01060140 C[BwOF
he
BUILDING DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11572 MORNING SPRING CT WOLFGRAM CONSTRUCTION 01060140
OWNER'S NAME: APPLICATION SUB DATE
GILL JAMES B 1900 ARROYO SECO DR 06/25/2001
. PHONE: SANITARY NO. CONTROLNO.
(408) 559-4224
O ZO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
m C BLDG ELECT PLUMB I'l
LL-I 1-- I__.I CI
Z vm=ii LICENSED CONTRACTOR'S DECLARATION Job Description
O z_' I hereby affimn that 1 am licensee under provisions of Chapter 9(commencing
[-yhW with Section TATO)of Division J of the Business and Professions Code.and my license KITCHEN REMODEL.
Gin full force and feet. 1 C
a 0 se U Liceve Cla� - Loc.p GJ
aa. Date_6=0?5 Carol m
O ARCHITECT'S DECLA
� i g I understand my phos shall be used az public mcoNs
a.r p O Licensed Pr.feasiotml
TION
FS
OWNER-BUILDER DECLARATION
1 hereby affirm shat 1 R-exempt from the ORATION s License Lew for the Z a following mason.(Section]031.5.Business and Professions Cade:Any city or county O
d S C which requires n permit to caramel,almr,improve,demolish,or repair any structure
i3�
"i to it,.. 'l'o recountsII ppl'c I'm,meltuaron,1 II .b d. anet .. .. _.. .
f'n he A firmoo,,U p, is a Oep' 1.1 rd C t t I' I (Cl aPtcr'J uF rIIkk1 OI' ea sir)A Valuation
(cool c g tl Section TOWj GU is J frit Business APr to so sCodc) 36'x`5 /i•or Nat he Is excmpf therefrom and the basis for the alleged exemption.Any violation
of Section)031.5 by any applicant for a permit subjccm the.,licam to a civil permit, �n1va�
mf not more than Five hundred dollars(S50(i 101 APN F lrivl�ATI ON `" Occupancy Type
°1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the smucmrc isnot imended'or'offered for sale(SccrTwl, Required Inspections
'Business and Professions Code:The Conloacmr's License Law docs nmpply aro an 103 - UFER -
rtit
owner of property Who builds or improves thereon,and who does such work himself
m erect fM1 his awn employees. Wilding
that such improvements is sol arc not intended or 104 - REBAR
.ercerea f.r able,u,n,boilde at wading or idea ofpra i is sad W din oro y ild°r 10 5 - ANCHOR BOLTS '
.prove font purpose
setae of mu,),r will have me boAcn of proving mm M1c did nos wild or '
'mpr°"` P°'p°n 106 - SEWER & WATER �
p per aeon connecting 202 UNDERFLOOR
_ i ❑I,mowner of the ro m.am exdnsivcl machin with licensed contractors to -
License
construct he project(Sec.pto a Busies and Professions Code:)The improves
chi mr F
= ,icemeLawdne.notapplytuan.boner.fpropertywnnbaimstnimps"eamerean. 203 - UNDERFLOOR MECHANICAL'
and who contmets for.suchprojectswhh.a cotnmetogs).licensed pursuant so the
contractor'aLicense Lcov. 204 -- UNDERFLOOR FRAME -
°IamexemptunderScc: ,B&PCf.nhi,reason205 - UNDERFLOOR `-INSULATION
_ Owpq ode 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 TUB & OR SHOWER
�• '- -Ihereby arermunder ce
malty mrperjmy°depnhef°u°wingdeaamtime, 303 _ ROUGH MECHANICAL
° 1'have and will maintain a Cenlllcam w.ie ser&md 1.self-i.... for Work r.
