01070153 CITY ILDI c DIivis ONNtl' CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS: PERMIT NO.
22091 HIBISCUS CT CUPERTINO PLUMBING 01070153
OWNER'S NAME: APPLICAATIONUB DATE
JOHANSON ROBERT W AND MARY L 10297 S DE ANZA BLV 07/31/2001
PHONE: (408) 283-0618 SANITARY NO. CONTROL NO.
COO ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
w BLDG ELECT PLUMB MECH
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LICENSED CONTRAC'TOR'S DECLARATION
_ - 1 hereb ,rte mat 1 am tem ed unser Job Description
OZ_7 ya prov Praftsofns Code9lmmmccense
p�[=w win semim-elan 1aromi.ian3anne eaamew and Proresmnscode.and ter license BATH (REMODEL WZTILE.
S: terse lass Jsjf yyaa �1rFpG�
rc l tU License class Lid.p
S:
gu Dae S DISC sot LED kwa&.L/11W(71
o-�+ ARCHITECT'S DECLARATIO
G VMl
O g I understand my plans shall be used m public remNs
RLicensed Portrait...I PR 2 9 2002
- OWNER-BUILDER DECLARATION
vo 1 hereby affirm that 1 an.excmpn from the Cormacmr s License Law for the $9000 O 0
F Z> following rt n.(Section 7031.5,Business and Professions Code:Any city or mumy.
E F n which rcquirts a permit to construct.alter,improve,demolish,or repair any structure
�3_ .m wits usunc.ul q :res the aprl' If n perms m ries signed satenem
I
th rs liceridpursaunt to the provisions fh Container Lcenminw(Chaper9" qOr Ma vs _ , Valuation
(c mme c g_Ih Sas Id,7W) f Div s m 3 of th 8 mens and Professions Cafe) r j.y i•'3, �L 1 ..I�tI i�-i_i I :,�: O� Cl
or that he is exempt dispersion d the basis for the allegN<xlmptlun.Any violation
-fporfnS«cmioanodian Rive annnynadprepancamanlafror(nsspdc0n1r.ansubjcstMapplxamtoanullpenalty 10 lAPN YV&MAT ION i T"""-`" Occupancy Type
❑Lasownerofine norm em to cos with wages as their sole cote
pd th Y Y P Y B compensation, -
Busino be work,and the structure The Comical
not l Lice se teredLaw for.wend apply10i1'' 103 � UFER Required Inspections:
PIERS
-;.ill
and'Prolesxiann Cnde:TM1e Comrucmr's License Law Jocs nrn apply a an
owner or property Who hands m impnrves hereon,and who d:xv such work himself 104 - REBAR I
or through his own employees.provided ha such improvements are not intended or,
-',eReeei- ' ICICN -ertA building r P echo ldwimmoaevearar 1:0'5----- ANCHOR -BOliTS - 's�, ; .,,�,
cdmplef hBudde IlhasxheWdc ofpmvigmahedid not WJdor 106 - SEWER & WATER
improve for puo,seeryose of all
___.._._.._-._-_._—,..._.._. r
_ . Ph the
ec.7 am Business andPract,,imor gemedeContraonm — -UNDERFLOOR--PLUMBING — - -,- - -'
License Law
oesn (Sec. to
Businessandertywhob nose:)Theemtm«nrs 203 - UNDERFLOOR MECHANICAL"
License Law docs not apply m en owner of Progeny who builds or improves thereon.
ti ...and.whn contmr.m.f«.such.proeas wih.n commcmnq.uccnmd puraam.m the ..—._.___2.04-- UNDERFLOOR-'-FRAME-...----....._._..�-
r, Contrdcmra License Law..
