01100026 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7558 HEATHERWOOD DR MCKENNA LANDSCAPE 01100026
OWNER'S NAME: APPLICATION SUB DATE.
BUCKEL JOHN J AND ELIZABETH R 15573 BENEDICT LN 10/04/2001
PHONE: SANITARY(408) 356-1842 NO. CONTROL NO.
pW ARCHITECTBINGINEER: BUIL 0PERMIT INFO
e m E BLDG ELE PLUMB MECH
y a c LJ 7 L`J f-.a
LICENSED CONTRACTOR'S DECLARATION
5 y g Job Description
Z hereby affirm that I am licensed under provisions of Chapter 9(commencing
;felt- wit Section7000)ofDivision3oftheBusinessandProfessionsCal andmylittnse LIGNTING, LANDSCAPING & S
x s full farce a rHen. N 1 S6 L 3q 3 Sre�m< nnu ax C`xaddr or TARCHITECT'S DECLARAONi
FYNA
LEDLLO
]understand my plans shall heated.,public rccnrds
oLicensedPrafexximul MAY 0 7 2002
OWNER-BUILDER DECLARATION
w I hereby alErm that 1 am exempt from the Canwnor's License Low for the
S?a following reason.(Section 7031.5.Business and Professions Cade:Any city or county BUILDING6 5
ee''CFC which requires a permit to construct,alaan
r,improve,demolish,or repair y structureY 0 0 0
i Is E Pct nor'ro ssuutce;dso rcgmes the oPPlcmtfw such pemuuo Bl..agmdaammeat• •-
...... _ _
M the 9censd ptsuant m Neprbusionsof the Contractors License Law(chapter 9
(c rmn ncing with Sect on7oful of Dinsmn Sof the Busmen pd Pofun...Code)
3'5%F"-W °L®xfP�i:%IATIC - . Valuation
m than tie a exempt therefrom soothe basis for the alleged ridmpibe.Any violation
-af Section 70313 by any applicant fora permit subjects d s applicant In.civil pmalty �t,,�,k,a,�
of ria mare than 0.e nmared sonars(ss a). 101pAEN t'C7UtVt7ATI ON Occupancy Type
❑1,as owner of tW pmpcny,or mY employees with wage az their sole compcosmion,
-will do the work.and IN,someone is not intended or offered for sale(Sec.7044,
Busineis and Profusions Code:The Commam's License Law docs not apply m on 103 - UFER Required Inspections
owner of property Who Wilda or impmves thereon,and who does such work himself
_ar through his own employees.provided that such improvements art not intended or 104 - REBAR
arfdme far sem.If,however, be Wilding or improcemrm is sold within one year or . . 1 O S - ANCHOR BOLTS .� . .
completion,Ne owner Wilder will havee W
thrden of proving that he did not Wild or `
imfaro.e far faarfaaxe arsale.). 106 - SEWER & WATER
.._. .
°Laowner of the Property,armBusidevrlbcanwaGngwi Care:)ne Chraemrsm 202 - 'UNDERFLOOR PLUMBING .:-;. -ri,•' •e '- -'
canxwn Ltheaw
Des n(sec.7044,Basted and Professions edea)The improves thereon. 2 0 3 - UNDERFLOOR MECHANICAL
- - License law does ria apply m an owner of propcny who Wilds or impmves thereon.
and who contracts,for such projects with a co aranods)licensed pursuant to the. 2 04 — UNDERFLOOR FRAME —
Comrectors License law.
- °lant exemnunderSec. B&PC.fo..his reason 205 - UNDERFLOOR"-
INSULATION
owner ' ' Date' 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
lhreby affirm ands Pendry of perjury one of the following declarations: 303 — ROUGH MECHANICAL
+ ° 1 have and will'ma mmn a Cenifcam'of consent m sdf.imure far Worlows 304 - ROUGH ELECTRICAL
Compensatiom as provided for by Section 37W of the labor Coda, for the 305 - FRAME
performmrte of the word for which this pemtit is issued.
