01090093 CITY OF CUPERTINO
• BUILDING DIVISION PERMIT CONTRACTORINFORMATI
BUILDING ADDRESS:. _ J PERMIT NO.
10535 S FOOTHILL BLVD 01090093
OWNER'S NAME APPLICATION SUB DATE
WERNER GERTRUDE A 09/20/2001
/ PHONE SANITARY NO. CONTROL NO.
s Z ARCHITECTIENGINEER:
O O BUILDING PERMIT INFO
O BLDG ELECT PLUMB MECH
tri _
5 y Z LICENSED CONTRACrOR'S DECLARATION Job Description
5 Z En' I hereby shirts that l am licensed under provisions of chapter 9(commencing
y__C� aysp s-uov 70001 ufL31v m 3arth B seta snap Masa Code end my beast PANEL UPGRADE/GAS
:rest U
ORIGINAL PERMIT 52182 DESTROYED.5
Date Comrenor
�a0�' ARCHITECI'SDECLAOTION_ , FEES PAID ON ORIGINAL PERMIT.
- N S r .I understand my plans shell be used os public onemes'
i 6 p p Umnsed Professional
ter„ OWNER-BUILDER DECLARATION -
1 hereby aBimt that 1 am u.mpt from the Constructor'.License Law far the
d a following memo (Section 70316.Business and Professions Code:Any city Or county
2 o which requites a Permit to construct.alter,improve,demolish,or repair any swcmm
63$ ..pior!9 issueme,aheregrimthc epplkc %fmsuchpumitmrikesignMsmwteem. . . _ _..
Jut he ii'littmcd pursuant to rh druVisions of the Conaacml.License law(Chapter9 Ft. FIOOr AICA•s• -
(cpmmenpng with Seniop 70W)of Division 3 of the Buiipess andprpfVcion:Cade) ": •; (-' eS9• , I ,,, . ;, ;-'. ration
or Net he is esemp(perefmm and the basis for the alleged saamptibd.My violation ' " " '' '' '''
'of$mioa 70313by any applicant for a permit subjects the applicant to a civil Penalty
as,opt man man five hrnerea adl.n as0o). 3 4 2' $�I 'b5b Occupancy Type
❑1,uoshe o k: property,as,.c is oreexwiN wagesupeer telecompeasetiaq '
will dope work and the sumnure 6 not intended or oRered for sae(See.70,14,
. Bush na'and'Professions Code:The Convector's License law does not apply to an 304 - ROUGH 1]39 IT MPI-iPctions -
owner of property Who builds or improves dsereon,and who does such work himself
or through his own employees.provided that such improvements are not intended m 501 - FINAL ELECTRICAL ENERGY
-:Offered far salt.If,howwer,the buitdpg as,bnprovcm.nt is veld within one year of -
completion,the ownmbuilder will have the bracket of proving that be did Out build or 505 - FINAL ELECTRICAL
improve for purpose of sale.).
❑L u owner of jec property,7{am exclusively contracting with da:)Thcontractors to
Onrwa me project(See.7004,Business end Profwsnot Cade:)The improves
Om or'. llJb.
License law ams not apply man owner of propmy who builds or improves Merton,
and [&.Lncss for such pmjms wire•romrumKs)livaied prruant m the.
01 mrsals,i under
Lew. 2 2002
'y r ❑I em exempt under Sce: B@ P C for mason NOV`� If -
.� 't• f t
Owner .... -
-;ijy ail WORKERS OhfPBNSATIQNDEGLARA710N ,.ps _ tst, uy .��
I hereby aRnn under Penalty of perjv one of me following declaado s BU• 101 N"y
^
❑ 1 have and will meimein a Cenifimte of Cmsem m relf.imurt far Wnkeri
Compenmum, u provided for by Section 3700 of the labor Code, for the
pekamuac.of the work for which mist parent is iurd. ,
❑1 have end will maintain Worker's Compensation Insurance as required by Section
3700 of the Labor Code,for the pemformanm of the work for which mit permit is
i. issued.My Workers Cnm,amsdon Insurance canons,ad Policy number am.
