02070105 CITY OF CUPERTINO - -
BUILDING DIVISION PERMIT 'CONTRACTOR 'DWORMATION:
BUILDING ADDRESS: PERMIT N
10581 E ESTATES DR LARRABEE CONSTRUCTION 2070105
oS, TAN SIC DWAYNE E AND CARMEN M T3275 STEVENS CREEK BLV, # OP➢1ICAT QN,sY'TA'/ 2002
HONE: L V
(408) 985-4121 SANITARY NO. CONTROL NO.
C s Z ARCHITECT/ NGINEER:
�O p _______BUILDING PERifIT N'FO
a U E BLDG ELECT PLUMB MECH
„ate I_I CJ L. I LJ
St- 2 LICENSED CONTRACTOR'S DECLARATION
vp Ihereby arr that Iam licensed under provisions°fChapier9(commencing REPLACE INTERN ' 11 ST
in t_a with Section] )of Division 3 of the Business arty Porfessmal Code and my littnse
in full force d effc )((
o ce U Li<enu Cm Lic.a S'7 5<l 13
Data Comran,t l TION e. lI—�B Vrt I"aC[Se lrm
LL o G ARCHITECT'S D.�Ci1�,RATION ,
g I understand my plans shall w true a bbe rc 2l,
iE
e O Professional
O Licensed Profil
X OWNER-BUILDER DECLARATION
m m that JUL 2 3 2002
I hereby eRrI am exempt from the Connector's License Law for the
I Iz following mason(Section 7031.5,Business and Professions Code:Any city or county 1850
F e which requires a permit m u
conmct,rim,,improve,demolish,or repair any a..cm
373°° '-poor to its issuance,also mquiresiw applicant for such permit file o signed statement- - i X19 ITIPaI . - __
that he incensed Pursuant to the pro'ii s Of the Contractors License Law(Chapter 9 T 3�,q .....
(commpptt ng th Sttt op]000)OfD on3 of the Busmassaid profesnons Codc) x , Y 3- S V i' ky Y Valuation -
or shot he ns is m uharefrom and the basis for he aIle P ed esem�ten.An a.''.1.. x v s ; S.' i. \}.. S ,}, ., _
c P A y v°lauon
Of Section 9031:5by any applicant for a permit subjects the applicant to a civil penalty
of not more moa five hundred dollars(s500). l 0 APN Ilei(AWDA ''�ri?'+r-::'- Occupancy Type
01,as owner of the property.or my employees with wages as their sole compensation, 102 - PIERS
'will'do the work.-and the-strvvmre'ii hot'intended'or-offered'for aale'(Sec!][N4:
'Buslnessand Praresdons code:The Contracmr's License Law does not apply to an - Required Inspections;.,;•`::.�,7.
owner or property who wilds or improve,thereon,and win dors such work himself 104 - REBAR
or through his owa employees.provided the such improvements ate not intended or
-
offered for sale.If,however.the wilding r imp y
I. gorintiovementia,mdwitmnone ear or _ .-105 '_ ANCHOR-BOLTS - -----------. ..-----._.._._._._._ _
completion,the Owner wittier will have the burden of proving that he did not wile or �`' -'.�O
improvemrparpam.1'sale.). 106 - SEWER & WATER
— --
2 0
;; 1;as awar of the Miserly,am exclusively contracting with licensed contractors to- --- -- - --- -- - ----- --- - --- -----
0 ---._. _.
rmmaruct the Project(Sec.7044.Business and Professions Code:)The Commmon s -" v - -- -
- RFLOOR PLUMBING-
LicenseLaweoe, or apply to an Owner of property 203 - UNDERFLOOR MECHANICAL"0
cc rww builds nonan thereon, -t:..,r r:u,+r .r....,
.ane who aontnense La soch.proja¢wim.a.commctodaJ.cansed.pursuano m the..__-__.__..__2.0 4.-_.-_..UNDERFLOOR_.FRAME
❑Iamexempt und. I.w. l '" ' "",B&PCforthisreason 205 - UNDERFLOOR, ;INSULATION
Ownc WO... COM Dole
Dom' r il'. .i..I
301 - ROUGH PLUMBING
KE DECLARATION -- TUB & OR SHOWER
Ihereby atrrtnunder Npaltyofp<'rjU_rypno fthe following decmmtions:- 303 - ROUGH MECHANICAL
d
01 have ond'will'maintain a CeitiBcalc Of Conscni to uif-Insure for Worker's 3 04 - ROUGH ELECTRICAL
: Cpmpaiummq-m-provided for by Socano 3700 or the 11, Code. for me 305 - FRAME
pedomte c f the•work f h<h ts pens t ed .
