01070065A
1
CITY
I DING o DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDINGADDRESS:
PERMIT NO.
10421 N PORTAL AV
01070065
OWNER'S NAME:
APPLIC TION UB DATE
SCHINDLER RONALD P AND ADA H
0, 2001
' PHONE:
SANITARY NO. CONTROL NO.
Z ARCIIITEC (ENGINEER:
BUILDING PERMIT INTO
BLDG ELECT' PLUMB MECH
—1 L_..1 1=� L=1
z LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
BATHROOM REAP I R
at with Section 701)1 of Division] of the Business and Professions Critic, and my license
.
is inve full toms and Goer,.
2 License Class Lic. p
Use S DECLARATION ARCHITECT'S DECLARATION
I my plans shall be used as public records
-•
Professional
xLicensed Profexxional
DECLARATION
Oat
_
I am exempt
1 heathy affirto that 1 am cxemp, from the Comer, Cod License law for ins
from
Ibllnwingne Code: Anyat or.county
Bmmess and Pe.
a
/� �'40Q(]
d,n0ns
aite,a(Sa'11On'IB!L5.
5 wbirM1 myuimsatomo matinsthepplicot fr e
suchPermits Bit a sigedmmewm
- trio , , 1 the applicant f ch Permit signed
-"- - -
- Chapteem.
that he licensedpursuant olhe Provisionsof the Contrarieties License La(Chapter9
netngwth TWO) Code)
J',
_Valuation
(co Section of Division3of thea sine'. and Professions
or the( he is exempt therefromandthe basis for the alleged istmption. Any violation
-
oll fora permit subjects the applicam m a civil penahy
of Section a than by any erred dollars
asr nast,marc than rvthandree emma(ssW).
101A��N@J�ATION
(Pr: � � Occupancy Type
01, as owner of the property, or my employees with wages as their sole compensaion.
2
PIERS
103
- UFER Required Inspect'ons " -
will do the work: andthestructure is not intended or offemd for sale (sec. 70,14.
Business and Professions Cale: The Contractor's License Law does not apply to an
owner of property Who builds or improves Increase. and who does such work himself
104
q
- REBAR i
or through his own employees. provided thaasuch improvements arc not intended or
_
-BOLTS-,-
the building or improvement n sold within one year of
coerce for sale. mpr
105
- ANCHOR'
owner -builder
completion, the owner-buileerwill have the burdenufprovingChashedidnotMilJor
106
- SEWER Sc WATER j
improv�er`"�ulpsoenfxale.).
(yi - nerLnhe - cry, .-e icon contracting _. __
propsny, oat exclusively rennin with licrnxd conrmcmrs m
.-202'"=
UNDERFLOOR --PLUMBING .._.._.... .__.-. _ -_..
t..._ r ...
coname, he pati«r cc. nw. Buanexx arta Profeaamm cw :) The cnnvatror'x
203
- UNDERFLOOR MECHANICAL o i
Ligase Ww d«s r - ply ro an owner of property wM Miles or improves themon.
and whu.comr a.h cit proj«a witn.a cantmaor(s) uan. d. pa gam ,n the
... _ 2.04
- -UNDERFLOOR FRAME --- -' -
Curb
o,tzrTLienm .iJ&Pcrnrtm.reaaan
205
- UNDERFLOOR,' INSULATION
Owner
301
- ROUGH PLUMBING
WORKER'S COMPENSATION DECL RATION
302
- TUB & OR SHOWER
I hereby affirm under Penalty of perjury one of the fallowing declaration.,:
3 03
- ROUGH MECHANICAL
❑ I have :end will maintain a eerrifienle ur con®nt m aelbin.art f« Worker's
304
- ROUGH ELECTRICAL
Compensation, as previdw for by Section JTW of the Labor Cwe, for the
305
- FRAME
perficmwnce of the work for which,his permit is issued.
306
- HOLDOWNS
❑ I have and will maintain Worker's Compensation Insmnee, as required by Section
37W of the Labor Code. for the performanee of the work for whim this permit is
307
- INSULATION
Issued. My Workes Compensminn lnsmance carrier and Policy numberurc:
_- ..i - .
