02020069 _: CITY OF CUPERTINO
BUILDING DIVISIONPERMIT CONTRACTOR INFORMATION:'
BUILDING ADDRESS: PERMIT NO.
218;55 EATON PL RJC CONSTRUCTION 02020069
OWNER'S NAME: APPLICATION SUB DATE
LIND'SEY' 'VOKACH-BRODSKY 21 MT ALPINE PLACE 02/20/2002
PHONErt Yf1.i a"t r _3`. " ' " ^•'• ' SANITARY NO:' ". CONTROL NO.
(925) 672-8925 a11z .
p 02 'ARCHITECT/ENGINCCR: -' ' BUILDING PERMIT INFO
U - - BLDG ELECT PLUMB NIECE
a•6 _ _ L� 17 1 L-J L_1
LICENSED CONTRACTORS DECLARATION
5' r In b tfi�nth tl licensed. d n Job Description
>Z p y apro' sof Chapter 9(commencing ��.,�M - P
t-w lh set 70M)ofl tineas es-o aP tcssinns Code.and myl venae �B^ L'L{vF'.L+• v E_LEVELING-' .
dms�sc s rurrcanamy/ aa1} £�'.�,f36
i 3,,.� u CI s wRCHITCCT'S DEL•LARATION SEP 1 8 2002
a 0 si ...1 under d as Pum. .. .
Licensed Profersi.nal _ BUIo DINl ,
'o OWNER-BUILDER DECLARATION L7>♦/ 1� IY\.t -
rai.'=� 1 hereby affirm that 1 am exempt from the Cismar is License Law for the
C?< following rasion.(Section 7031.5.Business and Profession,Ede:Any city or county
Fp s p which d,.imk a pemtitlo construct•a)tar,improve,demolish:or repair any suture $50000
w'3 '.poor to its - I requires the applicant for such pi,rout to fle.,i,ncd statement. pt,p I�q _
tnat Imit,licensiedp rsuant train,e on,of the Conumctor.License Low'(Ch pncr9 ,_3 cry 1'7 S'Z7C:A•Ed , psi Valuation(commencing with Section 7000)of Division 3 of the Business and Professions Code) 'l.IY Z$i. `:�I•UL '1:>_; X1,t.v
or that he is exempt therefrom and the basis for the alleged exemption.Any%solation '
of Section 7031:5 by any applicant for a permit subjects me applicant to v civil penalty-
ofnot'mom than five hundreddollars(9500). , 1014PN� DATION wpancyType
Oc
❑1,as�wnc,.f Nd progeny:ur my employees with wages as mdr sole eompensatio i,
will do the work:and the structure is nut intended.,'offered for sale(Sec.7(kt4: - -
Busineis and Pmkssiuns Cade:The Conuaoor a License Law does nor apply to an 103 - UFER Required Inspections
owner of progeny Who builds or improves thereon•end who does such work himself
.1 dbghh o empl > Provided that n_ p n. <nintendedor .., 104 — REBAR
toffaread?o sle:lfhu a the b ldn6 P ei Id, thn oneY:v of - __ _ - ..-._,._. .. .. .__ _. .... .. ....
.mpltlmn 1the awoe,huldcr wul nave the n.Nen or pmv ng mm ne aid no bis ld of 105 - ANCHOR 'BOLTS
1 1'1npNK roripu,�,c of"1.11:•::! " i: 4{ _ { .
min
106 SEWER' &!'WATERi-
rhe,rinepropen7NmB.sinevelycommcungn,Chemede.mdoichr. 202 - UNDERFLOOR PLUMBING
LiceseLaw
project(Sec.7044•Business andpro Professions Calc)The improves
thermr's •
curators, 1py pmpmywh.builcensed rsuatntoshe 203 — UNDERFLOOR MECHANICAL'
, License Lawdocs not to vel owner of p
and rwho eamer Licns for such projects with a.mmmmorts)licensed pursuant m the
- Comistor]License Law. ,
2'04 - UNDERFLOOR "FRAME _ ...... __.. ... . ._ .. ._ .
