01070093 CITY n of C m ERTONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10854 NORTHVIEW SQ 01070093
OWNER'S NAME' APPLICTION 57H DATE
HART JUDY K 0772' 2001
PHONE: SANITARY NO. CONTROL NO,
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
L ELECT PLUMB MECH
G i l L....1 1=1 I
30
LICENSED CONTRACTOR'S DECLARATION
A
Z'_ I heron affirm that 1 ant licensed under ram of Chapter (commencingJob Description
�N-� °ndP ° e DECK REPLACEMENT.
,- with mion70001 of Division Jrf nc Business and Npfessi nz Code.and my
a-^ oc full Trate and ct. /n7 1
=s - kens fl Lice a H-z.es 27�
3 a. « u Contra c or C se..
FLL ARCHITECr'SDECLARATION FINALED
I understand my plans shall bet used as public records
of
Licensed Professional
jtca OWNER-BUILDER DECLARATION JUL 5 2001
u.= 1 he«by utrfrm that 1 nm c,.a,f from the Contractor's Licit Law for the
z< rIla, „g« n action W3I S.Itasi,tas,and P,ce,i 1Cndr Any city or cm or, $3700
ais wbkh mvpNe,apermit R,rresthe aper, for. sc,acmol'ndt,sercepaig Prycmmma
. _prion 'a ,alsoteq ' ,rapplicantl' hmium'saicemse gnedsta. ant, �.3.� .. ._-_.._ .
Nath(commercial,
S kh urvid.Saoiom 7thcp visionNC Business
rumes Ltcetee Wwons Cad) s, ,.3�H.-.Rr TIPS7QyI®a•+ TSA. aIUHhOn
or that eine ih Scali n)0 adt the
7 RhcB sincssaalp Pofcsst vi Code) { t,y, ♦ 3-`OV'J'-9 ;\�S.e t f:.k
or that he is exempt therefrom and for .Pers it the alleged ea ficin,.Any violation
of not mo than
v any applicant far a permit subjects rhe applicam m a civil pcnnl,y
;of nmmrmNanfivehundred dollars(ssW). 101ApNATION Occupancy Type
❑I,as owner of the popary,or my employees win wages as their sale compensation. 102 PIERS
will do the work and the'srvcmre is rot intended or offered for sale f cc.7014: 10 3 - UFER Required Inspections
'Buxmess'anit Pmfexm
sas Crack:The Cm recw «
um's License lads no,apply to int q p ,,..
owner of popery who builds in improves theocrat,and who dims such work himself 104 - REBAR
or through his own employeesprovided that such improvements are not inend-or
compla(orme.lr:however,the lhave - t n xam wamd not - r 105 ANCHOR- BOLTS . __. . - ..... ..
building or,mpravemen year u - _ �v y;,� -
°ntplmiuoorw,vnerfbaalcJ'r will have the hnNenofpraving aM1,n he did net mild or 106 — SEWER & WATER
improve puryo,e°
a Ci own roim pop
Y.am encrosiveiy'enmraing with Ti a see cunuaat°rsm 202 - UNDERFLOOR PLUMBING
eonstrum Ne project see.7044.Business and Protestors Crane:)The corwascors 203 - UNDERFLOOR MECHANI CAL•' r
License Isar aces not apply to an owner of properly who builds lir improves thereon,
_ s with a contractions)licensed pursrant to the - --.. .. .-2 04 — UNDERFLOOR.. FRAME - . . _. ._.... . . -.. . . .... . .. .. ... .
d who contracts for such projects
o"i`m`tu t`�s s«: it&P C for this mason 205 - UNDERFLOOR INSULATION
Owner,, Date 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby affirm under penalty or perjury one of the following declarations: 303 - ROUGH MECHANICAL
❑ I have Pad will'maintain a cirtifcmrrf Conant as all:n,rre for Worker', 3 04 — ROUGH ELECTRICAL
Compensation.Los provided for by Section 37W of he LwW, C°dc, for he
performance at work far which this Award is is mealL 3 05 - FRAME
❑1 have and will maintain Worker's Compensation Insurance,as required by Section 306 — HOLDOWNS
377 of the Labor Code.for the performance of the work for which this permit is 3 07 — INSULATION
s M W rk fs Ca I .urance er er an Pel'y b a;
�5 ,.-. ( _11308 -' SHEETROCK - -._._,.. ._.__ ... ..... ... .. . ..
ami V1 u XEM IO 3 RK 't I .. ,. ..
