00100042 CITY OF CUPERTINO
nuu,DING DIVISION PERMIT CONTRACTOR INFORMATION: -
IiUILONG A)DRESS', PERMITNO,
OWN17RSNA1I10117 LAMPLIGHTER SfaU BL)D
API'I'ICA'n°n12i�Jfft042
PHONE: SANI'1'ARYN(A OI 0,c-ICy2lo np
y
DOBYNS .TORN F AND WYNh1E 1
z ARCIIITEC(ENGINEER: BUILDING PERMIT INFO
' O Ii I.UG BLECr PLUMP, MLCH
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v 3 LICIiad 1.CONTR9GfuR'S ULkm,cI C10N Job DCSCrIptI011
OZ_=❑ 1 Heresy afllnn tont I dm IicunvcJ under pnrvlsinrw of CFapmr o(connncmmng .
mrw with Section 7(Mp)of Divi,ion)dl the BusincvanJPntfcuion,Cao and my limns ,
owis in full L,rce., tE,f,
l Lieen,eGlra,-, .-77— �� FIIV
$a h Date Contmeor 9 D
F w O< ARCHITLCT'S DLCLARN'ION KTCHN REMODEL ~LE
. J 1 undmtund my plan.,mall sJ rw
all be uas public urde
} MAY 3 1 2001
W ,a.O LiamcJ Prnfcssional
°i OWNER-BUILDER UIiCI,ARA'fIUN
Ed e, 1 hereby affirm that I am exempt from the Contractor's License law lin the -
I_?�' following maven,(Section 7031.5,Brehm,and Profrosion'Code:Any city nr county BUILDING
2 o 1111111rquiree a permit to eeoetoct,roller,improve,demolish,or repair any structure
se
3j prior to its iauctme.also require thexpplicant for such pemtit to rile axigneJ statement
that he I,licensed pusuant to the provinces onhe commucur,umn.e la.tChapter v Sy. Ft. Floor Area Valuation
(commmoving with Section 71,X1)of Div.,cion 3 of the privies,and Pn,fcssion,Code)
or that he Is exempt dictation,and the haste I'or the alleged exnnppnn.Any vialudon
o(Secturn 7031.5 by any applicant for a pemnit subjects the applicant too civil penalty
of trot more than five hundred delta,($500). APN Number OCcu fIRV IN
01,us owner of the property.fir rat ernpleyee,with wagesastheirsale compdn,ation.
will do the work,and the wmnurc i,not intended or mitered for vale(Sec.7W4.
aurides,roof PrnfcsionI Cede:The Coa,... n Liccnsc law does not:y, I,to;at ,> (red Inspections
r ofpd,,my who NNd,or improve.mcreon,and who dee,.such work.lnm.eh 34t_42005."ise
or through hls own employcmprovided that such improvements are ret intended or
oll'erml fire sale.It,however,the building or inq,ry rtes,is sold within one year of
ompletion.the owrb
ne- uilder will have the burden of proving that he did not build or 101 — FOUNDATION
mproise for purpose of,:de.).
D 1,a,owner of the propcf1r,am exdu.mey contracting wt h licensed contractor,m 102 — PIERS
Liconsumer the project(Sec.7044.device,and Professions Cdde:)The Contractor's 103 — UFER
cense Law decs not apply to nn owner of property Abu build;or improve,thereon,
and who contracts Ibr.such project,with a contmctons)licensed po,sumu or,the 104 — REBAR
Chalmette,license law.
01 am exmnpd order Sec. ,R&P C for this reason 105 — ANCHOR BOLTS -
Owner Date • 1.06 — SEWER & WATER
W'ORKER'S COMPENSATION DECLARATION
I hereby dlBrro ander .at,,of pejuq one rd tire following decl.raboo,: 202 — UNDERFLOOR PLUMBING
203 — UNDERFLOOR MECHANICAL
C hove and will provided
n a Cby Se i of 37N)Counvof m ml f-insarc for Worker's -
a,nnpen,mn,n, ry provmed for by section 3ngl et the Lala,r code, roc doe 204 — UNDERFLOOR FRAME
performance of me work roc which this permit is issued.
