02020094V'
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
'CONTRACTOR INFORMATIO
BUILDING ADDRESS:
PERMIT N0,
21756 COLLINGSWORTH ST
CLEAR OAK DESIGNS
02020094
OWNER'S NAME:
APPLICATION SUB DATE
SOLIZ GUIDO L AND SUSAN C
1723 ROGERS AVE
02/25/2002
PHONE:
Z- 0
(408)436-5448
SANITARY NO. CONTROL NO.
OZ ARCHITECTIENGINEER:
M1
BUILDING PERMIT INFO
(=
BLDG ELECT PLUMB MECH
i LICENSED CONTRACTOR'S DECLARATION
I hereby affirm in., 1.m licensed under provisions of Chapter 9 (commencing
JObDE:SCR Description
p
With Section?W)of Division 3 of the Business and ofcsxions Code, and my license
KITCHEN REMODEL
,sin lull force aM «.
6 License Clazs Lic.p
Dam Comms
N ARCHITECT'S DECLARATION
I understand my plana shall be used as public rtwrds�I•sS
OLicensed Professional
u OWNER -BUILDER DECLARATION
os 1 family aR shin 1 am exempt from the Controls,'. Lice. taw for the.
a following reason. (Section 703 1.5. Business and Professions Code: Any city or county
D which requires perms construct, vita, improve, demolish, ore Pair any swcturc
$39000
.priaruiuiswance. a
n theapplicantor for sumpermr
— purmilrequirte
that lie is liccnttd pursuQnt totheprovisions of ec Contractors Land pr law (Chapter
LomaaLaw(Caapter9
(commcmin8 with Section]000) of Division 3sf the Business and Professions Code)
_ FIf, t--
r'f '�:'t3.yS,g T�, NIP9 valuation
or then he is seem t thcicfiom'and the basis for the Olt ea alim mA. An
V 8 V y violation
��."t'. t-�
''•
- of Smion lOJLS by any epplicarA fore pcmniuvbjecm d¢ applicant to a civil penalty
'
of not mom than ave hundred dollars (5501)).
10 ZENDAT I ON !' ' '' Occupancy Type
01, as owner of the pmpeny, lir my employees with wages as their sole compensation,
will do the work( and the suuemre is not intended o offered -for ulc (Sec. 7044. r
_
' Business and Professions Cade: The Comment's Licers Law does rpt .p vly {a
owner of ptopeny Who W iltls or improves Thereon. end who�sSS �q(k
�D 10 3 - UFER Required Inspections', '
p,ma�d5c
or through his own employ«s. provided that such improvem2gKitt�diNdl'_
'
t
104 - REBAR
offered for sale. If, however, the W ildin m iovcmrnt is !l551tl within ora
g or p year of
epmplman, ee owner -wilder will have me border or proving tsar hectic no buds
i.Prove for sale.).
�,
"' - _ .... ..... _
Z0�2 105 - ANCHOR BOLTS
puryose of
JU►�
106 - SEWER & WATER
❑Les owner of the n y gwi
prop. y. ame«siness dprorm tCocen.edeCo,«mtorp
snswd the proj«r (Sec. ]OW, Business and Pmkuionx Cade:) The Comnnor's
__.. _ , ... ... .. _ . ..... ... .....
202 - UNDERFLOOR PLUMBING ..
'
Liave law does nom apply to a a owner of pmpeny who Wilds or im 0
��� 203 - UNDERFLOOR MECHANICAL' -
.and. who contracts for such projects with.a contmetorts) licensed
Commemr,Lieen:<law.
204 = "UNDERFLOOR FRAME __-----......._... _...._. --- _
❑late exempt under Sce" B&PCTs, cis reason
205 - UNDERFLOOR INSULATION
° er Deta
WORKER'S COMPENSATION DECLARATION
301 - ROUGH PLUMBING
I hereby alfim under penal, or Pa, aofpreserhefollowingumfor 1)a®
302 - TUB & OR SHOWER
'maintain
Compensation,"
303 - ROUGH MECHANICAL
❑ 1 neve and will f Cby etee of Consent to .alt -insure for wars 1,
he provided roc by Semon 3]00 a( Ne Labor Cada for rhe
3 04 — ROUGH ELECTRICAL
_ Perto�rrnance or the work m, which this Porten Is issued.
