01020089 crBurr SINN
BUILDING CONTRACTOR INFORMATION:
PERMIT_
BUILDING ADDRESS: PERMIT NO.
10116 LAMPLISHTER SQU ILVD A PERFECT CLIMATE 01020089
OWNEk'S NAMB:, ., " +. APPLICATION SUR DATE
9 _.YRIF_ LN' ' 02/J5/2001
;Is PRONE: _ - SANITARY NO. "•CONTROL NO. -
t
.-fru ce O ARCHI'ITCr/GNGINEER: _ • BUILDING PERMIT INFO'
- s w BLDG FLECf PLUMP 'MECH
GXto
LICI?NSFD CONTRACTOR'S DECLARATION
h I Ineren nim than 1 I : d 1 ' . I Chat 9 _ Job Description
-pZ—� Y, I per (eennc is g
F t with sttrorcenn)mu 3 fthn Business dPec,'',,, ba,and yl c; • _
6 k f s n fall furcC and,tlfvr ""1 11 Y -
n c z iccnseCWIs Cn 0 .',Lc « / !J- - HEATER R AC -
ARCH]
C • _
3� Uae qy-D Icor I;r .
ARCHITECT'S UECLAR-(`]�1(,SvO
C�'u,5 I understand my plans shall b,used as publictc r
a O 1 ittnseJ Pr f::' n'I y/
OWNER—BUILDER DECLARATION v
I h mb,affire that I are except from the Pontt t Ice.city
for the +
k b f y f S I' ]IH S l n J L Code ,I Y n county
'CSO i 1 catmeas pr, i s alta imp c 1 :h rer,S LI ]'atom g
i
°•3$ That rte is licensed issuance.also yo ersthe poeoplieant fnr Conr.rnft fl se Lawal statement '
pmwant to the pm Division 3 It,cnnmu:m..Lind Pr Lvw(Cha ode) Sq. Ft: Floor Area Valuation
or that he is a with Section om and
Division 3 of e a Bu,inau and ionfAny%i Cade)
or Sectio 7 31.5 b thcrefiwm and the basis for the alleged exemption.Any rielmion ;
of Semon],h.n hY any applicant for a armit subjects the appucanl m a siva pvnaer -
„rnntmnremanBvennlmradanuaralssBB). - � , APNNumber ' � Occupancy Type '
❑I,exownerof1Iw rupeny,truly employers,with wages its their compensation, -
will do the k Ord the structure not intI ff for sale IS 7(94, 3.42472012Bo me,undP f. Code I he C t t 1 1 r t applyIn in - 'Required Inspections
rwI l ps tY Wl III p-veil 1 J h work hit II' '
' n-tn ghhi ply : providedmt h I tsar I tern Tor 204 — UNDERFLOOR FRAME
offered fnr sale.If hnwev,.r,the holding r impmvem,.nt s sold w min one Yn r nl
completion,the owner-hudderwill have the burden ofpmvingthat hedid not hoildin301 — ROUGH PLUMBING
impmvefurpurposeofsale.). -
01..n.o„ner nfele pra(m,ata exem,ivelyeondacdng with licensed conmaernx to 303 — ROUGH MECHANICAL
construct the project(Sec.]1144,Business and Professions Code:)The contractors 304 ROUGH ELECTRICAL' -
inna.Law does net upplY to an wooer of pmpe ty who huilds or tar,mve,thereon.
d who contmck,for.such projeets with a eontroett,ral liceowd pursuant to Ina 505 — FINAL ELECTRICAL'
n;nractoes License Law.
am eamop ander Sec B M P C fm this reason• 507 ', FINAL PLUMB I.NG e
Owner Date •i. 508 '= FINAL MECHANICAL.
