01090027 T
OF CUPERTINO
BmILILl\c mvtsto v gDCRMIT CONTRACTOR INFORMATION:
.BUILDING ADDRESS: PERMIT NO.
' 861-' COTTONWOOD DR RESIDENTIAL HEATING.AND /C .IN01090,02.7
OWNER'S NAME: - - _ ., '.. APPLICATION SUB DATE. ...-.
JOINER CHARLES S AND MARGARET 65 CRISTICH LN 09/06/2001
HONE: SANITARYNO. CONTROL NO.
4083774073
-3!Z, 'ARCHITECT/ENGINEER: BUILDING PERMIT INFO
n
ELWr PLUM 44EC
vii a.c, _
>z k LICENSED CONTRACTOR S DFCLARATION ]Ob Description
Z 1 y aRrm rhes 1 am 1 censN under Pro o s of Cbapon 9 lmmmencing
m , yup r 7000wrfn, sgr3 pneen r ares Pr - r, rherme . . * NO CONDITIIONS * ,.. . .:
In
p `C t9>(aY>�Sy/ C`(tactor tl 6 Nn ® S
I.,�� . ... ARCHITECT'S DECLARATION
, •.I undersand my plans shun he u.wd as public records JUN 0 5 2002
i 2' z Licensed Pmfea MMI
'K.cel - .';' OWNER-BUILDER DECLARATION
sc-m I '• •1 hereby,affirm that I am exempt frons the Contractor's License Law for the
baa . fdllowingmacro(Section 70313,Biomass and Pro&scions Cade:Any city or county BUILDING $7600
Y z C whkh requires a permit to construct,alar,improve,demolish,or repair any suunurt
to .pct«t t '.w c akw req the pplkam for sucM1 pemdtro Bleesg ad walemem• - ._ ...-. _ -. ._ _ _ - _
the ha9: cenied pursuant to the provisions of the Contractors License Law(Chapter 9
komrtm g hhSecuo ]UBO) !D'visionlofthe BusinessaraProfessonsCode7, Z 'I_�t ; l3�:�1 }.(� @r: �g�l! ki {3�; Valuation
or the he ii exempi Ihertfrom and the basis for the alligad tie ninke Any violation -
-of Section]031.5 by any applicant for a permit subjects the Applicant o a civil perally
of but...,ban Eve hundred donara(S500) 301�PN I PLUMBIN 1";', `r1 Occupancy Type
01:asowtterofthe,pro,tany.m.,employeeswithwages.thelrwlec..'eation, _
-will-do the w.X,-..d me structure is nor mnendid br myriad fur sale(Sec77619,- - --
'Business aad'Promxs iom Code:The Contractor's License Law docs not apply to an 304 - ROUGH E]BE(t TRM!Tp.:etions'''' •-� -
assual of,ropa.y Wgta wRar«imlaaves meteor.ares wlrm doer sacn wark nim.«Ir 505 — FINAL ELECTRICAL'
or m o get n' mployees provided that such improvements m t intended or; .. . . .. _.-
Ely, J o I .If n wive,the building t it le -h - _ - -.
gerandan `"1e" `Y of 507 — FINAL PLUMBING
complrfon.me owner bli roti wise na�r me baraen or mm.ng mat Irc and not west«
mpmer«par« mr lr.l 508 - FINAL MECHANICAL
-._.:_._..,.-.pope._..... . _ -.
-_, Q1,ax owner of thepropsny.am exclusive)ycumnwiIl cen Thpoepeon.,ac.nb-to _
.,L '- -'--- ---
c
amid 'J �:
constructm the (Sc. Business Profession,Code)The CornuhLicense does to pm,AmyY who be,or imprmes mchaso
_ nd, ho commurs
for.such pmpons,%im u contractors)licensed gtroaUm to(ho-
LicensL
°I'am eaempl under Sec. ' B&P C forthi,rrasmn lt,15 ,o;t
wnr
b
'Dat ...._
ORK�ERS COMPENSATION DECLARATION v'
n Ihereby of iso undrr,pnahy of perjury ane of the following declarations: - - pope .•'.•. .•. '. .. ._
6 O 1 have andwill mai ntain's Cmificaio b!Conwnt rlo self-insure for Worker's
lar�7 Compensation, u provided for by Section 37W of me Labor C"dr, rw me
peRorman¢of the work for which'hi,ps mit is issued.P 1,
Q 1 have'an8`will maintain Worker 9 Compansatiori In9urmL.as hquirof by Section
3700 of me lab«Code for The Imn-formance of the worr,,fiA which hispcArm'tis
xcu y rk Ys C pct 0in 1 .wet E P 1 Pin am-
%;
em
- ,r x If M WORKERS
. COMPENSATION INSURANCE{.