"no and will maintain Worker's Compensation Iaaunmr, by Senior
3 05 — FRAME
as untrained
3]00 of the labor Code, for the performance of the work for which this pcmur is
3O6 — HOEDOWNS
issued. MyWorker'sCompensationInsurancecarrierandPolicynumbermr.
- ..._
307 - INSULATION
. --, ..... ..
c.r:ie,r Ti4-T6Cohl/�PplmrNp_'ICOZ/0�-0%...
,. --
,-.,,.r_5308.,;.-.,.SHEETROCK,.,..,.,- •,;;:. •.'-
" 1.'1'.CERTIFlCCOMPENSTIONwoURA,NCE CERs'r'
s •' `309' ;:'EXTERIOR`LATI�1
' This section recd not be completed if the permit is for one hundred dollar
3T0 ; - .INT.ERIOR LATH _..----.....___._....
(s'omprlea,.)
311 - SCRATCH COAT
i certify renin m the IzRam,an« is me work for which this Permit is issued.1
313 - ROOF NAIL -
shall not employ any person in any manner m a so�ecome, subject m the Weaken'
Compersation LawvofC fa ia.Dav '7-�zS/OL
��
'
501 - FINAL ELECTRICAL ENERGY
:Applicant.. 0 r t)i�—
NOTICE TO APPLICANT: If, after quaking his emption, you should
-502 - FINAL PLUMBING ENERGY '
jbecome subject the Worimes Compensation provisions of the Labor Code, you must
fonhwimcomply with such provisions orthis Permit shall bedeemed revoked.
503 - FINAL MECHANICAL ENERGY
.. 504 - FINAL. BUILDING ENERGY
CONSTRUCTION LENDING AGENCY
'1 hereby affirm that there is a construction lending agency for the performance
505 - FINAL ELECTRICAL
oreeworkfor which thisPermit missued(Sm.309].CmC.)
Lender's Name -
.. 506 - GAS TEST
Leader's Address
507 - FINAL PLUMBING
I certify that l have mad this eppI cmion and scam that the above informn{on is
508 - FINAL MECHANICAL
correct I agree mo comply with all city and wunry ordinances and .tate laws rclatin8
to Wilding conswction. and hereby audmdu represenudves of this city to mom upon
S O 9 — FINAL GRADE
the aWVe.mrnree tomad sro:indemrify and keep
(We,) agree to save: to and keep harmless she City of Cupertino against
i •
510 — FINAL PLANNING
tad expenses
Rmiliries, juagtMnm, coins and apcac:whim may in any way «cmc agamm said
City in
514 - FINAL PU I C WORKS -
consequence of the Starting of this peemit. -
' APPLICANT UUDERSTANDS AND WILL COMPLY WITH ALLNON-POIN7
SOUR REGULA NS. (
on
Issued by:
wn '.r . Q ,..r o 2,/;,
Date �L
..gnamre 7ApplicanuConm on, Date
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE
Will theapplicam.1fotum building acupamsmm or handle haurdous mnerial
'a deGn d by the Cupertino Mmm WI Coda Chapter 9. 12. and dm Health and Safety
Type of Roof - - - - -
Code. Simon 25532(.)' .' -, /a ,:
Dyes
v .
7th ..
..
Will
All roofs shall be inspected prior to any roofing material being installed.
rhe appli<anr s, fumm building occupant use equipment or devices which
emit heaaMous m contaminates u defined by the Bay Area Air Quality Management
If a roof is installed without first obtaining an inspection, I agree to remove
DismierP
1)Y« .XN.
all new materials for inspection. Applicant understands and will comply with
'1
all non -point source regulations.
have read the is a ou. materials requirements under Chapter 6,95 of Ne
-
Califom"n Health & Safety Code, Sections 25505, 25533 and 25536. 1 undersand that
ramie building docs not correctly have a ry re notify the
that it ix my rtsance
.
- S�
m aw must
petvpent of the rcquimmenu which must be ten odor to issuance of a Certificate of
he of
C1 "
A F l�-dv vie
o«apancy.
A � 0 0
0
Signature of Applicant Date
All roof coverings to be Class "B" or better .
Own or emhonrc ogem Dam
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CITY ILDI NG DIVCUPISION
PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRMS:
PERMIT NO.
