01050123 CITY OF CUPERTINO CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
r
BUILDING ADDRESS: PERMITNO. `
10757 BROOKWELL DR .01.0._10123--
APPLICATION SUN DATE'
OWNER'S NAME:
CHET AZUR 05/1.4J2001
PHONE: SANITARY NO. CONTROI.N(1.
BUILDING PERMI"1'INFO
C p o ARCHIq'ECl/ENGINHER:
�+ BUIG ELECT PLUMB MEC"
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LICENSED red CONTRACTOR If'CL ATIoN 10b DOSCflpnon
ZGO�' 1 hereby affirm that 1 an lice dtov.lode o M1apter 9(cotmnencing ,
gy � with Sactinn9Wt) mSTft nes nd�l'rnfecion. °da unJ mylicenee
5555@ i.inrlll""aander a KITCHEN- 8 BATHROOM REMODEL-•.
u p 6 u ittmcf;lpss` J O Con radp r
ani 3 w h ARCIIITELT'S DEGLA 'PION
I I re - ,'Ima' ll h used phi' ofd -
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W6o� Lm JI f.: nvl
a. Oat I li BUII DI RDI DECLARATION
�1= by II - that 1 y t fir 11 ( ntrvu 1' L. Bn Ilio
C?Q following halon.(Section 70.3(5 Business andel 'on Cw 'A yciry orcounty
which arcane, pen tt consumer, h p d h rrep' 1 tructure
w 3 m pr to its i a al requires theapplicantf 4p n n fl 'g 1 late Hent
m th dp tt o p .: nn 1 t a 1 I (Chapl° 9 Sq. Ft. Floor ala' ion
dommene ng with Section 7100)of Div s ore 3 of the Bain d Probasco..Cole) 000
or that he is exempt thcn:fmnn and the basis for the alleged exemption.Any violation
a. nr Semon 7031.5 by any cold earn for;%icrmit subjects the appi cannn:t civil penalty APN Number Occup P
of not Tire thio live hun lmal doll.,1$510).
0Lastwnero(theprophey.,amyemph,yeevwLhwages.,theirsolecompens:tm,n, 69'1 009. 0la'1 _
will do the work,m
and the structure is nut intended or offered for sale(Sec 704.
Business and podls,slmns Cala:rhe Co doctor's ].;wedoe.oot Ipp1y m m, _ Required In ec[ions
r of property Who builds of improves thereon.and who does such work himself
or
,her
his own'mpioyecs.provided that such improvements are not intended or .01 — FOUNDAT I OId
.uttered far sale If.Imwevcr,the building or improvement is sold within one yen,of
etanNmion,the owaer-held,,wMornembroacher 1 2 — PIERS V
improve for porp...e of sale.). 10 — UFER
• Licennet a es tapply rer fproperty'enon ' I to m t
amt h contracts t such p jer:wh commanders)licensed p i the
105 — ANCHOR BOLTS
Con oeLicense 01 ro ,, pnYm IY tacgwal'c commit... 104REBAR
sa t o p j"pi 704 f in d l 1 ..lot Code:) 11 C t t,'u
0 Ixcnptatmerher, BA,remr'his reoo., 106 — WER 8' WATER
202 — U ERFLOOR PLUMBING
Owner WORKER•SCOMPLNSATIONI)ECLARATION203 — LIN RFLOOR MECHANICAL
I hereby alfimi under penalty ofperjury one(if the Following dectiouti , '?_04 — UNDE LOOR FRAME
0 1 have dad will andamin a Cel iecate of Consent to self-insure for Workers 205 _ LINDEROOR INSULATION
Campcnsalion. upro
s vided for IF, SectionSection 9700 of the Labor Ciale, ror one
p ri nnnneeonne wink ror whim nils p rine is i.sa d. 30'1. —ROUGH UMB I NG-
❑I have and will maintain\Yorker's Compenmtinn I°sumnce,as mmimd by Section 302 — TUB & 0 SI-IOWE R
37n)of the Labor Cal,forth perfonmmce of rho work fnr which this pamdt is , -
