01080108 CI BUILDING DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
20706 KIRWIN LN CUPERTINO CONSTRUCTION INC 01080108
OWNER'S NAME: APPLICATION SUB DATE
Ak CUPERTINO CONSTRUCTION 10079 SAICH WAY 08/21/2001
( 'HONE. SANITARY NO. CONTROL NO.
2r 3_ (408) 253-9000
a00 ARCHRT.Cf/ENGINEER: BUILDWG PERMIT INFO
u- BLDG ELECT PLUMB MECH
i zy= LICENS12:D CONTRACTOR'S DECLARATION
,n 1 hereby affirm that l am licensed under provisions of CWpwt 9(commencing ]Ob Description
NEW SINGLE FAMILY DWEL�G
.,n Fm with Scetion]000) fDi isionJof N<Bu<incssand Rofesi scree.and my license W
;xf5 i.mmnroneand ceel° i 796 3048 SQ. FT. LIVING SPA@EY�Q�
0 w a License Class Lic,a_ Leo
3 5 uu.a Dove_`- t T_t_ S DELLA Ca,6 434 S Q. FT. GARAGE.
u.p Q AR 'HITECT'S DECLARATION
p 0 I understand lshall hd public nmy pans sae useas puc records
SEP
EP t3 2002
r d
1 d O O Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby athrm that l am exempt from the Contractor's License Law for the BUILDING
d?G lollowind omwo.(Sermon 7031.5,Business and Professions Code:Any city fir county /�
d o which requires a poo it to construct.alter,improve,demolish,or repair any shoreline
d3 e •poor tels iswerme.also mquires Ncapplicamwell ch permit In filen signed slatcmem
- mthdigbeensedpuisahmtothepiovislunsofthConuactoesLicenalew(Chapter9 S Ft:,FloorArea at on
(commencing with Section 7000)of Division 3 of the Business and Pmf..mas Code) t sy , _�r_�q�, 0 <ai.Iy.y.r„]tl , $3 O86Velo
or that he is exempt Ihciefiorrand the basis for the alleged exemption.Any violation '
-M Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty
of act mmc man fire h,mdred dollars s5lxn bqg 0itOccupancy Type
°1,as owner of the propenty.or my employees with wogc,ns their sole c.mp,,m.h J,
will do the work.andthestructure is no,intended or ofertd for sale(Sec.701J, -
'Business ad Pmre..ions Code:The Contmctor.Livens law da,not apply to an 101 - FOUNDATHIWired Inspections: "
Her of property Who huilds or improves thereon,and who docs such work himself
ow
or Through hemployee,.provided Wm h' ri mol- t intended o 102 - PIERS
offered n, f Ir ho a fir the l have
n ..... - .. ... ... _.. ... ...
-cont let nn,the owner g 0 <mem .s sold 'throne ye r 103 - UFER "�
n bu lder will Hare me barren nr proaing oval he me Hol baud nr
improve tar parynae oRale.)' 104 - REBAR
- -' - -- --- -_ .. -- .. -- --- -
: .- . QLasnwner,prjec propcn yam exclusivelyd Prutssionslicenudcontmctersm AN HOR`BOLTS "'---"---
cicense the project(Sec.
ppl too Busiess andProfessionswhio th Cpde:)The
ves tm neon, 106 - SEWER & WATER t'
License Law does not apply to an owner of property who huilds or improves thereon, "
._and-wnocontracts for such projecla,with a cantractor(s).licensed pursuant to the .. . .. - -2 02 -'--UNDERFLOOR PLUMBING- --- ----
Contract.,s License Lew.
