01080092r
I
CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
21968 OAKDELL PL
01080092
OWN a 'S NAM
CIiARL9S SCHUETZ
APPLICATION SUB DATE
08/20/2001
' PHONE:
SANITARY NO. CONTROL NO.
z ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
J
_
BLDG ELECT PLUMB MLCH
n LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that l am fieemed ander prmlilam, of chapter 9 le°mmenang
ADD BAY WINDOW.
with Section 7,300) of Division 3 ofahe Bucinesx and Pmfnsfar, Cude. and my license
is in full force and effect.
a License Class Lice
O Dae Contractor
ARCHITECT'S DECLARATION
g I undersmnd my plans shall be umd as public nc<aJ,
Lic mord Professional
m OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt farm the Contractor's License Law for the
< follawali mmon. (Section 7031.5, Business and Professions Coda Any city or monty
$5500
C which requires a permit to construct. alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit or file a sigrsd statement
- -
,,�a, @�aa,�1�2,1g1Wrnsar Bprpa- .�
3Y'Of1'YTII"3V..V�
Valuation
- aha,heistiyen.sedpunuam,othepowismas°f the Contractors License Law (Chapter 9
(wminuTcing with Smios7UWI of Dawkion 3 of the Busweps and Professions Cade)
.,,list he is exempt memrmm rind be basis for the alleged escmptic . Any violation
of Section 7031.5 by any applicant far a permit subjects the applamin in is civil penalty
of not mom than Rise hundred dollars, (s5w)
516APNt9jfRNL BUILDIN
Occupancy Type
❑ 1, as owner of the progeny, or my cmployen with ..,as its their sale compensation,
Required Inspections'
'
will dothework: and the structure is not intended or offered for sake (Sec. TOu;
Basi..,, and Pmfn,lon, Code: The Cromm nr's License Law does not apply to an
owner of pmpeny Who builds or improves thereon, and who docs such work himself
or through his own that such improvements amacv mor
- -- - ----�--- -
ldcd
offered for sale. If, however. dhe buiJingor nipiovnnicm Is snlJ within a, yearof
-"sale.-If.
� - -- � -- -�-�
completion, the owner -builder will have the buaden ofparsinghalal Behe did not or
improve for parryrae ar,ale,l.
)(I. -al W,,co I ly I m cors to
-he m a Traci B with sed
owf t
c,ansirtics the project IS TMJ Business 1 professions Cade:) -no, ConarreaT
.
License Low does not apply T f propm, who bu Id, im improve, thereon,
end who emamsts far rich , ojom, with a marsamosta) heemard brostaird as dm
Cot
❑la es, pt B&I Cfor,thi, rea.
�WORK��I-Iiulo
Data
b/
N
I hereby affirm under penalty of perjury orm of the following declamations:
/
O I have and will maintain a Cenilicae of Camra, to self immune for Wmker'a
CompcnsiI or providril fur by S«tion 370U of the lads Code. far the
'Tw6mmonce of the work fur which this permit is issued.
❑ 1 have and will maintain Worker's Coinpenmtion lowrance. as required by Section
_ 379) of the Lada Code, far the ferfiamance W the work for which this permit is
issued. My Worker's Coin p motion Insurance carrier and Policy number arc: '
•, .
_
Nor:
Con¢ ' policy No.
.. rv.
..
�: CERTIFICATION OF EXEMPTION FROM WORKERS['
: .; ,..
SURANCE',,,. _.,'
. .,..,, �-CUMPENSATIQN IN, .. �..
IT
_ ... .. ___.__ -._. _-_.__ ._. .._._....__. _.._. _.__.. ___. _._.__.... .. _..
..
a" (Thisscction need not he completed lrme pe. I, is for one humred dollars
(gllg))ur lcxal ,
I cempl that in the p work for which this permit e oolvea
n;rany
I Tt ,. + _ i,u•j(
no mthe
in any manner w ux'w Ixc°nm xWjca to the Workers
shall not employ any person in
tf
lavvi of California. Uare
A lie . . ... ..
Applicant,
CE TO APPLIGNE II: atau'nuking TM, CeniOcum of Exemption. you should
"
ti become subject mthe Wdrkcls Compcnsaion pmviiions of Ne Whor Code. you must
-with
,
fnnhwitti comply such pmvisinn, or this permit shall be Jecmetl revoked
CONSTRUCTION LENDING AGENCY'
T
I Hereby h0inn that there iz a'con.umniun Icndin6 agenry Tooke perfurm,inae
s'
hich his 11pmon a issued "es, 3(197: Cie C.1
icnder'aor' Name - _..._ .... _...._: ....
Icnder�s Address
. '.a
1 enlfy That I have mud this application and same,hauhe above ofonnanon is
correct. I agree to comply with all city sod county oNinance, and state law, relating
to building construction, and hereby amhoriie representatives of this city to enter upon
I the above•nanri med property for miltection puepaws
3, IWclogree tb save, indemnify and keep hatmlessdic City of Cupeninnagaimt
A Iiahiliaiea, judgmmas, casts and expenus which may in any way steam against said
ZCity in eonsequence of The'grenting of d, pi':
:APP. NT TANDS .')W'ILI. CO\IDLY WITHAL NOV-POINT
(3
Issued V� /l ��� �"'— Date
so IRC. RE L NS.' `, .-i
y. --
.sigryTZu o(ApplTcantlConrmtracf1 % /, Date
Re-roofs
HtcrmtmOoL IATERIALS DISCLOSU E
an1(lneilcann coed
'Type.of Roof -- - -'-• '
ft
dcfnedlbhea Capcnior Murcadingaloa,ChPt�r911 ey
`
C,dc, section 1 5311u Is..,.,
❑Y<s , N ,• -
Il roofs shall be inspected prior to any.roofing material bein
,„ • ,.,.
55.0 the applicant future building accupont use equipment devices worn
If a roof is in's[alied'without first obtaining an inspection,II agree to.remove
cardh J air If, dby Th Bay ArcaArQ lay Slanagcmcnt
District,
all new materials for inspection, Applicant understands and will comply with
> oY ..."°
all non -point source regulations.
,1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Csale, Sections 35505.35533 and 25531. 1 understand that
if The building does m t cuaendy huvc u Tanam. Thai i, i.i my oepon,ibilhy m notify the
-
occ nm of the rf it cora whit 'roust be met prior m issuance °f a Cenm ificaof
Y """9`^
Signature_ of Applicant Date
r /p
All roof coverings to be Class "B" or better. ,
m —'Data
calimn>.edagcut'.
...� - ,., .... OFFICE