00020199 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMI IN(000201,99
10350 MENHART LANE
OWNER'S NAME. ArelacnrlOIII29Y 2000
ROBERT MCINTOSH
PHONE: SANITARY NO. cobtrROL No.
ARCHITI°C'1'/GNGINIiER: BUILDINo i'IiRMIT INFO
ae O BLDG ELECT' PLUMB MECH
Gai
FF H j LICF,NSED Q)NTRA andr,p I11!CLARATION Job Description
OO7.OE hereby it thin IfenIn he punto pid11 1..I o,C ly9(mnnnenense
p_t ithsrti„n Ixllll„fU i.i ni„nhena.inc a,drrnr nim,aend.n,dnlyhren. DEMOLISH EXISTING STRUCTURE? REPLACE WI
¢ win tilnhrecaddleei
xo6� Icero,Cla.. Lie.4 � ]Sf 6 FT LIVING SPACE. 408 GARAGE_
Date Co.
a.
ARCHITfI"S UECLARN ION
I understand �ppo I as P Nic menN.�
ca aq S cn.W Pmfn,l;nut L"S
af (OWNER-RUILUER DLCLAIIAI'ION
W=m I hereby atGnn that 1 u exempt truth n,a Colnraemr's Larr,a Law fur the
H 7 following reason(Section 7031.5.lra.,inc„and Profusions core:Any city nr county
F O which require%a permit to construct,other,improve.der nlish,or repair any%ttucture
ce
t.3°—° Ptionoit.i,.uancc,also require,the aPPlicam far such mouth to file a signed.statement
mathemseen.eaparsam,tot,me,rvi.Dam.nrmacantma,or,uansel.aw(chaprre Sy. Ft. Floor Area Valuation
(commencing with Section 7001)of Viviano 3 it Business and Profession,ode)
or dna he to uannlpt dwrefnim ami the ha.is far the one&xl e,emptionAny dalalian 00 a, AMML71II71
of section 7031.1 by any a,plieam ho usermit wtbjttaa the a,ph,oint to a cidtl Iwuahy
of ma r am than five handfed,bilar,(9500) A PN Number Occupancy Type
❑1,a,owner ofthend hestru my is
or,i,wifewagesa,eel for sle(Se 70,14.
x'ill Jn the nick,and me structure is no,intended olr oRcmd for sale(Sao.]MJ. }'
B.,Ine.a cad loose,se,Coi the Canmacar,l.toc,,,c Law doe,am appy to an Required Inspections
oner of properlyol
Who builds or Improve,thereon,and who does each a ,k himself
I,through his awn employeespmmidal that such halm vcmenK are nut intanded or
nuered lar at,.IL howeverhe building or h,n,rovemeut is sold wm,ia are year m' 101 — FOUNDATION
imnpinihfn`the nwnar``u1ilcar will have me harden al rowing that he did not build or 102 — PIERS
,npn,.e na,ph„e a
OLon,awnerarmeprnpeny.nor e.eta.iveyeonwelingw;B,licensed...racmmta 103 — LIFER
nnswct the project(See.7(W.Ravin.,and Profession,Cded The Common's 104 — REBAR
License Law thus no,apply Iona owner of property who h took;or improves thcrcan.
and who cammcN bar such priced with a eamrachanO ticen.ed put,umit to be 105 — ANCHOR BOLTS
Com mean', teems Law.
❑l am e,mahn mdersea. .B Ft PCI fids reason 1.06 — SEWER R` WATER
Dwhef Da1C 202 — UNDERFLOOR PLUMBING
WORKER'S COMPENSATION DECLARATION
13700 I herby air..a code,penwtyofperimynaehn he faua»;a,declanlor,: 203 — UNDERFLOOR MECHANICAL
1 Ie.aur°1,J I ,mini n a Ca nee a,of Ca;,,am to,elf-in,u,e dor Worker, 204 — UNDERFLOOR FRAME
p prvi, J rut by Semia.1 3700 or IN, Labor Cade, far me 205 — UNDERFLOOR INSI-II_ATION
erfomwnoe of the work for which da,,coma is i.waN.
