01110118 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22662 OAKCREST CT YOUNG SUSIE S TRUSTEE 01110118
OWNER'S NAME: APPLICATION SUB DATE
YOUNG SUSIE S TRUSTEE 11/28/2001
PHONE: SANITARY NO. CONTROL NO.
MIN FARCHITECTAENGINEER: BUILDING PERMIT INFO
4LDi ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATIO
H hereby v vm that I am licensed under previsions of Cha mending F NCE. Job Description
wita Section 7000)of Division 3 of the Business Processions e,andmylicense �j,;.g�d'r
i z�3+ is in full force and effect.
6 License Class Lic.N t' I
3 r Dam Contractor
ARCHITECT'S DECLARATION 1
�-O� I understand my plans shall be used as public records
1 p p Licensed Professional i
' o OWNER-BUILDER DECLARATION -
m 1 hereby affirm ihm 1 am exempt from the Connector',License Law for the
?o following reason.(Section 7031.5,Business and Professions Code:Any city or county '� $1500
z
which rcgmrc a permit t <moram,r It r.improve demolish,or repair any structure
ED� '
a3= pnotitssuance w
alsoequres the applicant forch permit tri file a signed stat nt -- - - - - -- -- -
,. ..
thm he is licensed pais em to the pro ns of the Commences License law(Chapter 9
(co - g with Section 7000)of Division S of the Business and Professors C d)
.,,hot he is exemp,thm erefroend the basis for the alleged eaempuon.Any violation Valuation
of Section 7031.5 by anyapplicant for a permit subjects rhe appliaot to a civil pen thy- �d,,�,k�.a,,
ofnmmore than r,-ehundred d.11. S5oo). 101APN'r•cJUN'1JATION Occupancy Type
°1,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(See,704q
Business andProfessions Code.The Commen is License Law cottony apply on an 103 - UFER Required Inspections
owner of property Who builds or improves thereon,and who does such work himself 104 - REBAR
or through h' wn employees provided that such improvements are not intended or _ .. ..._., ___,-
-"ore lei I .If,rida lith ll'metherimprovement
enofprviswhinhedidnone tyearor 105 - ANCHOR BOLTS -
completion the owner builder will have the harden of proving that he did not build or
improve for pumoae of dale.). 106 - SEWER & WATER
p.o�.-.,. _,- .. _._-.. .9- ,-. .. -- _ -- __. _ .202 - UNDERFLOOR'- PLUMBING
r of the ny,am exclusively d nor Proming with licensed contactors 's n -
o cewnmepresentiappl7oaa,owner ofandertywmonscane:)Thevestmreon, 203 UNDERFLOOR MECHANICAL
-
License Law does not apply to an owner of property wM1°builds or improves thereon,
and who contracts,for such projrots.whb a contmcmnaj licensed pursuant te.the _ .... 204 - UNDERFLOOR FRAME
Contractor's icense Law.,
°lam axe pt undgr sq &PCfo thio reason 205 - UNDERFLOOR'' INSULATION
ovu„nr +.nl'ty
301 - ROUGH PLUMBING
"WORN SATION CLARA ry 302 TUB & OR SHOWER
I hereby arrrtn unaqfr><r;ury ane er me fmmwing decmratiena: 303 - ROUGH MECHANICAL
f1+ ° I have and will maintain a Certificate of Consent to self-insure for Worker's 304 - ROUGH ELECTRICAL
s� Compensation, asprovidedfor by Section 3700 of the labor Code, for the
performance ofthe week for which this permit is issued. 3 05 - FRAME
- °1 have and will maintain Worker's Compensation Insurance,as required by Section 3 06 - HOLDOWNS
37M of the Labor Cade,for the performance of the work for which this permit is 3 07 - INSULATION
issue d My It rkers C mpen at n I sum r and Po I number are:.
Cam. 308 .-. 'SHEETROCK,;
e'. •,.i ••• `.:.Poky No '. ..
+ l CERTIFICATION Or EXEMPTION FROMiWORKERS "• cit %'309 `�'I EXTER'IOR''LATH'
_ COMPENSATION INSURANCE; _ _.. _.__ .._. -.. ... ............._.
-310:-:=,, -'INTERIOR---LATH
' (Thissectionneeda.,hecompletedifthepermitisforonehundreddollars 311 - SCRATCH COAT
(E100)or less.)
.v 1 cert fy th t in the performs cin of the work for winch th pates t is issued,l
313 ..-.. ROOF NAIL- 1 -`
11
shall not employ any person n any manner so as m becomesubject to the Workena' 501 - FINAL ELECTRI CAli ENERGY
Compensation Laws of California.Date'
Applicant .'-. ' 502 - FINAL PLUMBING-ENERGY- -
7'NOTICETO APPLICANT:If.after making ibis Certificate ofExemption,you should 503 - FINAL MECHANICAL`'ENERGY +
become subject to the Worker's Compensation provisions of the labor Code,you must
00 z fonovithcomply'with such provisions or this permushall bedeemed revoked. _ „504 . - FINAL BUILDING ENERG�' ._. ...
.F
;CONSTRUCTION LENDING AGENCY 505 — FINAL ELECTRICAL _
I he by affirm th thema const t lending agency for the performance
O -Lf to rw Na for which thspetm11 is issued(So.,3097,Civ.C) 506 - GAS TEST
...: ._ .. _.. ..
Z Le
riders Addm.-,'- 507 - FINAL PLUMBING
U:0 I c mfy that 1 have read this application and state that he above information is 508 - FINAL MECHANICAL
W Ey Imiect.I agree to comply,with all city and county ordinances and state laws relating 509 - FINAL GRADE
o V to building conatruction;and hereby mamnae representatives offluk city to enter upon
x .44 1 the above-menrondpropert)for inspection pureases. 510 - FINAL PLANNING
p,r (We)agree m save;indemnify and keep harmless the City of Cupertino against 514 - FINAL PUB I
Fw V) liabilities,judgments,costs and expenses which may in any way,accrue against said
V Z� City'in consequence of Ne granting of this permit.' ' '
APPI" TUNDERSTANDS AND WILL COMPLY WITH ALL NON:POINT ' Issuedb : Date `/ �-4 D�
$0 C 2EGULATION y
c
on et Date Re-roofs
FIAZARDO AIAIUALS I LoSURE
appliwnt or future building occupan ore m handle hazardous memnal Type of ROOF
a dfWby[hCupertino
°Yes a Cupertno Mum c pill Cod Ch pt 9 12,and the Health and Safety L i'_, i ,
Credit,Section 2 .�'+ 7 :" s w -r.w -...,• �' +a
,5532(8) a .v r '... ..
°N .-_All roofs shall be inspected prior-to-any roof2ng.material being installed..._- ._ ....
W 1l the applic t fmurebuilding Oc p tuseequip r rdevices which If a roof is installed'without fust obtainingan inspection, Iiagree td'remove
unit h zardo -ter conte ants as defined by the Bay Area Air 0 al ty Management p g
+Dioure" all new materials for inspection.-,Applicant understands and will comply with,
(� °Ys, °No all non-point source regulations;,.- „
1 have read the h ze drips maienals requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533 and 25534.1 indentation]that
ifthe itching does not currently have a tenant,that it is my responsibility ro notify the' "
occ an f the requirements which must be met prior to issuance of a Certificate of
pa y' Signature of Applicant Date,
or coreDate All roof coverings to be Class "B" or better
OFFICE