01100010CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT N0.
10317 MIRA VISTA AV
SUNDANCE
SKYLIGHTS
01100010
OWNER'S NAME:
APPLICATION SUB DATE
CLOUGH DAVID B AND ANNALISA
10585 FOOTHILL AVE
10/01/2001
PHONE:
SANITARY NO. CONTROL NO.
(408)842-9540
ARCHITECDE.NGINEM
BUILDING PERMIT INFO
IDG ELECT' PLUMB MECH
L - J J
LICENSED CONTRACTOR'S DECLARATION
Job Descript1 n
emby aRrm,Wtlmn bcensed under provisions of Chapmr9(commencing
wit moan 7000)of Dirtsian Jof me Businessand Professions Cale,andm license
INSTALL 2 SKYLIGHTS &
mluarte ane effee Q nj
ae Clazs Lic. p
Damn
LIGHT
SWITCHS.
Comracl
ARCHITECr'S DECLARATION
p ® p 9
�•• B E �.�5 �a E
1 understand my plans shall fe used as public records
OCT 2,4 20 01
Licensed Professimml
OWNER BUILDER DECLARATION
I hereby .(Ren I am exempt from the s License law for the
Professions
oli Code: Any city or
following mason. (section 703 L5. Business and C
on
lcounty
de
alms improve, demolish,
simprove. mpsig any structure
which require a permit m coons
the File
rcquiteamovipiosoftMContsaid far such mmina Rkasigtxdnmpter9annaml
-pna.toLL cen:x
- - -
— -- ----
F- --- r - - - - - - --- -BL
ra
m�t I,t is rem :<a Pur,uani to Inc pn�iamna oohs cantmrmra came Uw (enapte.9
Division 3 Professions Code)
... �Sq:FC:
f \
Floor Area . g , .. . ,OfdMffb n
(commencing with Semiom]00() of of the Bupt�ness and
or that he is exempt therthom and the basis for the alleged ciemptfan, Any violation
,1 :, p as_
of Section 7031.5 by anY.pplicam far a permit subjects the applicant to a civil Pemalry
of matmom,h.nrsehandreddollars a5u0).
A
um er
••.. 1. Occupancy Type
❑I, as owne,.fine progeny.., my employees with wngesas tionsolecompeasation,
_
102 -
F
PIERS Required Inspections'"` "' "
will do the work. and the structure is not intended or offered for sale (Sec: 7W. -
' Business and Professions Cole. The Comranor s License Law does not apply to an
owm of progeny who builds or improves and who dee.. such wah nim df
103 -
!
UFER
at such. or
orthroughhis own employees, provided that such vementemems.rt not intended
-
--- ` 4 .. .......... ... ..
you
offered for sale. If, however, buildingorimprovememnsold within one year of
104 -
REBAR
uildethe
oi,mpledon, me owner -Wooer will have me burden ar proving that he via not Wild or
imPm,f,aPur,o".fa,m.).
105 -
ANCHOR BOLTS
_..
pl:mowncrofthepropeny.amexdusivtly gwithlicenseJcomracmrsto
106 -
-
SEWER & WATER- -,,
Li.mood the project (Sec. 7M4. Business .cid Professions Cme:l The Contractor's
cense Law not apply to an owner of pmopcny who builds or improves memon,
202 -
UNDERFLOOR PLUMBING
and.who contracts for such pmjects with a eonttaetons) licensed pursuant to.the.
-203 -'
UNDERFLOOR MECHANICAL .... . '-.. - ..... -
Camriann's License Law.
❑lore, exemm aagqr set: ' . B & Pe holds rtapg^
2 04 -.
UNDERFLOOR' FRAMED
Owne, "' "Bate ""'"
205 -
UNDERFLOOR INSULATION
WORKER'SCOMI'F:NSATIONDECLARATION
301 -
ROUGH PLUMBING
neroby antrm under. penalty of pcqu,omgaf, tnq foil—ins deelwmians:
302 -
TUB & OR SHOWER
❑ 1 nave add will maintain . Certmca e of CLafcm to seu-invum for Workers
303 -
ROUGH MECHANICAL
Compensation, as Provided for by Section 3700 -of the I-alm, Calc, for the
permrma feofthe vmkfor winch hisperan is issued.
