01060134 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10706 PAR THREE DR 01060134
OWNER'S NAME: APPLICATION SUB DATE
TIM HEYBOER 06/22/2001
PHONE: SANITARY NO. CONTROL NO.
G e z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
H w O L ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
z 1 herebyrmrn that I am licensed ander of 9(commencingJob Descri ton
es provisions per
L:ad with fullfamc,an effect. on3ofNeBusinessanePrxfessiunsCole,andmylicensREPLACE SLIDING PATIO DOOR,
E..< isimm�rlass efrect. REPLACE SLIDING DOOR W/A WINDOW.
rc 0 z< License Class Co p
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O w O Data Contractor
w 3 d.
c v, ARCHITECr'S DECLARATION
=O g I understand my plans shall ba noel as public records F'
d o Licensed Professional
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OWNER-BUILDER DECLARATION
1 hereby affirm Nat 1 am exempt from the Connect License Law for the OCT t_ J?a following vsnon.(Section 7031.5,Business and Propermit faslmu Code:Any city or county O f1 2001
q o o1
de F o which requires n m construct,alae,improve,demolish,or no au any strvaure
i 3 phi mass a Is Q N pile tl d pen It fl 'g J t mnrem 8 - -
Iuan!is liesmiall tiosaahibydc pM1 o rme Contractor,Licano,Ltn,(Cmme9 (:PL,FIOOLAI'ei¢ , Valuation
(corinitenem,wlib St,t....7000),0 D'vis'I n Sof the B si e d l ror,smn Qrcle)
or that he vi eiempe Ihcrefr`o s and the basis for NC alleged au"puon.Any violation -
-or Scali.n 7031:5 by any applicam far.permit sobjects Inc applicam m a civil pcwhy
of not mom than five hundred dollars S500). APN Number Occupancy Type
❑1,is°wnerof theproperty,or m to eas with wa their sole compensation.thYsmP Y or
penia
wiu'dn,ne'work:ane the structure is not intended Lie offered for sale(Sec. a.do 1 O 2 - PIERS Required Ins ections o <a
t comer of property Von,b Cale:The Contractor's,and%Law docs not apply m elf Q p
f of property em doles of improves thereon,and who encs are
work intended
or 1
°w"` 103 - UFER
or through his own employees.provided that such improvements are nm bae year or
'-:off md'f0sale-I!,-h ever the building-or impmvemcm esald'wMin ore year of ... ___..
completion,the"wnervbudde,will have the burden or Prov ng that he did not build or 104 REBAR '
impmve for pairmseorsme.). 105 - ANCHOR BOLTS
o .-aa—owner of teprops,oy.aexclusively contracting with licensed 6nmmcinrsto - _1-06 SEWER- &--WATER--1.--._ - _-_,. ,-- ...---.._. _-.------
onstmct the project(sec.70vw.Business and Professions Cale:)The Connxoor s 202 - UNDERFLOOR PLUMBING
License Law does not apply to an owner of property who Wilda or improves thereon,
_and who.conitacts.for..vuch pro;ccts with a contractor(s)licensed pursmnt.m.thc
203 --' UNDERFLOOR MECHANICAL - - — -
Comredol3 :cense Law. .
and se. e'a emrmnrcamo 204 - UNDERFLOOR FRAME ''I''
6 '1 p� 205 — UNDERFLOOR INSULATION
_ O KER'SCOhII'E TION DE LARATI N 301 - ROUGH PLUMBING
.• Iharcny arrml snag p5naliy lir perjary line aline following dxmramns: 302 = TUB & OR SHOWER
❑ 1 have and maintain a eenificme lir cnnoem m v.msarc flit war ors 303 ROUGH MECHANICAL
Compcn..non.-as provided for by Swims 3710-lir the Ube, Gide, far he
- _
pasta ram.riceuftneworkfurwhilthin pytnitixionmi 304 — ROUGH ELECTRICAL
❑I have'6nd:an maintain worker's cmmpensaann br umnee,as required'by Section 305 — FRAME
=r 3701fof the labor CrIEe,for the peifortwnce of Be work for able Nis permh,is 306 - HOEDOWNS
-' rsiusd.My Works(,Co ax o stlon Inmrance carrier and Policy number arc: '""
307 - INSU_LATION _. . ..__._ _......