j. ...-......v.r•�. ___._.... _....--...f_.-.... _...............
._._.....-pope
(fhsectors Amd'w be completed-f me permit is In,arra hundred dollars ":Il. Fr.r rf.":,. . '� , •-Ira:"v, T\_,,._ _-__-____
1
r5�00)or ksJ,I
1 Pr PC us i
1 renty mat me Ko o(me work Po hicb m - scree:I '"' "'"""'"""`^'•^^ '- '-
xhall t employ any R Any Ananninjs hibecome brat ere Workers r...t': A1•i. -
Compe Laws of Calf Data - +•
o
NOTICE TO APPLICANT If.after in pk rgh sC ruf m fE cmDl yogshould
Z bac b3tothe h C
Q0fonnI Provision,oRh Lib«Coda.Yomust'
mps ons
r•-
k'
or this permit shall be deemed revoked.
SONSTRUCrION LEPDING'AGENCY ,�.
- Ih rtb3 ynri thatthem is A u6n,truclonilatach,age yf me perfomince
W_ Aldo,ward,lia,whicb th p 't ':wed fSe 30?7. " I
gL, .Ikndcr'sName_'.......... ...:...... ... .. ,... _a,,r•. r,
�.z
Lcindar;Addrell
Iccmfy tlI,Ih dth: (Plitt ml.tt th nh bo information to V
gree to cpmplY lh II cityAd county ordinances,and ahma las lating
f) pobu ld n8 construct on,and hemby amhbnac mprtwnuuves of thi thyro enter upon,
�I kzl me abm'e tnr t, 0 property f pectin p rpm., r
0. (Wr) e t damnify andkoep h les.the C t,"1'C pair o apalmt
L :h habi es,prdgmems..cos,and expenses which MAY in any way acerve against said
IJ Z C gnceofmc grant gofmis '• G
PI AN'pUUYD�E[RST NDSA�/p\/P�LLCO PLY WIT LLn.ervrL Issued by: Date
G `m °' '— Re-roofs
def d b the Cu ARDOUS MATERIALS DISCLOSURE I '
g.339 n A vv I r t re bd la g occupant (IXC«neral naaaN twines) - Type of Roof .
w
H
Will tha be
Y Dolt Municipal Cod Chap 9 13 and m Healm ares Sof ry f. I ••' rt ' r c - - .. --. ..- --' . .•_ -- -- .
Code Sm 255321,) t t II r 1' .'4 •,• '•r31 ,'..
❑vex ( ' °" tf :. 1. a15� `
All roofs shall,be inspected pnor.to.any roofing material being installed._
Sv 11 the pp`n future r bold' goccupantay AAA Ai t er namt If a roof is ins ed without first obtaining an inspection;llagree:4o remove
emir n b u tea fined by be B y,a ,A Q I ty Management
°Y L)No :• _ _
all_new materials for inspection. Applicant understands-and will comply with-
- - -
- ' " all non-point source regulations:
1 e the harardaus a mrials req mine blunder Chapter 695'of the I
Cnlif'o d H' in G Safety Cade.Sections 25505 25533 and 25534.1 undrrsmvd mal
i e 'ildi docsnof hoodyh mama that t resp" ibrl'ty to notify me• '- - - - -- -
._.. ... .
t h aqui I. m t pct suMe CemBcne a, 1 -
� I
mlis- i
Signature of Applicant _ Date
Amer
Auth®r d a nt a, �r - I Datr All roof coverings to be Class "B"or better
-OFFICE. .... . ..