01040098 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: -
BUILDING ADDRESS - PERMIT NO.
22365 CARTA BLANCA ST JM CONSTRUCTION 01040098
OWNER'S NAME: - APPLICATION SUB DATE'
FRIJIN VIRGINIA A 562 DIVISION ST 04/1.9/2001
'DNF. - SANITARY NO. CONTROL NO,
083799852
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ARCI'rliCiIENCINiiIiR: .BUILDING PIiRMiT INFO
rc BLDG PLUM NE
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LICENSED CONTRACTOR'S DIicLARATION Job D05crlptl
S y' I hembv.flim,that 1 am licensed under f ( g
provisions Col Cha ler9 rommcncin •
F,HF; wish section 7ilad of Divieionitof me Bu,inese anA Yro4sion>CWe,and mylicense
in full Iblce and Yea.
pz �.icenx�Cl...,, -/ Lie.« 5 -136 o6Ca FIRE REPAIR.
RCHITECT's DECLARATION
I und...and n,Y plans,Fall be user s,public wand, S({.? �.•.S','^{7
icep�p Licensed 14olesninnnl
m OWNER BUILDER DECLARATION 111 1�
•d=m 1 hereby affirm Iha 1 an'"Capt rrom the Contractor',Licen.c Law far the J V N V 5 2002
C a t'ollowing clime.(Section 71131,.5,Bushes and Pndc,.i ary Codc:Any city car county L '
c C a which raptures a permit,o construct.abet.improve,demolish,of repair any structure
soPrior to its assurance.aim)"mai the affliction for such pewinto fife a signed motorboat
a. that he is licensed purmantto the powitimn.(if the Commences LieemeLaw(Cnapter9 Sq. Ft � - Valuation
LLvnmsncing will,Semlon 7000),)r Divi'IL 3 one
be usial,,:mJ Prole.,Inn,Code)
or Than be is exempt In.fnno and the basis for,he alleged exemPnon Any ioI.Ii1 1 L71 0 L7071 V11
of section 703IS by any applicant fee.pc.,it m den,the applicant a.civil penalty Occupancy Type
of nm more than five hundred dollars($500), APN Number
❑1.to owner of the pralsny,many crapoyce,with wapc,','heir mile cont m...I an. �' .
will do he won,and the atmcmrc is oat intended or offered for sale(Sec.70,l 3261
Business and Professions Code:The Contractors License Law does not appy to an Required Inspections
owner of property who builds or improe, u
vrlercnn.and who do .uch work himself
,it tri,own co,doyec...rovmcd mm...it b„Provemen,are ton noodled or 1.01 — FOUNDATION
offered lir sale.If ho„xver,the building or improon
improvement is sold within e year of
completion.the towner-builder will have me burden of proving that he did not build or 102 — PIERS
improve farue
pmwc ar,dc.).
OL a,owner arthtrtamexclusivel contracting with 103 — UFER
grope y, pion gw, 104 — REBAR
newel the does
(sec.7(144,an o,mr of and Pdy who
Ctde:)The Commmnr
1¢ansa Lou Jose oat apply to an owner of property who bWi6ttin
and who com...Is ror...1, Iacjcct.with^,m,lravhm,) I i�Mil ECS -105 — ANCHOR BOLTS
Contrenm's Licenw Law.
