00060046 clew of cul>rCONTRACTOR INFORMATION:
BUILDING DIVISION
sto� PERMIT
BUILDING ADDRESS: PERMITNO.
MOMEO046
OWNEH-S NAtro2393 MC CLELLAN RD APPLICAr1ON SUR DA's?
2000
PHONii: MARTHA KANG SANI'T'ARY NO, CON"1'RM NO
E
w re p TT ARCHI GC XNGINELR: BUILDING PERMIINFO HhDG �ECI' 'DUMB MECII
�u y��' Jar.•
LICENSED CONTRACTOR'S DECLARATION .lob Description
I hemhy alma'her
I an licensed under pmsisimn of Chapter 9(comnwncing P
with SCcdoo 7000).f Diviaion3ofncc Breinmsand Pro@,room Ccalb.andan,license
~N t W
fell toper send eltc
o ;te11 9/�= c , nnl�► �y-/( NEW SFDWI_ — 4367 SO. FT.
LL O If A CHITECI'S UIiC1.ARA 1p
_ I and i-slY. plans zhall IN used as public records FINALE D
s 25
u i p O LicumaJ 11rorescioml
OWNER-BUILDER DECLARATION
w I bemny about Ibm I am eacngn I}om the Cumraaorn Liao%%Low lig the J U L 1 6 20 01
H Z Y forestal,re'aron.(Srctlon 7131.5.Bosinos%and Pro eWonn C'ndc:Any clay or county
zS C whorl 4 - Ise a s l o on rep Y.I statement
a�t rco Prot t tt I: pry prapplicantf um n fiesignedanem
tthat com ci licensed n aM1 p n fah C t t L I La (Chapterode) y Valuation
(commenrs eethSeaefom anofDis hebelan3of the legass%and ton Alaa ns Code) S FS�1rL` VG
or S,,he is exempt therefrom and the bogie for the aIs tI10 esen.prieto Any I soman
of 5cction lure it anya cddollIbro5001.anuhjcefr aim uppllcnna wuCis il pettily
of ool o.o.e.ba.l tire M1antbrd do0ars lss(xn. APN Number Occupancy YPe
01.uv owner of the pmpert,or my employees with wages r%their sole compcnwaion.
will Jo the work.and the sammu6 is not intended or offered for sale(See.7144.
Business and Profes%ion%Codv The Comracmr's License Law docs not apply to on nlred Inspections
of property Who buihh or impro err thcrem,sad who docs such work bimsalf
orr11 mugs his own aoployees.prcrlded aha well imrm9e Caul are not rare led or
oacrd lose sCIC.If.hmses.,the building or I,uprovenent i.r ,,to within one rear of 101 — FOUNDATION
omplelion.the owner-builder will have the burden of proving that he did not build or
improve for purl of sale.). 102 — PIERS
O1.as owner of the property,are eWlushely contracting with licensed contractors to 103 — UFER
eonannet the project(See.7044.Holum,,;,,at Ptmle...,n..Code:)The Comracto'sREBRR
hiwnw Low docs noap
t ply m aw
o oner ho ol'Property wbunds or impmveahetcoo. 104 —
and It,,contracts for such rn,CCt,with u ronuacaorpl licensed me,mal m aha
Contractors License hwl 105 — ANCHOR BOLTS
0 l am escnto ander Sec. .Il&PC for this reason 706 — SEWER & WATER
Coact Heir, 202 — UNDERFLOOR PLUMBING
W ORKIHt'S COMPIINSM ION DECLARATION
I hereby affirm ander penalty of perjury,,.of the following cl,ra unn.r: 203 — UNDERFLOOR MECHANICAL
LI1 hese and will mountain d Ccrlfirae of Consent to sel6lnsure for worker. 204 UNDERFLOOR FRAME
Compensation an movhlcd for by Sceloo 3700 or the Color, Code. for the 205 UNDERFLOOR INSULATION
perlbnmmce of the wink for which his[mount is issued.
