01070008CI suOFG
CONTRACTOR INFORMATION:
BUILDING tPERMIT
BUILDING ADDRESS:
PERMIT NO,
21390 COLUMBUS AV
01070008
OWNER'S NAME:
ROB & CYNDRA ROVETTA
APPLICATION SUB DATE
07/05/2001
PHONE:
SANITARY NO. CONTROL NO.
Z ARCHITECT/ENGINEER:
O
BUILDING PERMIT INFO
B E P MB CH
L J
2 LICENSEDCONTRACfOR'SDECLARATION
Job Description
I hertby sM,. that I an, licensed under provisions of Chapter (rommeneing
3 with Section7")ofDivision3oftheBuoiia,,andPmfession.Code,andmyliccnse
ADDITION 492 SQ.FT.
is in full force and effect.
ULicense Class Li, g
ARCHITECT'S DECLARATION
LARATION
5 Dae Conor
GAY SAY A ` �®
F A
1 understand my plans shall be used as public records
e Y L9
((tea Q
APR 2 Q 2003
O Licensed Professional OWNER- BUILDER
1 hereby .(firm that 1 from the Conwemrs License Law for the
the Contractor's
oro exempt m
following arson. ]031.& Business and Professions Code: Any city or county
$50000
Permit to
O which requires a permit m conswn, alter, improve, demolish, or =pit structure
m .priormitaissuer,ce,nlwsquim me applicamfor suds pemJuo fileasigned naterrem
- -- -- —------------- -
- tIiomitlianiedpursuamtDplepiovikinsoftheContractoriLicenseLaw(Chapter9
}�[� ,tea. kris �,r•!�A
r. „ ., Valuation
(comrrmncirg with Section 701of Division Sof the Buaine5s and Professions Code)
or thafh cis ex'empi therefcoi uim t the basis for the alleged exemption. Any violation
,.,t �3173'V.i.�VYl .'17,.0—t'
-
vanandredCaouam(ssoo. subjens the applicam maeivil'penaty
.5 five hundred Civil... (S50%,
'.oarfivsx..rc40than
101APN4Yr1lI!RDATION
f'°,q1'\• Occupancy Type
❑1. as owner of the propy, ertor my employees with wages m their sole compensation,
102 - PIERS
1 O3 — UFER Required Inspections,`"
9 p
'will"do the work: and the swamre is not intended or offered tar sale'IS& 70,14,
Code: The Contractor's License Law does not apply to an
s Business .ad Profession en
owner of propcny Who builds or tmrovea themon, and who does such work himself
104 - REBAR
or tsrou h his own employees provided that such improvements ,a intended or
-
offered a sae ILhoweve,tw bmldmgonmenofprnussold
lOS — ANCHOR BOLTS I"`` TAI,1 , .,'f
'
completion, the ownervbmlder well have the burden of proving Ihm he d d nes build or
he did
for paose of shies).
improvery
106 - SEWER & WATER
Xnenwnarof the propertyo`n'*axC'Iui:eiy-ca�tnac—dngwitn Iieansed"coAimetosm
_ --- 202 - UNDERFLOOR._.PLUMBING-----rl-t—F�;�13--------
wct the project sce. 7014. Business and Professions Cade:) The Contractor's
License Law does not apply m an owner of property who builds or improves thereon.
203 - UNDERFLOOR MECHANICAL ` "''''" "1'`"
_Wd.who.mnwem,for_such projens.svhh a coiractons) licensedpursuant to the
._.._2 O4 ----UNDERFLOOR...FRAME...___.__-_.__......_...-_.....____._—.._. _.._._.__._.
Contractors License Law.
❑lame ppt tdefs,.'' 9&PCfor this reason
205 - UNDERFLOORS' INSULATION
= Owner
301 - ROUGH PLUMBING
ORKER'S P,NSA GNDECLAIunory
302 — TUB & OR SHOWER
I hereby affirm under,pewlly of perjury one of lhefollowing declarations:
303 — ROUGH MECHANICAL
LO I hove had will-'mammin'it Certificate of Consent to self-insum for worker's
3 04 - ROUGH ELECTRICAL
)r Compensation, as provided for by Section 3700 of the Labor Code. fortheperformanceal workfor which this permit is iauad.
305 — FRAME
,01 limeand will'mainaim Watkins Compensation lydumnce, as required by Section
306 - HOLDOWNS
3700 of the Labor Code, for the performance of the work for which this Permit is
•t
307 - INSULATION
NSULATION
sou d My W :kers Compensation insurance comer d Pol cY robe rt.
CAmer +i ". ` X8MPTI _
YLERTIFICATION
_
3OS 7.'OHEpTROCR- -—
•. - ��hb.,aho.
