01030056 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
P0400 MARIANI AV 01030056
OWNER'S NAME: APPLICA'rION SUB HATE
BERG MARY A AND CARI F TRUSTEE 3/ /2001
•PHONE. SANITARY No CON'I ROL No.
IUILDINGERMIT INFO
P
w ARCf11T1iCl/IiNGINEEN: I
BLDG/ Ii1.EC" I'LUy13L MCfA1'-
N U i IJ f=_I _l J
5 y E LICENSED CON'FRACIOR'S DECLARADON ,lob Description
1 heecby affirm that I ore licensed muter prviumi,of Clm,e,9lmtmuce,ing
v.tw In Section7WB)of Divi.inn Joflne Business and Pndessions Code.and my license
— -� a full fnmc and'Ecc,.
cro.Clan. Lie.# TENANT IMPROVEMENT.
t m CWmnwmr
:=a. ARCIirricis DECLAIM ION
a I unden,and my plans%hall he recd n.Public records
i o o Licensed ProN..,innal FI F'S� +Qi Ep
OWNER-BUILDER DECLARATION
wm 1 hereby affirm Iha,I.am exempt from the Conmac,or's Liomw Law for'he
C III,,,to,Or:unn,(Section 7031.5.gnome,,mrd 11 lc,,iom Code:Any Illy o,auapy JULU 2001
rx O O�
S p wind,fmpdrc..:t Iw,mh
li, ....n.arn, Aso,,i improv..demolish,ur rcpmm
ap any.Iure V
w poor it)its issuance.also requires the applicant or such pvmduo the a signed statement _
In.,he i,Brien.edpmwamIt,me i,ism„nneCommcn,r.l.i«nwcLaw(Chapter9 Sy. Ft. Floor Area Valuation
(commencing with Section 700)of Division J of the Business and Professions Code)
or that he is exempt hemfmnm and the basis for the alleged exemption.Any vi,la;on Will DING 4L9000
of Section 7031 5 by any applicant for It permit wbjects the applicant to u civil(mend"
..rn..,tI I Iham five hum&cddollhil iOOi, APN Number - Occupancy Type
❑L as owner of the proWdy,or my employees with wages as their sole cote ge,rouion.
will do,he work,and the structure is not intended or offered for sale(Sec.t7fN4.
Business and Pmfesslm,CcliMe Contrmor's License Law docs no,apply to an Required Inspections
owner of pPeny Who builds or impoeves thereon.and sono down such work hinocif '
met his own ampn,yem•..provided rcpt such,"Inovcawnr;are not intended or 101. — FOUNDATION
offered for ewe.If,however.the building n,imp rovIntent In.old within nuc year ten
nppled..n•the twit-builder sill me burden or proving that to did am built it 102 — PIERS
' p ,. t pep_
1 a 4 nn p pony Iy , , , 'thlicensed , t 1. 103 — UFER
N I to project(S 70.13 B d Profession,c 1 )'n c mm, r 104 — REBAR
L 1 ,aplYt tp ly J hill p 'tl ten,
Cand 001 , ,minun l.. aJ,r'mmr vvlh oDramor(o 1,....W plrumt , Ibe 105 — ANCHOR BOLTS
o.,...lor.Islas.,Law.
