01030060 CITY OF CUPERTINO. . . .'.
'-BUILDINGmVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS:"." ,;n6. �1 t.:,.. PERMIT NO.
21583' LA .PLAYA .CT . :. ,I: YEHUDA & HANNA. BAMNOLKER ' 01030060
SUB DATE
OMN
GgtggnAE. & HANNA BAOLKER APPucA03/12/2001
(!, HONE: Uig _ - SANITARY NO. CONTROL NO.
s
Mal ARCHITECTIENGINEER: - BUILDING PERMIT INFO
W00 e - -
H BLDG ELECT - PLUMB MECH
1n as _
{. 'LICENSED CONTRACTORS DECLARATION
2 0 y- , Y« -•'." - Job Des ription
oz_c Iherebyinof that 1am Lathed under pm sonpf Chaptr9ndminecense ADDITION-3 ROOMS/1 BATH
F_t u with 5 ll once and effect.
f Di s o J ohne B ass and Profess s Cod.and my beano
s fall force deR ct
OU Dole
Class ' ^Contractor -
£3 01 ARCHITECT'S DECLARATION r' O �oo
(=a g I understand my phial shall h used as public recoNs FEB,
yr
y 6 O X Licena. Professional -
e(L t .OWNER-BUILDER DECLARATION -
1 hamby iffnn that 1 am exempt from the Contractor's Licen a law for Ne
which req permit t < tc1.aver improve demolish.n repair stmcture •u V: I
toll g reason.(Sect 7031.5,Holinessand Professions Code Any city or county ul`011VC; $58000
{ O
pow to ni'uance.ana,eq ire rhe applemfr such permit to file a signed surmount.
,hthd iglee.tNp4a ttothppmoisionsof Ne Convector Lc Law(Chpe9 Valuation
wiPll Secunlfi)of Division 3 of the BogaslidP ctilious Cod) l„i,11k1 -137ty 2'JUl1�ye jaDl�) ?s�'�l Aay,
or that i 'nifpt thcre(mm and the basis for the elicited ealminio i.Any violation
of Section 7031-.5 by any m licanuford permit subjects,he applicant to a civil penalty:
of not more than fire hundred dollars(S500): 101APN Ifdpj thgDAT'I ON` a v::cr>:'. Occupancy Type
111.ses owner of the property,or any employees with cadges as that,sole campenmtion„ ” _ '" " - "• " "-
-wil)do,th"mik;'and the structure-isnot intended 0r"ofere4 for sate lsec:1W,1, 10 3 - UFER Required Inspections'`''
'Busmue.i nod'Professions Code:The Contractor's License Law does not apply to an
owner of property Who builds or improves thercon,and who does such work himself 104 — REBAR .
or through his own empl yeas provided that such improvements are not intended or _- A_ NCHOR' BOLTS
ormurd forsale ver If,ho ethe b'Iditig n improvement s soldw ih n ane year of ------- - - ., � A -' "--------
_' _ '
completion,die owner-Wilder wilt have the burden of paving that he did not Wild or
105' Sl ,.tt •, a:
improsx mr purpau ar ole.). _ .,106 - SEWER & WATER
_ _ ______._ ._ T08'-="-PAD"--SETBACK-"-CERTIFICATION
,El I"es ow " f,tha' pony,am ex lus v ly contracting w th licensed contractors to
construct the project(Sec 7044,Basions and Professions Codiu)The Canracmr's 202 - UNDERFLOOR PLUMBING
.. '..
License Law does not apply it)an owner of property who wilds or improver thereon.
1.'_' :_a ad.who.contracts.fw:such,projects,with...can....or(.).fanree.pursuant-ta.rne_ -.._----------2'03-,,-.UNDERFLOOR--MECHANICAL
Contactorsld uad Lar�l'.{1':4Y^ -
..if Olantescmpt ander Sec. ,B&PCfotNis remon 204 - UNDERFLOOR'" 'RAMEL'
ooat ° 205 - UNDERFLOOR INSULATION .
_ Wr ORKLR S COMPENSATION DECLARATION
301 - ROUGH PLUMBING
Ihereby affirm unds penahyorarjtiyanc.ft'finawingdechntmo:— 302 — TUB & OR :SHOWER .
