02010022 CITY OF CUPERTINO `
BUILDING DIVISION PERMIT CONTRACTWINFORMATION:
BUILDING ADDRESS: PERMIT NO,
10716 LINDA VISTA DR CONDITIONED AIR 02010022
OWNER'S NAME: APPLICATION SUB DATE
CARLISLE JIM L AND SUZANNE F T1701 LITTLE ORCHARD ST 01/07/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 291-2220
q ZO ARCHITECT/ENGINEER: 3 BUILDING PERMIT INFO
kC BLDG ELECT PLUMB MECH
O' LICENSED CONTRACTOR'S DECLARATION Job De$Cr]phOn
ZO =Z I hereby affirm that 1 am licensed under provision,of Chapter 9(commencing 100 , 000 BTU FURNACE CHANGEOUT
P=C with Senian70W)of Division 3 of he Business and Professions Code.and my license
u E is in full force and effect.
m rc< License Cie., Lic.is
O a O Data Commnor
3 a.t; ARCHITECT'S DECLARATION
E;0 5 1 undemand my plans shall be uud as public rccoNs
�vo
us O a Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from she Contractor's License law for he $565
C?< following reason.(Section 7031.5.Business and Professions Code:Any city or county
Eq F❑ which requires a Permit to construct.alter improve,demolish,or repair any structure
53�...p o to, ace,of rtq r the applicant for such permit to file a signed mumem - - - -- - - —
-----
ththeibcensedpunttmuotheProviii of the Contractor.License Law(Chapter 9 �`n ,�' �,� y
Fromm a ng with Section 1")of Division 3 of the Business and Professions Code) -1 7j 1. j3 5 6'�d'��Ls(Q�V lJtea A,-j •S Valuation
or that he is exempt thcsefroin'and he basis for he allegedesempi,on.Any violation
of Section 7031.5 by any applicant for a Permit subjects the applicant to it civil Penalty
I of no,more than five hundred dollars(SSW). 301 APV60tff PLUMBING ::11•.•:r^':'I Occupancy Type
❑1,as owner of he property,or my employees with wages ns heir sale compensation, 303 - ROUGH MECHANICLI,
-
will'dnthe work, the simulate The
iCnneitorldbnse eredLaw for scut. ,11.an - 304 - ROUGH ELRG;'QlR&CV13pcctiOns^1 ,"Ilu "'Ii'
Businesi un work,eand th Cale:The is Connector i License Low Jnes not sec:to an "•"_"a"1"
owner of property Who builds or improves hereon,and who diva such work himself 505 - FINAL ELECTRICAL
or th ggh his own ply provided that suchimprovements t intended or _ -- -_-
".011rildf"-alcaf;h e th build'n '" - -"'- --'-- _ ._.. —_ -
'tompletion.Jhe owner Wilder will hovethe burinof,.,ng ha h,didnot year
5 7`- FINAL- PLUMBING- r .., Ti'
-
improve mrpmPnveof W,.). 508 - FINAL MECHANICAL
O 1.0 awncrof the Prapeoll.am exclusively contracting with licensed contractors to
_ comtmct that project Isle 71144.Business and PmPosslom Cade:)The COntrachu'sr,l q� P1 Lrl ..,, ..-�
-- License Law docs not apply to an owner of pdI who Guilds or impmvcs thereon,
�- C .forsuch.projects.wih.n.committed.)licemaLpurnexat.m.he. _______----_ .
rr. set Law.. -" �-" '�
_ _and.who.cammcts aj
:. mmcmr's Licen r; ,'i'yri •:>""• �'�pn
u inns
o pp
.. - .. ❑I tler gee.'-' - - B&PCfor this rtason {La
at , t '-.c0 to ',-..e Inn
' !WORKER S COMPENSATION DECLARATION JLI-
Sr 0 4 2002
p
n . (hcrcby nffi J< Penalty of pejdy rte of the fnllowmg dedumt acts..
,,. ❑ 1 have'and whit manmin a Cedi'me f Conserv to selL,nsurc for Worker's B�I�DI�ag�
eF Come
pnsation;as pro.Jed for by-Sadun-37W.of the Lahm-Code, for BUILDING
�I
perfmmance of the wmk for which this permit A issued..
