01030018CITY OFCUP R'FNNO
CONTRACTOR INFORMATION: _
BUILDING PERMIT
BUILDING ADDRESS:
1117h MIT NO,
20400 MARIANI AV
01.030018
OWNFR'S NAME
APPLICATION SUB DATE
BERG MARY A AND CARL E
TRUSTEE
03/05/2001
ONE,
SANT I'ARY NO CONTROL NO,3G
ARCEITEC'UHNOINEF.R:
BUILDING PERMIT INFO
; f n T
nLIIG PLECT PLUMB h iC
�vr Avec
I_ J I-1 1
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby vliimm mm I mm licensed under prolilion, of Chapin 91rmanor cin,
u'im section 70001 of Division l of me Easiness mm Pmlcssiom Coe, and my license
LiL - te full arra sena meet.
cense Chis, Lic. p
��y�' LILt t5V EMENT
"k'R'
Orae Comrannr
W'X
3
ARCH IECr'S DECLARATION
I understand my plans bull be used as panne reenNz
'UN 0
7 2001
-
U,en,cd Pn,l'c..inn d
(IWNIIR-BUII.UHR UECLARAHON
,
I hereby afford that I son exempt from the Convector's License Law for the
'
n. (Section 7031.5. Business d Pmfc,sko%Code: Any city or county
following re ruan
BUILDING
which requires a permit on construct. uher, improve, demolish. or repair any mobae
prior bit, i.su:mcu, also requires the afflict far such Pertnitto file a signed shneomm
mat heRl<vnad xm,.mwmepot, nloon, ofthe ca,nmemr,Literi.cl.nw(CheNer9
- Sq. Ft. Floor Area
Valuation
(,ommeneing with Section 9000) of Division i of the Bunmet, and Pons,,iom Code)
or that he is exempt mem(mm and the „osis for me alleged exemption. Any violation
of Seniors 7031.5 by any applicant for a permit sabJems it. applicant an a civil peoulty
APN Number
Occupancy Type
of ntnmare mail five handralskills, ($51Xp,
,
❑La ,wnerofine pmPenrio my cmpbyee win wage, as men sole,ompensation.
1's
Required Inspections
will dos the work. and the structure is not intended or offered for sale (ree. 704bl.
License Ww dons
Business and Professions Code: Me Commemrs nut apply It vis
owner of progeny Who nandk or improves thereon. maid who does such work hhnself
a.gh hie awn cmNoycua. pmvded that ,ace in.pnncmems are m,I intended or
101 —
FOUNDATION
oBcred Ilr sale. IL browser, the building ear imp nrvancm is sold within one year of
he harden he aid build
1.02 —
PIERS
completions. me owner.bu;mer will haw of proving that not or
mprowc rnmirroseuamc.).
103 —
UFER -
17 h: wndofinepropeaty, tai exdmnatycantnnn;try with nmo,ed cam,nactOfX 1n
ndcvoo, ,de:) Ila, Convenor s
,nam,e he proien (See. 7044, Bminco and PoG
104 —
REBRR
L;eeme Law docs oat .,ply,,, no owner of property who build, of improves mcreon.
and who contracts air such pm)ects with . commerono licensed pursuant m the
105 —
ANCHOR BOLTS
Coulanor.L ,Law,
1.06 —
SEWER 3 WATER
❑tum pt unsay .BNI'Cfrml,tnw,
C
202 —
UNDERFLOOR PLUMBING
Owner/�s— Daic
WORK-Xii1 •IPENSATIONDECIARATION
203 —
UNDERFLOOR MECHANICAL
umcrchynlhamm onaer pm,alty of pnlLry Local ma rouLwing,memrad"""'
0,
204 —
UNDERFLOOR FRAME
1 base and will maintain a CediBcam of Consent m «B -insure for Worker,
205 —
UNDERFLOOR INSULATION
Cmnpensadon, as provided for by Section 371X1 of the Labor Code, (or the
penanance of the work ror which this Permit is issued.
