02090166 CI BUILDING DDIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
888 BROOKGROVE LA 02090166
OWNER'S NAME: APPLICATION$UBDA
MURPHY HELEN C TRUSTEE 09/24002
iOPHONE: SANITARY NO. CONTROL NO.
O o ARCHITECTIENGINEER: a BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Descnption
pz hercbyeRrt thetlamlicen dunderp isiomofChopter9(commeream CHANGE BATHRM SINK/TILES
Fit with Stttion 7(1 I'D,vimon tof the Busine x Professions Code,and my license
na
is in full fore a t.
m LLticye{yeel. tie.«— S f� (DOWNSTAIRS BATHROOM) FEB 1 8 2003
`. f ec�ARCHITER'S OEM' ATION ^
t g G 5 1 understood my Plops shall be used as public records p a/a_
�V
6 p o Licensed Professional BUILDING®IG
OWNER-BUILDER DECLARATION
w I .(Seto that I ton exempt from the Contractor's Anse Law for the
C Z< following motion.(Section 7031.5,Business and ProfessionsCade::Any city or county
D which requires a permit requires
e candracu aper,improve,demolish,me a signed
g any statement
pouth4 liccurilpurlaomquitheobvisionsoffurCo mtteemicensegnedsmmmem 1 Valuation
fret t il,lic li we ooiim i,7090 pfDivision o CommitteesLicenseiM Protectionist,
Cad 9 S Ft.F oor-p rea ,;,, :•.`r.•• ,
(comm, , awHh Section,7,0,40)of Division3of she Business AM Professions Codel 'i,�_y 1i ':P.h9 1/_tlFi S!1-�t.Rq',it irk�.Y'.%:',.
°r,hm Ne Vi edemis,heefrom and the basis for the allijea exemption.Any violation
-of Section]03 P5 by any eMlica n for epturat subjects the epplicem ma civil penalty-
iarnotmamthanB.m hundred doll.rs($504 APN Number ;F:.r:x.:• `.• Occupancy Type
°L m owner of the pmpeny,or mY employees with wages m their side compensation, 101 FOUNDATION
..will pu the workfadd the awmvm is not intended or o0'cred for sale(Sec.7(AU 102 - PIERS Required Inspectioll9�..•'`". 'r=
�BusinexYend'Piofcxsions Cade:The Commit License law docs no,apply,o an '
owner of property Who builds or improves thereon.and who does such work himself 103 - UFE R _
or through his own employees.provided that such improvements arc not intended or ____ _ __• _ ,-
offered for s leAt',ho 'e then ilding or improvement,s sold wuhin ami-year of "" "' ' " 1'O 4 REBAR
completion,the ownc-burldcr will have the burden of t rovmg,hm he did not Wild or " '
improve for purpose.(Wit). 105 - ANCHOR BOLTS
_._.____-_.__.._. _..__—.-.-_____.--,.__._—__- -__.__..-_ __...__.__ -__'
01;as owner of she progeny,am exclusively .[.a.,with licensed wnuacmn to T06_� = SEWER--_&�-WATER___`-j___"___"_,_`._;, , _..,,.,,.,t_.
construct the project(Sec.7014,Bmimu and Pmfeuiom Cade:)The Comments's 'L Q 2 - UNDERFLOOR PLUMBING • `�'`' "
Littnse law does nm apply to an owner of property who builds or improves thereon, -
;.f: _.and who cannot for such projecu.with a...tracharsl.1hooded pursuaaew the. ....._---_"--2Q3'._....UNDFi•RF-LDOR__MECHAN;I-CAL._—._`—'_—
Cot t is License Le
Olson.. pt under Sec I ' �" BiPCforthisrosin 204 - UNDERFLOORt''FRAME ' '
t "'''"' 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION ATIONDECLARATION 301 - ROUGH PLUMBING
�; „ :
Ibereby.Rrm.nam pcnwty cur p<�Lry,di�nr u,g fonawing dttlmararo: 302 - TUB & OR SHOWER
_I ° 1 have:nil'wilrmaiat in'a'Ccnirum of Come.,to terminate for worker. 3 03 - ROUGH MECHANICAL
Compensation, m-provided for by Section 3700-of the labor Code. roe ,he
p.ronaaweoftaxavmkfar,pmgntniap<,trr�oialuyw, 304 - ROUGH ELECTRICAL
°1 have and will meihtIia Workers CconicuNan'Imnrame,a,rtquimd by Section, 305 - FRAME
31700 or the Lalsnr'Code r the Hama ce or the 'irk'ork far LDOWNS
Is ad,M Worker's C p sat ti.,9pinxu nc carne end Pal cy robe permu is 3 0 6 HO
9 /r RSL"s 307 . SNSUTATION
CERTIFICATION OF EXEMPTIpN��y �RXPq tlYl�t t 30.8., '� }.fSHEETROGK�.d If1.q .,. ••
COMPENSATION INbtGPA CE' u g _
- ., EXTERIOR—LATH- -- --'-- ---- -----
(Thissecii.nerd trotbecompletedifthePemIN
Permit 310'x- TERIOR LATH
•(61001 Or leu l _ _,
int
t6. ICropyymmthxat'ina.,naeofthe work sbeca,ehthspermitE!6',hsi edl !•FL,"+'f t,i.Y
h II n t tion L ono person m any ma ante become sunlecl b,,he w,ken 313 - ROOF NAI L
Compensation Law,afeal foto e.Pate ____„_5 0 1.. -....FINAL...ELECTRI.CAL_,..ENERGY,._. ...._ .___-.