El
I bee and will moimaio Winker's Conp .wtl
. cnon Imu,omnca,reached by Seainn 301 ROUGH PLUMBING
—
3700 of the Labor Code.Ear the pedomence of the work for which this pemah is 302 — TUB R OR SHOWER
issued.My Markers Coralmaion Inwmnce carrier and policy number me:
303 — ROUGH MECHRNICRL
roliryNo.:
C17RI IIICAI ION OP EXIa,M NI ION FROM WOR KERS' 304' — ROUGH ELECTRICAL_
C(IMPENSAI'IUN INSURANC17 a
his sector neeact be conflicted eted if the I.emdt is err one hundred dollars 305 — FRAME
(T .
(sROHmless.) l .30E — HOLDOWNS
I cceby that in the pcaornonce of the work ter which this rental is ksued.1 307 — INSULATION
steel no....ploy any Per',( io any re C,as as m necon.e Yaoco to aha Wnrkcrx' X08 _ SHEETROCK
Cmnpensall m Laws of C.dirmmia.Dem v
Applicant — EXTERIOR LATH
NOTICE TU APPLICANT:11,aftermaking this Cenificme of lacmptiare yen should 309
G heroine%abject to the workers Compensal.on provisions of the Lather Code,soca must 310 — INTERIOR LATH
Q Q forthwith comply with such previsions or this permit shall he deemed rooked. .r
F ^ CONIIdJC'IION 1.i?NDINGAGHNCY 311 — SCRATCH COAT
I he.chy Chinn lhal l rerc is a eonswetlon lending agency for the perlimnunce 313 — ROOF NAIL
of the work far which this permit is issued(ties 3097.Civ.C.)
c Irnd"'^Nam` 501 — FINAL ELECTRICAL ENERGY
Lender's Address
O I Ill my the l have read It's:mpfiel.tion and sane that the above l"Iforrition is 502 — FINAL PLUMBING ENERGY
ooccl.I agree m Comply whh all City amt roomy onlinerner e..d leee laws och r , 503 FINAL MECHRNICRL ENERGY
Q Vto building construclon,and bembv authorise representatives of this city sea enter upon
v aheaKne-ow.loweel .110Yfar inspection purposet. 504 _ FINAL BUILDING ENERGY
(—' A. (W'c)Ago,to save.indemnify and keep harmless the City of Cupertino against
Zi liabilities,judgments.costs and expenses which may in any way accent against said 505 — FINAL ELECTRICAL
U Z City In consequentt of the granting of oris permit.
AP .CANT UND17RS'IANDS AND WILL COMPLY WITH AL�ON-l' T — GAS TEST
URC1;Rr:GH .N. Issued by: 50FF, Date
_ �Z
PP '.m—.amrxtor 1 c Re-roofs
ARDO' .fAT13RIAL5DI 10SGRE 508 — FINAL MECHANICAL
Will the applira.n o. I laddingrccnpa me nr handle hasardnus mmcrial Type of Roof
as m1innl by the Cuperit Ni of Co mer 9.12,and the Health and Soley 509 — FINAL G RAA�D�E
Culp.O vcsn 25532Gd'; O No, rQ �W9l yPrkc � f�1 RI f
All roofs shall he�1J ct�21 n and r rina�¢pg� t t installed.
Waldo,applicaHor furore Nibb.,a eriend use ,ripmam or desires which 11"a roof is installeS Urithout ffr.1019ainRLJW- fPe(<t�bri 4ree to remove
emir hatardm.s air contaminants as refined by the Bay Area Air Quality Management '§
District? C1 No all new materials I�jOiRspe(:tiROC)FppGgaiYtAW ta{l�Tand will comply with
all non-point sour%�qutatiol%OF BATTENS
I have read the hazardous matedils requirements under Chapter 0,95 of the
colo mi:Health&Safey Code.Sections 2558.5.25533 and 5534.1 understand that s
if the holding does not currently have a tCnam.that it is my responsibility as notify the
Wcupant of thc requirements which.rust M mea prior m issuance of a Certificate of
One."'Y' n p/Rj9 p� Signature of Applicant Date
All roof coverings to be Class"B"or better