01120046 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BOSd`TAt'L"b TOWN CT PERMIT NO, 01120046
aOTSTREICHER DONALD R AND JOY AP1!E 1i-1 c V V l
,'HONE: SANITARY NO. CON"FROL NO.
w O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
s- BLDG ELECT PLUMB MECH
¢i 1—J I'=1 L=l L__I
ad
N= LICENSED CONTRACTOR'S DECLARATION Job DCSCTII7IlOn
Io,- 1tion 70ammomat1,3 ofthedanderrrn Profesichapmp9anmmenense DECK REPAIR
,m fw wish full ioncand efecivisian3nflh<Businozand Professions Codc.and any license
in full ionic end effect.
O U License Class Lice
,
i 3 l- Dam S DECLARATION J
a O< Ar, loll be u e DECLARATION
1 understand my Plvns shall he used as puhlic rccoNF /
j W}� (/
i i p 2O Licensed PMm,,immI D`
e i OWNER BUILDER DECLARATION Z
1 batch,
Maso.term on 1 am exempt from the Convacmro License Law for the
F Z a which re reason.permit
to
]onstr t,alms and improve.
de o demolish,
Code:Any city of county 15 0 0
z p w-M(n requires a permit to connrvet,alar,improve,demolish,nr repair any structure
aim prinrmsFcensed Taiwan ,,,he
rov,icr,of nl the Centuries,
m0levA".(Catemem
Immhmincing.edrarction700)ol iiision3 ftireBusinesLindProfewonsCer9 35�$1$IZrP(}�„ Valuation
or min he is awi!h Section Tor ad
Division 3 of the Business and Professions Code) _ ..
or Ihm he 7 31.5 b Itroy applicant
p li and[rte basis for the subjects
exemption.Any ripen Ian
of Section]031.5 by any hundred
o ll fora permit subjects the applicanno v civil penally
nrnot mom manrvennnareaannar,(ssw). 10 jAPN RMAWDAT ON Occupancy Type
❑I,as ow net or the property,or my combyeeS with wages as that r sole compensation, 102 - PIERS
will do the work,and the.bast ne is n.I:manses or offered for nam Sec.7044. iU3 - Required Inspections '
Business end P ams,,ors Cade:The Contractor'.License Law does n.l apply Io an q p
owner of prepeny wino builds or improves thereon.and who docs such work himself. 104 - REBAR
or through his own employees,provided that such improvements arc not intended or
10 5 - ANCHORBOLTS-
offered for le.If,h.werer,the Will ing or improvement is.old wnhin one year of " ..
completion,the nwnct-buimerwill have the burden ofpraying that hedid net Wild or 106 - SEWER & WATER
imrrnve for rurlom.f sale.).
_r 202 — UNDERFLOOR PLUMBING--
�7.;uawomonheplanc.70amBusinissanddnrunssions Cofincde: ed)The
203 — UNDERFLOOR MECHANICAL
construct the Pmjcm Isec.]044.Business and Professions Code)The Contractor's
License Law dos not apply to an owner of ooPeny who builds or improves[hereon,
- and who contracts for such.projects with a Com anto(S)licensed pursuant to the 2 04 e UNDERFLOOR- FRAME
CC ' ct LicansaLow. 205 - UNDERFLOOR INSULATION
�!m arevPI under Sec. ' B P C for this Mason
owner ore �'1- t` C91 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARA ON 302 _ TUB & OR SHOWER
I hereby ammn under pcnmty of perjury one oh
ne following declarations: 3 03 ROUGH MECHANICAL
(r. ❑ 1 have and w;a maintain a Certificate of Consent to self-insure for workers 304 - ROUGH ELECTRICAL
Compensation, as provided to, by Section 3700 of he Labor Code, for he 3 05 - FRAME
per ormome of the work for which min peon:,is Issued.
and will maintain Worker's Compensation Insurance,as required by — HOLDOWNSyuircd by Section 307 - INSULATION
3]00 of the Labor Code,for the performance of the work for which Ibis Permit is
issued.My workers eomppnsalion Insurance carrier and Policy number am: _ .. . 308 - SHEETROCK
Ca_arer! - - ` ' " Policy"°' 309• - ' EXTERIOR, LATH '
CERTIFICATION OF FXEMPf10N FROM WORKERS,
COMPENSATION INSURANCE " '__... _.._....31.0-.. .-.._INTERIOR_..LATH.._._....-..-.
1T]Iis section need not Na completed if the permit is for one hundred dollars 311 — SCRATCH COAT -
($dW).plc=," 313 ROOF NAIL - .-_ . _ , .
1 certify that in[he performance of the work for which this permit is issued,1 501 — FINAL ELECTRICAL 'ENERGY
shall not employ any person in any manner so as to become subject to the Workers
Compensation Laws ofcrforma.Dale 502 — FINAL PLUMBING ENERGY
.Applicant
NOTICE TO APPLICAND It,ulmrnmking his Certificate of Exemption,you choald 503 — FINAL MECHANICAL ENERGY
Z become subject to the Worker's Compensmion provisions of the Labor Code,you muss
Z O mri, mplywithsuchprovisionsordi,p.itAhanbcdecmcdrevaled. 504 — FINAL BUILDING ENERGY
Brwhco
FCONSTRUCTION LENDING AGENCY SOS = FINAL ELECTRICAL
a > 1 nereny a1Brm mal mere is a eonnrvmi.n lending agency fiche performance 506 GAS TEST
L me s Ada which his perm,is...tied(Sec.N07,Civ.C.)
of re work I
507 - FINAL PLUMBING
Z; z rens 508 — FINAL MECHANICAL
U O 1 ccnify that 1 have read this it,liemion and nate tha,be above information is 509 — FINAL GRADE
L. [-I correct.I agree m comply with all city and county ordinances and:tate laws relating
O U tobuildingconshmethov and hereby authorize rcpresentntives of[M1is city to enter upon 510 — FINAL PLANNING
'y the above-mentioned property for inspection purposes.
F„ As (We)agree,.analindemnifyandkeepllarndc..IneCityofCuperiin.arminsl 514 FINAL PUBLIC WORKS
Vl liabilities,judgments,costs and expenses whsh may in any way accrue against said
(,1 = City in consequence of the granting of this permit.
APPLIC . IND STANDSAS \vILLCOMPLYk1'RHALL6p/]�PQLST Issued b (�. Date
SOURCE ' I 5. h.I II7pi y'
Signature: AppflcanUComractor. " " 1 Dale Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
will me apphcam or future wilding occupmn slum or handle no moor;material .Type of Roof .- . . ..
as defined by the Capeninn Municipal Code.Chapter 9.12.and the Heahh and Safety
Code,Section 255321.)?
ores ' . ,>(o1. 1 ',. ' All roofs shall.be inspected prior to any,roofing material being installed.
W 11 the applicant or future building our pant use equipramor device.which If a roof is installed without first obtaining an inspection, I agree to remove
mit hazaalous air conmminunts as defined In,the Is,Area Air Quality Management
Dfshe6 '. all new materials for inspection. Applicant understands and will comply with
((' °Yea - all non-point source regulations. I.
4_y "I have read the haupdou,materials requirements under Chapter 6.95 of he
California Health Ac Safety Code.Sections 25505.35533 and 25534.1 understand that .
if me building docs not cement,have a temant.the,it is my msponsibili,y to notify the
occupant of the requirements which mus[W in prior t.issuance of a Cemficam.1
°�"�'" / Signature of Applicant Date
•�; I1/� All roof coverings to be Class "B" or better
OwgkeNlLsefllmmzad agent I Data
... '' '^.:' . . OFFICE -. . .-