I have and will maintain Wmm,-,Compensation Insurance,as required by Section 301 — ROUGH PLUMBING
of,he L'M,r Cade,mr the yerbarrv,nee of the worl,for which this Permit is 302 — TUB & OR SHOWER
'.cd MyWorker.Com,easat lr,uranceearrm,aadPNicynmbe,are: 303 — ROUGH MECHANICAL
unicr,Jt f"I lrr49f Nn 'J CI=/�
CER INCAHONOVEx1aMP'TONFRUMwuRK:R1 304 — ROUGH F_LECTRICAL
COMPENSATION INSURANCE 305 — FRAME
(Thi,eeation need not he m,mple,eJ if the permit i,for one hundred dollars@6 — HOEDOWNS
61fM)1 ar Ims.l
I unify fent in the perfarmanee of the work Iar which this„`ro,it is A,ecued,1 307 — INSULATION
,hau rat atnploy any n,r....I iu,au,y aa,nna.,o as to became subject to the Worker. 308 — SHEET ROCK
Claa,m knot.Laos,of Call D:ee
Applicant
E
NOT(OTICIi TO APPLICANT:If,after making this Certificate of Eactn,tinnpnu shouldEXTERIOR LATH
309
Z become subject to the worker,Compensation pmvi iota,anile Labor node,you mast 31 @ _ INTERIOR LATH
O O fonhwith comply with such provisions or this permit shall M Jecmed revoked.
F y
CONS IRix nONLENDING AGENCY 311 _ SCRATCH COAT
a, > Iherebyamrtthat ther„mans,ragency 313 ROOF NAIL.
nnhe watt far which this permit I,I...cd(See.PM)7.Civ.C)
y p
Leader*,Name 501 — FINAL ELECTRICAL ENERGY
.7 Lender's AJJre,. —
U O Ittnify that lhar'e read bi.applicaiion and cath thanhe aM,ve infnnnation is 502 FINAL PLUMBING ENERGY
w p ,chest.I ugree,o eamply wife all city and county ordinances and cyte law,rcahhg 503aFMECHRN I RL ENERGY
O U mbuildan,.„tdaactian.and bcmhy audoon ,ar...maile,of this eny m carr anon the above.mertim,ed progeny dormspe,rmr parp-, 50BU ILD I ENERGY
�e. a (we).,are tot,eve.indenmify rad keep h;omless nor City of Capcuina against y liabilities,judgment......1,and a,Pral,which may in any way accrue again.,.aid gLEC CAL
V City conuyucncc,"he graming nnM1i,permit.
LIEA NUERSTANDSANUW .COMPLY�W�"ALLNO; )INT Issued by: Date
\ OURCERECULATIONS. �,,
' FINAL PLUMBINU
Mgnau,m nfJ�ddaf nnhn,ba ,� D;n�� Re-roofs _
V AZARDouS IA ni R IAE 8 FINAL MECHANICAL
will the applicant or nbre building o,com n etas or handle ha.amo,u ru"stun Type of Roof hil9 — FINAL GRADE
u,deired by the Cupcniho Municipal Code,Chapter-).12,and the HeAth"nil Safety
Ce Scaion 25532fa)? ��
❑Ye,
ON. All roofs shall be`5Ao$ccTedFp�i 1% fyy ngl) eriaa{,b,Sing installed.
wiEthe applicant or future lamdiu,g orcapma cove equipment or devices which If a roof is instal Fool 4ithouf' NG6taiPil@nl�l�hcpkmb}1`Pagree to remove
Adaksnit M1aenrdnn,an come ninm,b ae dchineJ by the Ray Arca Air O,mlity Man,cro cot
il;stderr all new materials for inspection. Applicant understands and will comply with
C ❑No all non-point source regulations.
1 have rad me hamadou,mamrials requirement.under Chapter 6.95 of the
alih,miu Health S Safny Cdc.Section.25505.25533 and 25534.1 understand that
inhe building J«s not cuoemly have a mnnnt.that i,i.my rcsponsihil'ny e,notify the
atpmn or the reyuircnmm,which an, met prior m iswunrc of m CcniOco,e of
Oc'u,°aay' Signature of Applicant Date
6a
D nathn ims!agent All roof coverings to be Class "B" or better
OFFICE