01020005 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: --"' '--' -- PERMIT NO.
10381 JOHNSON 01020005
OWNER'S NAME: APPLICATION SUB DATE
TAMHANE 02/02/2001
'HONE:' '� � � �-� � � '- -'�"� " �� �- SANITARY NO. -- �- -CONTROL NO.
- 00 ARCHITECT/ENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
r.a.
L
�',`Z ._ hereby
by ,LICENSED CONTRACTOR'S DECLARATION
8 H_ :,; Job Description
Z_,ce 1 hereby off roe iA I 3licensed under provisions of Chapter 9 ad mmecense -
t a; x ih Sect o ]0001 f D 3 uM1 Rashers end Prof.o Cade nil my httnu
I ef,ll frrikdcf,fLi ' Lqr+«
. ADDITION 00- SQURE•-,FEE ' '-' , _. - --_ _., Di _ .
emm t9
V1 p.Fi ARCHITECT DECLARATION
.u7T
1 1 maderswne in,pl.nv shall be used as pi bl c recoils
is p0 Licensed Pnfiewrionol FINALE®
o
OWNER-BUILDER DECLARATION . Y�
1 hereby affirm
that 1 um eumpt from the Conti nor a License law roe the
t?< following rtaxon.(Section]031.5.Business anJ No(e.ions Codi:Any city or county ,1 q •r
$ wh¢h rtquirts a perm t t nzwct.alcor improve,demobsh rtWa any struciurc O V 1 3 20O I _
-poor t d m.al. ' q the appl sem fa mch perm n fl igrcd unmment - _ V _ __ _
Vh,G� .. ._-..-
_ thm he s 1 e. i pun a nd she rtovmans of the Contmcmr Lie Low ICnapmr 9Sq.-.Ft; 4 B 3 esRaa
o",I eaa ng ah Sea 7(1(10)of Div s un 3 of rhe Buiinc s one Professmns CMe) ° "r )'.' R S 4's 5 ) , 1
nr thm he is cximpi hercfrnm'aM the buns for the alleged exemp„oa.Any violation � •r
-of Section]031.5 Fy any applirnm(or v permit suFjcns the applicant m v civiPpenalry
ofam me mano.ibaner<ddnnaRtasal). - 37r )'':'r."'T'.•' Occupancy Type
❑1,as owner of the propcny,or my employees with wages.a then.11 mmpemadian. r
will Bo the work:and the saunbre'is nor intended or-offered for role 151E W W,-
Hurmics,64 Prbmssiom Code:The Commcmrs License Taw does nor apply tommsdc,mf101 - FOUNDAT spired Inspections"
or h gh h s own crop nyees oProvided�hat such improvements arc not many ed or ._. .102. e PIERS - ___. _.._
f,cope y p ad no does such work himself
bff ed l I.If,however the build n o t v n em its said w th n ou year of - -- -
ia'pleton,the"wner.bn,Iderwll have the bi de idpri tbar he did not build or. 103 - UFER 1 '
mpmanforparrnaeufsAa). 104-._
__.._... - - RE BAR
co 1;es owner of the progeny am ex sines y d Pruning wishodc:) d mmnmors m ( F',ti.Cf._Pld:': : -
mnmmn the project(Sec.]B14,Business end Prolersions Coda)The Contractor 10 5 - ANCHOR BOLTS
i '•_r;,, License Law does not apply to an owner of property who builds or impm.ca thereon,
r
and.vhe contract,foesuell projeatz with a contmnnrtsl.licensed purtunm to the .. . ..1.0.6._— SEWER._ &..WATER
111minxempteenselSec. 202 - UNDERFLOORI- PLUMBING
❑lam exempt underSec. '•` r "S' " ",B&Y'C fortis moon
o n °oat "`' ', 203 - UNDERFLOOR MECHANICAL
WORKER SCOMI ENSATION DLCLARATIOIJ, 204. "UN
DERFLOOR::FRAME' S .'
Ihercby 6rrrm na pen by of pal Yo d of the prlliiwhn,d I rat one 205 - UNDERFLOOR INSULATION
01 his e d w II'ma Stam a CcnifiC m of
C arms to self msum(or W tiers 3 01 - ROUGH PLUMBING
Compc aeon -as provided for by Section 370r) ofme Labor CMe, for,,he
venformanaanh wmkBar,whichdid r aittdissu,5q. 302 - TUB & OR SHOWER
❑1 haul a ill,rib mein Worke'sCo re ai nn IF4pmnoe as ndyahed by seaian
303 - ROUGH MECHANICAL
3]11(1 of,he'Labor C"le fur the pe fart f the po k f h' h this Permit
L.
