02050072..- -OFFICE- .._._ .. .,. .. h _.... ...... ..... _. _ . __... .
CITY OF CUPERTINO
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CONTRACTOR INFORMATION:•'
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
19132 MURIEL LANE
C. GISOTTI
02050072
OWNER'S NAME:
APPLICATION SUB DATE
�j.
GISOTTI
05/13/2002
rHONE;
SANITARY NO. CONTROL NO.
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ARCHITECTIENGINEER:
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECN
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LICENSED CONTRACTOR'S DECLARATION
DBSCIIpIIOn
1 hereby ofrtrm that 1 oro licensed under provisions of Chapter 9 (commencing
with Section 700D) of Division 3 of the Business and Professions Code, end my license
.IOb
603 SQ. FT. ADDIT
n in full force and effect.
R. t1 O� LFE RUMND
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License Class Lic. g
B *�7 %s'� i'
Date Comranor
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ARCHI'TECT'S DECLARATION
understand my plans shall be used as public records
JUL 2 4 2003
OLicensed Professional
OWNER BUILDER DECLARATION
m
I hereby Bpro, that 1 am exempt from the Con,.,.,'a License Law for the
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following mason. (Section 703 L5. Business and Professions Cade: Any city or county
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which reclaims a permit to construct, after, improve, demolish, or repair any structure
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toitsusuana:. also require the apPlicamfor such permit to Bic asig,med statement
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that he; is licensed pursfdnt to the previsions of the Convactors License Law (Chapter9
(commencing with Senirn 7006) of Division 3 of the Business and ppromissions Code)
m tha(he li ezemp(therefiom'and Ne basis for the alleged ekembtioe. Any violation
a py�srk,��-}qFct- I or./�AAyy��,,ea_,, ff rr
C'ON't3.7fb9�8,0 :If t/V)L•�f`�.f
Valuation
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of Sectum7031-.5hymyap,Ia,m for apc crit subjects the applicant to a civil penalty
mf na roma then five nanarea am�mx ($500).
��y1 mmhhrrrr
101 APN F 86hATI ON
" Occupancy Type
❑ I, as owner of Ne property, ur my employees with wages as their sole compensation,
_
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103 - UFER Required Inspections --1 a' I
me' Pro and the de:Tstructure C car Contractor's
or License
eredLaw foes aleno (Sec. to an
'Business Case: The Cotmm�or's License od ansa not apply m an
'owner of and
property Who who does such work himself
owner of property Who builds or improves at such improvements ore not intended or
or through h6 own employees, provides that such ement
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1 0A.-- REBAR _ 7 _.__.. _ _..-.. __ _ __ _ _ ... ----
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is mi
completion $the. IL hriwuilder e building avthe improvement ofpr v is that within one year or
completion,
<nmplaion, the ownerWilder will have the burden of proving that he did not build or
_
105 - ANCHOR BOLTS
improw,hojmpoaeofsale.).
106 - & WATER
Ireaowner of the p(Sol.7am contracifing
_SEWER _
02 - UNDERFLOOR PLUMBING
Professes Cocc) The Cuunorsm
tsenm's
the does
n (gee. to a, Bcsiacowner o am Professions ills or The improves
License
ud11i Laweras nmapply man ownerofpr
203 - UNDERFLOOR MECHANICAL'":.. ,,, •.._
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cauitywoobalmssimprovesthereon,
Co mica contra or such. projects .w N o cont et Ks) 1 encetl. pursuant m the
cm tr en
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�-'2'04•`=-UNDERFLOOR' FRAME
❑1 t en B&P for this reason
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205 - UNDERFLOOR"'INSULATION
`Date ''''S 2�j �Z
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301 - ROUGH PLUMBING
WORKER S COMPENS NDE^ ARAr N
302 - TUB & OR SHOWER
I hereby am. under penalty of perjery one of the following dalarations:
303 - ROUGH MECHANICAL
0 I have and will matinmin a'Cmfi,.tr or Consent to self -insure for Worker's
304 - ROUGH ELECTRICAL
Compensation, as -provided for by Section 37W of the Labor Cade, for Ne
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p<rrotmmccofinewar.m,wmeh,tni._pernwi.i'med.