❑lam exempt und«Sec.''' ;B&P.C,for this rmsm 205 - UNDERFLOOR`r'INSJLATION
l . . .. .. ..., .,
ovine, are
301 - ROUGH PLUMBING
WORKER'SCOMPENSATIONDECLARATION 302 - TUB & OR SHOWER
Ixrenyammandgp apy,orp«ia:Ydn onherouowingd mhos"oro 303 _ ROUGH MECHANICAL
ave und
_ ❑ 1 h 'will maintain'a'Cenifie of Conant to self-insue far workers
C:i " ' 304 ROUGH ELECTRICAL
Comperaaion,-as provide for by Section 37W ofvhe Labor Cale, for the
performance nnew
mancen ' „rkforwhichthisI ,irsssumfn,,, 305 - FRAME
O 1 have eiMwill mainain Wurl:er'S Cpmpenwiidn Gsuiatice,u required by Station
3 0 6 - HOLDOWNS
3100 of the Labor cork r the perry dmo f the work f i which this pc t r 307 - INSULATION
Is:e M rk is Co> n Ib:upmce r a Poly n or .
, t^uPtn rNn 0 0 308, j.. jS;HEETROCK
t t CHITI ICATiON,oB,ExBMPI'IONFROMWORKHRS 309 - •8XTERI'OR-'L'ATHI•
.-�,. COMPFNSATION,INSURANCE
3'10- =, NTERIOR—L-ATH— '- — ' -P --- — -----_._
b'' ' ITh:.sect nn need not be compicied tithe permit Is for me hands dollen n ,•' ")t'�•'� -;t
(Slnmaness.l 311 SCRATCH COAT
_ - -313 .._..-.ROOF- NAIL-
:.x. .
-m ply hat in the
perfantu c nth ork fo which h permit usue4l i
c0 it nan dr tq{2caq Bien to w«ke 501 - FINAL EliECTRICAli ENERGY
shall a m VY n rso�a ' 31 61
..A I: nt w u muldn :. _.__.... 502..-...RINAL._PLUMBING ENERGY_.._.__.
:NOTILE TO AYNLe Nr if aft ,us gl. mC�irc i re cops n yaa sn w 503 - FINAL MECHANICAli"ENERGY
L�.3 Ix r
PP _ _
� Z In wi s n^he WarIs C anon pro sons df the Whnr Cale,'you must
� rnrnwmeonnlwan. n n.mnaormspmtshall xd xd noonked. 50.4..._--_.-FINAL BUILDING-,ENERGY .,
FcoNSTRUCfIONLENDING AGENCY 505 - FINAL ELECTRICAL .
1 h rtby orlon ha here ns a const a n lercling agcmry far the perfonrlawe ,. ,_ t
w nth 'rkrrywhich thl Permit si¢aed(Sec 3091.Cis C) ;au , 506 - GAS TEST "
D,Z Lcnd 507 - FINAL- PLUMBING
U'O I<entfynh:nlhave rcednhsappliwti:nundsahanfur
teheuboveinmationls 508 - FINAL MECHANICAL .
t+"{.. career-I agce ro comply,wirh Wl utY atW agmty uWinanen art state law.lending 509 - FINAL GRADE
2.�'U to building construction.and hereby aulhoiize representatives of this city to enter upon
:io.-w heathovcm,At moeyl.pmpeny forimpeclum purposes - - _ 510 - FINAL PLANNING
d
(We) Wosae demnify and ph iml iitheCty or[ pernoag most
E 'v Thin j.egmm coin ane. pct- n n y via gnntsaid 514 - FINAL PUBLIC WORKS
tJ � [dI.curse pence: In f rte
IICANp $ IL MPLI'.WITH ALL NDNtPOYNT Issued by: Date A_Q
. .. ; ,...
plican Imemr,,,. .;,.,:..:f,,; ...-:.:. t•'. ;;;Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE.
me ttppl camo fm biddingoc pate t or handle hawN docs l .-Type of Roof,- _ -
as defined by he Cupertino Nrunicipl Code.Curler r 9 12and he Hold, ad Safety t- 1 t -' "'"' -"" '- -,'fli •1 __. _. _
Cafe Section Z5532(.)?,
°Y ° m
Am __All roofs.shall be spected.prior to any.roofing.material,being_tnstalled... .
c arm cat or future building cupamuse cq pditur or devices which If a roof is insialledlwithout first obtaining an'inspectlon'Iiagree;to remove
emit h anlnusar comammams as defined by the Bay'Area Air Quality h1amindoem
Irr Dint^a' all-new materials for inspection. ant understa
ll e Applicant ods and will comply.with
Oyes - a .� o , - r .. . . . ..,.- - .. _ _ ...----