01030194 CITY
BUILDING DIVISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10367 BYRNE AVE. 01030194
OWNER'S NAME: - APPLIC TION SUB DATE
BARBARA GWOZDZ 03/30/2001
PHONE: SANITARY NO. CONTROL NO.
n m0 z ARCHfrEC(ENGINEER: BUILDING PERMIT INFO
— ^$LDG ECT LUMP MECH
L <n 1 _
LICENSED COWRACfOR'S DECLARATION
0 S y' 1 hereby uffirm that 1 am licensed under provisions of Chapter 9(commencing .lob Description
_Fo with Section 7000)of Division 3Ofthe BusinessandProfessionsCode,andmylicause SFDWL, 3387 SQ.FT.LIVING SPACE,
a m L cense Curse and eliect. 406 S Q.FT. GARAGE .
z z�a Date Class Li
K O O Dam
m 3 tc� ARCHITECT'SCLARATI
O g 1 unJersmlumnd my psM1all be user public eco I{ I I 3
ddwrs LLL
n a po O Licensed Professional f
m T OWNER"OUILDg�Ch
LARAT f
— 1 hereby affirm throat am exempte Com rice ' Law farfollowing reason.(Seion7031.5,Hosinesi Co - n iry or coma
wh h rcy permit t c Hirth t u0 I h any s odai
3 ca—pr rt it issu nce also req re th appli n[for such perm no fl g ed 2aaemem Enuj�
- - — -
mat TeisNot purs provisionspursuant of the Contractors L La (cnapmr9 S F[. Floor Area Valuation
(co ec g with Section 71g1Q)of Div 3 fine Business and Profgssions Codel f I� s! '.,itl'„ +'• C f..'ri 3 ..1j ''h
or that he is exempt therefrom and the basis for the allege)exemFnon.Any violation
'4571 9011 nn
of Section 7031.5 by any applicant for a permit subjects me applicant to a civil penalty
of not more man five hundred dollan(S5W)- APN Number Occupancy Type
❑1,as owner of the property,or my employees with wages as their sole compensation, 1 01 - FOUNDATION
will do rhe-work,"and the'nructum is notintendedolreea Cor tale(Sec.7130.1. 102 - PIERS Required Inspections'
Business and Professions Code:The Combat License Law does not apply to an
"w
e
'of pmpeny Who Wilds m improves thereon,and who does such work himself 10 3 _ - UFER
or hrough his own employcm.provides that such impmvemcros ore not intended or
Bred Cor s":..'w However.the w,aamg or improvement is sold within our year of - . - . ..10 4 - REBAR� - -
mplafoo,mens."hadderwalhave she bardenofpmvingthe,hedid or Wild or 105 - ANCHOR BOLTS
a
prove for Puryox of aale.l.
. __. .. . . .. ...._ _ . _. -with._.. - ..
owner ohne prvpmy,am exclusivelyand professions
Call Ti promotion to . ..” ....Y06 SEWER-&- WATER-..
onauua the project(Sec.101 q,Business aro Rvfcsstona Cotler)The improves
dic mr's 2 02 - UNDERFLOOR PLUMBING '
_ - se Law does not apply to an owner of pmpeny who builtls or improves thcrron, '
and wm.emaniets for such pmijacu..an a c massumps).0cansW.puraam to the .203 - UNDERFLOOR MECHANICAL
cont am Or few.
am as
Iu' rSee> ,`e&rcrormia reason 204 - UNDERFLOOR• FRAIl
ate ������ 205 - UNDERFLOOR INSULATION
R E S ENSATI NDECLARATION 3O1 — ROUGH PLUMBING
-I hereb (firm under "
yes pe�ahyorper;aryonegrmefoRowingaeommtions: 302 - TUB & OR SHOWER
❑ I nave and will maintain a Cendicale of Cunsew to lef-insure for Workers 3 03 - ROUGH MECHANICAL
Compcmaion us provided for by Section 3700 ofhelabor-Code. for the
perfonnapae n'rm�wurk mrwni<h this permit is is��ea;, 304 - ROUGH ELECTRICAL
❑I hommal will ramiamn Worker',Comp er wird lamancerequired by Section 305 - FRAME
3700 fine Labor Code;for the performance o f he work f- which this pitman is 306 - HOLDOWNS
i so My W k s'C mpc axon in...ancc carmr'ana Poly b
a
K , .. 307 '; INSULATION:
C re l f EXEMPTION I SHEETROCK.., .