NOTICE TOAPo the Worker's
Compenk,gth, Cesiou o of Labor code,
by lst,, 502 - FINAL PLUMBING ENERGY' '
Becomesub3 ply me Workers Compensation Ismnsma'afe defied Cade,you must
O Q fnnhwuh comply'with such p i thisperms shall be deemed oked _ _ 503 - FINAL MECHANICAL _ENERGY____.,___.__.
n ” "" CONSTRUCTIONLENOINCACENCY ' '' 504 - FINAL BUILDING ENERGY ”
I h mby aRrin thm three u a con uurton lend ng ag my far jh,performance _ t t..,
of the work for which this perms is iixucE(Sec.309],Civ.C.), _ - 505 FINAL ELECTRICAL
pap Lmuklx Name 4 - - 506 ._=_.GAS_.-TEST -.
la d r Addm 1�.,,
-Z 507 FINAL PLUMBING "" °
U �Or I cendy mat 1 have mad th s epplieuon and stogie the,the above information is 5 - INA M CHAN I CAL
correct:I agree.to comply with all city and county ordinances and state lows relating
)u.building construction,and hereby authorize rep,isametives of this city to enter upon 5 9 - INAL DE
Gg7 'the.brave-gncn,ioned Pro PcMyforinspectionpurposes.
Os (Wel agree to save:indemnify and keep harmless the City of Cupe'mmo against 51 - INAL
r rn liabilities,judgments,costs and expiodu which may in any way accrue against said
City to consequence or the gmtning of this permit,; 514 - F RKS 7}1
;APPLICANT IN ST ND. ND WILL COMPLY WITH ALL NON-PO T (/
55 RCE REG' 4T10 Issued bye Date
_ - gmure PIApplca C n - •• '_ Data Re-roofs
ARDOUS MATERIALS DISCLOSURE
r Wil the'pplicam m f s hdd,ng accuPaot tom or handl hnerdous me,enel ,Type of ROOF . . .. __ -..... ..... .. .... . .....
to defined by the Cupertino Municipal Cade Chap,er9 13 and the Health and Safety
.Cada Sccmm 25532m) t . s^s r" ' 1 t �t'.:taw Yrtl 1 - ,ni I.,h9
All roofsshall be inspected prior,to,any-roofing.material.being.installed.._. . _
.,?1'm•Will the applicant or futu building occupant use equipmen)mdevires which If a roof is instalfed )ith6ut first obtaining an inspection;'I 'refh
'agree`toove
emit ha Mous air commminanu ax delned by the Bay Area Air Quality Managmnent
District! � all new materials for inspection,, Applicant understands and will complywith
°Y " all non- oint source re ulation ,
N . r. P g 5:. L.
'.1 have mad the harertlous maienels mgmremenu under Chapter'h95.of,he
cehlomis Hmlth i Safety Code sections 25505;25533 and 2 3a 1 and—tf1 that
ifthe burldmg docs n tcu,mmly have a mmnt mat n is my resp v bd'y,o notify the
' C y the mqu mem, h ch mu t be m t prior to Notion e° Cenifc t of
I Signature of Applicant. Date
oc m r ., : .. ., _ .._ _ _._ _ ... ._
p
Occu
S
ownc or ono adngent Data. All roof coverings to be Class B' or.better
OFFICE-. . -.-. -