CERTIFl� COMPENETIONI INSURANCE'WORKERS' �. a• 3O9 t =-':EXTERIOR-'LATH
• �� COSIPENSATION INSURANCE"� ' "' I ' �
.._ .. . . . . -. .--- -------
' '' '(This,aeroaneed not Wcompleted ithe Permit isfor one hundred dollars 311• - SCRATCH COAT I .I .
(Sllq)or lcxrt,)
313 ROOF NAIL .
I cenify ahmy the n in any mann the work for which this permit a Worke,I
shill nm employ any person in any manner so as to become subject,o Nc Workers' 501 - FINAL ELECTRICAL` ENERGY
Compensation Wwsa(California.DP"
Applicant 502 . — FINAL PLUMBING ENERGY .
. "' .. ... -
NOTICE TO APPLICANT.It.after making this Certificate of Easorman.you should 503 - FINAL MECHANICAL ENERGY
zZ nccome subject m the Worker's Contpcn,sxuon provisions of the Whim Coda you mast
5 04 - FINAL BUILDING ENERGY
O fdanwith comply with such poomcw,a,hi,perana shall be dames re,aked,
CONS TRUCTIONLENDING A-GENCY 505 - FINAL ELECTRICAL
1 hereby affirm that there is a emaiuciion lending agency for the petforam«e 506 — GAS TEST -
of the work for which this permit is issued(Sec.3097.Civ.C.)
yq Lenaer'x Nanta- . - .- - .. .. . ... . - -- 507 I- FINAL PLUMBING _ . . ... - ---
;,Z Lenacr',AJdres, ' -
..I terrifyNat I have mid0r,a Ecmloa Pad same aha the dar.to intom,°n°a is 5 508 — FINAL MECHANICAL
O corrtdr,I agree to comply with all city and county ordiwwcs and save laws miming 509 — FINAL GRADE
O U roWildingcunstruction.andhcmby'whodacrepreamaaivesofthiscityroenterupon 510 — FINAL PLANNING
,(,:, the above-mentioned property for inspection purposes.
y:d (We)agree tosave,interimdyand keep harotthe CityafCapt against 514 — FINAL PUBLIC W
'Vi liabilities,..dgmems,cogs unit¢pensee which may In nny way wame aguimt,aid
U Z Ci,Y sequence of In gruntin III permit.,
APP PLt'.WITHA LN N�POINT'ry Issued b Date
SOl CF UU DE 7M1A. .t �N y.
�ns+ ocre' Appl!eww"oRr
natmData Re-roofs
D0U5.IAT (ALS
W1I,applicantI t e,bu dinat
p nt.tore or handle msallom material Type of R
oof
A fCI - - - - -
by the Cupertino M ipa.Cods.Chapter 9 12 and the Health and Safety -
Cod:Section 2553-Ise) .r. .•c I 7\s ', .�{ st.3 I t:
DYes. e "'' ❑Na • . , ' - ,. All roofs.shall,.be inspected.prior.to any_roofing.material.being installed___._ _..-
• Will the applicant orfuture building«cupantuseequipment ordeviceswhich If a roof is installed without first obtaining an inspectiofi;'Itagree'to remove
cath hammers air conumiwdefined
m,as by the Bay Area Air Quality Management
. D',trrato ere. ❑Na all new materials for,inspection. Applicant understands and will comply with
, . . . _. . ..... . ... .
• all non-point source regulations. . .
1 have mad the kayo dais materials requirements under Chapter 6.95 of the
California Health&Safety Code,sections 25505:8573 and 25533.1 undersmnd atm _
if uilJing d«snbt currently hmeamriant.aha,ii ii rymsponsibilityi a fit ythe -
o t a m
if the require -rt which ¢ e ten pr o isnance a C i mar of
" �0Signature of Applicant Dale _
owner or nodaedagentare All roof coverings to be Class "B"or better
.- .. . . . t OFFICE. _