Carrier L..i:� i.. :.v ":.:� 'Policy No.: - .. . . ".. _... .. _ .._. ... ._.. .
.. 'K'• : FR
--::CERTIFICATION ORMEMP ION OM WORKPA I,
....... COMPENSATION INSURANCE. •. .. ' ., ♦'
IThii eectic.need not he completed if the permit is for one hundred dollen
($IW)as less.)
1 cerify'that in the performance of the work fm which this ' -
pt ad t it orker 1
Com ons employ any person in any manner so u m become subject w she Workers' •- '
Comps--'n laws of California.Date
Applin ...'. -
"NOTICE 70 APPLICANT:IL after meds,oris Cemficue of EaempOon,you should -
C 0 tiecome subjen m pe Workers Compense,ion provisions of me labor eodq ym retia
fonhwim'eomply With such provisions or this pemut shell be,deemed revoked.
-CONSTRUCTION LENDING AGENCY
�. 1 binary affirm that pert I,a cmamcuan liths,.,easy for the PerfarmaiRe'
w. of die wmlrfar which oris pandit is issued(Sac.3097,civ.C.)
gyp„ Q Linder.Nem.
Lenders Addmp ..
'V'� ':•.:(I wufy thasl lave rtad Jeri apPlimtian and sum per the above infoamuion is
k+j Fa ;comn:d agree ta'romply".wiN'all city end county oidinences end stir laws rtlating
�.D�Q .so buildingreastrakion,and hereby eumodu reprt'mose,Of Nis city mercer upon
ebove-mentiond property for inspection purynses.
(W.)agree m save,indemnify and keep haml-s p.City of Ctipcnino.guns:
y liabilities,judgment,cost end per"
which may in any way accrue.paints said
VCity in cnuegvence of the granting Of pis person ,
APPLICANT UNDERSTANDS AND WLLL COMPLY WTm ALL NON-PoLNT
• SOURCEREGULAnONs. Issued by: Date
S,gnaltre of Apphcan✓Conuacmr Dere Re-roofs '
,. HAZARDOUS MATERIALS DISCLOSURE
'.N'dl jhe applicant v from W96n8 decupant atmm m hand.humdaui material —Type of Roof
m defied by,me Cupcaino Mrnid]*Code,Chapter 9.12 and the H.alth asd Safety -
CodaSectian295321e)7. i_ '„ ,i.•_.t,a .1.• . • , ". . ,u ..
oar. Nola., All roofs shall be inspected prior to any roofing material being installed.
Will the eppli.sm or Idiom building occupant use equipment or devices which If a roof is installed without fust obtaining an inspection, I agree tdremove
is harddous air contaminants as defined by the Bay Asea Air Quality Management
D1trLC
Man C Na all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
ve red she hewdous maam" requirement unit-Chapter h.95 of me
Healp @ Sa(ny Cede,g-tom 25505.23533 and 25534.1 undersand per
ng does not curretly have a tenant,that it is my responsibility to notify the
f the requirements which must be mai prior m issuance ofi Cenificare of
Signature of Applicant Date
uthorized agent Data I All roof coverings to be Class"B"or better
—.i
:.. •- ..,.t .: . ,. - ' OFFICE •
CITY of ,
CUPEOINo
BUILDING DIVISION
I'I' CONTRACTOR INF*IATION:
�
BUILDING ADDRESS: I PERMIT NO.
10535 S FOOTHILL BLVD 01090093
OWNER'S NAME: APPLICATION SUB DATE
WERNER GERTRUDE A 09/20/2001
ONE:
SANITARY NO. CONTROL NO.
