00090012CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS:
OWNER'S NAME:
10413 MEADOW FL
PHONE:
DEGRODTS MIKE & KATJA
I hereby affirm'hat 1 am
with Section TIIXp of Divio�
W!! Lie.g 59846'1
Cana. lar
CHI I'LC
ART'S D)FCIARATION
plain,hall be used hs puhlie records
OWNER-RUILDER DECLARATION
I thereby affirm thin I am exanpt from the Comomun'x Licc ce Law lest the
following reason. start! 71315. 11 asxx and I'rncoinns Code: Any city or cnumy
which ,,mars n p anal Io cornu lcd. Iller, llnprnse, detnolleh, or repair any....cine
pr.. tol . 1. y : d III tnl l 'h p. ul ,, l 'g d.r lcmenl
that re licensed dp a It m P - :nf 11 C I Ir' hi I IClapmr9
¢unmcaang w'th Sef,n 7fid ifn onl f the Business i dI f 'Cmlc1
or that he is exempt thercfmm and the Iasis for the alleged exemption. Any violation
of Section 7031.5 by any applicant fm. permit .hjeas'he applieant to a civil penally
of not mom than five hundred dollars ($580).
O I, its ownet of the propery, or my mnployces with wages as their sole enmry tsatlon,
will do [tic work, unit the statute ute is art intended or alf.md far soft (Sec. 7044,
Bayport, mal 11lcsximts Core The Cnmmemr's Llccnsc Law Joe, nal uppty ns ;,It
orr of property Who builds or hnpnwex thereon. and who dots salt work himself
II rough his own employees. provided that such improvements are no, intended or
offered for sale. If, however. the building or improvement is .sold widtin one year of
completion. be owner -builder will have the burden of pmving that he did not Wild or
improve for pu,ne of safe.).
O 1, as owner of the property, um excl uxivcly comruct Ing win) heunsed contractors It
mw ma the aojeel IScc. 7144. [1 aexn call pm1'ev-sal Codef Ilm Conramor'n
Llccnsc Law Jocs nm apply m an owncf of pruperty who bullus car inq+rnvcs them..,
and who contracts for such pmjecb with u contrec ors) licensed pursuant In the
Con.loes License La,
OIumexemptunder Sec .13AI'L'for this remols
Ox ser• Dec
WORK17R'S COMITNSA'HON DECLARATION
I hereby allirnt nndcr penalty of perftlry one of the following deefumtions
O I have and will maintain a Cenifitam of Consent in self -insure far Worker's
Compero.tion, to provided for by Ssrinn 32110 of the Labor Colefor the
perfnmwnm of the work for which This permit is issued.
O 1 have and will tamarind Worker's Compensation Insurance, as required by Section
3700 of the Labor Code. for the perhnnwnee of the work for which this permit is
M
(This section need not be completed ache permit is for one hundred dollars
(M 00) or los.)
1 certify thus In btu trcrforn arle of the work for which this permit is kxwtd. I
shall not naploy any Iwrsnn in tory 'U nett so ax It h Urate whjecl 11) the Work"
Cmnpcnnatinn latwx at Culdiame. Duty
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become abject ,+ tire Wa,ker's Co., ... tlo. prnvisinm 'IF 'he Ladd, Ceske. you mus'
forthwith comply with such provisions or this peed, shall be dimmed revoked.
CONSTRUCnON LENDING AGENCY
I M1erehy off ...that them is a emo't'ion ltra ing ngcncy fnnhe pcifbnmance
,I he work for which Ili, pcnotir is issued IScc. 3097, Civ. C.)
Leader's Name
Lender: Address
I certify that 1 have feud this application and vale that the aMrre information It
coma. 1 agree m comply with all city and county ordinances .nd swat lass relating
to huilding construction, and hereby authority representatives of this city to enter upon
the nbovo-mu lli'med propery far insPrctan purposes.
(We) agree to save, lad—olity and keep hxrntire e City of Cupertino onina
lamillllcu, imt,aaa rs. etas and cxpt,aw, which may in troy way uccec a@ningsl said
V HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or fuwro rankling o,up.nt store or handle haebNnm metrial
as do(ural by Ilse Cupertino Municilwl Codd. Chuprcr 1), 12. and the health and Sofe'y
Curie Sectio,25532(a)?
❑Yes El No
Will the applicant or future building occupant use equipnnenl or devices which
.mil haeardnus air comanslwnts as defined by the Bay Area Air Quality Management
Yes O No
I have mud the h;vodoas ...aria 1, mgniremenl. nndcr Chupler 6,95 of the
California H -111,R 4dny Code, Sections 25505.2553) nnJ 255)4. 1 m dia,mad thin
irlhe hu ilding dnc un cumm'ly havc;1arena, that it is my msponslahly m natiry the
occ.paWj,f Ille Uri4remen's which anal be mel prior In issuance of a Cenifica;e of
M.
A PLICA'HON SdIk86§00 12
k;.ti IVaS:\YgUl
Job Description ` `
ADDITION AND REMODE�
L
Floor Area S/]c
R Ired Inspections
34229041.i�n
Re -roofs
Type of Root' 505 — FINAL ELECTRICAL
All roofs shall begsF'ected jj'g LO51 Lofin r material being installed.
If a roof is instalPffl itliou nI'§ atai li6U it sKtion, I agree to remove
all new materials`tb'tNnsFecffJf IFAppliFlGfChYPJ*IraoRs and will comply with
all non -point soug0sggulatfoI-NAL GRADE
510 — FINAL_ PLANNING
Signature of Applicant Date
All roof coverings to be Class "B'+ or better
101 —
FOUNDATION
102 —
PIERS
103
— UFER
104 —
R.EBAR
1.05
— ANCHOR BOLTS
1.06
— SEWER R WATER
202
— UNDERFLOOR PLUMBING
203
— UNDERFLOOR MECHANICAL_
204
— UNDERFLOOR FRAME
205
— UNDERFLOOR INSULATION
301
— ROUGH PLUMBING
302
— TUB & OR SHOWER
303
— ROUGH MECHANICAL
304
— ROUGH ELECTRICAL
305
— FRAME
306
— HOLDOWNS
307
— INSULATION
308
— SHEETROCK
309
— EXTERIOR LATH
310
— INTERIOR LATH
31.1.
— SCRATCH COAT
313
— ROOF NAIL
501
— FINAL ELECTRICAL ENERGY
502
— FINAL_ PLUMBING ENERGY
503
— FINAL MECHANICAL ENERGY
504
— FINAL BUILDING ENERGY
1: d by:
Date
Re -roofs
Type of Root' 505 — FINAL ELECTRICAL
All roofs shall begsF'ected jj'g LO51 Lofin r material being installed.
If a roof is instalPffl itliou nI'§ atai li6U it sKtion, I agree to remove
all new materials`tb'tNnsFecffJf IFAppliFlGfChYPJ*IraoRs and will comply with
all non -point soug0sggulatfoI-NAL GRADE
510 — FINAL_ PLANNING
Signature of Applicant Date
All roof coverings to be Class "B'+ or better