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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
1272 POPPY WY
JOHNS BARBARA C TRUSTEE
01100013
OWNER'S NAME:
APPLICATION SUB DATE
JOHNS BARBARA C TRUSTEE
10/02/2001
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECTBE GINEER:
BUILDING PERMIT INFO
BLDG ELECT UMB MEC14
u 1-.1 u
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby aKnn that l em licensed under provisions of Chapter 9lcomnlcncing
win 5<eion 70001 of Di, man 3 of he Business and Professions Cade. and my liana
REPIPE.
is in full fuse and affect.
'
License Clms Lic. p
Date Conuvemr
ARCHITECT'S DECLARATION
1 awersmrd my plan. anml W n,ee a, pmnbr rtrmrdx
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm Wut I ion exempt from the Conlme u s License Law for the
following reason. (Secion 7031.5. Business and Professions. Code: Any city or county
$5000
which requires a Permit to contract, alter. improve demolish, or repair any structure
. pnad, its ixwarce. Mso requires ilia applicant for such permit n Bka shroud--
thaheii,liccnseepdnwmtollicProvizionsmftheContmctorxLiccruclaw...Cor)
Sectien o Bninexa Proressmn ecce)
d r s,{ r
� `. 3'�ff 3 fes• )S1'4
. . Valuation
eramat he is him base n aM
the Any violation
of that he L exempt therefrom ant the naris for the
om arm
tht mean,
, ,
l
subjects to
-of Section 7031.5 v any applicant d ll for a Pemrit subjects 0e mpplicant to a civil penalty
'of not metre than five nanartaaanars(sson)'
20�PN �9'Aiili�RFLOOR P
BING'' Occupancy Type
°I,as.x'oer ofthc proany. or my employees e'ith wage as their sole compensation.
-
_
502 - FINAL PRUMBeTO&IIHNERGY'
will do the work: and the suuctaa is not lacerated or offered M sale (Sae. 7064;',
f Bu -sines and' Professions Code: The Contractors License Law docs not apply to an
owner o1' prepany Who builds or improves thereon and who does such work himself
507 - FINAL PLUMBING
or through his own employees. provided that such improvements am not intended or
-- - -
: oBacd for talc. l[ however. the Wilding or improvement is sold within one year of
Cl I-
the owrren W ilder will have the Wrden ofpmving ohm he did nm Wild m
immpleinn,
mp far purpose of sale),
r
al to
a: exclusively y commct,%ion,
r pRhe P(Sw
7. Crude.) The Contractor's
The Contract
cace., ow Pnln ISec,,1114. Business anderty
�I •
whorold,or
Liana law d i not apply m an owner mf who Wilde teor
I
seimproves
. emac da,
and who m (m such projects with a mmmconsl licensed pursuant ro Ihe.
Contmctoc Li nw W.
❑lam and -a.'' ':B&PC forthisrason
v 'FII ALE®
Dw Data
WORKER'. MPENSATION DECLAR N�
OCT O q % •I
2001
IWrathy affirm under Penalty of pefjuryore of the following declarations:
V
° I have and will mminiain in Cerpfilma of'Comenl to self-imum for Wokers
compensation, n provided for by Section 3700 of the Labor Code, for the
BUILDING
'performance of the work for which this permit is issued.
O 1 have and will'mainmin Worker's Compensation lnwrince, as resuirtJ by Sen ion
37M of the IaW, Cada for the performance of the work for which this Permit is
issued. My workers Compensation Insurance captive, and Poria number am: _
� 1 :4 }v 9 Polic. Noe
- -
r ii.r Tcs-p1"r(; s t ?'.'.:f;
• s s
a• � ! '•
CERTIFICATION'OFEXEMPTION FROM WRRKERS-1
COMPENSATION INSURANCE';'rc
___.___ ..._.____._. _-._._.. .......`._.. ... .. _........__.
.•_
-_. �I'
pemm' Ilan
fID s secure n'cul nal be oompined f rhe t u fo hundred im
sf7' �;'.Cllpolsls sV
ISI003 w lees.) :-
r
-- Ian fy thatin theper" of the orkf r -rich th. pp t siswcd:l
_- --, �._.. x_-- r �. ,14 . - -
'
zhail not employ a"' N ...many madicr w see m bnconteiunlecl to ilia Wurkcrs'
Cmmpenxrdmn L'ews of Culifomid_Dam
NOTICE TO AP ... CANT:If. ager making this Ccnifcme of Exemption. you should
baooe subject or the Workers Compenation prowl s of the Lama Code you muN
-with
frmos rh comply such provision nr obis permit shall W deemed revoked.
-. _
....,ynu.•::Yf. CONSTRUCTION LENDING' AGENCY... :. r.. ..
'.tp .:.. 'sr,: •'-•..-• -.
I h<Rby M. don Ihem is a cannmetion lending agency fm the performance
efrh workforwhich this permit is issued(Ser:'3097. Co. CI '.'• : .•..:.•
s
Tder'x'Address• ,•
Inf'rIC •. 1r� ,'rl
1I tea 1 have read this on andmdi that ilia int mrmlati is:
cityd stat s.relating
and and state
1 agree to comply with hal all city oW
a mpre ental es to
to con of this city ro <m<r upon
tir Wildingcorooned mirth for
ineectionertpresematives.
inspection
•one aWfWa)aree1. pnpenyforify
I Agra to sox, solemnify ad Worries, of
rand keep harmless Ian agui egaiw
expenses way com
liabilities, judgmems, cons and expenses which may in any way ecene again.a said
s. j
mit. ;
City in as . trance of the ju ming of chis "VI
UUDE ANIJS'ANDw.; 1P N' li oN
SPP R
Issued by: Date
ig o Appiicxd ammnbr.t - .. .. me
Re -roofs `
.' HAZARDOUS MATERIALS O5URE" '
' wit the pplicam m Nmrt W IdinB a<upant stem or h rdl WssNon ma¢nal
Type of Roof
'-
as JefaJ M1y th C Mfr oMn PICoJ Ch Pr 912. anJ tWH (nand Safety
nr- + 1.it
r ' t
Cwde 5 ct on 25532(o)P
❑Y ,, „ °No }' 1 t i
All roofs shall be.inspected any roofing material being installed.__._
wu to pal uxnt rfuture b Id s r pa 1 nam t devices which
prior.to .
If a roof is installed' without first obtaining an inspection.,I agree to remove
emnn d d condominium, definedbythBay Area A Quality Management
Diann
_ all new materials for inspection. Applicant understands and will comply with
...[Dyes { (, °N r., r - -:
'all non -point source regulations.
' r I base readithe haxallou4 marenels m mremants:under Chapur!695 of Ju
Cnl Yarm. Heel & Snfery CmdC Sdti 33 and 2553x. 1 andemmd that
' if@,building not currently hast a t sant, Nal it 1. Whifylhe
2aa" m of al anhicBmua mel, p' m is a Ceni rat of
°p'a`y' "
Signature of Applicant Date _
All roof coverings to be Class "B" or better r
own<raawnariud agent('. Dae
•;: .. _. _ ... y OFFICE