00100013 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT No.
21771 MEYERHOLZ CT EDWARDS RAFFA AND MICHELLE
OWNER'S NAME AI'PLICAt'[ON SUI{DATE
EDWARDS RAFFA AND MICHE—LE A 10/03/2000
PHONE; SANITARY NO. CONTROL NO.
O z 2 ARCHI I'EC IENGINFER: BUILDING PERMIT INFO
Iu 00 - LIlO :IiC' '.DMB MECH.
ce
�'`' LICENSED CON'FRACIOR's DECLAHAI ON Job Descrip[Lnn
z 4 9 I hereby affirm that I am licensed under provision,of Clmpmr 9(commmtucing
0—To1-M with Section 71MM1)ofDivieion3ofthe Businessland Rufessi^n Codc,ond my license
F m 5- in full force and effect.
�� a leen, cln,x a BATH REMODEL/REPAIR DRY ROT
m ie ii y Date Contractor
ARCHITE 'S DLCLARAB'ION
0 g nndersland my plans ehall hu used nx puhlie remnlrTo
/
xA 0 Liccnwd Preavvonal
2"
MiR-BUlLDFR DECLARATION
"IL tt, hernM1y ulEnn tarn I ani esemp,Iron,the C.... rk L icen,e Law t'or the _ L
F 2>' following reason.(Section 7031.5.Business and Pmfenions Code:Any city or county
5 which requires a permit rt < Iter.inaturove.demolish, ti p yswnure
i t o prior tts unince.also1 the alp,litarnl h pc m i to file g d,amorent
that he is Iacvr,adI t, tire n - I he concturne,Live...L (Chapter9 Sq. Ft. Floor Area c Valuation
(eommenemgwith Section 700(potI)vrni....3 urine Btune land Prefe,im,Gdc)
or that he is encio ,therefrom and the basis for the alleged exemption.Any violation
rfseadan'mn.s by tiny anprnant for a Derma sable,,, w aprraam act a civil parnity APN Number Occupancy Type
ru
(if than five hundred dollars(55rN4. P Y yle
Cl L n owner at pmpeny,o,my cmnl^yee,with wage,as their Som comlNnwdon.
will do the wrak.and the sanetive Is nm Intended or ahead lot xat,'Sue.7144.
Business and Profevcon.Ctde:The Contractor,License Law doe,nut apply to an Required Inspections
oWmr of nrolteny W ho builds or improves thereon,and who dace such work hil if
r^ugh his own al nn,vided that such inmn,vrnool are nor intended or 101 — FOUNDATION
uttered ter vale.If.however,the building or Improvement is,old whhin race year at
ompletion,the owner-builder will have me burden of.poll that he did not build Lir 102 — PIERS
improve for purpose Lir>med' 103 — LIFER
❑Lco.carol the prolan,csonsocly contracting with licensed contractors to 104 — REBAR
consumer the pmjcc,(Sea 7044,Business and Isma slon Codc:)The Contractor',
License Law dive not apply to nn owner of property,who baild or imposel damon.
T why e,mronv to ,cel, pn,Ieete w arnti,rnor s) 1'sail Pur aunt to the 105 — ANCHOR BOLTS
crn,raam, License 4Law 106 — SEWER 8' WATER
❑1 an,asem , dersm. .B s r C murals smorn
m
202 — UNDERFLOOR PLUMBING
'ORKER'S CO. NSATION DECLARATION 203 — LINDERFI_OOR MECHANICAL
ntsmnhy ttnio,t ttndcr fell rpaimy cil the touowing rwdararon,: 204 — UNDERFLOOR FRAME -
❑ 1 base and will mainmin n Cenifil of Conant to elf-insure for workers 205 — UNDERFLOOR INSULATION
Cantpcnwtion, as provldal for by Section 37141 of the Labor Code, Ir bthe
panoorrame r1 the wo'k ro,which in,permit 1s l„u,v. 301 — ROUGH PLUMBING .
