01030063CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMITNO.
10790 PENINSULAR AV
01030063
OWNER'S NAMIi:
APPLICATION SUR DNI 17
BROWN, JAYME
03/12/2001
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECI'IP.N(IINEIiR:
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BU .DING PEItMI'f INFO
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-
LU EI T PLUMB MECH
J IL1 _I
LICENSED COM RACTOR'S DECLARATION
fob Descrlpt I
1 hereby a inn'hat 1 am licensed under pmvisions of Chapter 9 commencing
wish Se.,ion 71MgB of Ilivinion 3 of the B.,incs, and Fmm,.xi... Calc, and my license
is' {u 11 farce and all�cl.
Clto, 15 Lien 3 2 _
x_�—OJ
PATIO
COVER ENE
Umc Cammc _ —
LEE—- ARCIII'1'1?C"I"S IILCLARA ION
I undcmm�A npplum .,hull M u.wJ as public rccorJ.x
FINALE
C)
Liern,rd Prore,,koml
OWNER-BUILDER DECLARATION
I hereby alRnn that I am emmpt loom the Corm coWs License Law for the
tbllowi.g IL Pover, Calc: An, city seco
(Senior, 9031.5. Rnxines, andmrc r unty
JAN 1 0 2002
.
which ('mire, a pc, ..i, m.... .unci, aIle(', imprwc, den h.h, or epnr any smOme
• Prim fo Ib ootto,c, apse rc4mirc�,humpliaun forvuch Penni, lu lilt u,ignul smanvn
S o rea
Valuation
Bud he is licemedpnrtunnao,ne pmvisionnal' the Contmeno, License Low(Charler 9
(commencing with Section 7B,Rp of Division 3 of the Bminec, and Profession, Co lq
�1�i
c,
co,bat he is eon o ,henfmm and the basis for the alleged cacmptioIt. Any violnion
$12500
APN Number
Occupancy Type
ser Section 70313 by any applicant fora permit .subjects the xpidicam to a ci.;l penelq
of not mom than Eur hundred dollar, ($500).
eirec copeution.
❑I,,, owner of, he cnmcny, or my LEE,I,iyee, with wage Its wi Jmm
:3PIFE1713049,
1710
will do the work, Intl the oructme p I I,ncnded or uttered to, sale (Sec. 7(90,
Bur nd Proles , Code:'I ba C.m,oaclor. License I.ov docs not apply to ll
':, .TUI, n
Required Inspections
owner ugh his o y Who bails, or impedes at ouch. and who d,a„Ian ware lded il
of
m, awn employee,, of Ora not intended or
icl nI,,l Loch,coman
101 —
FOUNDATION
i,
or impmeement is tufa within one Year of
for building year
nttercd Por .thea If, Fuiave
err'midethe
«,mrmd.n. me owner-boaeer will have nue Burden rr pn,dng that neaid ..nt wily or
t
102 —
PIERS
nutome ('opus., Insole.).
103 —
UFER
❑ T. a,.wne of he prpeny.;I. cad.sively contracting with licensed contmmton m
1.04 -
REBR R
Ll...nae, they pn,jcc, IScc. 7044. Bo. Lou] Profs,. , Code..lbs Gmuacu r',
cco. c Lnw does nu, apply to an owner of pmlxny whn�bolld,.r i.npn,vc, ,mean.
105 —
ANCHOR BOLTS
and who nnnmet, such p,.jms with I, commnaan) B,rnan par.oam r the
Li,itowfor
ContractorO l It. eaempf mWcr See . B & P Cor flux maxaa
106 —
SEWER & WATER
Owner Dae
202 —
UNDERFLOOR PLUMBING
WORKER'S COMPENSATION DECLARAnp”
203 —
UNDERFLOOR MECHANICAL_
I ncrchy it under pe..,fly of pcipry one of The F)II—iog dccbrnrom.:
204. —
UNDERFLOOR FRAME '
❑ 1 have Ona will recruit. a Cenire:ue ,d Cometh In wIt-i.... c Por worker,
205 —
UNDERFLOOR INSULATION
Cotore... nor. a, provided for by Seenon 3700 or the Lab. code. Por the
rerl.we of work for which dui, permit is is sued.