fored.Nl/yj�s/}'or�kers�eom�pean.adonhumancea..arand rpolicy nu`ntheram, 303 — ROUGH MEC ANICAL
Cmwr:(L( �Foliay No,L'i f� 304" — ROUGH EIEC ICAL
CIiRI'IFICAD(1N OFIiXEMPTION >WWRfff555h1 N'oRKBRS' FRAME h0"j —
COSHIENSA'I'ION INSURANC17 3
1This,ectionneed not hecompletedifthe pem,itisfor one hundred dollar> 306 — HOLDOIJNS
$mo) I,las.) 307. — INSULATION
. 1 certify that in the performance of the work for witch this permit is issued,I 308 — SHEET ROCK
shall not employ;my person in any manner so as m become subject m the Worker: r
coTpeosaronLaw,ofCadknon,.Dole 309 — EXTERIOR LATH
Applicant s _
NOTICETO APPLICANT:1 L after making this Certificate of Exemption,you should 310 — INTERIOR LATH
become subject o the workers Compensation Pon Won,of the LVMr Code,you inuif
p C fnhw,banotat,watt, art,powkimnsn,(his pemhir..hall badeemedm,amd. 311 '— SCRATCH COAT
CONSI'RUCTION LENDING AGENCY 313 — ROOF NAI(_
F
1 hereby ath that there is a cramarmaidin lending agency for the p,mommner
wonhe work ror which this partnit is issaed(see 3007,civ.C.), 501- — FINAL ELECTR I CAL'-'ENERG.
q 1.endlrsAddre 502 — FINAL PLUMBING ENERGY
� z Lender's Address -
v O l serif,that l base read this appreatmn and.lata land me abase iormmini imt is 503 --FINAL MECHANICAL ENERGY
W �y sonar.I agree m comply with ill ratty anal amity nfbraises and nail laws,lad ng
o v toballdnngamr:mlron,aadherebaamoH,erepre.emmovaof'his city toenter npno /�. (yJ� 504 — FINAL BUILDING ENERGY
the M ed e i rte I save.pent f feet p In 1
� Vt I bftlwinas t��t 1, lope. l .1n,1l ,inanycwayacalueoull chid 505' FINAL ELECTRICAL,,
V z
City in onsequence oftn granting of his pe t. 506 — GAS TEST
A�PILIC�hFONDFROST WILL COMI'LYWITH ALs OI
Issued by: .,_ - Date
simmum of Apphrnnnconthu,' - Date Re-roofs 508 — FINAL VIECHANI CAL
HAZARDOUS MATERIALS DISCLOSURE
WiBncm app)eam or metre baBdiagneeapnm>trreo,handle na>,mlous mwedal Type of Roof 509 — FINAL GRADE
as defined by the Ct)renin6 Muih Tal Cale,Child,9.12,Ind the Health and Sider, '
Code,Saron2-5532(a)7 5,10 — FINAL PLANNING '
OYCS' ON. All roofs shall be 4 ectedFpy Map arty rmf t�Vm015W(�eing installed.
wolthe applivamm learn,Handing oaopeut use egnirynant or dcvleca w1d0, If a roof is installed without lrsto talmng an inspechoU agree to remove
emit haenNou,air consumers us defined by the Bay Area Air Quality Management
• Optimal - all new materials for inspection. Applicant understands and will comply with'
GY. 0 N all non-point source regulations.
t I have all the hazardous material,requirements under Chapter 695 of the
Calif°min Health A,Safety Cale,Sections 255)5.25533 and 25534.1 understand that
if the building does not currently have a round.mm it is an,responsibi li ly to notify the
pant of the mompro an"which muss he hi,'ail"1.iasuance al"°Cunincam of
Occupancy. Signature of Applicant Date
, )���
._1L_ 5'/4— °)
nwncrar aumorbafagent � Date All roof coverings to be Class `B'=or better ,
OFFICE ,