03070216 CITY OF CUPERTINO tva> Ntr � `< t •n�a- n nrta �, 7�zg
BUILDING DIVISION PERMIT ViCONVUOTOR INFORMATION
BUILDING ADDRESS: ATLAS REMODELING COMPANY I LRPd1TND03070216
7810 T-TTMAR (-T
iR'S NAME: 831 COLEMAN AVENUE PERMrr lssuE DATE
GREG & SANDRA WRNDSCHLAG 07/29/2003
PRONE: - (408) 293-2617 SANITARY NO. CONTROL NO.
ARCHDDCryENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+Op LICENSED CONTRACTOR'S DECLARATION IobDescri tion
U❑ I hereby of0rm that 1 am licensed under provisions of Chapter 9(commencing p
with Section 7(A)U)of Division]ofthe Business and Professions Cade.and my liecom is
iin full force and effete. REVISION--IN HOUSE USE ONLY
Lleenm Class Lie.°
Dam Contractor NO NEW PERMIT ISSUED #03010132
ARCHITECTS DECLARATION �J
I understand my plans shall W used as public records /
soG Licensed Pmfessienal
3
OWNER-BUILDER DECLARATION
CmanION C'
COO hereby maso .(Sero on I am exempt from Ne Tessio mCo :Any Law for Ibe \V r
<p O following reason. arch i ]coir Business and Profession Codc:Any city or county
$ which its isu a permit tat construct.gime improve,demolish Permit t m repair any ned rammem
uZi that hnitscensed pursuantto the pression&o for Cela Pesmiuoiensele a Law(Cha mens
•¢a
thathelicensed 3orthef the ntucessandenmlawlC odu)or Sq. Ft. Floor Area Valuati(7g107'
2 f•D that he is xem with Section7")the
Divisionr of al Busaged exempt Professon.Anynvi Cnlc)or
that he Is exempt thcm(rom and the bssu for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3G2Xa63*er00 Occupancy Type
not more than live hundred dollar.
0 I,as owner of she property,or my employer with wages as their sole compensation,
will do Ne work and Ne mderme is nos intended or offered roaalc(Sm.7041,Business �g��I'��❑
and Proressiom Code:The Canuacme,License Law does nos apply to an owner or 101 — FOUNDATOVd Inspections
propenywhobuilds or improves Nemon,and who doessuch work himmlf or through his
own employees,provided that such improvements sm not Intended muttered for sale.It. 102 — PIERS
however,the building or improvement is mid within one year of completion,the owner-
builder will have the burden of proving Our he did not Wild or improve fur propose of 103 - UFER -
"le')' 104 — REBAR
01,as owner of the property,am exclusively cordercing with licensed contractors to 105 — ANCHOR BOLTS
. consider the project(Sec.7044.Business and Professions Code:)The Cunuaerori Li
e Law does not apply m
who Wilds 106 - SEWER & WATER
Lmx
License
i` Lawes for such projects with aom
aracmr(t)ncenmu
licensed the Contractor's 202 — UNDERFLOOR PLUMBING
eaemps under Sec. .B&PCjar Ni�R,?n 203 — UNDERFLOOR MECHANICAL
DimWORKER COMP
ft. 204 — UNDERFLOOR FRAME
ENSATION DECLAR ON
Ila ysurn. do RhyOfPerjuryOneOfthefollowingdectmatil 205 — UNDERFLOOR INSULATION
❑I have and will maintain a Cenificete of Consent to self-Imum for Worker.Compen- 301 — ROUGH PLUMBING
melon,as provided for by Section 3700 of the Uwe Code,for the performance of the 302 — TUB & OR SHOWER
work for which this Permit is issued' 303 — ROUGH MECHANICAL -
0 1 have and will maintain Wurkera Compensation Insurance,is,required by Section
37M of Ne labor Code,for the,performmce of Ne work for which this permit is issued, 304 — ROUGH ELECTRICAL
My Workcre CnmPenmtinn Insurance artier and Policy number are: 305 — FRAME
Carrier: Policy No.: 306 — HOLDOWNS
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE 307 — INSULATION .
(Thumction mod nmbccomplemd lithe permit is for one hundroddollam($IN)) 308 — SHEETROCK
orleaa) 309 — EXTERIOR LATH
I certify that in Ne pe ftor ance or the work for which this Permit Is issued.I shall nm
employ any Perron in any mane an a in become subject o theworkere Compenanlcn 310 — INTERIOR LATH
Of
aLLws of California.Wm
Applicant 311 — SCRATCH COAT
P
NOTICE TO APPLICANT:if,alter making this Cenificate of Exemption,you should 313 - ROOF NAIL
become&Object to the WorkeM1 Compensation previsions or the Labor Code,you must
],Z forthwith comply with men provisions mthis Permit shall Wdeemed mvekm. 501 — FINAL ELECTRICAL ENERGY
z CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY
I hereby oM.that Nem In construction tending agency(or Ne Performance tar � 503 — FINAL MECHANICAL ENERGY
> thewohfor which Nispermitisissued(Stt.]097.Cit.C.)
Lenders Name 504 — FINAL BUILDING ENERGY
11 Q
Z) z L nder,Addm 505 — FINAL ELECTRICAL
j 0 1 certify that 1 have read this application and stain that she above information is 506 — GAS TEST
y I••' correct.I agree to comply with all city and county ordinances and sum laws relating to
0U buildingconswerion,andherebyamhornemprcmmnivuo(Niscitytocnmruponthe
C FIN PLUMBI
above-mentioned property for iespeerian purposes G
,
(We)agree m save,indemnify and keep harmless the e City o(CuMnino against 08 FI L
r to Iiabilities.judgmenu,ems and capcua which mayin anywayacerue agaimtmid City 5
U Z in cunmqucnce of the granting Of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH-At.I.NON-POINT Issued by:5 i NG Da e
SOURCE REGULA NS,
Re-roofs
Sierre ofd onuaeror Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant or future Wilding Occupant store or handle hmudous material
as dc0ncd by this Cupenino Municipal,Code,Chapter 9.13,and the Health and Safety
.Section 35532(.)? All roofs shall be inspected prior to any roofing material being installed.
O Yes
Will the applicant or forum building occep rat use equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove
cmlt hmardnus air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
Dbvict?
0 Yes
HE maJ Ne haaardtms materials myvimmcnu underChapmr6.95 of the Califor- /^ /�
nia Health&Safety Cade,Seedtuu35505.255JJandM534.Iumb. dw if Ne Wilding
does not correctly how a room,that it is my responsibility m nndry ftotturr recurrent
of the J
reyuim entswhic mu Manor Oce remy` Sin ureofApplie n Date
I/ ° II roof coverings to be Class "B"or better
w r auNori'ru 'cm Dom