308
_ -_ _. ,, ,,,,, •
- SHEETROCK
Cartier,'1''' Policy No.:
,CERTIFICATION OF EXEMPTION FROM WORKERSt
l.�l •. r 309-'EXTBRIOR:
LATH':-i'..a: t
COMPENSATIONINSURANCE ""
_
-- '----310--=
--INTERIOR --- LATH....--- . . ....... ... ............ _,_.. --- ........_._.
.,.Ll....
-"(TM1ix.xe6d6nkcene,be'casnrpmlenirmelwrmi,i.rasrnothnnereeanuam
311
- SCRATCH COAT ..
ISINI nIcss.)
313--
ROOF NAIL
_.
'1 ttrlify'that in she perfurmoncu'nf rhe work for which this pern'Iir is issued. 1
�'
CAL ENERGY
nail^not employ any person in any spanner so as.to become subject to ths Workers
501
- FINAL ELECTRI
Compcnt. LawtasrGal'ITU01a'Dae
Compensation,.. ,, ..
502
- FINAL PLUMBING .ENERGY .. -
.. .._ .. ..
NOTICETOAPPLICAl If. after makirilCmificaeofEaumprion.you mould
-
503
- FINAL MECHANICAL'ENERGY
become subject to he W'orker', Compensation provisions of,he Labor Code, you matt
mnhwith comply ,In such Nvdshma a, his permit that be deemed revoked,
504
- FINAL, -BUILDING ENERGY
CONSTRUCTION LENDINGAGENCY -
505
- FINAL ELECTRICAL ,
I hereby affirm tha, there i.sa'construction lending agency for the peffonnona
506
- GAS TEST
of the work for which this permit is issued (Sac. J09t. Civ. C.)
Lewar's"a'na"
507
--FINAL PLUMBING
lender's Address)
508
,
- FINAL MECHANICAL
I cc that I have read this appecuh0n and state that the shove informahnn is
correct. 1 agree to comply with all city and county ordinances and state laws relating
509
- FINAL GRADE
jj toWilding cotcti dhereby authorizep ,tivcofth.'rytoem`uton
510
- FINAL PLANNING
!h b edp pryf sped nPm,oe
y (W ) 1. d mnifysadk pharmlesstheCtyifC penro gains,
A liabilities d n r. J Pence which may n any y cru against said
Cty f 6 gnf rM1. p ,
514
- FINAL PUBLIC WORKS
_
APPLI N' C DE ANDS AND WILL COMPLY WITH ALL NDN OINT
��j
Issuedb y:
Dat
SOD - , 5 ..�._ !6 _
sig. t reorAvpOcanvccmmcmr 'watt
HAZARDOUSMATERIALS DISCLOSURE
Re -roofs
Will the upplicnm nr Otma building «cupam beam or handle huaNuus mamul
Type Of ROOF
..' .. . • - .
He
as NCCu Cupertino Municipal Code. Chapter 9.12. and the He and Safety
,
Code:Selby
S¢Iion 355]3( a)?
.
�be
ave. i 'O No Al..' t •� r
All
- ll.roofs.shall
ms ected riorao an fOOfi❑ material.be
P P Y g. ing.installed...-
_,_
the app licant.orfuture building «cupantuse equlparent ordevices which
.
If a roof is installed without first obtaining an'inspectidn; 1 agree'to'remove
'�tWlll
emit hazardous air vm aminann ai derined by the Bay Aria Air Quality Management
Demic"
all new materials
for inspection. Applicant understands and will comply with
ove< .. ❑Na
all non -point
source regulations. , n.
I ha.c rhe hazardous maedals requirements under Chapter 6.95 of the
Cullfomiat uh Safety Cade. Sections 25505. 25533 and 255)0. l understand that
-
'iI"ttol erg lar dy have a ,.art, hot 1, is my o,,mr ibilhy to notify the
bdcup if which most be me, m issuance of a Certificate of
re
of;aP
l�M1
Signature of Applicant .. ..... Date
^ G
All roof coverings to be Class "B" or better
Ow, Dare
r author( agent
OFFICE - "
A
1
CITY
I DING o DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDINGADDRESS:
PERMIT NO.
