01080131 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ' CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21431 COLUMBUS AV 01080131
OWNER'S NAME: APPLICATION SUB DATE
PONCETTA LINDA A AND STANLEY E 08/27/2001
•PHONE: SANITARY NO. CONTROL NO.
i
QZO ARCHITECTIENGINEER: BUILDING PERMIT INFO
e od{= BLDG ELECT PLUMB MECH
5 w 2 LICENSED CONTRACTOR'S DECLARATION Job Description
Z_p I hereby eflinn that I am licensed under provisions of Chapter 9(commencing
,_C with Section 70o0)ofDwision3oftheBusincssandProfessionsCede.andmylicense REMODEryiC[,� FAMILY/BEDROOM
j,aE< Lil in full force and effect. Y -#I s, n '
re0 i Data Class Contract., !rte ��1 M rel
i 3 e N Data Commaor +�-q
ARCHITECT'S DECLARATION
O ej 1 understand my plans shall be used as public record, O n
7 i p O Licensed Precssiowl
3 2002
OWNER-BUILDER DECLARATION
1 hereby afima that 1 am exempt from the Cannvcmr's License Law for the
ti a following reason section 70313.Business and Professions Cade:Any city or county UIi1+d p Ips $150000
8 t o which requires a permit to construct,.]let,improve,demolish,or repair any structure LDI1 V`7
i 3,a -.0,a,b, licensed
a.esonsUmrn Neappluam fm suchpvmittfdas gndsmlaer9
(comae afce Sed pSectiot ame pronsmnsor Nc Contractors License!e ...Cade)
o mneme mseamnloomorDinsran3armeBusl Plainest; fon:cog) „ F.
Valuation
or that he is exempt therefrom and the bass for the alleged ascription.Any violation
of Section 7031.5 by any applicant fora permit subjects the appy.., m a civil ivil sentry '
of not more than five hundred dollars($500). 1014PN DATION Occupancy Type
0 L us owner of the property,or my employees with wages as their sale compensation, r
will do the work.and the structure is not intended or offered for ask(sec 7004,
Ba mass and Profession,Code:The Contractors License Law does not apply to son 10 3 - UFER Required Inspections''
owner of pmpcny Who builds or improves merrnu and wtio dna such work himself
or through his own employees.provided that such improvements are not intended or 104 - REBAR i
offered for sale”If.mwevtr,me building or improvement is sold within one year or -10 5 - ANCHOR BOLTS `
completion,the owner Wilder will have the burdan of proving that he did not build or i
zamprov for purpose of sale.), 106 — SEWER & WATER
linuoimeropartr.am«elusivelysomouningwithluepuarastra<tm to 202 UNDERFLOOR PLUMBING
. onawtt Law les n(s¢.7044,Business and property
who else:)The Contractor', 203 — UNDERFLOOR MECHANICAL'
License Law does not^such man owner with
property who builds or improves rtotiBacteria,
antl.who contracts Lies for such projms with a comranor(s)licensed pursuant to me _
`•' cantiazwr.uaensclsw. 204 — UNDERFLOOR FRAME
Of.m h`ila�tun ,B&P C per this reaaom 205 — UNDERFLOORS INSULATION
o»•^e/�Onto' — '1-0/' 301 — ROUGH PLUMBING
1 ORKER'S COMPENSATIO DE RATION 302 — TUB & OR SHOWER
I hereby affirm under,Penalty of farj^ry one ohne following declarations: 303 — ROUGH MECHANICAL
❑ I have and will maintain s'Cenifieme of Co..,so relf-trema felt worker, 304 — ROUGH ELECTRICAL
Compensation• as provided for by Section 3700 of the Labor Code, for the
'performance of dse work Colt which this permit is isolated. 3 05 - FRAME
❑I have and will maintain Worker's Compensation Iruumnce,as re,,imd by section 3 06 - HOLDOWNS
3700 of the Labor Cade,for the performance of the work for which this permit is
tl 3 0 7 - INSULATIONiisb n nn
N
dl 'eohcyNa. 308 :SE,EETROCK...;r .,,
CERTIFlCATION OF E%EMPTIONFROMWORKERS a_ 3O9Y•_ ^•}�-.'�{'TERIOR"'LATH,
_. COMPENSATIONINSURANCE .. _..__...--. __..
