01120085 OF
CI BUILDING DIIVISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
7877 LEONG CT W/V& 01120085
1 S DATE
�`�30'VINCENT M AND PAULA R 12/20/2001
PHONE:
PHONE: SANITARY NO. CONTROL NO.
D zZ ARCHITECTXNGINEER:
R W.DING PERMIT IN
BLDG ELECT PLUMB MECH
aU u
z 5 m z LICENSED CONTRACTOR'S DECLARATION Job Description
o z-o I hereby affirm that I am licensed under provisions of Chapter 9(commencing BATHROOM REMODEL (3)
zw t-w with Section 7000).f Division 3.f the Business and Professions Code and my license
m f-q is in full forte and effect.
c M 6 License Class La.e
X O E U Date Contract.,
cA a is g ARCHITECT'S DECLARATION
s }I 1 understand my plans shall he used as public records r-iN /� ■ D
E-p O Licensed Poofessica al R"f'Ra
OWNER BUILDER DECLARATION 200ya
I:lu I hereby ofEsm that I am exempt room the Connector's License Law for the-
t: MAY J $50000
z'a following Mason.(Section 7031.5.Business and Pooo 0 L fessions Code:Any city or county
Sd O which requites a permit m convect,alcor,improve,demolish,or Mpair any structure
E3m -pnorto its issuance also rcquireatoeapplicmn for such permitm file au,nedstMment -
-
metheislicensedpursrpmtothe poovisams of the Connnno/a License Law(Chaptn9 I •� �,csl�f�ty�I�aD�Qsor,y�ea,-,.; , Valuation
(commnicmg"ItSection3")of Division 3 of Ne Business•and Profeaions Code) `- I` PJ �yjf��l(RW ,Ggea. -6lf•i,tSL 's
or that he is exempt them0om an4 the bans for the allegeed exemption.Any violation
of Section 7031:5 by any applicant for a permit subject the applicant to a civil penalty ,pt.,,s .�
of not mom than rive hundred dollars(5500). 101 APNI&I94 MATION ` :"- Occupancy Type
D1.asownerof Nepropeny.ser my employees with wogc,.,,mirulecompcnsation. 102 - PIERS
'will'do the'worr.antl the'swnure is notWended!or offered for sale(see.roti: 10 3 - UFER - Required Inspections
,Business and Professions Code:The Contractor's License Law does not apply m an q p •'•
owner of property Who builds or improves thereon,and who does such work himself 104 - RE BAR _
or through his own employees.provided that such improvement are not intended or _.
comple ton sale.ILbowcvci;the building or nden of Prov n that h did one year of 10 5 - ANCHOR BOLTS - •' t",
'Improve mr,i owner-builder will have the burden of proving rhos he did not build or
Improve farparposeafmlea. 106 - SEWER & WATER ,
o.. g. - .__. 202- '= UNDERFLOOR'-PLUMBING
1,as owner of the pmpery,am exclusively convening withlicenseddic) I Cannon m -• ":": . :.. '
t
ons rvn me protan(see lou.Business and Proressmms cote:)me comtrano,s
203 - UNDERFLOOR MECHANICAL:
License Law docs not apply to an owner of property who builds or improves thereon,
and.wha.comrects for.sueh projects with a.emnractogs).licenud punuem to ilia
e na t r License ave S f e - 301 - ROUGH PLUMBFRAME
D en a&Pcmrmrsresom 205 - UNDERFLOOR I'NSUDATION
owner
Date /1 u ING
ORKF SCOMPENSATI N CLARATION 3O2 TUB & OR SHOWER ,
-I hereby affirm under penalty of perjuryonepf the following declarations: 303 - ROUGH MECHANICAL
.= t D 1 have and wiil'maihtaid o Certificate of Consent to telt-insure for Worker's 304 - ROUGH ELECTRICAL
d�:_,� Compensation.as provided for by Section 37W of the Labor Code, for the
- _ 'Compensation.of the work for which this permit is issued. 305 - FRAME
" ❑I have And will mountain Workm's Compensation Insurance!as regbited by Section 306 - HOLDOWNS
37M of the Labor code,for the performance of the work for which this permit is 307 - INSULATION
'I issued.My Worke , mannaCompeInsurance under and policy number are
_ 308 .. "SHEETROCK ...
