01060136 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21545 MONROVIA ST 01060136
OWNER'S NAME: APPLICATION SUB DATE
I LOUIE ARNOLD Y AND JENNIFER Y 06/25/2001
PHONE: SANITARY NO. CONTROL NO.
�1
o z z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
O O BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
w 1 neren firm that 1 am licensed under - f Cha 9(commencing Job Description
i z a pro„amore° per g
m L: 1 wdn section yBOB)or Didamn3nnnenaainetx amf P�oreuion,code.aha myfcense 232 SQ. FT. ADDITION &
Lmfollloree aha erce l _ REMODEL. 1200 SQ. FT.
:..< Liana lass Lie,p
o d nam cnmmnor
i3 ut” gRCHITF:CT'I DECLARATI N FII�IAi..E®
V,0 a
1 understand my plans shall W ores m public repo
oa. o Licensed Professional 0 8 2002
' n
OWNER-BUILDER DECLARATION
ca'�-' I hereby affirm that 1 aa,exempt from the Contrwhir's Licence law for the
1-Z Q, following reawn.(Section 70313.Bust«ss and Professions Code:Any city in"modry
Y z D which requires o permit so mo met,alcor,improve demolish,or.Wit any shucmm
IS 3 m .priors 't I req_ she ppl anti pe nit to file a sig Tal stumment, - - --. -. - .. ...that he aadpu. ants me pro of the c t mrsLicenselaw(Chapter9 S Ft. Floor Area r Valuation
(cmdow mg with S«hon 70)(1)of Div s°n 3 f,n B mess read Proresions Code) L,'Q i." i 'd I,.%. I : �.::�t,`.f 'oi\
or that he is exempt therefrmen and the basis for the alleged exemption.Any violation
-of Section 7031:5 by any applicant fur a crout subjects the applicant to o civil Penalty
1 of not more than five hundred dollars S500). APN Number Occupancy Type
CI 1.as oche orthe ndproperty.or my employees intended
wagesres etheir role compensation, - 1 _
will do the work,and the sticture is not intended or a Law for snot(Spey to an sss
onset fpco ary sidona code Tne impose,
Contractor's License Law does not apply to e 102 - PIERS Required [nspec[ioiis
owrm
r of p his ow Who Wilds or improves thereon,and who am, w<h work intended 103 _- UF_ER
°r through hire own employers. boldin toot aupM1 erromcis sol within
not intended or
ofrcmd for sole.If nowoldethe Wildon tis sold within one car or
g or smprovemen y 104 — REBAR h{ ;�n:.., •� .'', .,
'improve fee me owe ofWilder will Lave he Horden or Prying mat he did not bails or I
improve Tor pnrpo�nrwle.). 105 — ANCHOR BOLTS
❑
- — ... _ SEWER
._
_ 1,aowner of the property.am exdusnNy cummning wnh licensed<onganorsro 106 — SEWER--& WATER-
construct
ATER 1 'tl � • .. ,
- - ,nstret the prona,l Saa.7044,Budnesx and Profession,Code:)The Contractor's 2 02 — UNDERFLOOR PLUMBING .t sr • t,
License law does not m
apply to an owner of foc,su y who builds or improves thcon.
and wh......m ,for such projecta.wim a contraclonx)licensed par:uan,to the 203 UNDER'FLOOR--MECHANICAL_._ _.... .._. . .
Cumract°r's Liccnsc law. "
❑I am eiall"under Sec. '.B,&P C fortnia tessom 204 - UNDER FLOOR'`-'FRAME];)"
District dims" 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
Ihereby affirm under plus fly ofpijmy,one ofthe following declarations: 302 - TUB & OR SHOWER
❑ 1 nave and will cointain a Ct.ificale of Consent 1.self-invite for workers 3 03 — ROUGH MECHANICAL
Compensation, as ptnvided for by section 37W or ,he Labor Code, for the
performance of the work for which this,permtisissued 304 — ROUGH ELECTRICAL
❑I have and will mountain Worker's CompensationInsurance,as required by Section 3 05 — FRAME
37M of the labor Cooke.for me kofirrmance office wcrk for which this pemtlfis 306 - HOEDOWNS
...ad My Worker's-Compo f I ..ac corriarrund Policy n robe 4ae
c, . `�Ci4fE(xikti�. +wucyy 1� TC�Oono'S`I$:` 307„ FG,f.;.INSULATION,' ,, :. — --;,;•t'u„i , ;� ..---'—
'4l sI iCEofFICATIOTJOFEXEMPTION� OM,WORKE� K5 -- t v ' N -308 e -),SHBETROCK, I'-
...::rr- [.