CI ha4e''and 411`ooinuin'a'Cenifc6rt'of'conieni in self-insure for Worker's 3 03 - ROUGH MECHANICAL'
ComPensmiy?trr m provided for by Section 37M of the Labor Code,-far the -
Veformanceofthe..,it Fh h his paroul is trued,, 304 - ROUGH, ELECTRICAL
305 —FRAME
❑I hive and will ir'utnm n Warktt a Compensation Insuranc at required by,Section
3700 or the Labor Code.,For ins perfprtvatpe ann;work•m/wh�ch'this peuniria 306 - HOEDOWNS
issued My Wo ter C rape u n Insurance comer and Pansy numbs
, 9', A - 307 INS CATION._
Cartier t � TIP I yN ' ) ,n t, 1:
,1 11�il� C,I!T1rICACIOkIOF EXEMPTION
FROM ORK�T tT 1 '3'.08 Ar 1SHG TROCK
_i , : . .. 3'09 .- EXTF,RPOR-'LATH- ...-- - - —
(Ihu oat n neeJ not b<caml
peteJ if the permit rs for are hualred dollars 310 - _ INII'EkIOR' LATH'
(slm)nrin.a.)
31.1`= SCRATCH "GOAT t
)rte u(yy ihzrin th pert nn ncfine ort f' henin ce t iW kaA - . I t +1,.,.'-i nr'1`I' ...�..1 F" .,,.., •� ._v
',l 11 not uploy any pc,9n to ny manners a is b nate subject i orkethe Wh' 313 — ROOF NAI—hi—J"
compcn nanLrwl.nFclmmhat'n,tau
NOTICE TO APPLICANT If ad",
ft but
gthrC nfcme r1. Pt n.you should 501 - FINAL ELECTRICAD''ENERGY -
'- 6,cum;suhlen,o the WorAMS C 'pens in p n-ohne Labor Code you must
O mon me Ply"ih otic n tinnspeonnao-nn deemed td; _ 502..- .,FINAL PLUMBING_ENERGY
"coNsraucrlON LerlDixc ncelvcY -503 - FINAL MECHANICAL ENERGY
' t Ihertby_Rmi,hanh ' o t r I d'nB aP ncYf rth performance .i -`
bon ar n nn x r ars 3x97c cI " 504 - FINAL BUILDING ENERGY
V �z -- —.
505 ="FINAL-ELECTRICAL_
Isnd r s AJdrcr-
50 GAS TEST
,, I c n fy ttia I M1ave reed This acct cue nand state tout the abava ,f rmavoi is
tsa'E. ,rnrrcet I gmmeomplywuhell<ityande umyorynunenend.n warela,mg 5X7 - INAL P UMBING
OitJ .mbuilJingconuanion:uiulhercbyamM1orizeiepresemdtivcs0fthiacitymea.recon 5 8 INAL' C ICAC
�i W :rhe aMreanemioneil property for inspection putpous.._ —
= F;a We)agme io sore.mdemm(y and ep hvmless itie CiEy"ofC pninoogainst S - INAL
,t VI liab Ins , Jgmcros,co, d expenses xhmh m y t any say me against said
'U-Z 'Cityyn ns<qu•nce oP Oe gr nuns of inn peran
'APPUCAN,T UNpER57AND5ANDWILL COhYpLY WITHIALL:�O:�fPOIN'y' 510
Id
ssueDate
4 SOURCE kCGIILATIONSry ,,, ?'t, I - .,, �}I
signature fApplicandC l=et , . :' 1 'Dare ; Re-roo16 — IN L BUILDING
y PP HAZARDOUS MATERIALS DISCLOSURE
.11 ' W II the it"ll c t n found buildmg wcupam smrc or handl haralloor material e.Of.ROOF.
s defined by.them
Cu,a no Municipal C rte Chapter9 12 and theHealth and Safety.
Ses "p
Coot mon 25572(11 y .�li•pF
Ye ' _.AIL roofs shall be ins ected prior to.any,rC.oOfing.material being installed
�eWindhlspliraaawftr.buildingwvaliant-s equipment odevices which If a roof is installed without first obtaining anlnspection'F agree to remove
mrh rd atm Dots -tl fneJ by thea yArcaA Quality Ma agemnt.
D..'t tote t ❑Nur r t all new materials for inspection ,Applicant understands and will comply.with
-all non-point source regulations
" 1 h n mad;the hamickman maranalr sequiraments fr h Chapati 6.95 of doe
California Health&Safely Code,Seedoes 25505,25533 and 1.5534.1 undersand,har
irrhe boilofthe oe.epwcurtentwhich
tints ail heir.me,
it to responsibility tonotifythe
'occupant f in< <,ju re cors h .;n hem t pn 7 ui iraI,, "f Certificate of
7. C f pnY . . .t .."„' ”
t -. ,Signature,of_A_ pplicant __._ Date. - -- _
t o a monaw gem nate All roof coverings to be Class"B"or better
;, _t