❑lam exempt See. snit re for this reason 1.06 — SEWER 8 WATER
owner 4-LY oI 202 — UNDERFLOOR PLUMBING
5 COM Pp..SAI'IUN DECLAMATION
203 - UNDERFLOOR MECHANICAL
I,crcby all rnl amler pcmdly of Earju,y oee of the roll etio,d'elum n 1
204 — UNDERFLOOR FRAME
❑ 1 nave and will provided
maintain f Cby Sect pf Conten, Io rd nhor c for Workers
campem.adan, as pm•'iaed rte by Section 37ou of me w,m„ Inde. for me 205 — UNDERFLOOR INSIII_RTION
,domeracontlhework mrwhichlhis .nhisissued. 301 — ROUGH PLUMBING
DIAavl;Ind wig rmnad..Wakers Cmnpemahon lnspmma,,e required by Section302 — TUB 8 OR SHOWER
3700 of the Lr Calc,ton the pemane
nue A the work rte which this penuh is
Issued My Workers Compmmention l..anntsn metier and Policy mmuhc,are: 303 — ROUGH, MECHANICAL
corer: Policy
rION: —
CENTIrICAI'ION OF PFFROM WORKERS' 304 ROUGH ELECTRICAL
COMPENSATION INSURANCE 305 — FRAME
(snag a,need not x.....mtried it the ,Innh i.it o..I I..nm,ed d..ltorn 306 — HOEDOWNS
m lesrd
1 ceni,y that in he psrfmmanac of the work foe which,,his permit is i...ed.1 307 — INSULATION
shall no,employ any Pcesm in any manner m as,o become subject to me Workers 308 — SHEETROCK
conownseion Li"or Califomia.Dam
A,huae 309 — EXTERIOR LATH
NUI ICE 10 APFLICAN 1.11:alter lurking tris Cenllicac nl Eamnption,you should
Iweame sunjlm m me Woke,.C..mcn,miun pmviion...dire Union,Code m met 310 — INTERIOR (_ATH
O 7 forthwith comply with such pmvisons or this Krout%hall M deemed revoked.
Z B 311 — SCRATCH COAT
CONSem is a col LENDING AGENCY
I herby affirm than mem is a donor (Sec. lendingCo,agency) fur me performance 313 — ROOF NAIL
�i
W of the work Im whldh tris pdnnit is Lwwtml Ilia.31197, .C.1
y p Lnder',Ad 501 — FINRL ELECTRICAL .ENERGY
5 0 1<wernndmf,b 502 — FINAL PLUMBING ENERGY
U O I certify it)co hoc rcml this city
and on and late mat she d%l
a maws reading
i.
Iz darter.1 agave r comply with all shy and dumpy ordinances and,Cite taw,mm,mg 503 — FINAL MECHANICAL ENERGY
O j Ifedeomgcanprluau.oma hereby amIdoe,...re emami.arndnd,ywemer open —
dl dr 504 FINAL BUILDING ENERGY
y We)agree I 1 'ly I II may
lss life
way
or Cop mm suinw
f rn habitants..me, ,: I 1 r, "Inch y ywpy..rima ago nal said 505 — FINAL ELECTRICAL
City in acw,of he ounin,of this gcnail
APPLICAN'PUND[RSfANUSpND WILLCOMPLY W,rtIHALL NOIssued by: 506 — GAS FEST Date
SOUK GUL 'W �ltt-H
sign., ra caitmcmr "' Date Re-roofs .508 — FINAL MECHANICAL
MAI IIRIALS DISCLOSURE
Will dmcapplidanto,into,,Wpdmngtwculwot.Inm...handle ha.:Woun..alernal Type of Roof 509 — FINAL GRADE
Code.as defined by the Cupertino Municipal ChroO,9.13,and the llew,h and Safety
CWC.Section' 355321x17
Elie, EIN° All roofs shall be 937 flced pPM ! y PrIl
�
dal being installed.
Will1icupP, dlummehuddingoedupmn.Ieq..ipnwattodcwfall Ifa roof is installePffhout to remove
coil hw:adnu..sir mmmminnnl..a.AelincJ by the Huy Arm AV,mllry Mxnngcnmm
;pace all new materials for inspection. Applicant understands and will comply with
O Yes 0 N all non-point source regulations.
I have read,he na.a dous materials requirements under Chapter 6.95 of Ise
Caliton in IIcuiIM1k Safcry Cmlc.Sec,iun.]$511.5,25513 wW 35$13. undmmnd dint
,I the,uilding Joa nm enrenlly have a mna..I,mea it i.my re.ponrinilhy m notify Ibe
,ocupial el me rcquilenaaa,which muni be mct prior u.I..w:mm of a Ccnirii of
OocuPaev.
��.� �•1—=-`r—�f Signature of Applicant Date
net..7namenad..gem Data All roof coverings to be Class "B" or better
OFFICE