02050043 TY OF
CI
BUILDING DIIVIISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10564 N BLANEY AVE 02050043
OWNER'S NAME: APPLICATION SUB DATE
JON CROCKETT 05/08/2002
15�
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENOINEER: BUILDING PERMIT INFO
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DG ELECT PLUMB MECH
� CL i
:8 F. LICENSED CONTRACTOR'S DECLARATION
y I hereby vrfrtn that 1 am littmed ander provisionv of Chepmr 9(commencing Job Description
I with Section 7000)of Division 3ofthe Business and Professions Code.andmylicense RELOCATE FRONT DOOR/ADD PROCH
' mfseClasforce and ePoat. ctor PINALED
O�U License Class Co p
Data S DECLARATION 3 LL too G<: ARCHITECT'S DECLARATION
�J 1 understand my plans shall be used as public records
i ai,o Licensed Proressianal JUN Z 0 2003
' OWNER-BUILDER DECLARATION
R m 1 hereby adman that 1 am exempt form the Contractor's License law for the
C?< following reason.(Section 7031.5,Business and Professions Code:Any city or county 1 p�
S, O which requires a pe p p y ILDIN YO O
ER Permit t construct. Iter,improve,demolish,or repair signed swment
3� -then n t s e,d req Novisiocant for men pcmuuoiceseLia, statement
of dic
(cimao nsin mdpun enuq,M)dbao of provisions Burdamsatractors ne reas(nsCodharnel 9 i•r l', �eap,.ypt, C' ar ,. , Valuation
a,t g uhSa4tq 9010)ofDivision3oftheBget!dandraAntonsCode) �j e 53-1'CJU. •:'. �7?:1T. 3'Sd}_•�.
or Net he 7 exempt thertfmm and the bests(or the subjects
th tl dempt Any violation
of Section 9031.5 by any applicant f«a permit xuM1jecu the applicant to a civil penalty
arum mare than five hundred dollars($500). 101�q
-PN� DATION "'' :i Occupancy Type
D1,es owner of Ne pmpscny,or in,employees with wages as their sole compensation.
will do'thework.and she structure is not intended or'offered'for sale(See ]844, - - -
'Business; ad Professions Code:The Contractor's License law does not apply to an 10 3 - UFER Required Inspections
owner of property Who builds or improves thereon,and who does such work himself
or through his own employees,provided that such improvements am not intended or _ - ,10.4 - -_RE13AR _
"aRered for sale lf,ho to bu(ding " mPravamem ik sold shin one year of� - ---.—. .__.•—___ M1 ___ . . -._., _._.._..
completion,she owner-builder will have Ne burden of proving thin hedid not build or �" 105 - ANCHOR BOLTS `'" "'td
impon"forparposeafa.m.). _ ! 106 - SEWER & WATER
s l eso ncio(thep------ exclusively mrating ithlcenuGcontrect t ' 202 - UNDERFLOOR PLUMBING
Construct the project IStt 704ul Business and Prnroodmis Code)The Contractors
License L.w d«arm apply to on..a,of property wh.builds m imponvea thareon, 2 03 - UNDERFLOOR ME CHAN I CAL" :
.and who.contrects.for.such Projects with a.comrector(s)licensedpursumn m.do ._ -- _- -.2 04' - - UNDERFLOOR-'FRAME------`--—- -"- ---- ----- - -
Comrwtoes Licenw law.
_ Gla der Sea. B&PCfarthimid,to 205 - UNDERFLOOR`' INSUliATION
o'� ✓ n RKE 0 Data S 8.07% 301 - ROUGH PLUMBING
WORKER'S COMPENSA'1TICN DECLARATION
IhertbyaRimunder Penalty.orpeijury✓✓one arthe following daluations: 302 - TUB & OR SHOWER
D I have and will maintain a CcmUche of Coniem to self-insum 3 03 - ROUGH ELECTRMECHANICAL CAL
tae workehe 304 - ROUGH ELECTRICAL
't compevnce of ae worl,for for by section J900 of the Labor coda, for the
- -
performance of the work for which this pecten is issued.