304 -
ROUGH ELECTRICAL
❑ 1 have and 'will maintain worker's Compenkeilon Insurmmc as required by Section
305 -
FRAME
37 p the Lam: Cm r the re rormance or the wok for which this permitri,
306 -
HOEDOWNS
i' d.My W kis Co pc t 1I rtmm.vmd r/ ddCP{oJf/cy/gnuunbe,me:
z
-
3 07
_ _ _. -,- _ ..- _- --. ,. •. -
'INSULATION, '�
Cimer T'^" PolicYNo. [(�i`3- ,
; � ,
,-
�,,::'. ERTI EXEMPTION FROM WORKER$'(
- " "" ""
��, ' ''3OB' _iSHEETROCK'
COMPENSATION INSURANCE
,.
--'— -- 309, -,,,',EXTERIOR
-LATH ...'...
hb s scamp need nor be completed it the permit is for one hundred dollars
310 -
INTERIOR LATH t
l$1001m leas) ••
1 ccnif that in the 'rf •. • . ..
Y pe am a'af the work (m whxh th permn is issued. 1
311 -
SCRATCH. COAT
1
shall am e, pl y any pe . o any manna so A m become b3 i i the work ra
313 -
s t (q L
ROOF NA I L "'U"
Ashes p. La.arnr .Die,
501 -
FINAL ELECTRICAL ENERGY
NOTICE TO APPLICANT:ILafter milking toss Ccnificmc of EaemPtion. you,sMuld
502 -
_
FINAL PLUMBING ENERGY
b«ame sanject to me workers comPcnvauan pmvi.aona Orme Iwnsa eine, you man
Forthwith comply with mm provisions or this pn,mitshaBxdomedrevoked.
503 -
FINAL.MECHANICAL.ENERGY
"CONSTRUCTION LENDING AGENCY ''
504 -
FINAL BUILDING ENERGY„'
" 1 hi eby aRrm thin them iso communion lending agency for the Performance
of mawork for .'mehthisPermit isissued (Sec.3m7,Co. C.)
505 -
FINAL L ELECTRICAL--
�d'sAdne.
506 -
GAS TEST
;)• ,
507 -
FINAL PLUMBING''..
i anif>ma,lmve rwa mis.Ppramm�ond stem taro ton anon inrormada�is.
men. I agree to comply with all city and county ordinances and state Iawa,d. ing
508 -
FINAL MECHAN I C
m Wilding construction. and hereby authorize mpaninmtivcs of this city to enter upon
509 -
FINAL GRADE
the above-mentioned pro,egy for Impemion purposes. ,
(lYU agme m save, indemnify and keep harminsk the City of Copenino against
hmaities. judgment., ovus and espemee which may in any way acn,K against said
510 -
FINAL PLANNI G
City i on sequence of the 6mming n is rmit
"DF W 'C
_
N P IC KS
5P .ICANT TAN A MPLYWITN'ALLNON.POIM
ISSUedbSl
y:
e—
L
sgn. ofAPPlicanV n cta -' r •'• ate
nor
Re -roofs
. p HAZ MATERIALS DISCLOSURE
WII the u Pn� f , rt mddin6 acuPant sort nr WmdY haivd m mae,ial
Type Of ROOF -
-.- - - __• _ _ ... -.... .... _
as dby the n Mu 'e Dal;Code. Chapmr912 and th H hh and Safety
".
ni u'
"
s11 .r\-:_ . ' r
Coda etttion 255 2(nl
"Dues " �; ;,"°'%"'``;r','A•'' "' ^' :' ';
•' t ,
All.roofs.shall be. inspected prior, to. any roofing. material being, installed.
_ ,-; ,.
:Wiumepppheart orfuture Wildmsoccupant use equipment ordevices which
If a roof is installed'
without first obtaining an inspection; I'•agree'to remove
emit M1 da s it rote m .def ed by the Bay A A O I ty ht egcmem
Dist t
all new materials for inspection. Applicant understands and will comply with _
DY ono
all non -point source
regulations.
1 c mad the ha ordews mumrml requirements under Chaper 6.95'or the
,
Calif. . Health &Surety Cuae:Seclions 25505,25533 and 25534. 1 understand that
_ _
ifthe iIding docs notcumamlyhmrmenmr,matit' y nponsibility to many the
n p
a r ten
u cit or ific 'which si W and or m' suan<e of 5 Ccni Bcam uf'
` p
Signature of Applicant Date
All roof coverings to be Class "B" or'better
ne rantnt,d:�a .gem at
OFFICE - ..