Policy No.: " f
Cr } s 4CERTIFICATIONOFEXEMPTION FROM WORKERS,', rw ' ei309 -31 f-,
ktERIORPLLATH • tt '
_ COMPENSATION INSURANCI
h a:mdii' _ ._3'1'0" `-'INTERIOR-liATH'- :. ___..__... ._...,
on need
nnnecompleied tthepermitisfuronehundreddollar 311 SCRATCH COAT
_. .-
_.
313 '- ROOF-NAIL
1 r fy,hat
the
' rf .mc aki_nfif.sd
misncrnk for rca_teb a- - ._.i.. ou_odo,,i
Chau n t employ any person r any at v In nett .evabjcct .,the Workers.
501 .._ ..-.FINAL...ELECTRI CA..LENERG.Y
C mpon LuwvofC61romio.Data
: udint 502--.--..FINAL..-PLUMBING—ENERGY....
NOTICE roAPPLICANT
bac s bf imtheWorker,Corape p sons of he LuburCode,youtmust 503 - FINAL MECHANICAL ENERGY
O z .,,,,,hu comply with such p...i ons or this Te mn hall be demed Mvuked. 504 - FINAL BUILDING ENERGY
....._.-----
t„
..
_._......
CONSTRUCTION LENDING AGENCY 505 -
FINAL ELECTRICAL
I hereby llama t Ihim d' construction lending agency f the Performance
nce
'fNe rkr,, hihm pent issued(tiee309� c c) _ 506 - GAS TEST
:D
Leader's Name.;.•. _ ..... ... _ _.__507 --- FINAL PLUMBING --
� z La nJere Adores. �- -
U--O 508 -- FINAL MECHANICAL
1 cenify that lhave read this application and nate that he above information l5
correct,i I greetoc a heall hereby J county Ordinances and.cite Iowarelating 509 - FINAL GRADE
QtO •tobuldingconstruction,ranionndhertbyauehtionpa representatives fth.elymennrupry 510 - FINAL PLANNING
}h b ve e t onto propend farinspect p harmless
-
.L IW) greet . e ify penJktph ayinanybe wayAcruengainstfiao aid 514 - FINAL UBL C WORKS
W liabilities.judgments,costs and expenses hich may in any y c rve against Said
U,z _City in consequence of the granting of this perms. '
AP,PLICANT INDE SLINDS AM1'D WI LL COMPLY''WITH ALL NOY-POINT Issued b f Date �� �• �/
SOURCB�V/'wULJ ONS. u e/ Y
si,mAam fXpppBaAmdmrasto, sone Re-roofs
HA POOLS MATERIALS DISCLOSURE
Wal the applicant 4 future biuldirijocetipart,torm On handle hazmdous maenal __Type Of ROOF -...-.
�a defined by the Cupertino Municipal Code ChapMr 9.1 and the Health and S.fny - f
'Code Sectu M532111 .y, �+ } � �- :':'s`)a J t 4
All,roofsashall be inspecred.pnor-to-any-roofing material being installed.
.
_W41 th appTcamortmurebudd s pant use egaipn.ant ordevt nen If a roof is instalfed without first obtaining an inspection;I agree to:remove
lh No air contaminan�eT d by the Bay Arta Air Quality Management
'District all new materials for inspection,_Applicant understands and will comply with.
ar- DY .x. , No - - .. _ - _:.
all soh-point source regulations,.
�— I hoe Mad rhe haanrdous materials.requirements under Chapter 6.95 of•the
.California Health&Safety Code,Ssmums2505.25533 and 25534.1 undersundthm -.-. _ -- .__ .
if thebold' gtl not currently have a ac..m.that nus my responsibilDto - V.notify the - - ' _ "—' ' " --'. -'- "
p tof q m m h ch must be n Prior nuance of a Certificate of�O paned - .
Signature of Applicant Date
M
OwnePoranhoriMaa nt at All roof coverings to be Class `B" or better