305 - FRAME
01 have and will maintain Worker's Compensation Insurance,as requited by Section 3 06 - HOLDOWNS
3700 of the Labor_Code,far the performance of the work for which this permit is -
if sued My Worker's Com nsation lnsurarcecarrier and policy number are: " 307 - INSULATION
comer „r rr��PaityNa.r - - SI-IEETROCKr: ,,
'CERTIFICATION OF EXEMPTION FROM WORKERS s '�3 0 9 's s EXTERIOR'LATH`
COMPENSATION INSURANCE
' __
- —3 E0-i--, INTERIOR`-LATH -- - - - - -- - —
(This section aced not he completed if the permit is for one hundred dollars I '•`'t 'i^''t ' '1•`
(saom one==.) 311 - SCRATCH COAT
_ ,.
1 can ry"that in Ne pettorttunce of the-ark fo hich Nis pemut i rsxued 1 313-" R00 F NAIL--- "
"shall a.'
e an an in anq rmnn&as td becamFe o)en to , workers
O - wWCopm"e�t�g��P i" p youou.nmomd'sd t _55.0041 _-- FINAL. ELECTR I CA. L` ENERGY
Cm"p 502 - -FINAL PLUMBING ENERGY—_
„
-
_
NOTCE
Z Il503 FINAL MECHANICAL ENERGYC _FINAL -BUILDING._ENERGY. - i' _2 1 CONSTRUCTION LENDING AGENCY
_" ---
Ih' by �Ttmthat thoconstruction'lending agencyfrtti performance 505 - FINAL ELECTRICAL., ,
' `� of thewink for which this Permit iissued(Sec.3W7,Civ.e)
Le seN 506 ..- GAS_ PLTEST_
y G '
U Z L ae aAdd_ss 50 _ FINAL UMBING
certfyN tin ad thi' pplet est the,to m formation is 5088 FINAL MECN
HAICAL
co7rta l agrc t mply, th en ty nd ty J c ane t t I s relating 509 - FINAL GRADE
f,J to building connatio ,ead hereby amici reprcsemaiaax ofN cnyto emer upon
} l:7 Nm
e.1swo- enlmnea.poi my for impactionpmrpoeex. .- 510 _ FINAL PLANNING
� Rs
+. (We)agree tb cove,indemnify and kap harmless the Cary of Cepcnino against
y liabilities,judgments,Lasts and capacious which may In any way creme against said 514 F INA P I C WORKS
V City in consequence of d e'coming of this permit. ; " ' 1.
A A ERSTANDS'AND WILLCOMPLY WtfH ALL: ON-POINT ' v C/
oUR GULAnoN -.Issued by: Date
of APPlicanvContrector " " 1 .'• Dore".;,.. Re-roofs
t HAZARDOUS MATERIALS DISCLOSURE -: :"
.,.
Will the applicant of(atom building decorumsiore or handle laudations material .,Type Of Roof ...... _
az defined by;Ne Cupertino Mun cipe�Code,Chapter 9.12 and the HeeIN end S.fery _ - , ' -' " '' - - --- - -
Cnde OcY yes
5,53201° r t - t t I i ; Y "1�.t e < •, .. ' ,r t _. ..._._ .
_ All roofs shall be inspected,prior to-any,roofing materia] being installed,
W
tn.apprgant r t re,milaog oeeapam as,equipmentor devices which If a roof is installed-without first obtaining an inspection,'PagreeA6 remove
em hazard us air conmmmems as defined by the Bay Area Air Quiilny Management
Dixtrud? / all new materials for inspection. Applicant understands and will comply with
Dye EK."
ip. all non-point source regulations:, ;: .
'f. I have read the modoas.mamdels raquireme,bs"under Chapter fi 95 of the
Cellfomis Health&Safety Code,Sections 25505,25533 and 25534.1 understand that
if the building does not curemly have a dollar that is m 'bilis tonotif the
y remarroC y y
oacupam clubs requirements which'mdli be at prior to issuance,of o Cenificme of
Signature of Applicant Date
�" raumoraeaagenl"; ,,
Data All roof coverings to be Class"B"or better "
-OFFICE