301 —
ROUGH. PLUMBING
0 1 have and will tinuctifin Worker s Compensation Insurance. a% required by Section
302 —
TUB (t. OR.SVIO14ER '
is t' Ica Por Ile performmtice of the work ler which this pemfl is
ova. My worker. coos Buse on lo.anmca e.,rrieraw rorty ..u,m ram:
303 —
ROUGH MECHANICAL
earner:.5�"Atz � ror.y No.: 13'7 3 7 Ise
304 —
ROUGH ELECTRICAL
CFO IFICAI ION OI' EXEMI' TION FROM WORKERS
COMPENSATION INSURANCE
305 —
FRAME
('Ibis section need not be completed if the permit is for one hundred d.Ili s
306 —
HOLDOWNS
alu(nnle.,.)
307 —
INSULATION
1 .miry had In the performance of the work Iar which d, prnri, is Lnmd. I
"'013
.hml ort mmrloy any Paso„ in n„ y mummer .o a, m nc•.on...nbj... m the worker.
308 —
SHEETROCK
Cnnirejma,imal.awxafcnliron,ia.Da,e
309 —
EXTERIOR LATH
rr If. Ether lni.Cenirsot on;aemrtiedeyou umust
N(InCETO Ar,,
310 —
INTERIOR LATH
the ok:
become Bunce., r Inc wooer., cmnper,xafon pravi.inn, ohne IaM,r c„ee you mm
forthwith comply It its nuchpnnixian, onhis pxmit shall be deemed revoked.
311 —
SCRATCH COAT
CONSTRUCT ION LENDING AGENCY
313 —
ROOF NAIL
Ih...by Ili... had there 1.aco...tlucfirn lending agency l or the performance
onhr,',Narwhi.hn,i,n.rminxi„med(see,3n9znxc)
.n
501 —
FINAL ELECTRICAL ENERGY
1111he
Nanta
larder, Addrms
5 —
F NAL PLUMBING ENERGY
Iverily that l have mad this application and sae that the above infomwdou i.
03 —
F NAI_ ME HANICAL ENERGY
aoroet. 1 agme ,comply with all city and county ordinances and state law, mining
o
a, budding com,rction. and hereby aathorim mpm,enntivcs or this city In era, upon
504 —
INAI_ BUDING ENERGY
the above-meminned rmpeny for Impnin I pnpmc,.
(Iv) ounce to acc. ind,noul, andapo- 1 F, Cty fcpeRn,ng;ino
505 -
FINAL E CTRICAL
lirol i. 1 Ig t: t 11 : 1' , y way g,n,t sad
City in comary,mee,I'he granu,g of ti, puri f.G�
AS T
UWILLCO ALLN��
Issued by:Nrl
_
Date L—U
SAPPLI�NOU RCE RFGULAn)NSND
nrnvcomm.m; Dec
,naturenrrrcn
Re-roofs & —
FINAL MECHANICAL
IIAIrARDOUS MX1 BRUITS DISCLOSURE
' Willthenppllcumorform,boffing¢cupamx,oreorhandlehwr,rdno,mnend
Typeof'Roof- 09 —
FINAL GRADE
as dalined by ,he Cupcnino Municipal C,xlc. Chapter 9.12, mal the Health and Surety
Code, so cc2553200'('
—
04
FINAL PLANNING
❑vet 71 No
All roofs Sha be acted
ff an ��n�LlnWe[�'a rsng installed.
Will the applicant orfuture building occupant use cipatconordei ;ee,which
If a roof is nstalled without
first 1��66tainmg an mspeclon, agree to remove
emit na7andom air contaminants as defined by the Bay Area Air Quality Management
Districe
all new I aterials for inspection.
Applicant understands and will comply with
D Yes 0N
all non- oint source regulations.
Ihave mad the naeardons n,umri:d, mquircmon„ under Chapmr 6,95 111 the
Cal it'orni I I Iwlth & Sutefy Code, Sections 21505, 25533 and 25534. 1 endaxwnd ohm
he buildlmg doe. on c...rally navea..•num, the if I. my ne.po...inirty m malty nue
apam .1 the nc,mr moa which ma„ he met ('nor m i,,un we or a Centric rte of
`capan`y �D
Ph
Signature of Applicant
Date
(/� - -� ' 4ori 3-12-2Ywu.
All roof
coverings to be Class IB” or better
Dat<
annf7,.�e ager
OFFICE