01070145CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT N0.
10822 NORTHFIELD SQ
01070145
OWNER'S NAME
KOO NORMAN H TRUSTEE & ET AL
APPLI ATION UB DATE
075272001
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LL-ILJ I..I (.J
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that l am licensed under provisions of Chapter 9(commencing
REMODEL SHOWER.
with Section 7") of Division 3 of the Business and P f ons Code.andmyI,mme
is in full force andfcL L �r
L/1 �O^9C� 1 O
.¢
License Lie. as
/
Date Cantrxmr
ARCHITECf'S DECLARATION
1 understand at, plum shall W used as public records
Licensed Professional
OWNER BUILDER DECLARATION
I hatch, affirm (hat 1 on esimid from the Contmemr's License Law fur the
following mason. (Section 7031.5. Business and Promsdons Code: Any city or county.
$4210
which requites a Permit to consumer, alter, improve, demolish, or repair any wreactum
.prior to its issuance, also rectums the applicant for such permit to file a signed statement.
that he is licensed pursuant to the provisions of the Conlmctar s License Law (Chapter 9
�`.,., ppprro^s �.Inn ,p,,,�
3 §1O°r
Valuation
(commencing with Sectiun,7"? of Division 3 onto Business and Professions Code)
- 1� G f V n... Y
or that he R aempt th2refmm and the basis for the alleged esentptlon. Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
ata., me than five hundred dollars (S5(X)).101APN
gay ATION
,'.'•. .I Occupancy Type
111. as owner oftne pmpen& or on, employees with wages as their sole mmperaatitn.
-
103 - UFER Required Inspections
tBian m irk si mewr to Iintended « ad ' 6 to an
'Bu . and P r x Cd, Th C I I Licence'o d t poly to an
rp Wild, p ,n d n rn Oak himself
104 - REBAR '
orthrough h glee provided that such i .... <met. inot intendedar
his e
Offeredr id rt hu In Noticing p t 1a within re or
_
105 - ANCHOR BOLTS
completion,to bu Id will have theburden f Proving that he did t Wild or
impro for purpom r lel
106 - SEWER & WATER
❑ 1 o f the ' s ly r i g th licensed t t In
'
202 -_ UNDERFLOOR- PLUMB IN'G` — '
construct Project 6 7044 Business nd Professions Core:) Th c t
2 03 UNDERFLOOR MECHANICALLiha -" '
does noaPPI manownerproperty scsdh`rt1
..and.wo.comruns,focsucn.pnIcc¢ with opursuant
_.2'04 -UNDERFLOOR- FRAM ._.
Licnelaw_
01rimCXCmplunder sm: " I3&Permtmsreuon
205 UNDERFLOOR' bNSULATION
Dwadr°•-' Batt"' ''-'
301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION . _ .
.:.
302 - TUB & OR SHOWER
Iherein, aftmunagrpenany.ofli9tryone .[,hefonowingdealamtmns:
303 - ROUGH MECHANICAL
❑ I have and will maintain'a'ceniBcae of Consent to .elr.inume for Worker's
304 - ROUGH ELECTRICAL
-G.rr,e sn+e ';-, is idea-former-settioa�son-er-Me-Cabot-ewe.-fm-kre
performance 4dlhe work,fm wln'h disrcrm,ti is nsucd.
305 - FRAME
❑Ihave ' and %A]maintain wurka.seompen,rums ncma,ov,imdbySmfi
306 - HOLDOWNS
3700 or he LaburCode, lir the petf.mmnce of he wore: lir whim no penial is
.s�r
307 — INSULATION
isiied My Worker' C iation lnwrm,<e cunt • ,6tid Pol'c mm�h
.. .... .. .....- Vic:,. u..n .c - I
o "'' r 5 �"
- ._ _. .
"SHEETROCK` :•,.(Illi
carver: Par."I . y't
t' CERTIFICATION OF EXEMPTION FROM WORKERS"-
r C
.3'08:"'=
- - 309- - EXTERIOR LATH "
COMPENSATION INSURANCE ',"•,n
310". ,=; INTERIOR LATH— _`....._ ___.; "l -__-.