301. —
ROUGH PLUMBING
YIluwe and will maintain Worker's Cmopenwtion Insurance. av required by Section
302 —
TUB 8 OR SHOWER
Ip of the "Nor CWe, far the perfnmemce of the work far which this permit is
issued My Worker's Compemation Insurance earner and Policy mother am:
303 —
ROUGH MECHANICAL
cnnien poneyNo.:
304 —
ROUGH ELECTRICAL_
CI!RTBICATION 017 EXIHMPnON FROM WORKERS'
COMPENSA'r1ON INSURANCE
305 —
FRAME
(This section aced not tic completed ;f the Permh is for one hundred dollars
306 —
HOLD014NS Its,U100)arle,,.)
307 —
INSULATION
I cenify that in me performance of the work lit which this pxme, is issued I
.hall not employ any Person in any manner,o as m became ,uhject to the Worker
308 —
SHEET ROCK
Canpen,ation I,— of Carlo nil, Dam
Apprcmt
309 —
31.0 —
EXTERIOR LATH
INTERIOR LATH
N(n'I CI?'DJ APPLICANT': II', aver nwking this Cen'nisac tilExemption, you ,ho..Id
lesion, object othe W'orkre,Comoom,A mprowi,anxofthel,NoCWeyoumuss
for imconmplywithsuchlowi,ion, or his pennitshall bedermcdmvoked.
31.1 —
SCRATCH COAT
CONSTRUCTION i,l?N DING AGENCY
1 —
'i 3
ROOF NAIL
I herby Idlinn mut mer, I. a ann.vlmetlan Imding agency Ga the p erfo mmate
,�
ofLeadc,,NmrwNanmi,Pemm�it ia.nmce(seea(9,ciw.c.)
the
501 —
FINAL ELECTRICAL ENERGY
's Nmnc
Lender, Amlre„
502 —
FINIAL PLUMBING ENERGY
1cLrtiry mut n,nw, reId o,l..hpnctthom non awte mat them„'', imfbmntia'it,
503 —
FINAL MECHANICAL ENERGY
correct. 1 agree m comply with all city and county ordinance, and state paws relining
it, budding r0mir-Romi. andli by withorizz reparesciandiwxfm' cifv mruptm
c —
FINIAL BIJILp4ftlp ENERGY
me allow f Iproperty f .pmt para
(We) ounce t d ty andkeep h I::meCty ofCl ri agamt
505 —
FINAL EL RL
fmdt i Iytcal..u t d xltn.n: n y anyway' g mw..dd
City c no n, grant, ng of this pram L
AYPL UNUERSfAyy.ZaNl)WILL /OMPLY WITH ALL N(�
C!R CI` IONS. C /,r\ 3
'OL T I
x..104
- %�
ISSUf:d b Q 6
y' —
a, 5rppp-Cy �/
Date
Re -roofs 508 —
FINAL MECHANICRL
SI mummarApplicnnUComrnnor i I T)/,c
HAZARDOUS MATERIALS DISCLOSURE
Will me applicant orfuture wmhngoccupaat sit= orheritage haym,u,m:nerial
Type of Roof 509 —
FINAL GRADE
as defined by dm Cupertino Municipal code. Cbapmr 11.12. wad he Health and Safety
Code. Srxfi 2553a.T'
510 te
FINAL PI_R NIN
`
❑Yc,
All roofs shall be�ryyspp�ected
¢¢}},r,����QQ�� anm�.!ng installed.
tflthi"btftail{iI
Will me applicant ear luwre naihlio occupant uses equipmcar ear devices which
Ila roof is install�tib7ithout
'MSpe .agree to remove
Irmsekai air nmtamin:mms e, d ed by 'he [toy Area Air Quality Management
all new materials for inspection.
Applicant understands and will comply with
;strict; -I
Wit
El oNo
all non -point source regulations.
I luwe mad the hamNous material, requirements under Chapter fi 95 of the
Cvlifom.[Icahn &Sai "le, Senium 25505. 25533 and 25534. 1 understand that
;I the builmogd� a dy nave: tcnun,m:n it i, my m,neibilitym notify the
xcupunt o ¢, t « to whmht,�M1c met Prins I u C''�yrr+tt lieu of
ixcal,m'r` 1,, /
�0
Signature of Applicant
Dale
/F
All roof
coverings to be Class "B" or „eller
ormoSbrie,d agent D,,,
OFFICE