation representatives; of this city a enter upon
Lal to ebovo-memioram property for imptedim ptm o ,.
yy 0. (We) agree to save, indemnify ad keep bannister to City of Cupertino... just
4, I Habjlitiea judgments. co,u ad expemu which my in any way accme aping said
�namm m nppucanvs.ann wmr vow
_ HAZARDOUS MATERIALS DISCLOSURE
Will the applicant m future ip l Cg ocmpant score m Mlle HWth u, Se f ty
u defmd Section
to Cupertino Municipal Cade, Uapter 9.13, end to ... and Safety
Code. S yer 21533(0?
�OYes• "� ����No
Will the applicant or fumes building occupant use equipment or devices which
J.emit hazardous air conuminanu u defined by the Bay Asea Air Quality Management
Djstn't7
DYea - )l1 No
1 have read the hauNalus_materials rtqujrtmenu under Chapter 6.93 of to
California Health & Safety Code. Section 25505, 21533 and 25534. 1 understand that
e tenmt, that it is my responsibilit
muse bo ern prior to hauame of s
W
BATHROOM REMODEL b E�l6gdA4q .0
MAR 0 6 2003
101
BUILDING
$6000
1V
103 - UFER Required Inspections
104 - REBAR
105 - ANCHOR BOLTS
106 - SEWER & WATER
202 -'UNDERFLOOR PLUMBING '
203 - UNDERFLOOR MECHANICAL'
204'- UNDERFLOOR 'FRAME-
205 - UNDERFLOOR INSULATION
301 - ROUGH PLUMBING
302 - TUB & OR SHOWER
303 - ROUGH MECHANICAL
304 - ROUGH ELECTRICAL
305 - FRAME
306 - HOLDOWNS
307 - INSULATION
-.308 -','SHEETROCK _...
'� :3:09 .`-' •EXtTEREOR`.I,7iTH�'. '
310-( INTERIOR -LATH• _...._. ..... .. _ .... _
311 =SCRATCH COAT
313 - ROOF-NASL'- - ••
501 - FINAL ELECTRICAL -ENERGY
502 --FINAL PLUMBING.ENERGY
503 - FINAL MECHANICAL ENERGY
504 .-_FINAL-BUILDING ENERGY'l .
505 - FINAL ELECTRICAL
506 - GAS TEST'
-507- FINAL PLUMBING
508 FINAL MECHANICAL—
5 - INAL GRADE (`C/
5 0 - INA P NG
51 - NAL B RKS /
Pr
Pr
/
Re -roofs
Type of Roof
All roofs shall be inspected prior. to any roofing. material being. installed..-., .. .
If a roof is installedwithout first obtaining an inspection,'I'agree to remove
all new materials for inspection., Applicant understands and will comply with ..
all non -point source regulations.
Occupancy.
()Signature, of Applicant Date
All roof coverings to be Class "B" or better
Ow ear crud agent Date _
... .. _ ...... .. OFFICE .. .. .. _