„.
' (Thrc sen as need nm M mmplcust f the Permit is for one hundred dollars
311 - S CRkiTCH COAT -
(51001
---31-3--- 'ROOF- -NA.I.p .. _.- -... ...... ... . . _ ._..
'T Ic n fY••tn l in the pennon... 0 f the o k f wht h th pe' t d is...d. 1
ihhll not employ any person in any throat so as to become subject to the, W,rkas
,
501 - FINAL ELEOTRI CAli'� ENERGY
Athihmml laws tc Ifnmia oma "
--502-- .FINAL .PLUMBING ENERGY...
503 - FINAL MECHANICAL' ENERGY '
NOTICE TO APPLICANT II ser making thCertificate of Exemption . you should
'
be es object lm the Workers Compenst Provisions of the LaborCade, you w
forthwith cn lj with such provisions ur his Permit. hall he deemed revoked,
F,INAL BUILDING.ENERGY_..
Y"' ' CONSTRUCTION LENDING AGENCY,`
__----504._.-._ _ .-..--
505 - FINAL ELECTRICAL
1 herctiy alio, that mcre'ii a conxuvcrion lending 5g cy for the perfumiaam
506 - TEST
of e work lotme which this Permit is issued309], Clv. Cd
i
Isnder s N me I—, -
_ _GAS
-..._ ..._ ..... .. .... ..... . ._.
507 - FINAL PLUMBING-
C, tie aA(s .a
,
508 - FINAL MECHANICALI
I mmfy that I have mad this application and state that the above inrormamn :
31.:1 agree to campy with all city and county ordinances and state laws relating
509 - FINAL GRADE
mei
building mnstrudtlon, ads hereby authorize �epmsantmmes of this airy to enter open
510 - FINAL PLANNING
the above-mentioned pnT<ny rpr'mspeetioa purposes.,,
gm,ao-odem ayaadk ph ml:s,he6, fC.,mn.agam,
(so) a
514 - FINAL PUBLIC WORKS
liabr ams. I I'im ns m t, nJ espcnm h chy y against said
C f nr Ih
gnof
Iyrumor" at al m I
LIC ERSTANDS /�y�[y'( LL NON POINT
Issued by: Date
SOU
foci, .
HAZARDOUS MATERIALS DISCLOSURE '1 .
Will
Re -roofs Z %—®
'
Roof----
he appricam m rmure building ottvpan, wore as handle haa4dots matend
_Type of - -., ._. ... ....... - -
asdefined Cupenina Municipal Code. Cnapmr 9.l2,...J the tieanh and Safety
, I•s.. ,.
Ctide gctian 25Yes 25532(aJ%SG s.p Nn`q,l s /"A'.....
- •. -
ing.installed.
roofs shall.be.inspected.prior.to.any.roofing material being
_
Will theapplic loran re bulldingocc p t use equipment ordevice. which
._All .-..._.._
If a roof is irisidlled'without first obtaining an inspectiori,'Fagree to remove
Or
ca it haaaMnus ar nmuaminanu as diliaed by the BUY Areu Air Quality Management
Di,9ia?
all new materials for inspection. Applicant understands and will comply with
.. +oven,.i, ,; .O•No_- - "
•�
-all non source
-point regulations:..,,
' I nave'lread the hwrmdows mmeriuls requiminems under Chaptcr'6.95 of he
California Hemir & Safety C vlv. Se2timn 25505.25533 and 25534. 1 uMematW Ina
Ifthe pu Id 'ng dce I trt fly haw a, itI t t s po 'b'Iny, notify the
'imapam ,1 Ven m: hath Yb a u e ra Certificate of
O cape
Eili.G ,• 7 2 7O �
Signature of Applicant Date
All roof coverings to be Class "B" of better
Owner or authorize, gent . cam
OFFICE