10421 N PORTAL AV
01070065
OWNER'S NAME:
APPLIC TION UB DATE
SCHINDLER RONALD P AND ADA H
0, 2001
' PHONE:
SANITARY NO. CONTROL NO.
Z ARCIIITEC (ENGINEER:
BUILDING PERMIT INTO
BLDG ELECT' PLUMB MECH
—1 L_..1 1=� L=1
z LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
BATHROOM REAP I R
at with Section 701)1 of Division] of the Business and Professions Critic, and my license
.
is inve full toms and Goer,.
2 License Class Lic. p
Use S DECLARATION ARCHITECT'S DECLARATION
I my plans shall be used as public records
-•
Professional
xLicensed Profexxional
DECLARATION
Oat
_
I am exempt
1 heathy affirto that 1 am cxemp, from the Comer, Cod License law for ins
from
Ibllnwingne Code: Anyat or.county
Bmmess and Pe.
a
/� �'40Q(]
d,n0ns
aite,a(Sa'11On'IB!L5.
5 wbirM1 myuimsatomo matinsthepplicot fr e
suchPermits Bit a sigedmmewm
- trio , , 1 the applicant f ch Permit signed
-"- - -
- Chapteem.
that he licensedpursuant olhe Provisionsof the Contrarieties License La(Chapter9
netngwth TWO) Code)
J',
_Valuation
(co Section of Division3of thea sine'. and Professions
or the( he is exempt therefromandthe basis for the alleged istmption. Any violation
-
oll fora permit subjects the applicam m a civil penahy
of Section a than by any erred dollars
asr nast,marc than rvthandree emma(ssW).
101A��N@J�ATION
(Pr: � � Occupancy Type
01, as owner of the property, or my employees with wages as their sole compensaion.
2
PIERS
103
- UFER Required Inspect'ons " -
will do the work: andthestructure is not intended or offemd for sale (sec. 70,14.
Business and Professions Cale: The Contractor's License Law does not apply to an
owner of property Who builds or improves Increase. and who does such work himself
104
q
- REBAR i
or through his own employees. provided thaasuch improvements arc not intended or
_
-BOLTS-,-
the building or improvement n sold within one year of
coerce for sale. mpr
105
- ANCHOR'
owner -builder
completion, the owner-buileerwill have the burdenufprovingChashedidnotMilJor
106
- SEWER Sc WATER j
improv�er`"�ulpsoenfxale.).
(yi - nerLnhe - cry, .-e icon contracting _. __
propsny, oat exclusively rennin with licrnxd conrmcmrs m
.-202'"=
UNDERFLOOR --PLUMBING .._.._.... .__.-. _ -_..
t..._ r ...
coname, he pati«r cc. nw. Buanexx arta Profeaamm cw :) The cnnvatror'x
203
- UNDERFLOOR MECHANICAL o i
Ligase Ww d«s r - ply ro an owner of property wM Miles or improves themon.
and whu.comr a.h cit proj«a witn.a cantmaor(s) uan. d. pa gam ,n the
... _ 2.04
- -UNDERFLOOR FRAME --- -' -
Curb
o,tzrTLienm .iJ&Pcrnrtm.reaaan
205
- UNDERFLOOR,' INSULATION
Owner
301
- ROUGH PLUMBING
WORKER'S COMPENSATION DECL RATION
302
- TUB & OR SHOWER
I hereby affirm under Penalty of perjury one of the fallowing declaration.,:
3 03
- ROUGH MECHANICAL
❑ I have :end will maintain a eerrifienle ur con®nt m aelbin.art f« Worker's
304
- ROUGH ELECTRICAL
Compensation, as previdw for by Section JTW of the Labor Cwe, for the
305
- FRAME
perficmwnce of the work for which,his permit is issued.
306
- HOLDOWNS
❑ I have and will maintain Worker's Compensation Insmnee, as required by Section
37W of the Labor Code. for the performanee of the work for whim this permit is
307
- INSULATION
Issued. My Workes Compensminn lnsmance carrier and Policy numberurc:
_- ..i - .
