02020026 (2) ' CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10370 LINDSAY AV 02020026
�s1N4 G JERROLD K AND LOUISEAbP�crrjoys}�6`62
PHONE: - SANITARY
NO.
CONTROL NO.
W O O .ARCHITECT/ENGINEER: HUT IMG PERMIT INFO
8�
Z tp� BLDG ELECT PLUMB MF.CH
0 S Z LICENSED CONTRACTOR'S DECLARATION am
w I hereby amrm that Tani licensed under provisions of Chapter 9(commencing KI 1113= o � to 'REP I PE.
�y�I with Semiorys]UDO)ofDivision3of the Busine sant PmkssionsCd � ORE
10
ILC-C is in fullCC�ffalaAl//e an� r1
0:'6 Licenu L,IM
Fe - ARCHITECrS D' AMTIDNa. FEB 2 6 2002
n 1 understand my plans shall be used as public records
wE es o Licensed Professional BUILDING
e' OWNER-exemptBUILDER DECLARATION
user I arae alTnn Nm I am exempt from die Convenor's License Law for The $25000
FZQ whfiallich requires a Permit
cont, t,siness end Professions Ca de:Anycity orcounry,
I F❑ whmh req n gem,t t construct,applicant
improve,for such
demolish orerepair
asig any swned ment
g37 -1 no ilicenaocagl coq, p apams,of for Commamuuoicense Law(Chapter
thathq Nylittwithal TansiI Sectiont7 'pp Divisinthe the Bus
License law(Chapmr9 } yyN 6M-t Wa �I,A�a,, x 'y ' Valuation
(cam eng with Section]OpDJ ofDivision)of N<Buayiessund Prpfessmns Code) 1 ;..a; l-a�.-a ,. , .Y_ e13,.N,j r9��kt;M i
or that he is exempt Ncmfirch pad the bass for the allpied ehempubn.Any v,olmion `
-OfnotMOMthanvehundreby any ddoltrs(550mtitsubjects meappEc:mtmacieuPenalty 1b1AP-N ¢OWNDATION ;:Ir' •,. OccupancYTyPe
Of normore than live hundred dopes SSW.
1,as owner of the prop¢rty,amyemployees with wages ea their vele m+mpensatiam 102 - PIERS !• �
-;.Il I-do,the work"and rthe structure N nut intended-or'offered for .In(See 7}14" - ' - UFER - -Required
e u e - ec ----- ---
•Busln a d Professions Code The Contractor's License Law doer mit apply to an - _103 - Required Inspections �` •t �t'-7`
ow
nerafpropeny Who buildsorimpmves thereon,and whodocsauch work himself 104 - REBAR
or through his own employees,provided that sueb Improvementsnot intended or _ _
doer for the
owns in building o p - i i Id iM1 done yem of 1.0 S 'ANCHOR" BOLTS ----
completion.
inov.ethcawe.fralderwillhavetheburdenofpmvngihmhedidnotbuldor 106 - SEWER & WATER
improve fur purpose of sale.). '
,
-__.--._..... .___.som —_velyco202"-=' UNDERFLOOR—PLUMBING-- -.;. -;, --
_ :: �. ❑Casowner of Ne p(See 71, I.eusinissadPratengwithlicensed Context to Ei+ + .:,1' -- i':P`
cicenseommon-iwhe project Tapp. toa owner of anderty who mildsor Theves Thereon
- 203 - UNDERFLOOR MECHANDCAL..' %irr,
--
License law does not apply to an owner of progeny who builds or improves Hereon, -` ` ''"
mod
,whacammcise Linw.ch-projcns_witti.e commctortsl licensed
pursmm.to,Ne. -'Z.04,,._-...[JND�'R�.'LQQR...�'.RA[V]�',..-_._.-_ .__:.__
Commnofs License law. _. ... .,,... ,. -�--�-�--
-- ="r ❑lamecmptuneprsee ""' 6'&PC farhiartason 205 - UNDERFLOOR`: INSULATION
Oit-
. ' woR�..i,. .,.. .. 301 - ROUGH PLUMBING
KER S Co
ATIO1 N DCCLARATION 302 - TUB & OR SHOWER
I hereby affirm under penalty,of pe7 ryi a of the fol lowing declarations:- 303 - ROUGH MECHANICAL
O I hra nn1 wll munt C nifmat 'it"Consett to elfmsurt for Wmkcr's 304 - ROUGH ELECTRICAL
C pemat n- n-provided 1 by�Section 3700 f theLabor Code: for the
p r ,neahh0walk for+nehIbis per i tied ., 305 - FRAME
[IT h nd II'rno t nWprkei s Co pensauon his uennce s req irtd by section3 0 6 - HOLDOWNS
r - S7W of the Labor Cale f dr performance of the work forhis s pe t is 3 0 7 - INSULATION
15ad-My W tons Compensation insurance m and Pal cy an,be a
O,rne'1'''• fro r,. st Ir_,f}d7Pol yNO. -..i I ... , 308 SHEETROCK--_.:...:,...�:,.,...:,.., ,.....',.1L
t t1'CERDIFICATIONOFEXEMPI'IONFROMWORKERSc - - i. t, N 313.0.3"._.?i XTEkOR:bLATH;.