21756 COLLINGSWORTH ST
CLEAR OAK DESIGNS
02020094
WNER'S NAME:
APPLICATION SUB DATE
SOLIZ GUIDO L AND SUSAN C
1723 ROGERS AVE
02/25/2002
I10NE:
SANITARY NO. COM'ROL NO.
zc — 1101
(408)436-5448
ZO ARCHITECT/ NGINEER:
BUILDING PERMIT INFO
E
BLDG ELECT PLUMB MECH
CJ LJ L__I
LICENSED CONTRACTOR 'SDECLARATION
1 hereby or. that 1 am licensed mode, provrsmna of Chapter 9 rcomme teing
Job Description
ar with Section7")ofDivision3ofheBusiness and PrornsionsCove, and mylicense
KITCHEN REMODEL
m fwl roree ana ree
6 License Class "'a
U Dae Z Liinrmmnr _
L
FINALE®
ARCHITGCT'S DECLARATION
aj 1 understand my IN, as
0 O9
plana shill public records!'
JUN 1 8 2002
z LicensedPOIrWoaal
OWNER -BUILDER DECLARATION
.
1 herby aRrm that I am exempt from he Contractor's License Law for he
a following reason. (Section 7031.5. Business and Professions Code: Any city or county
O which requires a permit to construct, altar, improve. demolish. or repair any structure
B U I LD$� @ o o
_Prim to its iameace, slat mquhn the applicant for such pemauo rile a signed statemem.
/.,,, �acp,�FLs��raqr{���a .�•Y:,
t,i)NTI� 3.J�l�l":/sV?F7
Valuation '
— that fin is licensed vanuant to the masisman M he Commeroh License Law (Chapter 9
(emossacingfrith Section.'710I of Division 3 ofthe Business and Profession Cade)
or that be is eiempt theicfroui and the basis for the alleged exemption. Any violation
yi0'U lt. ,f,;?ii.-,
- of Section 7031.5 by any applicant fora permit subject the applicant to a civil penalty
of not mom than me hundred dollars (5500).
1014PNUNDAT ION
Occupancy Type
°1, as owner of the prnpeny, or my employees with wagexas their.sole competsation,
_ PIERS
will do the work: and-da'struatux isnot lamended or offered for sale (See.']014,
'Business and Profession Code: The Convector's License Law does not apply to an
-
103 - UFER Required Inspections"'
owner of progeny Who builds or improves thcrcon, and who does such work himself
or hmugn his own ptit.;dea hat sunt improvements are opt intended of
104 - REBAR
frowner, g or i p ycld of
-oRcrtd for sale. If, howeveq the Wildin m mvemem is sold within one -
completion, the owmmWider will have he burden or proving that he ata not Wad or
105 - ANCHOR BOLTS ' "•� •
improve for purpose of role.).
106 - SEWER & WATER
_
°I,af uwnerunne pmpery. am eanmsicelycontmeung vetch licensed conuaaors m
_
'-"-
202 - UNDERFLOOR _PLUMBING-_ ' .•I!'.
tmmore
acewd the project (wallow. onerBusiness and Prnieny who
code:) The Cimimproves
license Low doer no apply m an owner or progeny woo WBea lir m,prnaes hereon,
'.. . - .
2 03 - UNDERFLOOR MECHANI CAL ',
and. who contracts for .such.projects-with-a. contrecmads) licensd. pursuam.m he.
- Cnmmctnrfueerwluw.
204 = UNDERFLOOR FRAME _ _ ..... _...
° l am exempt under See:' :,B& P C for his reason
205 — UNDERFLOOR INSUliATION
ENS a
' WORKER'S COMPENSATION DECLARATION
301 — ROUGH PLUMBING
302 - TUB & OR SHOWER
Ihemby aRmf under penalty of perjury one of he following declarations:
303 - ROUGH MECHANICAL
° 1 have and will maintain a Ccmficate of Consent to selein,ux for Workers
Compensation. as Provided for by section 3700 of -the Lffim Code. for he
304 — ROUGH ELECTRICAL
yerb�or arca of he work for watch his permit is issued.
305 - FRAME
®'(ha4e and will maintain Worker's Compensation Insurance, as iequired by Section
306 — HOLDOWNS
37W of the tabor CMe, for the performance of the work for which this permit is
- issued. My Workers Compensation terrier and Policy number are: ...