❑I hrvalmdwill'me nmm Worker s C nPensauan Insurance is requieed by,Seetion
3700 of the'Labor Covic,or'the pirfinandare of iW b k f r hich'this Permit is
i d My Wnrker Compenwtlon insurance came,end POLry umbe
CameratCERT1FlCATION OFEXEMPTION 1,1[,!:.1
TION FROM,WORKBRS�'"I' )fugil;ti44.. :�5`.Ssi •1.
COMPENSATION INSURANCE•° "'a-' _ _ ____ _____ _______ _________ ___ ___ _______ ___________ _____
rrus secdori need not tiacomplctd if he Permit is for one hundred dollars ^ ` •,1'l:ir t;:e1: ;?n t c':lii7u'lh' i I[;.'^
h
h *1 n fy iat ,h perfimance f th rk for svNch th permit sits.N 1 ���«•< 1e
M1 II not mploy'a Y Person mars e'i
Y ds to beimus, to the Workers - "'i:'t t.v I'.•nrCl L i Id -'
C mpe s t law of Cahf rat 'Dat -
_APPheanL. .n.,. ,.:. _ _..._ .. _ .._._. ...
;'NOT CH TOAPPLICANT it,otter making this Cenfcatrc of E1amPhW:yom.1hmld 1 \'
PY P Pe L Y � Yumu t
C Q forthwith c m with h ed _,_ ,--.
become subleet 16 he Worker ompensm npro stnsorh labo Code
s this rat shall reamed tk `. ---, _, -
111-CONSTRUCTION LENDING AGENCY 4 "
Ih b ff h nh n 1.11,.n dig Ic for ifomt ce JII
f thew k f which ht perms .issued(Sea3fn7'CI C) i„-,• c1
OWi:.Q Lenders Name'n.n, .. �.. .:.use._-, _. - ,.-... _
d AJJa.'
.=7'Z
(,.:Q .,^�Iq;,,l certify thatlhave reed this applicmmn and state hanhc above information is
W cF loran:I agree I.comply with all city and loudl,.ordi....as,anQ stme laws relating
building ronatuction;and hcrcby autbuda rcptesentitives ofthii city to enter upon
;theuhave•maniionedpmper fminspectionpurpo s.,:.
gr�ss'L (We)agree m'save.thdemnify dad keep harmless the Ciiy of Ctifert aga;nss
LI'14 liabilities,judgments,costs mad .parses which may in any way accrue against said
r V.Z City i onsequence f h Rr i g of tht Persin ” - "
- - APPLIG\NT,UNIDSRS'fANDSAYDWILL COMPLY WITHALLvOV.-PO13T"
T. SOURCE'REG[lEATIONS,;, '' ! ?-.;i-,:. - Issued bye DBI.
,S gnaturc APpHeanUC tadorIs, - '-'� •-Dat Re-roofs
HAZARDOUS MATERIALS DISCLOSURE r 1
lII h u"'n t or fumrc braid ng scup nt snrc o handle haaard a matedof Roof _,
ie df ed by the CupcnmoM opal Cod Courier 9.13 ad the Health and Safety - ? : tt a f.IT
.
,Code inn 2531121,) ,?,tq dNo It)j t �}t. .. t! ts7v. 1t, tr'y. S__ .,7 r.fts .
D e All roofs shall be inspected prior to any,roofing material_bemg installed. __-
tt
t ,Will• tb tC rc b Id g p use prim r devices which
o rain t def dbyh B yAAir Quality Manag m nt If a roof Is mialledWithout first obtaining an inspections s iagree'to`remove
all new materials for inspection Applicant understands and wilI comply wnh__„
• <r ,oY. , •; pNo ,.,- ,,, t fl..,. all non-point source regulations;--„
�tf 1 have read the M1aardon,maenals rcspa.rniti under Chapta4,6.95-of the.
Cali(oinia Hehlth&Sandy Code,Sections 35505.25533 and 25534.1 undersand that,
ifilic Wildi doesnoicurbard halon rcnant.thm it is res
.i qg Y Y Issuance of.
the
OhCp3nt mite�iequircmenis which must W at pd,to iisuance o.a Ceni6iate of -
omhori:, g pp _. Date.
t Si nature of Applicant
da ant All roof coverings to be Class B lor.'better
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