°I have and will mainrain Workcr's Compensation luxuriance,ai required by Section 306 - HOLDOWNS
- 37 W rd the labor Code,for the performance of Ne work for which this permit is 307 - INSULATION
My Wrorkers Corn-pe t I sud_ce rather and Pat ry robe
a�e L'G /f, 6 t PaiirYNo: 1 30/100 19 8 1 OSI }. .:.3,08,.n- . SHEETROCK
c
CERffbICATIONOF EXEMPTION FROM ORKER$R'
-, COMP ENSA71ONINSURANCE' 309 EXTERIOR'•LATH
__... _ _ ..310, ,-INTERIOR- LATH_..__..- .;
-(ibis section need not be completed if the famous is for one hundred dollen I' -
(S100)arless.). 311 - SCRATCH COAT
' I coif that in the performance or the work for which this 313 - ROOF NAIL
Y R permit is issuN.I - •
shall'uot employ anyan
,person in any mner an as to become subject to the Worked' 501 - FINAL ELECTRI CAr 'L
A ' ;-ENERGY
Aantpplicon Lewxorcddbmi..nate 502 - FINAL PLUMBING ENERGY. ..
NOTICE TO APPLICANT.If,after making this Cenihcateof Bxcmp"0 you should t
Z become subjecttotheWorker'sCompensationprevisionsof1helabo,Code,youmat 503 - FINAL MECHANICALENERGY
zforhwithcomplywiNsuchprevisionsorthispermitshallbedemdreveled. 504 FINAL BUILDING ENERGY;
F-� ' 1,CONSTRUCTION LENDING AGENCY SOS - FINAL ELECTRICAL
�.' '' I hereby affirm Nat there is a construction lending agency(rode petiom Lice
of
� Zthe work for whichthis'pem,hisissued(Sm.3m_7;Ch,C.) - 506 - GAS TEST )_
`ndrsrvam` 507 - FINAL PLUMBING;I.,, .
Lancets Address" .. ,
U:0 . 1 certify at 1 have read this application and slate that the above information is 508 - FINAL MECHANI CAL
hr'F cbrrtct.1 ague m comply with all city and county ordinances and sane laws elating5 0 9 - FINAL GRADE
O: w
.V to Wilding construction,and hereby amhorissemti
reprenves f1his city m enter upon
;t. W theaWve-mapdonedPloppnmyforinspectionpurposes. . 510 - FINAL PLANNING
L. A. (We)agree to save:indenify end keep harri the City of Cupertino against
h .liabilities,judgments,costs and expenses which may in any way accrue agolnxt said 514 - FINAL UB C
V zCiry in c sequence of the gaming of this permit., •.
CAPPL, 'a
A UNDERSTAN SAN WI MPLY WITH ALL NON-POINT"
SOU EREGULATf NS t- /7_r A' Issued by:
i t fApplicxn., moa r pate Re-roofs
HAZARDOUS MATERIALS DISCLOSURE _
will Na pplicant future building arc pant swan or handl hadNam material Type of Roof . - • - ---- " -
ssdeli ed by the Cupertino Municipal Code Chapter 9 12 and theHealth and Safety A,*Code Secton 25532(.) s I * j' -l .... .a ' ..• m•Y ° w i:1. 1 '1 a I.
❑res Na' ',All roofs shall.be inspected prior_t11 o.any roofing material being installed. _
Will the applicant or future building prem use equipment n devices which t `
amt inductions air contaminants 'defined by the BayArea A Qu Quality Management If is Installed'Without first obtaining an inspection,'I'agree to'lremove AM
f Dlat nall new materials for inspection. Applicant understands and will comply wit
°Ye ON. all non-point source regulations: ' t
�� I have mad.the hazardous materials requiremcros'under Chapter 6.95'of the
CaLfomta Health&Safcty Cid,Sections 25505,25533 and 25534,1 understand thin
fth dN gdocy- o currently ave creat that itt my responsibility m unify the
m he quitm I hch 'nbe tpriorttiss m
ce of aCflcdre of
a:�
"
ore, p ] r� o �V� Signature of Applicant Date
I n man thotaed agent 7C•t `7 All roof coverings to be Class:'B"or better