WORKER-S COMPENSATION DECLARATION
I nereh rrrrn ttaden h r - 5t4 — FIINAL PUBLIC WORKS
ye Penalty perjury one of the fnllmviny Jmlamtions:
O 1 have and will maintain a Certificate of Consent in self-insure for Worker's
Conysnsiume. as provided for by 5eeion'3700 of the Labor_Cade, for the _
per4vtnonce of the work h,r whicl,thii permit Is issued. s ,
CIhave and ll medulain W k 'C _P r 1 : u v a,myumd by seu'mI V' - • '
371111 111 the Labor Code,For the pentonr ce of the x, k h r which his pyrnp is ,
tsmeJA Rus Cn_I ,/_ Insurance sumer red l'nfsy numberam:
'-
Came' �A /sr tI�_policyNu /
.CL'k I'II9CAr10N OF EXI3MPTIO, FR IvsURKMS ', • - - _ .K COMPENSATION INSURANCE
(This section need not Inc completed if the permit is for one hundred dollars
isIOR)nrle"')
1 employ
tbarin me purfnany an nr the work I'or which this permit eLouse,I - -
shall not employ any Iwrenn in any artlnner sn ue w btt<nnc subice m the WnrAurn' ,
Compcnsuinn Laws of California.Date t
Applicant
NOTICE after nmalmot o Idesfof1.1an,ionyou oI...I
hccumesuljeatto rhe such peCompcn..his peari,ions or ate Lama Code.Sou nm>t
O p .forthwith comply with such pruvisiorn onhis permit shall be JeemedrevokeJ.
,z^r Z CONS9'RUCr1ON LENDING AGENCY
I hereby an or that there is It conswction lending agency for the perfuemaace +
G., of the work for which this permit is issued(Sec.3097,Civ.C.)
Q Lenhns Name
V x Lender's Address .'.; ., '• -
I certify that I have real thin application and state that the shave information is „s
, rma.1 agree to cnnrply with all Oily and county ominances and',am law.relating '
O V ,I huilding imsemctien,and hcreM1y xuOrnnze represenmrivex of this city le enteropon "
the alreve-mentioned pmpeny for impecdon purposes. -
E Il (We)agree mmve,indemnify and keep narmlesxrhe Cityef Cupertino against {
On liabilities,judgments,c t n I exilwarews which may in any way acerae against said 1
U Zz City in no Luce of the'evolinflut hispe.it / isl
AP DFRSTA DS AND WILL COMPLY WITfI ALL L '1NT
Slit L. UN
Issued by: Date
Sit, plpname n,va ern - (a`•-- vr1 . - Re-roofs
'+ HAVAkDOUS MATERIALS DISCLOSURE
' Will the applirmlnr I'nutre nuilding rrcnrpam stoat wr hnnJlc Inwmuuv mamdnl ,Type of Roof( �•. - •' -
as defined by the Culmina Municipal Code,Chapter 9.12,and the Health and Safely'
Code,Section 25532(x)'!
,ores ❑No All roofs shall be inspected prior to any roofing material-being installed.
Wil Wthe'applicant er)))tura building occupant use mInipment or devices which If a roof is installed without first obtaining an inspection,.I agree to remove.
emit hbzxmnus air cwmmninanrs as defined by the Ray Area Air Quality Management
t, • Dlorie? all new materials for inspection. Applicant understands and will comply with
{. ❑Ye; ' n' n all•non'point'source regulations.
I LI a mad'the hazardous inumrid,m,nueneens under Chapter 695 ofile • •- '
Cullf n 4li 4th h Safety Cndc.Stt a ti 25505 55N and"em' l undersand tl e ( '
I buil does not eunenlly hare atenant.that ui.+wry rngmniMlny ro nmtfy ilio -
ncnI t of rhe mmems such sono be Lust prion m issuance of a Cenmcale of
Da n
`" d Signature of Applicant. Date -
Owoernr aedaticat � Da ^h All roof coverings to be Class `B"or better
OFFICE;'
CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11124 LA PALOMA DR KITCHENS BY MEYER 01110089
OWNER'S NAME: APPLICATION SU DATE
RODNEY BROWN & CORNELIA WOODIO 278 CASTRO ST 11/2012001
/
/DNE (415) 968-8318
: SANITARY NO. CONTROL NO.
