01090078 CUPE
NO
CI BUILDING SIONNO
DIVIISPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10080 PHAR LAP DR HERNAN PETER J JR AND MARLENE01090078
OWNER'S NAME: APPLICATION SUB DATE
HERMAN PETER J JR AND MARLENE 09/20/2001
qPHONE: SANTfARY NO. I CONTROL NO,
W O O ARCHITECTIENGINEER: BUILDING PERMIT INFO
E BLDG ELECT PLUMB MECH
1' _'I J ---i L:.1
8 y= LICENSED CONTRACTOR'S DECLARATION Job Description
j Z_C 1 hereby eRnn Na I am licensed under provisions or Chaptm 9(comm�errctog
vdtlu withSemion7000)ofDivision3oftheBusinessand ProfessitnsCode.andmylicense D ARBOR ON SIDE YD.
f a S�j is in full force end effect.
e K 3< License Class Lic.M s
3 h
Date Contractor
ARCHITECT'S DECLARATION
=�O 1 undersand my plans shall M used es public retorts
3 p w Licensed Professional
Oat I am BUILDER DECLARATuan
1 hereby affirm Nos I am exempt from the Contractor's Lie..,-law for the
t Z .fallowing reason.(Section 7031.5.Business and Professimu Code:Any city m county $2000
FFFF O pp
3O° p t R e, im, provll �v w P 4''t ` -_ -
which rt cores° retie m conswcr alien.improve,demolish or rt ......num
'bor ns issuance,also uav Nen I¢ent fonuch pcnnnmflea waned areamens
that h s licensed t$onto the• s ons of the Contrcmrs License law(Chapter 9 �s oaf
(cmu e e gwithSeclmns7000)of Division 3 of the Business and Profcesmns Code) (,l� 1 32 1 _ _ a j;_1, 1 1 r Valuation
or Net he is exempt Nesefmm and the buts for the alldged ednnpsibd.Any violation
of Section 7031.5 by any applicant I..permit wbfects the epplrcw to a civil Porolry
of not mom thanfvehundreddanars(s5(a). 101APNelftAT i Occupancy Type
°I,as owner of the property,or my cmployeu with wages an Nab sole compensation, ing
will do be work,and Ne swciure is not intended or offered fm We(Sec.7016, — ,
Business and Professions Code:The Con°vam's License Law doe,a not apply to an 103 - UFER Required nsp'ections
owner of property Who builds or improves human.and who does such work himself 10 4 — REBAR i
or through his own employees.provided that such improvements art not intended or
,=his
-- ... . ... ..
or sole.IL however the building or improvement n sold within one year of 105 _ ANCHOR BOLTS I`
completion,the owner-W rider will have the burtlen of proving that he did not build m t
m forpumaae°role.). 106 - SEWER & WATER
I.aovnmufinepmpeny,arae.emsivelycontractingwithueenaweoonsul.to 202 UNDERFLOOR PLUMBING
onatruct the project(See.7004,Business and Professions Cade:)The Contractors
License law dor not apply to an owner of property who muds or improves thereon. 203 — UNDERFLOOR MECHANICAL -
- acid who contracts for such projects with a conoucarfq Rented pursuant to the
Comracmla ucenus law. 204 - UNDERFLOOR FRAME - ' -
°lam mpr dm sea. BAPcrorniama°n 205 - UNDERFLOOR"'INSUI]ATION
owberDate 7A of . 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby affirm under penaltyof perjury one of,Ne following dedardona: 303 - ROUGH MECHANICAL
° 1 have end will hours in a Certificate or Contain m self-indium for Workers
I Compensation, u provided for by Section 3700 of the labor Code, for Ne 304 - ROUGH ELECTRICAL •
_ perfarmanca°f Ne work rm whichNia permit is issued. 305 — FRAME
°1 have and will maintain Worker's Compensation Insurance,an required by Section 306 - HOLDOWNS
3700 of the lancer Code,for the performance or the work fm which this permit is _ 307 - INSULATION
issued.My Wadma"Compensation insurance cartiv and Policy number art: ,vrr •_,-, -„— _ _.,__ .-
darnec ,l I nl, ' PolicyNo..' .. 308 "-.,SUE''RQCK . r -.... ..
CERTIFICATION OF EXEMPTION FROM WORKER '31- ' t
COMPENSATION INSURANCE*"" 309 ='"EXTERIOR'''L1°ATH''
_... ._. . 310-.._ , I1.NTERIOR"LATH ....;._ . . _. — - . . .
(1100)ortlnajciion need rat be completed if the permit is for one hundred dollar 311 - SCRATCH COAT I N
I mmly,that in the performance of the work for which this pemut is issued,I 313 — -R00 F 'MALL -... _t'-,,. '.
'shall at employ any pennon in any manner,so u to become subject to use Worsen' 501 - FINAL EtECTRI CAL' 'ENERGY
Compensationicanlawnnrc.nramia;Dne.' _ 502 - FINAL PLUMBING ENERGY -
Applicant -
NOTICETOAPPLICANT.1Lager making thisCenificeieofEumpion,youshould 503 - FINAL MECHANICAL ENERGY
became sobject to the Workeh Compcnselion'p"a sionsofthe labor Codayoucome
OZ rmNwith comply with such provisions arthis pmdtshall the,detailed eakd. 504 - FINAL BUILDING ENERGY
..
"CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL '
'I hereby e1Brm that there is a s0astmtuon lending agency far tham ormance
ohhe work for'which Nix permit is issued(Sec.3097,Ci,C 506 - GAS TEST
y_G 12ndcrx Name.: . . . .. ..... .. .. ..
p,-y Landersnddresx 507 - FINAL PLUMBING
V Q d certify Net 1 have read shin vpplicaion and nvm Ihauhe amve information is 508 - FINAL MECHANICAL
G*r E.r correct.1 agree to comply with all city and county ordinances and state laws raining 509 - FINAL GRADE
O U to building construction,and hereby euJimiarepresentatives ofhis citysoenter upon
w. Ne.covee)agieemeavpemrmnfyandikephounde. 510 - FINAL PLANNING
W (Wc)agaem propenee. or ins action phpones. the City of Cupertino against
'v) liabilities,judgments,Costs and CFpCmea which my In any way accmt agalnxl said 514 - FINAL PUBWC WORKS
U City in consequence of the granting of this permit.
APPLI T U DERSTANDS AND W ILL COMPLY WITH ALL NON-POINT
sou 1 c TIONS. o t Issued by: Date
Signam o Appliomn m=1mr ": a¢ Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or felum Wilding occupant store rehandle haodcus=ads] Type of Roof
u dehTed by,the Capetian Municipal Cade.Chapter 9.12,and Ne HaaIN and Safety
Code.Section 25531(a)7
❑vex. ;i, All roofs shall be inspected prior to any roofing material being installed..
Will he a,plicem m future building occupant use equipmcm or devices which If a roof is installed without first obtainingan inspection,'I a lee to remove
emit hessrdous air cartoonnants as defined by the Be,Area Air Quality Management g
Dixtrim7all new materials for inspection. Applicant understands and will comply with
Dye, all non-point source regulations. •
1'have read the hosardovi'mmerids requirements under Chapter 6.95 of be
California Health Ai Safety Code.Sections 25505,25533 and 25534.1 understand dans
if the Wilding does not currently have a tenant that it is my responsibility to notify Ne '
M. nt of the ire nocmems which must be met prim to issuance of a Cenifica c of
°`y' Signature of Applicant Date
of
Tr vuthodaed agent Dar All roof coverings to be Class"B"or better
OFFICE _