01100098 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7558 HEATHERWOOD DR MCKENNA LANDSCAPE' 01100098
OWNER'S NAME: APPLICATION SUB DATE
BUCKEL JOHN J AND ELIZABETH 1. 15573 BENEDICT LN 10/17/2001
lZ PHONE: SANITARY NO. CONTROL NO.
(408) 356-1842
WE
cc ARCHITECf/ENGINEER: BUILDING PERMIT INFO
m U F BLDG ELECT PLUMB MECH
H a c LJ _"I LJ -
5 w 2 LICENSED CONTRACTOR'S DECLARATION Job Description
z_O 1 hereby affirm Nal I mit licensed under provisions of Chapter 9(commeneing
=1]� with Senion 7000) f Division 3of the Business end Professions Citic,rodmyliceme ADD ARBOR.
is in tan rare an < <ri �6..343
S s Li«ns
U ,11, LI[,M
O a Dam fu Contractor O
3 a 0 L'-, ARCHITECT'S DECLARATION
u`a 00.5 1 understand my plans shall he used as public retards
3 i p 2 Licensed Professional
' o a OWNER BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contncror's License law for the
h?< following reason.(Section 70313.Business and Pmfmmma,Code:Any ciry m counry
Sd o q pe rut offer,improve,demolish,or repair any structure $5000
uth is is s exempt mitual nm a themom,of tooth Perot t to im a ngtrW smmmem ..__ .. _ _ _ _ _ _ _
w rtes construct,
or
'o tot els uircs _.__
that his s I m sed p nue 1 to theDroit ions of the Confixtors L tens few(Chapter 9 Valuation
(comment ng with Sect 7(KK1)of Division 3 of the Business pad PmfGuions Cade) 1.1 l 's t 1.3 9*2 9 r; 0a„•G• 1:y � g t�,\ ,
' and the basis for the allegdl eAanpt oG Any violation U h P
of Station 7031.5 by any applicant for a Permit subjects the epplicam to a civil penal'y
�,q -
Of not mothan five hundred dollars(ESfNIy
re 10 i PN DATION Occupancy 1`yp e
C L,as owner of the property,or my employees with wages IS their sole mmpensauon,
will do the work,and the structure is not intended ar offered for sale(Sec.7044, 102 "TRR.15;
'Businessand Professions Cole:The Contractors License Law does not apply to an 103 - UFER Required Inspections- '
owner of property Who builds or improves Nexon.and who does such work himself '
or through his own employees.provided Oat such improvements are not intended or 104....: REBAR
offend for is.If however,the Wilding o p cmem is sold within one you of
mroplt m rbuld< will have the burden fps gmathedid atWild or 105 - ANCHOR BOLTS
improve for pairpairmse ofame), 106 - SEWER & WATER
El 1,as owner f the pnpeny am exclusively contracting with licensed contraction,m202 - UNDERFLOOR PLUMBING `
can i'hep ) t(Sec 7044 B lid Prof as Cade,) the Coinmmors
Limme Lita,eesnat.,,i,I. ..or orp pay who bildstoimproves thermn, 203 - UNDERFLOOR MECHANICAL'
and who cantata for such projects,with a comm<mr(s)licensed pursuant to the
Contractor's License Law. 204 - UNDERFLOOR FRAME . . . ."•. . . . �__
"
❑1amexempt under Sm. a&PC for this 205 - UNDERFLOOR` INSULATION
owner Data - 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
302 - TUB H OR SHOWER
' I barony atGrm under penelry of perjury one of the fallowing dederadons: -
, � 303 _ ROUGH MECHANICAL
❑ 1 have and will maintain a Cby Seti of Conant io xl&insure for Work the 3 04 ROUGH ELECTRICAL
con,penxhm, as pmvmee rte by smdrn 3700 or he Lobar case. for m<
Performance of the work for which'his permit is issued., 3 05 - FRAME
❑1 bade ad will maintain Worker's Compensation Insurance,as sequired by Section 306 - HOLDOWNS
3700 of the Labor Cade,for the perfmmence of the work for which this permit is
issued.My Workers Compensation Insurance wrier and Poli number am: 307 -
y . . Pe -_., Policy
Comer LC* S• V 1 i,. ..• �ya� -...,INSULATION.....- .. , , ._ ._ _...._._� �..