111 am exempt under see o ;B&PCfw this rason 205 — UNDERFLOOR INSULATION
WORKERS COMPENSATION DECLARATION o •""' D"` 301 — ROUGH PLUMBING
' '
I he a Man oner Penalty of peijmy one or the rmlowin;declar-ums: 302 — TUB & OR SHOWER
303 — ROUGH MECHANICAL
I have;ad will mmorrin a Canificate of C.mdia"o self.mawe ra 00 Waren: 3 04 — ROUGH ELECTRICAL
mprnmiian. es provided for by Section 37of the Who' Cade, for the
perforrom tie of he work for which his,parmit is issued, 305 — FRAME
o I have d w R maiam n ice :m9 d by section 306 HOLDOWNS
]700 f o f
the
'if c f rk l which this pern.r is
_'a W 'stip= ma aPol,ymorb m 307 -INSULATION
Polic30.8 SHEETROCK.: .,.
er CERTIFIcAf10NOFEXEMPTIONFROM,WORKERS'+ t , °309' '—"EXTERIOR"`LATH`
'COMPENSATION INSURANCE- c
' .. 3T0','-- INTERIOR—LATH__. . ... ..............__—
•(This"sectionnemiiotbe<umpinedinhepertnnistoronewndmdeonars 311 — SCRATCH COAT
ISI WI wIcssJ "
is,.-ad I 31'3 ROOF NAIL `
1 mp that n the per non a of k r 'n n m pc r - " -
Cuaminiemply-611—.' yate so,smbecome oleo to the Workers 501 — FINAL ELECTRICAL ENERGY
pcn1 c 11laws of C IT mice.Dam,
APpI`aa' — 502- — -FINAL' -PLUMBING,,;ENERGY. -
ZNOTICLTOAPPLICANT If B making this C efcam of E- -pi you should
bbcon subjectt 'thew k, Compensation provisions dnn n Code,you must 503 — FINAL MECHANICAL ENERGY'
0 0 fonhw nh comply wile wen provisions or this permit shall be dcemdd revoked.
z -, "- '- - - 504 -- FINAL BUILDING !ENERGY --
p..0 ` _ CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL.
pe^^is a construction lendingn<e
of thn work far which this it is issued(Sec:3097.Civ.C.) '
�'
agency for the performs
yp 12nderanName IEmithmmdre ._ .: .. ..i. ,., . ._. -: ., _ _... ..5.06. — GAS. TEST.. _
U o dc,*,Address 507 - FINAL PLUMBING.
I certify that l have read this application and sure that the above information is 508 — FINAL MECHAN I CAL
F correct.1 agree to comply with all city and county ordinances and state laws relating 509 FINAL GRADE
—
0 U to building construction,and hereby anhoom representatives of this city m enter upon
y m meatima-memi nedp,.,,oyforim cclom ii,reev 510 - FINAL PLANNING
F„ p, (We)agree t.love,indemnify and keep harmless the ,ofj?i ciiino against
W liabilities,judgmenu,costs dna apenscs which i y} l6c a aga:nsI said 514 -_ FINAL PU 1 C WORKS
Z City inronse�eoaswpMgua' of this pe e�
'-' AP IJGn7R'II. ERSTANDSAN V .1PLYW•w• LRON INT 1
sr RCE RE'�ATt0' .- �'` Issued by: Date
'gnaturc of Applican interior' a Re-roofs
HAZARDOUS MATERIALS SCLOSUR -'
"- Wdl the a,Ii.t orPomm building occupant store or nand a hnurddus mamrial Type of Roof.
as defined by the Cup= e,sfiunicipaj Code,Chap ter 9.1 2nd the Health and Safety
Code,Section 25532(a)7' S .( 4`' d 6 :•
-.. ., ,_All roofs shall be mspected.pnor to any roofing material,being installed.___.-
Will the applicant or form building letup,Bay Anc9uip =monde Management
If a roof is installed without first obtainiti an ins ectiotL I-agree remove
emirhwmous aircnnumir form defined by the Bay Arca'As Qualityevices mem g P
Dann°? all new materials for inspection. A hcant.understands and will comply with,
I vee alvo, - .. P. :PP..: _ .: P Y
6 : all-non=poinfsouice regulations;
�-•'� 1 have read rhe hamrdous'material,requirements un '�epur 6. of the
califomia Hcall h&Safely Code:Sntions 25505.25533 }534.1. land that
•iftM.buildm does not curren0y have a m ark:N my reaspoasi ' yto notify the -
dacuppbtoftn list pnwt 1. of enificne'of
=De'pa . ,, Signature of Applicant i Date
ownern a.thon=ed agent'- ,t< All roof coverings to be Class "B"or better
::. - OFFICE