305 - FRAME
01 have and oil] maintain Worked., Compensation Insurance, as required by Senion
306 - HOLDOWNS
37M of the Labor Code, for the perfunni nce'of the work'for which this permit is
Mucci.Myw kr'Compen.imionmsa
307_ - INSULATION
adPolicynumlxron:
Cmtl
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1308...3 tpSHEETROCK,;.
309 'EXTERIOR 'LATH
: CERTIFICATION OF EXEMPTION FROM WORKERgt.{j}
' COMPENSATION INSURANCE
--_ANCE,,,•,,F
need hc'ahmplcmJ if is far hundred dollen
_
31O "• INTERIOR LATH -+.T- I?
(This section not the permt one
($1o0mricol) . .,
311 - SCRATCH COAT '
^ 1'rBilt IxrfoHifuniima a rte work fp wh his perhnt leissued i
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.. -..313'-- ROOF--NAIli ,_ I .. - -: --
ih ll not m any on n r an T o g um bj t at the Workers
pe� 4w S3501
- FINAL ELECTRICAli'ENERGY
Cil'Curi'miet
502 - FINAL PLUMBING ENERGY-
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CETOAPPLI VIf aftermaking this Certificate of Exemption,'yoh .could
ahr
�arneaan(nirom wrrkeracrmpenab P ninnnaLaM1orcale,yhdman
503 - FINAL MECHANICAL ENERGY
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too of Plywitn suchp .muse thisp , hall be deemed revoked.
504- --FINAL BUILDING.. ENERGY.---- ------_...
9
CONSTRUCTION
" 'LBNDINGAGENCY
505 - FINAL ELECTRICAL .I
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T hereby affirm that th re a a construction lending agency for the p.e ormanre
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ofttie;win for which this permit ii blued(Sec. 3N7, Civ. C.) ',-_GAS,.
TEST_
Lcnder'i Name =-'..•.»•..--•__. �_.._. ..,_ ., ...__—,.'__._.
Lender,Audr s: -
Icenify that l have read this application and state that the above information is
_-_.. 15.06.
507 - FINAL PLUMBING_., -.i,;
508 - FINAL MECHANICAL
cmieclJ agree m comply with all city and county mditnnces and nate laws relining
tab rxrcpose tzmiv of thi city to enter upon
If nsoned
509 - FINAL GRADE
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Bove -m property
m bn( ) toneep pend( pen purposes. ..
lwl.,mems indemnify pimayina Cty fCpninontsaid
liah Ins s) figments costsand export s h ch may any y e gmnn said
510 - FINAL PLANNING
514 - FINAL UB C WORKS
C y nc n en¢ fth g ill' 6nf th prima. -
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APPLIC T DERSTA SAND WILL COMPLY WITH ALf NON
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Issued by: Dale
$OUP. .. S
Signature ppucandCrntmcmr.
Re -roofs
' , y HAZARDOUS MATERIALS DISCLOSURE ,
''..' mllhdhe applicant or, future Wilding occupant store m. handle hamtduus material
_-.Type.Of ROof.. t
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u def ed by theCupertino Monte Cod Chapter 9.12. and theHealth and Safety
Cale Secmo LSSRfa) q"
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i I Yv ..•. < 'ry f 'r jar t Y '�-r • .1,
All roofs sfial] be. inspected-poor.to.any rooSng.material being installed.
Will theapplicanto !at rc bu 14 g p t ie t .,devices hon
mail h d Ir n norm noel. n Vn d by the Bey Area A Quality Management
If a roof Is tnstalle'd without first obtaining an inspect3ofi; I -agree [o remove
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❑Yrs ..due,.::
all new materials for. inspection, Applicant understands and will comply with .. _,.
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all non=point source'regulauons:.,
alermma re areme�'.. v
" 1 Wve seal the haiallous m' q u order Chapter of
34,1undenotiftand that
mia Health &ot
Code, Sectionstenant,5at
iftheCa
cis yrespond
it is my responsibility the
- aequm
occupant nem whit onsou Ise
sincupan quirements which run W met prior m issuance of a Certific ¢ rf
e[ primp, entfic(.
Diet
Signature of Applicant Date
Al] roof coverings to be Class "13 or better
miner nr bathrriaea agent'_ '- .ate .
..- -OFFICE- .._._ .. .,. .. h _.... ...... ..... _. _ . __... .