COMPENSATION INSURANC[•`•"•'a y
310•;• -INTERIOR-LATH -----'-'•
(Thisirniontiednmbecourni ilfthepetmnisforoanhundreddollen 311tf SCRATCH COAT r,rt f,•: �' ,,r i;, .,
(5100) 1 ) -
1 f 1'cmify that in the perrorma c hhc ant,far hi h this{ t ,tx e 1
'shllnt crop( yuOy per nyok ra I n adeamluf ep_9_ M1ep 501 - FINAL ELECTRI CAL''ENERGY'
C pnQt n cmI D; ` I „-,50.2 -...F.INAL PLUMBING ENERGY__
NOTIC i TO Ar If mrmnk ¢nuc s at Excinfilion,you .,a,,al,, 503 - FINAL MECHANICAL'ENERGY
Z hcc Me
a uhldtio the Wo ke! C ,npensaton pnvsnns of the Labor Cade,you niu
O C Tenhwith comply w thsuch Toroll,drit,or his permit haEb deemcdrevoked 504 FINAL BUILDING ENERGY
Zy . .., .... .._.. ..
a
,t ere "tCONsereis orvLENDINCAcrNOY - ` 505 FINAL ELECTRICAL> I hereby firm that there nswcu n le J get) for the pert m c
gg
Lfthe work to,which his getout issued(Sec3097 Ci C) F ati 506 GAS TEST
E;:Q Le der. N •W'- �+
code.s...... '�.• .-,. .. PLUMBING--
.
_. .._
-507'"--' FINAli PLUMBING """
v O ,, '. 1,1, ..,r, , 508 - FINAL MECHANICAL 'r
^ I unify th l I have read this application'md smte Nat the above information is
7 4LrE„ coii5n.I agree to comply with all city And county.Pfdi...fes and state laws relating 509 - FINAL GRADE-
O:U (a building con.wuction;Mdherebyaddamnicrcpusenmtivesofthi2citytuenur.upon 510 - FINAL PLANNING
the above-mentioned pmpeny for in spcaiop purposes.,,,
We)vgreamseve:Indetont(yand keep harmlesstheCity'd(Cupeninoagainst 514 - FINAL PUB C WORKS
f J liabilities,judgments,costs and expresses which may in any way accrue againsi said
U'Z
City c nseq once f d e ginning of ibisperunit " •`
APPOCANT.UNDEXS'f,,ND$AND W ILL COMPLY WfrH ALL NDN-FOiv
.: so(Acj3uc'ATI S., 11 Issued by: Date
.§ (t ApPI as ircaltmrl r n t Re roofs
Pr nHAZARO0U5�fATERiALg DISCLQSURP r^
Will the applic t r Tut rt bo Id ng Pam ogre 9r h ndle hau rdous n un I ,..Typo Of ROOF
-'ds d fined by ih Cnp n n M n p,l C d Chapmr9l I th f{ Ith d Safety
Cade Seaton 23572io1; "'4' r1 j( 'j E(a fl ,.t,. la S.'"'{ f"'.'r r. aj- : l. l'• v. ;1
-- All roofs shall be inspected..pnor to.any roofing•material.,being-installed.
w�uN ppr ants r t r n�iid g < p t se eq ipm msrdev¢eawhich If a roof is installed'iVithout first obtaining Pg an ins eetion I'a ree.to remove
en ih dosesalrco comma i 'd fined byth day Arc,AuQualuyhlanugemem
all new materials for,inspection Applicant understands and will comply with
❑Yea :--, ono t.r,'; - all non- oinCsoufee re ulations" -'- -
1 have«aJ.the hazaMo s' 1•.. ~ P g 41:'
mamr els requircmems under Chapmr 69l of She
Cattfomm Health&Safety Cade,Sections 25505,35573 and 255)4 1 understand that
"ifthebuildingdas tot currtnllY haveamnam;Nat it ismy responsibility m notify the "-'-' - - ""_-.._-......- ... ._.__ _-_.. .. __. ...
ac pato to ah requiameni h,h m s,he mm poor to issuan f a Certificateof
Oceapa Signature of Applicant Date
All roof coverings to be Class B'or better
-
I,. ::,.,.nt '... ._•..t-_ a. _. .. ..-' OFFICE. ...-__ . ._ - -- -- _--- -__ --- --- -..