INTERIOR 'LATH' — — —
(This seam.rmW'na be complemd d the pnmit lis fm rete hundred dollen r r ti t
Blom grtey.) 311 — SCRATCH COAT
'I afrtir that in me karma
..'' y. pa n¢ar the work far wmch'this Permit is issued:I ' 313' — ROOF 'NAIL -
'sh31c not employ any person in any maim"an as to become subject io the Workc
f CliRn' 501 — FINAL ELECTRICAL t(ENERGY
Compensation Laws oamai..Date -
Applicant ' - . '. 502 — FINAL PLUMBING ENERGY -
Nen.suOpPPLICA.An's flermakmgtha Cisions of,a samptian,you shoald' 503 — FINAL MECHANICAL ENERGY
z bacbme au comply with
the such..Compensation provisions thelefim Code,you must
�Oy O farhwiN¢mply wsn,um provisions or Ni,pernil,nau We¢med revoked. 504 — FINAL .BUILDING...ENERGY
7 "' r" CONSTRUCTION LENDING AGENCY SOS — FINAL ELECTRICAL •' 't '' - '
. ' ihereby'-Mim that Nae is a cormmciion lending agency for the'n omdn¢ .t
.. oftlK';vbr,or which is Parma is i,med ser 31A7 Cm.C.) 5 0 6 - GAS TEST
Via.Q Lender's Name.•.... ..... . . .. . . k
OUMBING
PL
FINAL—507 " ..
�Z IencRanagRss� �
. . , " -
U'O I certify that 1 have read iia a,dicadon and nam that the above information is 508 — FINAL ME CHANI CAL
j0j..
Ircbren1..I agree comply with all city and county eadim ¢
rns and state laws naming 5 0 9 — FINAL GRADE
V to Wilding construction,and hereby aumoriu representatives ofmis city to enter upon
y, w the aWve"mandopedproperty for inspection purpe,ses., 510 — FINAL PLANNING
d (we)agree to save,indemnify and keep M1armlcss the City of Cupcnino Natural
liabilities,judgmcros, o his vin pe s which may in my way a cine against said 514 — FINAL PUB IC WORKS
V'^ City in consequence df me gmnun� (this permit.
PP (CANT 'DEASTANDS�'aN�sWILL MPLY WITH ALL NON-POhNI"-
Rc AT N /, y Issued by: Date
ign t f pl ca tic i Date Re-roofs '
' "HAZARDOUS MATERIALS DISCLOSURE `
. . win me applicant f t W Id'dg ottvpa t taro or hwdle harardws material- Type of Roof
as def ed by the Cupert o Municipal Code❑Yes Chart912 and the Health d Safety -
Code Section 2532m1 _ t k J.,r. .;(}-' " f•;`•:; .' , . .1�.. •.
t' i I }
All roofs shall be inspected prior to any roofinginma[erial being installed. . _
d" will the applicant or future building ocaupem use equipment or devices whim If a roof is in stalled'without first obtaining an inspection,'I agreete'relDOVe
emit ht auxbos air enntaminams as deftad by the Bay Area Air Quality Management g
Districorc,. N -, all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
1 hive read the hamrdous materials requimme^¢undo Chaptei 6.95 of the '
Califdmia Health&safely Cade.sections 25505.25533 and 25534.1 dr,cmWd mat
iflhe building docs not cur¢nd haveamnant that it is my responsibility la notify the -
'occupant of the re uircmea srw uc n be met pirl issuaree^f a Cmifca a of
Occupanq. .• j\ Signature of Applicant
�
7- / g PP. Date
umori reagent" Data All roof coverings to be Class "B"or better
OFFICE