1
C O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w FFBl ALECT CLUMB MECH
5 y= LIC SED CONTRACTOR'S DECLARATION Job Descripti
SZ •p therebyamal.mliccnudunderprovisionsofattar,9(.ommcncing KITCHEN REMODEL.
,_� is S..ion )ofDivision,ofche Business and Prole ss ions Cade,uta my lis tem
sows 'i (.11 heun ,"air FINALE®
0'y ARCH1IEQ S DECLA ATI N
y,p I unacrtmna my plans hall he used as public retools
I r o n Licensed Professional FEB 2 0 2002
' o OWNER-BUILDER DECLARATION
m 1 hereby affirm char 1 am exempt from the Connor's License Law for the
!•Z following reason.(Sanson 703 L5.Business and Professions Code:Any city or count, $32000
Fo whichaccrimsapermitI.....bait,alcor.improve,demolish,oropine any swcwre BUILDIN
i Cam-pnnnoirsixsuance,also requirtnh<afplicam(or such perms..fileasignm smmmem - - - -- - - - -- ----- -------
cnmv
h�i;li¢bYA pursuant mthe pmvtu.nxoftM Conhacmr's License law lChapter9 p 0 e�.v.
(commencing with Section 7M)of Division 3 of the Business and Professions Code) Iv 1�`;_a` ':3 �1t6T!$° y §. TLL i ted a Valuation
o that he 1d exempt dommom end the basis for the alleged mampnion.Any violmion t �1., b t C
•of Section 7031.5 by any appliwm for a permit subjmz the applicant co.civil persalt,
of..,metre thanfive hundred dollars($100). 10'APN NPTbFDATI ON • Occupancy Type
°I,us owner of the property,army employees with wages its their sale cumpentation,
.,It do the work,and the structure is'noY inlendm or offered for sale(Sec.7004;
Business eadPrefe.bars Cale:The Comrtcuo-v License Law does out epPty 1.na 103 - UFER Required Inspections'
ow
Der of propeny Who build,or improves thereon,and who does such work himself 104 — REBAR
or 1c mu h his own employees.provided that such improvementsanis sme not intended or
owcvcr.cite Wildin .___. t is sold within oneyear. Y "_- ._._-..
coered orsale.Ir,h gonmpmofpro o 105 - ANCHOR BOLTS -. 1:. ,. ,, .;•:'�:.; �.
completion,the owner-builder will have the burden.(proving that he did not build or
improveforpurpom o(sale.) 106 - SEWER & WATER
_ ow .o -- _._
°1.as owne pacied(Seefoppery,oro exclusivelysinssad contracting with licensed contractors oulact 's 2 0'2' - UNDERFLOOR PLUMBING- -: �P,t A� "i
Licensetheoejen(se..,Baanowners,dna Profeaions Code:)Th.ves tanor'a 203 — UNDERFLOOR MECHANICAL"! r'( '''`
License Law docs not apply m an owner of propcny who builds.r improves chcreon, '' '
.,ed who.contracts far such p olectx.with n contra
nada)licensed pursuant to the. _ --. .. - 204 -- UNDERFLOOR- FRAME "
Cnm ono L cense La
❑1 pt dqS« Bxrpcmrmrsreaan 205 - 'UNDERFLOOR 'INSULATION
Owns, Date301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I1 thereby affirm under Penaltyof perjury one ofthe following declarations: 303 - ROUGH MECHANICAL
fl ❑ I have end ai,'nuinuin'a Cemrcme of Coself-insure
Consent or far worker's 3 04 - ROUGH ELECTRICAL
{� Compensation, as Provided for by,Semiou 3700 of the Labor Code, far the
_ perrmmance of doe work ret whir.phis peach is issued. 3 05 — FRAME
P.