308
_ -_ _. ,, ,,,,, •
- SHEETROCK
Cartier,'1''' Policy No.:
,CERTIFICATION OF EXEMPTION FROM WORKERSt
l.�l •. r 309-'EXTBRIOR:
LATH':-i'..a: t
COMPENSATIONINSURANCE ""
_
-- '----310--=
--INTERIOR --- LATH....--- . . ....... ... ............ _,_.. --- ........_._.
.,.Ll....
-"(TM1ix.xe6d6nkcene,be'casnrpmlenirmelwrmi,i.rasrnothnnereeanuam
311
- SCRATCH COAT ..
ISINI nIcss.)
313--
ROOF NAIL
_.
'1 ttrlify'that in she perfurmoncu'nf rhe work for which this pern'Iir is issued. 1
�'
CAL ENERGY
nail^not employ any person in any spanner so as.to become subject to ths Workers
501
- FINAL ELECTRI
Compcnt. LawtasrGal'ITU01a'Dae
Compensation,.. ,, ..
502
- FINAL PLUMBING .ENERGY .. -
.. .._ .. ..
NOTICETOAPPLICAl If. after makirilCmificaeofEaumprion.you mould
-
503
- FINAL MECHANICAL'ENERGY
become subject to he W'orker', Compensation provisions of,he Labor Code, you matt
mnhwith comply ,In such Nvdshma a, his permit that be deemed revoked,
504
- FINAL, -BUILDING ENERGY
CONSTRUCTION LENDINGAGENCY -
505
- FINAL ELECTRICAL ,
I hereby affirm tha, there i.sa'construction lending agency for the peffonnona
506
- GAS TEST
of the work for which this permit is issued (Sac. J09t. Civ. C.)
Lewar's"a'na"
507
--FINAL PLUMBING
lender's Address)
508
,
- FINAL MECHANICAL
I cc that I have read this appecuh0n and state that the shove informahnn is
correct. 1 agree to comply with all city and county ordinances and state laws relating
509
- FINAL GRADE
jj toWilding cotcti dhereby authorizep ,tivcofth.'rytoem`uton
510
- FINAL PLANNING
!h b edp pryf sped nPm,oe
y (W ) 1. d mnifysadk pharmlesstheCtyifC penro gains,
A liabilities d n r. J Pence which may n any y cru against said
Cty f 6 gnf rM1. p ,
514
- FINAL PUBLIC WORKS
_
APPLI N' C DE ANDS AND WILL COMPLY WITH ALL NDN OINT
��j
Issuedb y:
Dat
SOD - , 5 ..�._ !6 _
sig. t reorAvpOcanvccmmcmr 'watt
HAZARDOUSMATERIALS DISCLOSURE
Re -roofs
Will the upplicnm nr Otma building «cupam beam or handle huaNuus mamul
Type Of ROOF
..' .. . • - .
He
as NCCu Cupertino Municipal Code. Chapter 9.12. and the He and Safety
,
Code:Selby
S¢Iion 355]3( a)?
.
�be
ave. i 'O No Al..' t •� r
All
- ll.roofs.shall
ms ected riorao an fOOfi❑ material.be
P P Y g. ing.installed...-
_,_
the app licant.orfuture building «cupantuse equlparent ordevices which
.
If a roof is installed without first obtaining an'inspectidn; 1 agree'to'remove
'�tWlll
emit hazardous air vm aminann ai derined by the Bay Aria Air Quality Management
Demic"
all new materials
for inspection. Applicant understands and will comply with
ove< .. ❑Na
all non -point
source regulations. , n.
I ha.c rhe hazardous maedals requirements under Chapter 6.95 of the
Cullfomiat uh Safety Cade. Sections 25505. 25533 and 255)0. l understand that
-
'iI"ttol erg lar dy have a ,.art, hot 1, is my o,,mr ibilhy to notify the
bdcup if which most be me, m issuance of a Certificate of
re
of;aP
l�M1
Signature of Applicant .. ..... Date
^ G
All roof coverings to be Class "B" or better
Ow, Dare
r author( agent
OFFICE - "