4082575076
ARCHrMCF/ENGINEER: PHONEI BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p I PANEL UPGRADE/GAS L__1 1__.3 1._J I_-I
{u o o
fN>PP'CTICINS DATE INSPEC TO ARRANGE INSPECTION JOB DESCRIPTION
CALL 771-3238 MONDAY-FRIDAY 74 HOURS
u� SIDFNT_IAL:
El
BEFORE REQUIRED INSPECTION.LOB ADDRESS ❑ SFDWL O KITCHEN REMODEL
i 'FOUNDATION/PIERS/H.D.S. AND PERMIT M ARE NEEDED WHEN PHONING.
y_ 13 ADDITION ❑PLUMBING RE-PIPE
,�t tUFER GROUND O MULTI-UNIT 0 STRUCTURAL
�X< PAD/SETBACK-CERT RESIDENTIAL—COMMERCIAL_OTHER_ MODIFICATION
Is
GARAGESLABS/PREGUNITE 1 HAZARDOUS FIR .ARFA O INTERIOR 0CHIMNEY REPAIR
'E:0 I POUR NO CONCRETE.UNTIL ABOVE HAS BEEN SIGNED IMPROVEMENT FI SWIMMING POOLS
E�' 0 YES If yes•!undnnund that a Clms A mef assembly is required. 0 BATH REMODEUREPAIR O DEMOLITION
p o UNDERGROUND/SLAB ❑ OTHER
S.y PLUMBING—'—' ' ^" ❑ NO Initial I.C.B.O.
N
Wz EL CFRICAL ,
DO NOT POUR FLOOR UL ABOVE.HAS BEEN SIGNED $TING ROOF COVERING f_OMMERCIAI
UNTIL
❑ANEW BLDG/ADDITION [I DEMOLITION
PLUMBING 0TENANT 0 FOODSERVICE
L.
MECHANICANumber of existing covering. - IMPROVEMENT
'ELECTRICAL To be removed To be mta{ned 0 OTHER
.yar. FRAMING VENTS
INSULATION
•11,i PLACB NO SUBFLOOR UNTILABOVE HAS BEEN SIGNED TYPE OF ROOF COVERING
ROOFSHEATH/DIAPHRAM EXISTING, PROPOSED:
PLUMBING 0 Built-Up Roof 0 Built-Up Roof
TUBS&SHOWER PAN 0 Asphalt Shingles 0 Asphalt Shingles
MECHANICAL. 0 Wood Shakes:i : •t ❑ Wood Shakes
U,'.I
❑ Wontl SM1idgtes 0 Waod,Shingles
BLEGTRICAVP001.BOND
PRAMING/STAIRS/E.EGRESS OOIM1gr,(Specify) :—+. sI�, ❑ Other(Specify)
INSUI.ATIONIVENTILATION Provide I.C.B.O.Report No.
GRNO WORK UNTIL ABOVE HAS BEEN SIGNED Provide Mfgr.Installation Specs.
EX7•ERIAL SHEAR%HOLD DOWN
INTERIOR SHEAR/HOLD DOWN INSPECTION SPECIAL INSPECTION REQUIRED D DATE INSP
SHEETROCK/SHEETROCK SHEAR
- "P.X •f6R.LATR/W-SCREED
SHO'hER LATH
NO TMB OR PLASTL'R UNTIL ABOVE HAS BEEN SIGNED
.SCRATCH COAT
•SEWER/WATER
.•TEMPOIfARY APPROVALS
OCCUPANCY '
FINALS
PLANNING 777-3308' .
0 Q GAS TEST
GRADE fP.W.777-3354) -
� 7„ FIRE . .
0- HANDICAP
6;jj C ELECTRICAL'.
F PLUMBING
y Uri MECHANICAL
ENE ROY:.
U .VJSl/ACFINAL ONLY'
OC CY OPULIBLDING IS NOT PERMITTED
%*hf BUItD)NG F1NAL IS SIGNED BY BUILDING
JrxSPGc•-TGk_ _ CERTIFICATE OF OCCUPANCY 0
•' 'r ''PRE-INSPECTION': ' PLYWOOD: IN-PROGRESS
INSP.' DATE INSP. DATu INSP. DATE
TP,AR OFF INSPECTION: BATTENS: - FINAL:
,INSP.' DATE INSP. 1 DATE INSP. DATE
< " NOTE:'OSHA APPROVED ACCE S TO ROOF SHALL BE PROVIDED FOR INSPECTION
;','� ¢PPLICANTS POSTING COPY