°1 have and will or Walk,,';Comperionam Insurance,s requircd by Section 306 - HOLDOWNS
n 37M of the La We,for the performance of thework for which this permit is 3 07 — INSULATION
issued MY crs Com ynumber -
., . 3'Q8 r .SHEETROCK..
e sauon In arm cr carr er and Policy
C -' Pohey Nu . �o I fl, y
(CERTIFICATION OF EMPrION FROM WORKERS t {� �'• a Is 3'0 9'' t' EX'I ERII ORS•'LATH'
COMPEN$ATIONJNSURAN .
CE'" : .... _
- 310!:.- „ INTERIOR.-'LATH- ..
"'1(Thii gensors nem not W cmbpletm if the permit is for one hundred dollars 311 ` .SCRATCH COAT t'
IS IIp)nr kssJ
.`I c lat'l thaain the performance of the work for which this permit is issued,I r - - • r
Appltam to 501 - FINAL ELECTRICAL`"ENERGY
Comlprcempl ow_r.calimml.°u;tanner,aaa .._502----FINAL PLUMBING -ENERGY.. .. .__.:._._._ . ..
'NOTICE TO APPLICANT If after making this Certificate ofExemption,you should
y thermos objectto theWorker's Cape provisions of the Labor Cole,you rots.
503 - FINAL MECHANICAL ENERGY
0Oforthwith comply ith such provisions ,,this conat shall be decried rc nkm. 504 FINAL BUILDING ENERGY
E,.`t� ` ' "• -' ”
1 hereby affirm that chem is.conscromion lending agency So
CONSTRUCTION r the perform505 — FINAL ELECTRICAL
ance .
of the work for whim per
thio snic.is issued Isec.3097,Civ.Cd . - 506 — GAS TEST
y.Q -landeri -
Name ,. . ,�,�_ .:._—._...._.- _ .. .- - __- __ . ._ . - _-
p 2• Ce adrr'sAddress ', 507 - FINAL PLUMBING
' UO lmrtity 0.11 have or don applicafom oma orate mat meanove information is 508 — FINAL MECHANICAL
G.-Fad '1;pean.I.gree toDomply,whh.11 city ono county ordinances end elate laws relating 509 — FINAL GRADE
C.0 10 building contraction;aid herebyamhorize'represenatives of this city to enter upon
gy, the ab m
above
nproperty for'roped purposes. 510 - FINAL PLANNING
t d (W 1 6 ee co sal indemnify and keep harmless the City f C p n ougaiml
-m hablti ,dgeni tad which, y, against 514 — FINAL PU IC
City , pat IL 1�G —o✓
APP IC i�. ERS v ILL OMP, HALL NON POINT
soU uLAr '> i. '• I Issued by: Date `�
ig ure,ofApplia Contractor t .Date Re-roofs
HAZARDOUS MATE ALS DISCLOSURE "
Will the pplicanta future building ottupant sore or heMl broadaxe:rmtenm Type of Roof. - - — — -as def ed by the Cupertino Municipal Cod Chapter 9.12.and the Health and Safety -
Code ❑cti Sn 2553211 ll l�No .rl t .d... _ ! i ;. '•.4' ell l ¢�a 3f'2il.,x..S n, L t s v:: .,_ ..._. .
n All roofs shallbe ins ected prior,to.any rooffing.materialbeing
installed
Willfuture
the applicant building peal o e vices which If a roof is installed without first obtaining an inspection:I-agree:to"remove
doll anomalous ircomamnanl.es defined b-the Buy Asea AirQdit,Management
District? ,. ,.. all new materials for inspection. Applicant understands and will,comply with. ,
°Y`'' t.°N° .t all non-point source regulations:_'
st' 1 I ha e' the haiaN.."materials yu'remenB'ued r Ch.Dle 6.95'of�me
C lifomm .fey Cade.Sections 25505,25533 and 25534.1 understand that
"if[ i not cu. ave a tenant.Lou it is my¢sponsibilicy to notify the
or at c tusc be met prior to issuance of a Certifrca a of '
D
'• _ Signature of Applicant ate
;-- ' 0 cr0rua1'o zed at . I /— q.re All roof coverings to be Class "B" or better '
OFFICE._ .. .._. . .. ---.... ... .__ .,