COMPENSATION INSURANCE',,,7 �,.• _
' ” < 309- EX11-11, ' liPTH
MP -..
,. s..t :, t:Ci IIFLi::Ct 1' ,'s.
GTis action
'a ad eta he srmple'ieJ if me permit is for nim hundred dollars 310 - INTERIOR LATH(
ISI WI I.a.l „ ,
311 _ SCRATCH,-COAT
1 nfyrthr ,h performancerds,walk for h hd R . .w
1ed Is.l.^•�•_.It:n m
:nen i t ply y Ix °`y . t np a b, t ca, War kaia 313 - ROOF NAI lit
' t '
Cnmpe . , laws,rclr nr 501 — FINAL ELECTRICAL ENERGYA,d ".
NOTICE TO APPLICANT:If,after makingthis Certifiame of Exemption.you should SOZ - FINAL PLUMBING ENERGY k
IivTome limitations,Workils Competssaion......Toni ufsne LuWr Code,you must
O mnnwim dnmpty with such Provisions or Imre ppnnit,nau rte aeemea revoked. _ - 503 -- FINAL MECHANICAL-.ENERGY .-
'4
ECHANICAL..ENERGY ._ _
Zoe CONSTRUCTION LENDING AGENCY' 504 - FINAL BUILDING ENERGY,"' t e.•r
^ '°` o or allbithdannemie ackcxd(Sr.,lending Sgency perfomsanm - `•
a > Peri„iri.�yealse<,31n7civ.e.). ,Carole,`,. . . 505 -- FINAL ELECTRICAL
of the k n , rs
.. .. — — —
i z Unreel' Nam 506 — GAS TEST
,7-,Z Iknd fix Address, .: .• � .., .• . .,
U0507 — FINAL PLUMBING
I comfy mm 1 have read chis application and state that the above information is
E: correct.I agree m rompoy with all city and county ordinances and state laws relating 508 — FINAL MECHANICAL
o V to Wildingcontruction,and hereby iWornec'mpresentativcsofthis city toenter upon 509 — FINAL GRADE
the abosruccatioged pr.,c,for inspection pmpmes.,
r IS, (W<)agree iii save.imlemnify and keep harmless the City of Cupertino against
-In habiluies,judgments.costs and expcoses,Inch may in any way recant amino,sail 510 FINAL PLANNING
V:z City in consequence of the dractingothis Permit.' - S _
APPLICANT UNDERSTANDS AND WILL COMPLY WITH'ALL NON-POINT Issued by: NA P C WORKS Date
SG 5.. . :� g:—Z2—o
Si...ni o pplicans/ nfnfr,�to,"ak .- :` ,Date"' Re-roofs
--I NA 0US MATERIALS DISCLOSURE
wnthe ppf<mt6i0:m Wla g«cnparn so.6,handle M1a:ardmr,matenal Type.of:Roof. ." •- -'- '-- ---- _. ---- -'
.m d<f ed DY MC ped Mu W^I:CJ Chapter 911 and the Health and Safety l 1 i°1;' '• l`'i i t, .•1' '; \• ai .'
Code S❑ecyes 25532(al", t / ft :+ I'1 a •. t
.All roofs shall,be.inspected prior to any,roofing,material.being,installed,_-.-
; umaireaaPhparo;{ntaro bosoms«ivpant useequipmentor devices which If a roof is installed•without first obtaining an inspection (
; 'regret to remove
e od hamiwiaous cnmaminams as def led ty the Bay Area Air Quality Management
Drama .• all new materials for inspection. Applicant understands and.will comply with,
Pyes. ° [ t all non-point source re ula[Ions•,
�1 . . P g i" . .,,t.
1 he d,hc fire d u. n,Tial., yti em' ks and Chapt 6.95 of the
Caliromia Health A Safety Code.Sections 25505.25533 and 25534.1 to derssnnd that
irthe W ilding d«u notau a m
need ntof,hey hove a tenant.that it is my responsibility to notify the
nmquiresnemi which must M met prior so isiva«i'df o Ccriifcam of
<y Signature of Applicant Date
Owner m sea age 8 �o ea! All roof coverings to be Class "B"or better
,., ;, •'. :. - OFFICE _ ... .. _ .. . . .