❑1 have and will maintain Wodcr's Compensation Insurance,as required by Section 302 — TUB 8' OR SHOWER
37m)of the Labor Colic,Ea the perrnn":nine of In,work Liv which this permit is
,aed.Mywarker,eom nnadattmsaranaeainramn'aevna;onerare. 303 ROUGH MECHANICRL
C:nnur: PolierNo.: 304 — ROUGH ELECTRICAL_
NiICIIFICATION OIt 13XIiMIMON FROM WORKERS'
COMPENSATION INSURANCE 305 — FRAME
(Tru,worn mwd on,he a..."nletnd fine peruit is for ,.a hundred dollars 306 — HOLDOWNS
SiNdo,le,,.) 307 — INSULATION
I candy that in the rr c of the work for n ,his permi,is issued.1 —
s1,-u nm etnpl„y t .5 o�any t.r Dna'w a to nianr m me wakes 3@8 SHEET ROCK In ”` 309 — EXTERIOR LATH
Aprl. n ' - Iu
cBTf tic kern, trg i.ce tcetearcxenmhrn.yoa•n""Id 310 — INTERIOR LATH
,,Itoo Lir,Cotnlmmanrm pwvlxloo,of the Lubar Code,you runt
O E,ehcchcrnd, di'loanpravi,mor.this permit shall be deemed revoked. 311 — SCRATCH COAT
.
HCONS'I-RUCnONLENDING AG17NCY 313 — ROOF NAIL
1 hcrchy cif act taut there is a con,wotion tell agency for the pebornnmce
of the work far which this permit i,,,mel(Sec.30)7.Civ.C.) 501 — FINAL ELECTRICAL ENERGY
Z, z IcodernAmne 502 — FINAL_ PI_IJMBI ENERGYLender's Aar,„
(`� o Iaenifythat Ihave read this application and%ratethat the abnveinformation is 503 — FINAL MECHAN AL ENERGY
4o F., correct I ngroe to comply with all city and county ordinances and state Ewe raining
0 u mbtrldingerr,faction.andhe,ebyattint,rocapte,,,naave,ofths it, ,,a;ne,upon 504 — F I_ ILE
ILD. IG ENERGY
rW me adwemamioned pmrerty for ir„penbn prof Ove,.
a, (We)agreemsave.indemnifyanAkeepharmlee,theCityofCupemanagainst 505 — IN L ICALliuhilhiu,judgment,,cum unJ es Pcnme which may in any w tie again„saidcrL..Iz City in enmequonee ot granting nl this nennit.A LICANT UNDER NDS AND WILL COMPL ON'1'OINT Issued by: X06 GA DateIG
.(�O
IRE
signatu ,ppm m- Date Re-roofs 508 — INAL MECHANICAL
` ' D)US MATERIALS DISCLOSURE —
Wtnnte" :trt or Bruce M1uddr,aerpant store ar handle hammrus,natedal Type of Roof 509 FINAL GRADE
as defined by the Cupcnino Nlarcip;d Code,chapter 9.12.and the uewdt a"d Safety 510 — FINAL PLAN,(V I hIG
CGdc.Section 25532mr! r
❑res ❑Nn All roofs shall pegte D yS L }G erg installed.
Will inn applicant fir fttt„re naildin.t,caa t use a„ti ,fir de,iea,wltialt 1 +�� e IT . �
pr ti ran 1 omen If a roof is installed without first t taming altThIS �1�n” agree to remove
emit humid air asmuminanu as defined to the Bay Arta Air Quality Management
all new materials for inspection. Applicant understands and will comply with
Orn ❑Nr all non-point source regulations.
I have read the bazamaus materials requiremen„node'Ch. ¢r 695 IF the
Cartoon,
arta n,Health&Sale,,Code,Seri nnx 25505,25533 and 2.1 ,mdcrs,nnd that
to com
(fine vanillin,doc,nu,curtn have a mnam,thm it le to sibllity mnmity the
use.a ire hich mus,he ntet par ace of a Ccrificate of _
ccara"ny' rSignature of Applicant Date
Im
wna'o o u — ” Data I All roof coverings to be Class '•B" or better