01030031 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10060 MOSSY OAK CT MICHAEL MCGAUGHEY NEATG 8 AIR01030031
OWNIiR'$NAME: APPLICATION SUR DATE
' 5 ALAMO DR 03/07/2001.
'PHONE: SANITARY NO. CON'IROLIN,
225-7378
pari ARCHI'FEC'UHNOI•NELR: BUILDING PERMIT IND)
WOO BLDG ELECT PLUMR EC
N j LICENSED COMfRACfOR'S DECLARATION Job Description
1 hereby Xf).f lha 1 um IicenaJ under provisions of Chapter')Itt,mmencing
mFw with Seainn 9lXq)of Division 3ofthc Hmmovsa'ndfrok..v^^ion`s Coddcr.and my license -
:W 5'� in lull lurcc un Ifere� Q Y O /S / D
rc0 n i.ia Cl:m G�� Lie.N 1 FURNACE
Dale°:2 J , Conlmclon�
van 3 w J/ -� ANCIII'1'f:C'I"5 UECLAI _
I unduml ul my plan,,Lull be usuA u.v public rcnaJs
i p O Lic<nxcI Profy affirl
OWNER-BIALDER DECLARATION ( �
1 rxaxvu ,sect that 1am 1. .Benin lam the C,,nnacm a Clone Irw for the Y/
t? following rcav,m.ISmailoa]1131 S•Business and Pm@scions Ctnle:Any city lir county
5 F C whim rtquirta a maila,enn.alvn.al¢r,improve.demolish,ar rcpmr any nuucwm
45`4 prior In its is.mm'e.also requires the applicant for such Permian File a xignedslaemom
'hat he i,rcansed pnnwnnl to the Pan Worn,ofthe c-ame,lir,License Law(Clurner q Sq. Ft. Floor Area �uation
(commencing%'rill Section 91XXR al Division 3 of the Business and Pnnessions Cade)
or that he is exempt domfan r and the basis for the alleged exemption.Any violation
of Section 9831.5 by any applicant Iia a Instant subjects me applicant to u civil penury
,of more than live hand red douaa(S51X). APN Number - Occupancy Type
Ol.uvowncrol'the Property.or mycmpleyemwitn wase,u,dwire,1la ca,npcnxu,lna,- -
will Jo the work,and the slmcnnre i, an intended lir offered Iso sale(Sec.]IAO,
Rn,me,.,art,rn,r„.o,Coderl'be C....motn„License Law coconut apply at as Required Inspections
x r al properly Who build,or improves lnercna,and who Jtes such work hinacll
(itthrough his own employee,.provided that such impre,=mem,are not intended lir 2:04 — UNDERFLOOR FRAME
(offered ban sale.If.bmacer,the building or improvement is solid within line year of
completion.the nwner-buiderxaBhave the burden ofprevsngthat hedid ran build or 301 — ROUGH PLUMBING
tailrace
El 1,as owner of the properly,ani exclusively contracting with Reamed contractors to 303 — ROUGH MECHANICAL
comma the project(Sec.7(114,Business and Professinm Coda:)The Comee'Ofs 304 — ROUGH ELECTRICAL
1.1c,ad soh Law does nor pplysuch to p..)Ne, all to oaar who ) imverdparunin to rtn.
e 505 — FINAL ELECTRICAL
amt sono aommrn rte,Lien 1n,wire a ontmam.' ild%orit :sot er Ino
❑ :un exs,I.iccmc Law. n,
0 1;Lot sur,
„np,order See. ,nxerCl6r a,il,et„o, 507 — FINAL PLUMBING
Ownu Date . 506 — FINAL MECHANICAL
--SEWS COMPENSATION DECLARATION
IDaren,arrnnander penalty of perjury one of following declaatiuns: 514 — FINAL PUBLIC WORKS
0 I nave and will maintain to Canilicue of Cement to«If.imum for Wonken%
Compensation. a, provided for by Section 37W Lir the Labor Coda for the
performance of be work for which this form is issued.
01 have and gill maintain Worker',Compemn'ion Ineoence.a,ar,mord by Station
971X1 of the Lahur Coda fur the parfnn male of the work cur whish this pennil is
snot.My Worker'',,�Conpemaion Inamner carrier and Policy numRr an:
,r.
_M(/A Poli,No:
C❑R'UPICAIJON OP EXI1MP'1'ION FROM WORKERS'
COMPENSATION INSURANCE
fall,uOm,need no'be cnmplcted if Ibe peanut is Fur one hundred doll...
(SRXB lir less.) -
I amity that in the penotion. a of dr yyyjj11 k roc which this permit i,issued.I
,hall not employ any person in an[);it, rn�Lwdlecuo the Workers' -
%hollntemoom44477,
awl Cal' yyy��rUac ff// OO 11
nrMConic:,m .��! '
N(yrlcr:' X I L , ba ,n, t if,a,,of Exnnp'ion,you should
nec.,o ,ubj,.:u”the Worker.Cnngmn,auo.'prop roof L" Craft,r Cr. ,rounnsI
p yeI..tfrail,eouply if,inch petc,itnlove Ili,pr n, , II be detailed rc.v,krl
V] CONSTRUCTION LENDING AGENCY
1 hcrchy affirm that there is a om mOlon lending agency for the prrRmnnncc
Ra
01 he work liar which this permit i,issued(Sec.3099.Ci,C.)
L Q Landds Name
7 Z I,ndrt,Addma
V 0 1 really that I have re ad'hi,application and arra that the abtme inlonnatimu is
Ir. P comeo.1 agree to comply x'i'h all city and county ordinance and,tae laws rclaing
U ,,building comwnion.and hereby authmiic repreaenrtives of this city',,seer,upon
the nbrve-mentioned pmpeny for impaction purposes.
F
"In (we)agrce m save,lndcnmilynmd keep hamdces the City of Cupertino alarm,
habili'ic,.judgments:1,111,and expense,which may in any way accrue against said
U Z City in o,,Iawquetec of In,g:anenglir Ins lscomit. _
APPLICANT I' DERS 4NDSAND yy''11 .COMPLY WI'I'If ALL NON-POINT Issued by:
Date
tP 4AT Sh /�/O
nmar<(oinppheanoc(onvan,r nate Re-roofs
HAZARDOJS MA'rER1Al D RE
Will dw appfcam on ware baamng ocral omen handle na.:rmoo,material Type of Roof
motorboat by Be Caper int Municipal G :ChaPrer 9.12,radio,Hallo and Safety
Colo.Section 25532(u)Y
Ore, All roofs Shall be inspected prior to any roofing material being installed.
Wil the apprcamorBlmrcnnJdir,gtccu Kegaipmen'ordrvlac,which If a roof is installed without first obtaining an inspection, I agree to remove
coil hueardnus air conemlnnte,as Jelin to lin,Area Art puullly Management
Disotim all new materials for`
nspection. Applicant understands and will comply with
_ ova No all non-point source regulations.
1 havoead rIIr,hem,Jou,mmcrials,v,mevmns cti learn CI 6.95 of the
California]Icahn&Safe,Cock.Senlnn.,25505.25533 and 25534,1 wulcotand that
if the building docs Bol currcnay bane a cannot,teal it is my re,pon,ibili,y n,nmily'nc
,.pant of the rcquircmens which na,h met prior m is,uonce of a CIniflae of _
(K "pmoy.� Signature of Applicant Date
Date v3�
lac All roof coverings to be Class "B"or better
OFFICE