3 0 7 - INSULATION
pInsurance
Caret JiTA`TLCoM1+tPolayN '/1PZ 03d -Ol
308.,; SHEETROCKQ.N
1_CERTIFICATION OFjrT,EXEMPTIONFROM NORKERS}
" `alt (.309''f—'`EXTERI(DR''iLATH• t
._ .. _.
(Thai xntonneed em be completeedd if he pe�NCEo_, d --rs
roronenundredammaa
_
_ ___—. _ _ .- ......_ . _ __ ...__
.l t
(sIW)orless.) .
311 — SCRATCH COAT
ryhtnthpit -
oIt henavaperttisnm I
—
3T3 — ROOF `NAIL"`"
c r
shoo t ploy any Persony manner so as ipbccomc sub)ea to he Workers
comp<nxt pn Laws nrcapro�tatoe. On an ..
—Y7o-�=
501 - FINAL ELEGTRI CAL ENERGY
.Applicant._ (s1'.P�H'/G CJ _ s ���
... _ _ 502- ----FINAL- PLUMBING ENERGY- -
NOTICE TO APPLICANT:, If, after making this C rat ¢a¢ o'i�xempuon, you should
becnme subject to the Worker's Compensation Provisions rim, Labor Code you muff,
503 — FINAL MECHANICAL ENERGY
j rorn'rn w;hsuch p .inns cryo p itanauxe narevoked.
ply.....h._
504.-._.FINAL..BUILDING'ENERGY._.. ._....
CONSTRUCTION LENDING AGENCY
I heeby alAtm that them is a conswction lending agency for the performance
--. .
505 — FINAL ELECTRICAL ll.
oeder'shrorwn;en tatsPem,h is�ssmed (see 3D97. ci.. c.)
� Ik,aee?s Name:.,. .__.; ..�. .., _...__.:..__. _.,: _.,. .-.�:..
_ 506 GAS TEST
- _. __ . .. .... _.
, LenaeraAaaxss
507 - FINAL PLUMBING, •:, _
1 cenify that 1 have read this application and state that the above information is
'cormet.
508 — F I NAL ME CHANI CAL
1 agree to comply with all city and county, ordinances and state laws mining
to Wilding constriction: and hereby amhodm reprcmam ives of this city to enter upon
509 — FINAL GRADE
i heaWve.mentioned prpppny for inspection pmppsep,
(We) igm. io'save, Indemnify and keep harmless the City of Cmpenino against
510 — FINAL PLANNING
i' liabilities, judgment. costs and expenses which may in any way p«rue against said.
514 - F I NAL PU I C WORKS
City inc nsequenee of the granting of this permit. '•
'APPLICANT UNDERSTANDS
AND WILL COMPLY WITH ALL'NON-POINT'
SOUR.ZREGUULAT{ONS.' �"', /z e
I
Issued by: Date �L
SrgwmrcAppbcant�Canmanor ¢
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE"� •"'
.,: Wil the tipphcarit m,futom Wilding'occuloantstom m handle hamidous mainaal,
'n
Type Of Roof.
dcOned by theCupen Municipal Code aspect 912 and he Health and Safety
...._.._..__
Cod Sect 253a21a) .' -
°Y -
,s,
-m'• a 't '•"j'' '
All ioofs shall6einspected pnortoanyroofing,being installed.
emit h do a contaminants defined by theBay ve clo Quality Manage which
rr n th apple t t (t budding occupant sc co AirQ t r Mail s comm
material
If a roof is installed' without first obtaining an inspection, 4'a ree to remove
g
all new materials for inspection. Applicant understands and will comply with
"r
all non -Goin[ source regulations.
•''
I h d the Imitations ed mriilrequirements`'
nee Ch punderstand
6stand the
if lir H-hh&Safety CMe Shu ns155053itis d2S5341ved tendhat
n
f th<building does um rt tlyhave e tenant: Nat t ymspo b1 yt enify the
Occup f the 'tore t which must W t p t s u ce f Certificate of
oec w ry
Signature of Applicant Date
Al] roof coverings to be Class "B" better
i
,own= Date
_ .. _ - OFFICE ..... .. ._,.. - __ .:.. .. _ ..
1