"'I'M MyWOAr'sC i n3tinmaaacic a dPolicy nan,nmare.,,, 304...-..-ROUGH ELECTRICALa:- _
` s�rar� � a�yp.
Camev.s CERTIFICATION OF,EXEMPTION FROM WORI(ER5 olicNo.:
3OS't"i !FRAME-''' , I .=E i,3Q: '.,
COMPENSATION INSURANCE
dtx28mviFieeirmlplrmitierornnenanai<eemlan 307�';� , INSULATION 1 " Oc;u�',:�c� 'Ni"— -----
._.-..3.08_.._--SHE ETRO C'K,.-.. ._ ... . ,. .,.,,.
rl cmirry,that in the perfurniance W& .ilio nch toe'I i, m1
en II i 1 employ any p m any mrm; a us n herome bjen fib,nie workers 309 — EXTERIOR`LATH,I 7 • ''i Is'
Cmai re Caws f C hf .D mte "'
.. .... ..._3-10-----INTERIOR-:LATH-
NOTICE TO APPLICANT I(afmrmakt gh¢C<ntfcme of Exemption.you should 1` 'at K•
become subject to the Workers Compimafion pmmsions or the labor eodq you mad311 - SCRATCH COAT
Q O Bardwitn comply with such provisions orchis per mit shall he domed rtvoked,
_ _ -.-----_31-3 ---ROOF -NAIL
F'Ln ' ''CONSTRUCTION LENDING AGENCY' ' ' ' ' -4�• i
a, tle_by'ffnndid here laeostct Iiagugnyrtheper(nonan 501 - FINAL ELECTRICAL: ENERGY
of the
of forWhich th pm ort is'ss I(Se 309] C,v.C)
a 0 LeaderM ) Nare tI n Remi:avvlrtet d state that_ _,.-.--. 502 __..-FINAL PLUMBING ENERGY---
Z
Lenders
U ' -he above information is 503 FINAL MECHANICAL' -ENERGY
fiat�' -nrrcm I agree to comply.with all city and county ord'nonces and state la s relating 504 - FINAL BUILDING ENERGY
ioC:1 tabula gco st afo and herebyautlionz� preum the fthi rny.toenter upon 505 — FINAL' ELECTRICAL
the int e or -i n d pmpenY f r asps Lion purlvisei ,,
tit pW (We)egrc lo ae d clarnfy and keeph noel ss beery fCupen 'o egamst' 506 - GAS TEST
h retail t s j dg nems, nus antl expense which may in any ay accrue against said
V'zCity n con eq encs t the Scoot 6 of his per 't. `
:�3PPLICANT UNDEISTANDSAND WILLCOMPLY WITHALL NdN'POINY' SO7 — 3NA BIN /
E REGULAT ONS r '"c+ ISSUed N f Date
Signnryre afA an oatmeor:::1,0"1;'�: ".r ' !"t;l)am' Re-roofi09 — FINAL GRADE ,
M "ParraMATERIALSDIsaO3URE Type o5�dIDf_ _FINAL PLANNING --
Will the hppb t ,furore boddm occupant Sort or tnI Ith hm.Na.material
.defined by the Cu nn Mun c ode Chopt 9 12 end the Hevhh end Sofe,y
CedeSection 25532(05 514 I FINAL 'P.UBLIC WORKS
❑Ye Nn 11 ---,All roofs shall be,inspected prior.to-any roofing,material,being,Installed. _.........
WI
me arvr= Sin f t e iI g < p t -6 pm nt nae ccs h ch' If a roof is iilsialled without first obtainingan ins ectlon ltkiree`to remove
co t bars do a c nmm o f d a by to B y Area Av Q lily M n4gement 1 p g
�D_trict❑Ye all new materials for inspection. Applicant understands and will comply with_
"if6OWiIdiu,dm,a.tcmm
rallnon-pointsourceregulations.d Ire ha sex mo¢nals rtqu rtmcnt'undcr Chnrmr 6,95'of the
&Safety Me.Sections 25505;25533 and 25534:1 understand hat,a.tcucy mnolify the.qui„ ,e t h n n;dat ae nt p anon a apo roe cearpare or ..Signature of Applicant Date
to eed ag t t, 1,-..;, Date:, All roof coverings to be Class "B"or'better
-OFFICE