205 — UNDERFLOOR INSUI_ATIDN
0 1 have and will r code.,Worker's c.aa,esnn Ie,w.,k f as cold had by Section
37(gl o!the labor E'ed[,for the perlormunce ata the sick for whivM1 this pen,it i, 301 — ROUGH PLUMBING
,ord.My Worker,Compen,hirm lnmtanm carrier and Policy handier arae 302, — TUB & OR SHOWER a
Carrie; Policy Ne,
CERA u,ICA1ION OFEXEMPT ION FROM wORKHRS' 303 — ROUGH MECHANICAL
cOMPEN NI ION INSURANCE 304 — ROUGH F_LECTRTCAI_
(This section need not Ind cmopletwithe pennitisfor one hundred dollar, 305- - FRAME
($10()el Iew.)
1 certify that in the performance of the wad her which his permit is issued,1 306 — HOLDOWNS
i
llnot e „hire,ht the Workers' 307 '— INSULATION
a' h mp11.a' 308 — SHEETROCK
l'ICE7me,anj«tmmeworker>c e , tproviaon,onneLanorcoe.you"'°" 309 — EXTERIOR LATH
nwnn comply x;m seen no vronv or mi'pemm,sell rte deemed rooked.
CONS raucrION 11sNu1NGnclfNCY 31.0 — INTERIOR LATH� > I hereby alliin tharthcta iso concwnion lending agency for the performance 311 — SCRATCH COAT
W
of work lit,which this ,.if is issued(Sm.30D,Cie.C.)
0 o LmdersNo —
te 313 ROOF NAT(_
D Lender's Addis -
V 0 O Imnuvhod utaven,,art n,i,rphlicatioocal,tardhal do,Abuse mrn,taaooie 501. — FINAL ELECTRICAL ENERGY
of;.. F verhoIagree l,,d b,lywitnoil city and coumycost...I.,add%utelawsrclaim, 502 — FINAL PLUMBING ENERGYL (1
O V oft building con,truetion,and hereby malbraire m,c-dmb,c,of this city to enter upon 11•�
looahov mcntunedpropanytori.dpcetionputpo,re. 503 — FINAL MECHANICAL ENER
(We)agrm ,vice.indemnify add keep namnev,the Cit, I Cupertino u,ainst
tq Irobilitiex,judgmentcos.and cosand expenses which may in any wry accrue mid i —
d 504 F I NAI_ BUILDING ENERGY
(� Z City is oaaw,...i of the graidin,of this permit.
APPLICA TONI! . . SAND 'ILL COMPLY WITH ALI,NON-POINT ISO, 505 — FINAL ELECTRICAlD,1e
SOURf ,.
sl,na, —m r�d�. - - nate Re-roofs
HA'. nu, ERIALSDISCLOSURE 507 - -FINAL PLUMBING
w5I1 me apprimn r fodare building�::capant stere entaaald naertdm,mamriaf Type of Roof
u,Jelinnl by me cupe no Munlcyal code.Chapter 9.12 and the Lcalth uoa Safety 50r�8q — FIMRI_ MECHRNICRI_
CrNe.sec tion 2s5321a)7 Sffl r w1 r•. n�
❑Yee ow' All roofs shall he cede 1:1[O ah MITI material bei, installed.
Will the apprtcad(or future building recrpam use egor,mand or device,which If a roof is insta�lt lvitfio FtNf�,ITt' lir�Mhl Action. 1 agree to remove
emit anomalous air ennntminatns a'derided by the(lay Area Air Quality Management
Dison,? all new materi.ii5 StinypeEttibPUAA.p[BRLhBLtdl9'e1:,Wii R4Yfr'Id will comply with
0Vet 0N all non-point source regulations.
I have ideal the ha ardor;materials require richis under Chapter 5.05 of the
'alifomia Health N Safety Cod,Scetiom 25505.35533 mW 25534.1 made r.;wnd fnut
if the building dm%nut curently have a mtunt.that it is my responsibility to notify the
capunt of the m,dircments which nmst be mer Prior a,Issuance of a ComiBemc of
°acupoo r' Signature of Applicant Date
Ownerandmauedagmtd Dam All roof coverings to be Class `B”or better
OFFICE