°I em exempt under Sec. ,B&P C for this reason 203 - UNDERFLOOR'' 'MECHANICAL
owner - Date 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATJUN DECLARATION 205 - UNDERFLOOR INSULATION
IberebyaRrmunderpnalrypfprjn one.ofineNunwmge«amu°":: 301 - ROUGH PLUMBING
° 1 have and will maintain it Cenifcme of Conant t°Wf-insure fa Worker's 3 02 - TUB & OR SHOWER
#Compensation, as provided for by Section 3700 of the Labor Code. for the
performance or the work tar,which this permit is issued; , 303 - ROUGH MECHANICAL
°I have and will maintain Worker's Compensation Insurance,us required by Sectio 304 - ROUGH ELECTRICAL
i 3700 of the Labor Cod far the performance of the work for which this Permit is
issuedMy orkcrscec al}'O nspmnee carrier Policy bate: 305 - FRAME
lamer. ntt�— �+s�u drueyNo: PiesJpf cid F�J 306,. ;; HOLDOWNS i
" „
s ICERTIFICATIONOFEKEMPTION FROM WORKERS r sfs �;t3 O.7' '='••INS'UI�r]'IGNr' t...n)':
,.... t _ COMPENSATION INSURANCE',
'-' SHEETROCK..... ----- --
ITh Melton need not be c°mplcled f the permit is for one hundred dollars 309 - EXTERIOR LATH r' 'Pt,
15100)ar less)
j.: -_ .. . .. 310. _...INTERIOR LATH
1 ttnify Nat in the pesfonnance of the work for which This pcnttit is issued;I ;,t•j'lit'' `'h - •^• -'� n••^ -- _
shall not employ any'poison in any moaner so as to become subject to the Workers' 311 - SCRATCH COAT
imh
Applic exon Laws of cal to t Dant
ate 13 - ROOF NAIL
NOTICE TO APPLICANT If after making this Certificate of Esthrophim.you soma 501 FINALELECTRIC L ENERGY `''
z become subjectt the WorlmA Compenmon upm oa mof Ih Labor Code you must 501 A -
pO forthwith complywithschp tt s whis parmit shall te,dewriedreokea. _ 502 -.FINAL PLUMBING. ENERGY.
y
'CONSTRUCTIONLENDING AAGENCY 503 - FINAL MECHANICAL ENERGY '
agency f the perfmmaram
ofth w kfy n-h,ms's�Is, ,oedlsd3097Civ.,c) .,t _ _504 -_ FINAL BUILDING 'ENERGY
ai the ch fftm Nauhcets aconswcto lendingn
L Q Lend r Nome - ._..
p Z Idnde Address•- , .. 505- - FINAL ELECTRICAL
U 0 ..�..,.,, . -' . . - - 506 - GAS TEST , t
I certify that I have read this application and state that the above information n
I's,�E-t cbhmiv I agreem comply with all city and county indinances ane sate laws relating 507 - FINAL PLUMBING
0.L1 to building conswcno',.and hereby amh°iite representatives of this city to enter upon
y•W be abovememitmed mpmyfarinspectionpurp°as.., 508 - FINAL MECHANICAL
agree to save:indemnify and keep hamdisssthe City of Cupertinoagainst
i. m liabilities,judgmenu.cowls end cxprnus which may.ia any way accrue against said 5 0 9 - FINAL G E
U ► cilyinconsequenceofusegrantingofthisPermit. 510 - N NG
APPLICANT UNDERSTANI S AND WILL COMPLY WITH ALL NONPOINT
SOURCE REGULATION . "e , ' �� / L r Issued b%j Date
a.
defined by Ne ClHAZARDOU MA Dat Re-roofs - ROOF PLYWOOD NAIL
' HAZARDOUS MATERIA DISCLOSURE Type of ftg - .......
al
pp Muniipaamg occupant stae2.andse Health sae¢nal - ROOF BATTENS ^
Chad,Chapter rte theH Health and Safety
604 ROOF ,IN.-PROGRESS r
Will e ant r
...eSection255321) ,f . .t -at t. r'• s l a'. ,, t
Cod
°YC5it' �"° ,_All roofs shall.be.inspected prior to any-roofing-material being.installed._. ..
W Il the applicant ofuture budding occupant use equipment ord ices which If a roof is installe'd'without first obtaining an inspection; I agree'to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Manag<menl
District+ . . all newmaterials for,inspection.,Applicant understands and will comply_with
°Y all non-point source regulations. .
i 1 hav read the heiaN u. matenid y erre is under Ch pie 6.95 of the
cariffmoris Health&Safety C de S cdons 25505 25533 and 255341 understand that
if Ne Wilding does not currently have atenmt Nal it isirry responsibility tnotify the
/c weriOccup nlc f the requirchn1 which most be met prior to issuance f a Cenificate of
.w y i
Signature_ of_Applicant Date
Owner m rtu orred turn, Fare All roof coverings to be Class"B" or better'
d ,•
cr'- • .. - -'. .- -- _ - OFFICE- . .._ - . . . ... .. . . ... . ..