Caniii:x '^'i PolicCERTIFICATION OF EXEMPTION FROM WORKERS';' lli � 3'08- 2iSHEETROCKt= '!�•'t
TION INSURANCE". " � "
__- ..._ ..,. _ _ -. ,...- —. -- 309-r=..-EXTERIOR-LATH—
(Thiv slitloa'oced not be cnmplelyd Pit,Permit is for one hundred dollars 310 - INTERIOR LATH
f511p1 l ` '
311'-- 'SCRATCH-COAT.,,,.
shall1 uflhany Noef br r hh "ark for wh hN. ctm permit'. surd
shaw it'd ' 1"s
ll not employ any pe n m any man s m boo n sab;ep me workers, I Li � "I " I 313 — ROOF NA
Co.p<�.ytmn laws nrcmimmla.Dae - .
Appueam _... .501 ..- .FINAL_ELECTRICAL ENERGY .. ... -
NOTICE TOAPPLICANT.If,afro,making this Cenifieatc of Exemption.you should 502 — FINAL PLUMBING ENERGY '
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith mainly with such provisions lir this permh shall be deemed revoked. __ 503 FINAL_ MECHANICAL ENERGY .
__. ..
P-v� ' "' 'CONSTRUCTION LENDING AGENCY 504- FINAL BUILDING ENERGY
F". ' 'I hereby oohed Nal there isdtdn.ilmcdnn lording hgmncy fur Ne pedonnan<e - ...
w: 'or Newnrk(a,whimhmi peimhisis...d(Sai.3097.Civ.C.) 505 - FINAL ELECTRICAL
y;= Leader's Name - ._ . - -- - 506 - GAS TEST
Lender'sAddress �'• •.
U-Q }certify that have mad this application mJ sac that the aWsc information is 507 - FINAL PLUMBING'
s'F vn edl:1 agree w mnmply.wbn all car and county,gmmaxa:mastate laws relating 508 - FINAL MECHANICAL
- O_,f, wbuild'mg conswmdon.and heresy amWda rep sentaives ofthisdly memcfupon 509
m — FINAL GRADE
the ubmo,smat tired property for inspection Purposes.. -
- F.0. (we)agreetosave,indenifyandkeephxmlcsxtheCityilfCuv,rtinoagainst 510 - FINAL PLANNIN
UVi liabilities,judgments.coxa and expcnscs,which meq in any way accrus again said
- rnr m m qct rt fthc granting°finis pgrmit. 514 — NA U ORKS
^ s P WITH ALI1.NONPpINT
' sore (� 2 2/O r Issued by: '• Date
APPL cut liamZAromen,PJATERIAL9IPSC .T' -•" ate ' Re-roofs
mll Nc npplicam or future huilling xcupum score o0r handle hnzirdous mmsnal Type of Roof _..__...._ ._ ... _ ...,..
as debt d h N N Municipal I CW Chapter 9 r'2, d the H rh and Safety
_ t•
Cod Sen on 25532(x1. ❑N ,. 1 r 'tp
❑yes' f ,'�, . _. All roofs.shall be inspected prior[o.any-roofing,material,being.installed.
I irsilillNe,pplb tfinfinum braildingar pantme equipment or devices which If a roof is installed'without first obtaining an inspection, l'agree`.to remove
"i...h n moa i s defined by theBay Area A Quality Manag ent
District-' all new materials for inspection. Applicant understands and will comply with
❑Ye o�n 'i, all non-point source regulations. -
'` 1 Azvereal NChaairdous mai<rixla rcquiremenu under Chapter 6.95 of the
Califomio ffealrh&Safety Cale.Sections 25505,25533 and 2553+.1 undersand Nat
If, bJilJing does nm""mall,havront
enna ,Nat it is or,responsibility epansibllity ratify the - - - -
upas of rcquirtmenls which must be act prior m issuan a of a
' � 2 2Dace Signature of Applicant Date
Ow
i ns,orao a e age t - / All roof coverings to be Class.IB„ or better _.
' -
OFFICE