304 ROUGH ELECTRICAL
Compemation. as provided for by Section 37W of the Labor Codc. for the
_ performance close work for which this Permit is issued.); 3 05 - FRAME
-- °1 hale andwin maintain Worker's compensation Insurance,as required by section 3 06 - HOLDOWNS
37M of ate LOW,Cod.far the performance of me work mor which this permit is
t 3 0 7 - INSULATION
issued,My Worker's C.mperoution Insurance carrier and Policy number are:
trans semon'mcd no,
COMPENSATION
INSURANCE
is for one hundred dollam —_-309 -EXTERR�CK
30.8 - SHEET
Cm t CERTIFICATION OF EXEMPtduaPTION FROMWORKERS'g �" tn• - TOR--LATH`
COM1IPENSATION INSURANCE ' ' ,. --- 310— 'INTERIOR LATH -
slo6)nrnss,) 311 - SCRATCH COAT
- ' i«rtry.nt ' m cera fmc kf 'Nhth'sP r. - - 313 - ROOF NAI L.--- . - .• -
uedl ,. '
;nam ply:nyp y ' rA _ �r rn, tt to wmrkerrs 501 - FINAL ELECTRICAL-ENERG' Y
Co pcl ... 502 - - - FINAL PLUMBING ENERGY
A,
:rvorlc (CANT anermk gm.Crtrcat rE pt ym�:h.tiw 503 - FINAL MECHANICAL ENERGY `
z 0 became bject to the Workef Compacts t p s ons m tit Lobo Code,you must
r.rtnwm=.mplyw;m =npra"..n.arm P iawnxaecmw oke. 504_-- FINAL -BUILDING _ENERGY ..
F:^ 'TCONSTRUCTIONLENDING AGENCY 505 - FINAL ELECTRICAL
I hereby affirm that there is a c°ndruction lending agency for the pma
fourve
nn k( Licht ce dSrc= 3r)TCi,.C.) 506 - GAS TEST
a Name
�.Z Ler Add,.: 507 - FINAL PLUMBING
U mi mot 1 nave reae ms appheati.n a aceta mat he abo mr. a on i. 508 - F I NAL MECHANICAL
E., cortect.I agree to comply with.11city and county ordinances and sm a laws minting 509 - FINAL GRADE
Q U tob Id' gc t do dh by tit° representativesof tit.city to nm upon
the 1wmentioned xtrf cect Pd 510 - FINAL PLANNING
E}. G. (we) ma to indemnify and k ph I .,the City fC peri °against
m liabilities.mo Ib t., d p ..e n n y any y n.taaa 514 - FINAL PUBLIC WORKS _
U.
'40
Ciry c 4 cof the granting
t
^ A l TI )ERSTA\D WILL COMPLY W HALLhONPOIVI' 2S O
U t$E A > ,� ys• Issued by:
ignature,ol'Appl anllContmentr. " ' Date Re-roofs
,•c ,i'.. HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or Room building occupant store or handle hazvdous material Type of Roof -- - •- --- - - - -- - _.. .
as claimed ny me Cupertino Municipal Ctvle,Chap¢r9.12,and the Health and Safety
°r E "
._All,roofs shall be.inspected prior to any..roofing material being installed._
n~o Will the applicant.,future Wilditi,eacuirpon mueegalpment mda,ice,which If a roof is installed without first obtaining an inspection, I agree IO remove
coup haLolimi air comm.n ms is defined by the Bay Area Air Quality Management
District all new materials for inspection. Applicant understands and will comply with
❑Yea _ N. all non-point source regulations,;
I have read the hazardous r ials mcuimmants under Chopter'6.95 of the
California Hmlth&Safety Code,Sections 25505,25533 and 25534.1 understand that
Hill buoldingdocs not cumemly have vmtmmnhat itis my ras,minility to notify the - - --- - '
oecupm of the rcquir inns which must be met do,to issuance of a Cenifcem of
em_ Signature of ApplicantDate_
bone authmiae agem - - ..-Dam . All roof coverings to be Class"B"o[better
_ r
_ . ..I 7 - ' OFFICE ...