00060150 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADURESS: PERMI I'No
oWNER'SNAIy,PZ649 NATHANSON AV CLEAR OAK DESIGNS APPLICAIIOy21e@FQ150
•INE'' RENNINGER ALAN L AND ADELA R 1723 ROGERS- AVE snNlTnxtuc06�2ccpErOl�Qy.
0-7. ARCHITECT/EN'GINErX BUILDING PPRMI'I INFO
o❑o (408) 436-5448 OLuc I:IatClPLUMB MECH
2WU LJ lu r_1 t_1
LICENSED CONTRACT'OR'S DIiCLARATION Job Description '
QO= I herchy al lin III,,I:nu licensed ander p...lWonx fir Calmer 9l conmiencing .
G=
with seems,roan of Divid...13 m'Ih1 la, oat Pmrelliona code.and It„I core
2
Sa, ; isinfiner and ch co.
z License se Class I.W..p
ie Dom w
1 ARCHITECT DECLARATION KITCHEN REMODEL
-a0
5 I undemn nd my plum shall be.,cd as more meoMs
ce
p O Lice,red Profcu,ionul
LL o OWNIiN di UILDHR DHCLARAI ION
I mon,affirm
her I it,camps from lac convacmr's Licrnxc Law for the
F Z a following reason.(Section 7031.5.Business and Pmms%i.no Code:Any city or creamy
S 0 which y mad I .t t It amps a do I'.h r¢p y t durc
to 3 prioto is t lso xqnim%the applicant fosuch peu' file a signell:t t mens
drah -licensed pursuant the prolulnum,ord Coulowre"lLive Ichapter> Sq. Ft. Floor Area - Valuation
(s,mmu ,in,.iM1Section 70000ot Dvia.n 3,f du.Itusu and In 1 c,%ions Calci
1r thatSeel Inc In 703 1..5
h:Ihcmtrmn and or haein fnr the libobject,
Iml cx Neill ,,Any vialminn
of no,
a ba 5 by any ortal oil for v permi,suhjccLs the vpplicnm In a civil penalty
ern.:mors th6a ln1 Immortal dollars(S500). APN Number Occu412�;6"
01. ,f th P Pent yempl y th 'Ile- their I pe. eon,
ill do h k red he roacome is not intended or afered[ (Sec.70,14
Buse n I ,. a cd The Couract [,,.n,cLaw do,,norar'lrmaa 32643074.k1119uired Inspections
ownerl propertywh l II r l 'a J 1 kl'nalr
offeredlei 1 11 th b 6 P n I II' •rearof
completion,the owsar-baildlr will Loa,av.me Women ret proving that he did not Hold o, 101 — FOUNDATION 6/
improve for parp,ase.folic.).
102 — PIERS
❑I.as owner of the prapemy,ran eoelusively conoanin,with licensed contractors in
onstmm
ct e project(Seo.7344.Baiaeo and Prmc,shms code,)The contractor. 103 — UFER
Lleanso Lnw doe,not apply to on owner,arpn,peny who baud,fir I Pmvm thcrean,
and who...roma,ro,xneh pm"t,-I'll v Lmnmaom)ficemed pm.aaal to the 1.04 — REBAR
01ame;empt`��aesc. .B&11CPar this reason 105 — ANCHOR BOLTS
Owner.Date 1.06 — SEWER & WATER
WORKER'S COMPENSATION DECLARATION 202 — UNDERFLOOR PLUMBING
Ihmm,y mnno,a,mlr renwyy,r pajny rola of nil lnillnwing aalar:e1O1a' 203 — UNDERFLOOR MECHANICAL_
J I awe and will maintain a Cenilieate of Conant to self-inure for Worker.1
Camm
peahnn, as pros;ded for by Section 37M of the Labor code. for the 204 — UNDERFLOOR FRAME
O
performance offbe work f.rwldch thispemtit is is.uw. 205 — UNDERFLOOR INSULATION
❑I have and will mainmin Worker:Cnmpen.aaaoo liv,mo me.as required by Section 30]. — ROUGH PLUMBING
3701 of oro bo
Lar code,Ga Ilia perlbmmnce or the work.for which Iain peron,in
asuedMy Wo,kdrs C I,,no i Ilnumnce enol.'.nand.Pole,another
mQe: 302 — TUB & OR SHOWER
Comm, 1LL.._�Mv- , Policy No.: I..UC IJs+lsle 303 — ROUGH MECHANICAL
CGxrincmION OF EKEMI'1'ION FROM WORKERS'
COMPENSATION INSURANCE 304 — ROUGH ELECTRICAL
rrhia.c,non aeat not he ram,lcmd arae Per mh is comae hundred rich... 305 — FRAME .