111 am exempt under Sec. - ,B A P C fur mus ream 106 — SEWER 8, IJATER
Owner . ,Jlj.ri 0 202 — UNDERFLOOR PLUMBING
wQRRLR+u,MPLNsnuoN Ol cl.nnnnoN 203 — UNDERFLOOR MECHANICAL_
I hereby affirmural penaltytoperjury one of the following
ud�l- NG 204 — UNDERFLOOR FRAME
1 h J 'II ma t C e plena, f C n nn ,It- . i- . It , —
mfoplanun, as pmnded for by section an«f of me Labor Code. for he 205 I_INDERFLOOR 'INSIJLRTI ON
Performance ofine wan for which the, earn is„ted. 301 — ROUGH PLUMBING
❑I It...and will m.onwin W..A,',Compensmion Insurance,as required by Section
3710 of the Lad,,Code.for the performance of the work far which his Permit is 302 — TUB & OR SHOWER
ill Id,My worker',Compensation Insurance carrier and Policy number art:
Carriers_ T��y Policy No _A 1913— 1-9,
303 — ROUGH MECHANICAL
c xnnc TIONC EXE_MPr1OsTR MWORKET=Rs' 304 — ROUGH ELECTRICAL
COMPENSATION INSURANCE 305 — FRAME
(II, acli�,ocednothecos„pWwrlfthelsroulisnor.,hambtdd"Bar” 306 — I-IOI_DOWNS
(slop)or Ie,s
1 orm y that in'he perrnmmuce of the won tor which mi. .it i,i...ed.1 307 — INSULATION
,hall mit co,flor any per,ms in any annual,m as to become.i,bj,a, ,the Wr,U, 308 — SHEETROCK
Commion L
fensaw,of California.Dale
NOTIApplCE' 309 — EXTERIOR LATH
NOTICE imj APPLICWmme,C making'his Ccninwtcof [-.be,od,youshould
OZ belamt,ugcaamt ...htit a,n.ndonprrolinhuhhetLanorndeyou r'm” 310 — INTERIOR (_ATH
O limhwith comply u'i'h.acM1 pnrviniom or this permit,hal h reamed revoked. -
FW CONSI'RUCr10NLENDING AGENCY 311 — SCRATCH COAT
4
C I hereby anima mat inert i,a can,waion lending agents for me p rharr aw, 313 — ROOF NAIL
or the work for xder this p anar,I,..,ucd(Sec.VC.civ.C.1
a C Lender•Addr° 501 = FINAL ELECTRICAL ENERGY
z corny
502 — FINAL_ PLUMBING ENERGY
U O terrrr Iha leave m:,d 111i appllcad".are m:neden tot aMwe im...ran ,n is
s cm.m 1 agree it,comely wim.II city.ad county ordinance,and.late law,retains 503 RL MECH N I CAL ENERGY
O U
it)Wilding construction.and hereby aumori,e refresentai.e,of this city to enter upon
p the above.meailand'u"mrrtorin"chnnpurl,wc,. '4 — F AL PI_I DING ENERGY
.�„ Q, (We)ugrec to ave,ind„tori ry are keep h:lmdt,x the City of Cr,il inn agai n.¢
cn cantina.,judgment.,.los„and expectes wh r may in any way aremc against.oto 505 — IAL E TRI CAL O/
V z Cin in c,mmqu f the gram'ug of mus nit. EST
AP (CANT ,N ERSTA AND WI. COMPLY WRIT ALL N N-Po NT
' uncER .nT Issued by: ate
tf t� ENCR
ignmum d, Ir con
our U m Re-roofs
HAZARDOUS MATERIALS DISCLOSURE 5 — FINAL MECHANICAL
wiud,eapplicant ormmre Wilding occapam son,orhandle ha,„ntm,smaterial Type of
xdernmbybeca,minoMnnicifiCode,Chapter 9.2.and thelieahnandSale(, 09 — FINAL GRADE
Cade,section?5532(.):'
OYe, ON. 510 FINAL_ PL NNII
- All roofs shall be sp ¢ted p y g installed.
Will nhe tppceant ar Warm nnilmng acatm,m tot tnrdplltm„matvmc,wmon Ifa roof is installed,&bout t�irs'L 6l�lnn�nr 'aii--Ids�pacfibH,`
mit h...Mo.,at,connotations a,defined by rbc lfsy Area Air Quality Manegemeo, e ree to remove
'i°^a”n.. ❑Nt all new materials for inspection. Applicant understands and will comply with
WN F Oall non-point source regulations. -
1 have th the Safety
Code, mmensls 5 5.25lenla under 1.1 Chapter M195 of the
Its iIdi"s,no,cty C,de,Sectio num.led
ere,,ond }1.IunJemmnd that
I Ih I'll wmturtndy hm'cammmr.,liar it i.my rc,Ism.ibilhymnmily the
'mlfum Col Ih re4dreme h;uhhe nml "ino to f"arance Col'a Cmllffeme nl '
Uccufunr '
Signature of Applicant Date
ownt,.00nma ,tT,gtm -, � • All roof coverings to be Class "B" or better
OFFICE