CLisv
`-+CERTIFICATION OF EXEMPTION FROM,WQR
309: --'E%TERIOR�' LATHI'
COMPENSATION INSURANCE' - ' ' '' '�
..... - '_ ..._.
I(This
310,-:,:\—INTERTOR'"liATH; -----------.
rection neN'natbe romp m dinhp tat is rata emndrtd dnnem
311'- SCRATCH COAT
(5100) r less )
.:.
I f mfy 'hal In the perfonn.ntt of the brk f r hah this p dais: dr
.......... ...3.1.3,_---ROOF'•NALL..__.. .,; _...-.....,.._..-....._..,.,,..
1
- -
”
had n t employ'an'y past.
a n n any mann as d„o b ane xru,egt m me wnike s
"'
501 - FINAL EliECTRI CAli 'ENERGY
Cgmpcnsmion Lews o(Cim ma.,, DAie "'
AppRea.t_ --- •...
502-=.-RINAL•PLUMBING-ENERGY---------------- --_..
-NOTICETOAPPLICANT:ICaBermakingthisCenificamofExcmptioo,youshould
503 - FINAL MECHANICAI'tNERGY 't
> become auhjecuathe Workers Compensetionp visions ofihe labor Code. you must
j fo_nnwitneamplywitnaaenproviamnaarmepermitahmihea«mearcvaked.
_5-04..-- FINAL. BUILDING_'ENERGY_.._._.__.
"! tl"'CONSTRUCTION LENDING AGENCY
.._...___..__..-__..
SOS — FINAL ELECTRICAL
1 lircby china that there hs a conic i m leading Age y f the perfohnance
which ""
t • .rt. .,,
506 — GAS TEST
of the work for this Permit is issued (See, 3097, Civ. C.) x
Lender's Nume''-- nn ,___.. .-:.. ,_... �_ ... _,,..,_. ....
._ _ -. _. .__ — .___ ._ —.___-
> Lender's Addrvsi" • . • , .. -
507 - FINAL PLUMBING ,.1
508 - FINAL MECHAN I CAL
• . I certify that I have read this application and shim thrt the above informmion is
correct. I agree to comply with all city And county ordinances and state laws slating
509 - FINAL GRADE
to building ennsuunion, and herthy autfioAre sepreantati4es ofthis City to enter upon
r: the above-mentioned property for inspection purposes:, -
510 - FINAL PLANNING
W We) agree to save, indeirtaily ind keep hadmiless the City o'Culpeninc, against
O
514 - FINAL PUBLIC
liabilities. judgmenW costs and expenses which may in any wit asxrue against said
C city m o isquenceofthegmmmgofms emout.
" APPI 4\ ND6 \D$AND \yII,L�NFLY N'ITH ALLh N t'
_
602 — ROOF PLYWOOD IL p\ `j -?i
aTT7 -POI
tem - 1��0I
ISSUOd 11 ate
yh'OUEHEpULAT�NK(7./ ,./..
4/
t Stgmgmc f` A(pplman't/C`otmemmr, i a ,.
HAZARDOUSMATERIALS DISCLOSURE -
Re-roon04 - ROOF IN-PROGIIES
%„' G 3
'1Typeof0:?Q�1
Will the applicantorTutusbudding,kcupantacreahandlehazardousrrmmnal
as dePosd by theCupertino Municipal Cada Chapter 9.12, and the Health and Safety
Roof _. ... _.... __. _
Coda Section 25j32bq? SxA ,t....
oYc, f ,a ' r 1 tt , l
: a CCC... .
All roofs shall.be inspected prior to III] fln aL eing, m lied._______
/ / t; Will the applicant cf mreb (ding occupant use equipment devices which
_
If a roof is installed without first obtainin`g'amin e '-p_agre6,to remove
amithazardous u conatimincials asdefined by the Bay Area Ali Quahry Management
Disvlm
'j
"I— j
all new materials for inspection.- Applicant understands and w1-. comply with
. . .Yea 1 , �Na(. - ,•.,., •.,-
all non -point source regulations:
A I ha ie d.thc hazarded inamrials rtqu rtmmt5 under Chapar 6.95 of the
Calif raa i,.I h'& Saf ty Cad Scorns 8505 255A and 25534 1 Wdersu Chet'
nond
f ih5 build ng dgesn itcrrentlyh have terata thtu oyrtpnsblty to ufy the
'-'-'
lJ
occupy t f the re 6' em t Nchmust be met pn r to ode ce of Ce date of
-XI?o or
Signature of Applicant Date .
All roof coverings to be Class "B'° of lietter'.
.axed egem Dem
.t'
OFFICE. _ _. -