droll ale„d
I remit,that in me pvrhnmmue III the work lo,which thud t{,i...ed.I
306 — HOLDOWNS
.hall not empinw any person in any nranaer xa ase fe Iron Msrk, 307 — INSULATION
Compenmtion fCuli ami Dutc
APpnrat ._�� 308 — SHEETROCK
NOTI,. TO AlI,,the Worker
r%alter stakingthis Ccninsofth Lagan ion,you should
neemme aaniea tome works emiy,enxarina p,o.i,;onaonne L.anm code.rnl imnd 309 — EXTERIOR LATH
p G mmiwmo to ldy with grdl PoMkions.rdr,panel shot be deemed resolved' 31.0 — INTERIOR LATH
V1 CONSTRUCTION LF.NDINGAGUNCy 311 — SCRATCH COAT
1 hereby union thauhem is v amsmuai.n lending agency for flue performance
of the work for which thiot is issued(see.31YO,Civ.C.)
L C Lender's Name
r`"ni 313 — ROOF NAIL
M 7 LeadIr',Address 501 — FINAL ELECTRICAL ENERGY
Up I_ F slyhstlrel ars : ppl' i , n
ils thtdif . .r
tv o t I s t pc p u Ir d Iy rre I r1 Lsu 502
— FINAL PLUMBING ENERGY
o :.building :mcti and hereby to rp tar' Its cityort pa
he h e t ed Parrett,finspection I Hx 503 — FINRL MECHRNICAL ENE
G
L
(W ) g me or aIe.indearmliv adAeph ml the ey ofC-1-
U 01 CabII^cc,judgents.costsrme,picre,.ba`n°n. r yaccrue agama.aid
504 — FIMAL BUILDING ENERG
505 — FINAL ELECTRICAL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REQtILATIONS.
�� SignumreofApplicanl/Contmam Date Re-roofs 507 — FINAL PLUMBING
HAZARDOUS MATERIAIS DISCLOSURE
Wll the upplicmn fir future holder, incury,m a me m handle lmrmlou,material Type of Roof 508 — FINAL MECHANICAL'
w defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code.Section 25132(m? 509 — FINAL. GRAD
over �o All roofs shall I1ypecte pgi ' , o'�y < I t�r,,�}?�Iterial being installed.
Will lheapplicant orfwmc building tac,am use equipment nrdevie.which Ifarool'is inst3YlEcT'wilho t't7 isq�7bt51t� lT%?eCtion lagree to remove
mat hamnlouv air contaminants as defined by the Bay Arca Air Quality Management ly{
all new materiat5s I inspfctW. LApR -t�t�del. M d will comply with
oyes Alo all non-point source regulations.
'hoc rend the anntrdous mxlefials reynlc rI,under Chapter 695 of Ile
CallOvuia th,ohit&Safety Code.Sermon,25505,25533 and 25534 I 1 to,or 1111,1 '
if the hOlding dna,not eurrcnlly have o mnan61hut II I,1,,respomih'dity Io sooty 1111
i,cu,aw of the on rimments which mud heroin prior n,i....nee of n Cemilieme of -
Osaops"� 7 l Signature of Applicant Date
O nhormed.t3gera ^”—Il �'1�`�Dole All roof coverings to be Class "B'• or better
OFFICE