" CCRTIFICATIONOF E%EMPI'ION FROM WORKERS,:
.''"rrnias&tmnneeanobeEomPnONrNSURA.NCEfor one nunamaaotm ------.....3.09"-'EXTER-IOR...LATH-- _7 . ..---'--'-'- ' -- —._ ........
alfg11 or 1ma.1 dollars 310 'r- INTERIOR LATH
p r v a .y --- ... . .,. ... 311'- -•' SCRATCH COAT-. .
co ..
i I mfy that in the pdrF.r m xe of the work for which wis permit is issued,1
shali not em to an person to an manner so as to become subject to the Workers' 313 - ROOF NAI Lli`i
cnmicant nLawsgrem�abmm.°ate _. 501 . - FINAL ELECTRICAL ENERGY..
NOTICETOAPPLICANT.If.ofermakingthi,Ceuficam01Excmpamust 502 - FINAL PLUMBING ENERGY
become aubjro
cct to the Workers Compensation pvisions of te Labor hCade,yout
Z -to nhwithcomplywith such pmvisionsorthis pamitshut]heaeemedmoo ked _ ___503 = FINAL MECHANICAL ENERGY
eoiusrleuenoNLENDIi:eweF:NCY 504 - FINAL BUILDING ENERGY
a.� Ihertby aRrm aha mere iseconslrvClion lcMing ggermy for the perform SOS — FINAL ELECTRICAL
en
W r. of Ne work for which this permit is issued(sea.3097,civ.C]
0..c cendor,Name.. 506 - GAS TEST
Leader's Address
UFO
"l certify that I have read this application and same that the above information is 507 - FINAL PLUMBING
m F correct.1 agree to comply with all city and county ordinance,and state laws relating 508 - FINAL MECHANICAL
1.mildingconswctiugmdherehymounizerepresentativesofthiscitytoenterupon 509 - FINAL GRADE
the above-mentioned property for inspection puryows.,
tt0. (W)agree Insave indemnify and keep harmless the City of Cupertino against
_I4 liabilities,ju Ig acts costs I expense which y in any way accme against said 510 - FINAL PLANNING
V-Z Cly noes nce 'fihe gcnting th 'pe' t „
APP( ee ANDS WILLC LYWTfHALL�NPOINT' 514 - NA C WO
'l S '1'A NS.."' "n - / Issued�i8: Date
sigma MApprcan✓Cmor Date' Re-rock - ROOF BATTENS
' w' ti 'pplmH:Aa.ZAnoRmDwOrUe S uauagwaupantsISoCreLoO
tiSURE '
nablehazardous
mmw, of �of- ROOF IN.-PROGRESS
ms J f J bYheC n no Munea aCode ChPr9 12dthe Heathands fry . pr
Code Section 2553211 �.,,,' t..• " / ',p.. . �' .'f:. s, 1' !s
' . . All.roofs shall be inspected prior.to any.roofing.material being installed. . .. .._.
❑Yes ❑No
q Will the app ium or tumre building rccupam use cquipmem or eevias which Ifa roof is In Stalled without first Obtaining an inspection; I agree IO remove
-emit hazardous air contaminants as defined by the Bay Area Aar Quality Management o
Dix'^c" all new materials,for inspection. Applicant understands and will comply with
Ores IJ P PP Py
all non-point source regulations:..
I have read the hazardous mammal's requirements under Chapter 6.95'of the
Califomia Health&Safety Cade.Sec' s 25505.25533 mal M534 I understand than
if mg no,dunenlly h - enol,that it is my responsibility to notify the
up. of rcy irements wh' be con prior to issuance of u Cenificam of '
Signature of Applicant_ Date
ra t our= agent _ Dae All roof coverings to be Class r`B" or better
.OFFICE - . .
✓12.2 e��c�'��� d �'
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