„ CERT CATIONOP,EXEMPnONIly�OOKHAI�OAI ,f �•, jt308�' , SHEERIOCK,.ITH'
I . \ 309' - "EXTERIOR'"LATH' 1
_.. _. COMPENSATION INSURANCE .-.',a _,•,_,4, " _..-_. ..._.._... . .._
p perinaiarmrmnrnaxadmlars 310,..., 'INTERIOR7LATHr..__ .
"(This senior need not ha'cnm feted if the l
IS100)arlegs2 311 - SCRATCH COAT
P Y y.P any manner s as to Woom subject to the Wo _`.. ' .. ••>.. .. .f .• .. . "
I c n ry but in the.perfarm ' of work r hirh th s perm t Lssuw,l 31"3 '-'- ROOF NAIL ,
Coin rtsatonl.ewsafcslf ' rk<rs 501 - FINAL ELECTRICAL ENERGY
-Applicant'' 502 - -FI'NAL PLUMBING ENERGY
'NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
Z become subject to the Worker's CompensationprovisiousofthclabmCode,you mum 503 - FINAL MECHANICAL ENERGY
0 0 fonhwith'comply with arch Provisions or this permit shall be deemed revoked.
z 2 - .---- -- 504 - FINAL BUILDING ENERGy-
ra ' �,o'1, 1 CONSTRUMONLENDING AGENCY SOS - FINAL ELECTRICAL
' 1 hereby affirm that there is a construction lending agency for me performance
of the work for which this permit is issued(Sec.3097,Civ.C.) '
,P�•t p _Una N 506 - _ GAS TEST i _. . .._ ..._.. . _.
G'z Lead Address 507 - FINAL PLUMBING.,.,I:,'I
U'0 1 camify that l have read his appl Cat on and s,am that tae above information is 508 - FINAL MECHANI CAL
'correct.1 agree to comply with all city and county ordinances and stem laws mlating 5 0 9 - FINAL GRADE
0 U to building cmmmnion,and herby umad
hm representatives ofmis city to enter upon
the above-rhamionedproperty for inspection Purposes. 510 - FINAL PLANNING
y, We)agreem,cost indemx,onwx keep which
in me City 6f Cupenino a gain' �J
to liabilities,judgments,costs and expenses whien may in any way accrue against said 514 - FINAL P C WORKS
C.7 ti City in consequence of the gmming of this pert. -
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
solm R sltLA vs. ' r• Issued by: Dale
Signature o pphcam/Commctor, : - Dne Re-roofs
- HAZARDOUS MATERIALS DISCLOSURE '
Will me opplicantofmrnbuilding occuptimatione,or handle hmallon material, Type Of Roof - - •-
as defined by the Cupertino Muppp c'Pal Code Chapter 9.12.and the Health and Safety - -
Code Section 25532(0)
oY t:'I 4 All.roofsshall be inspected prior to.any roofing.material being Installed. ,.
•, Wlldueapdi an' futueb ldingOccup ntmeNupm t rdaviceswhin If a roof Is installed without first obtaining an inspections I'agree.6 remove
emit hamrdous tar conmmrm us`]es/•&rncd by me Bay Area Air Quality Management
DistricioYe. ' a/Na all new materials for inspection. Applicant understands and will comply with
L-. I "1\\\ , - all'non-point source iegulatioris,
1 hada iced Safety
ety Ca e, eitionals 505,2no,ifir533 a under 4,1 un 6.95 of me
Californiabuling Inlth x Safety Code;Section ant,that
it
and 21534.1 understand that
occupant of Of rear mentscummanly lose a tenant,he tier prior
r my nuance of tonotifythe
occupant of the requirements which inuq be mer prior m issuance of Cenificmebf
Occupancy
l0,
ws
Signature of Applicant Date
Owner or authorizedauthorizedn'aed agent � Dem All roof coverings to be Class "B"or better
OFFICE _ . .