of have 'M Omainta WOA Cmpcwi 1 en�e,as rcqufrce by Section 306 - HOEDOWNS
_ 3700 f ane uhrc ease,r the pear mmm of Ne work for which this permit is 307 - INSULATION
o Myw ftes COmPerstaximn firsurimer cadricr and Policy mber&a _
308 -. SHEETROCK
rriaF'4eY1e6 M•i{\ Policy Nls�/ �1\3 Q\ .. . r=.-..
t CERTIFICATION OF E%EM FROM.WORKERS 3. t. I a 3:09;,- .'.EXTERIOR,LATH• '+-'s rti'r•;'i
3 _
; 'COMPEHsanoNwsuRANCE ' 3.10.�___INTERLOR_LATH_._._ _
or : .n«a
not beaomvrteenrmaparmnsfir,
one hundred do][. 31L`"�f `SCRATCH COAT .., t I�);' .
W) box.)
:n! I cert fy.tnm'n'A perform o or work f rwhichmi pe s "- - '-'- ___,313.._.7-.,,.ROOF. ,NAI L-_,,,, l _.- -•
sued 1 . ...^_.
m1 to ply ma i Y niter ast hecmdshlemt ineWorkers 501 - FINAL ELEC'TRICALibENERGY.-�
Compcneevon Lows or California Date"` - •
Appl t : �. _302_ - FINAL PLUMBING ENERGY
NOT,TOAPPLICANT If a4 akig the Cenfeam of Exe pe On y' chola 503 FINAL MECHANICAli,'ENERGY
Z become subject to Workers Compensation Provisions of the Law Cod you most
Z0 fonhwthco ply th such movisionsor,sp,othshallwdea drtoke. 504 - FINAL BUILDING ENERGY
cor4sTRurnoN LENDING AGENCY
505 --FINAL -ELECTRICAL- ' '
"''"' Ihertb affnh thattho, sacomAuct° 'I e 506 - GAS TEST ,
C s7 Y g agency for the perfomuiice •" `
�- of me workf which th,pe 'i s ed lS<c 5097 C .C.) "•" " _ v � t .. i
i
G.q ISMa,Nm - .-----"507— -FI-NAL -PLUMBING
Lende ,Ade ess ._ -- '- -- _
V O 11 t 308 - FINAL MECHANICAL""
. I comfy that 1 have mad this ty. cmnon d stem that the awv laws minting
is 5 0 9 - FINAL GRADE
4a F correct:1 agree to comply N 11 iry.uid c tY ordnance,ane.-'-'a la s rtlatrng
0 C.) t Wildingco struvion.and hemby enhance mpoicomfivaa of this city to enter upon
W theabove-mentionee,properry for in purposes. SIO - FINAL PLANNING
L., (Z)A. (We)nineave d IfydndkeepharmlumeCityofCupennoegeiast 314 - FINAL PUBLIC WORKS
Z City liabilities,,judgments.cost and ex s h ch y m y war ccm ge st said
f.) Z City iii qucnce oft, grant g this'pe t `w.v
AP [iP.'TUNDEkSTAt.TJ i Wlw 014PLYBITHALLrvONPOSIa 'I"' Issued by.
U EQUULATfON i Date
Si- art ofApplicrovC van !" ^"f"' ;, Re-000fs
Dte" .:1
' H RDOUSMAA RUIZ DISCLOSURE r - l"O '
`I Will the - P.M. g occupant wort or haMl hoard s coal
darned by daPPl pen i b° cpae.Chaps 912 hi Health aeomond Type.of Roof t." i
Cotle:Sm 25333(ala 4 u fyf C 5'I''i t t " . s. ! )\ '. + 1.
wnthe.pplc. torr .. - ._All roofs shall be mspected.pnor.to any roofing material being installed.__ -
[It ueo s uimne gq` pat " qpm iota a: hien If a roof is installed without firs[obtaining an mspec[ion;Lagree[o remove
y me B y e A r Quality Maines hent
D9nf all new materials for inspection.
-oY r pe Applicant understands and will complywith
°No `vI :( all iia_p6mf source regulations ,u d
1 hoc moil tie hecand-tre met m a mqu'mmenu'Imcii Ciapicr 695bLNe i
California Health'&Safety Cif`hod,Sccv ns 25505:25533 and 25534.1 understand that
oc P e .ante t h ss r o notify the
O, ¢bile n il s not cu dy ha ten i t l i ice of a C n fiate of
t my spa blryt
w Si nature of A lant Date
7 iJ p g PP. .ic. _.._ .
w" '"
mot + - : I Date All roof coverings to be Class "B"or be'tter
i tik
OFFICE. .