00110071CITY OF CUPERTINO
CONTRAC'T'OR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRESS
10194 POTTERS HATCH
ROCK SOLID, CONSTRUCT
IT NO
i� 0011.0071
OWNER'S NAME:
PLESHA GENE S AND CHRTSTI\IA
M. 3.37x^_ CREIGHTON PI_
APPLICATIO ll Ali
+/2000
HON!:
SANITARY NO. CONI ROL NO.
1
(408)249-7625
ARCHITEC1YENGINFEN:
BUILDING PRRMITINFO
I76ECl' PLUMB MECH
I,ICENSGD CONIR,%MOR'S DECLARATION'
Job Description
I hereby rill irn thus Idat licensed under prrvi,iarv. of Chapter 9 (lo nmencing
with section 7Oanofoivision 3 ofma easlnesslmd Profession, code.and it, lwcose
KITCHEN
REMODEL
is ull force and el t.
e a co,/ .t-1 �t_ Lie. n7lor
d to°'=, .�j _o aan am_ OU am
,
ARCe1TECI'S DECLARA N
1 understand by plans %hall he, used as public records
..'re'edn tea '1
OWNER -BUILDER OI CI AI2Al1UN
II, Crun for Inc
he M1y (I ct that 1 nt f Ili C I cm I'
et.
/ y
CW city
hollowing c (Sectiont S Business dl ly county
/
which I till 'n '11 c P J b,h p- y:t cb ',
prior p issuance. also requires the applicant l or such pent t to file asgned voncne9
Sq. Ft. Floor Area
that he is licensed pursuurn to tete provi,mns of the Contractors Licene l.,w(Chapter 9
tronmtencits with section vsxn ofDiviaion 3 oftne 11a.mes and Pmfe.,iorn Code)
or than he ie event, Iherd et and the basis for tis alleged czcnlption. Any violntin I
of Section 7031.5 by any applicant fora pooh subjects the applicant to a civil penally
ofnm.moreIban rec hundred dooms (SSW).
APN Number
Occupancy Type
34235040.00
.try
owneror Incnd
❑ll
Required Inspections
d he structure is notreswhodosesax d ((it sac (.See, 7094.
will er, a wad;, and lbc swcmre is not intended or caw for sale apply to an
and Professions iltile The Cors Law d«a not opting to
ll
hems , and W
r of property who nom, o, intprores menton, and who auks such work him.elr
awneros property
101 —
FOUNDATION
Iola noun carcrecmenl.v ore not onenJcr ser
offered fh his own however, th building int n .old within one gem or
offered for sale. IL however, mel
102 —
PIERS
have el enof Prot
`avenoc lot me ownedbalm)r will nave me n,men or proving That he did nut Hula or
atpmvarrnarpn,eorsnle).
103 —
UFER
01.ds,wncr of the portico,. am uxelusivdy cornered g with licensed commcmrs to
1.04 —
REBAR
Lmswcl the project (sec. IDu, Bashes, aryl Profesions Ctwe:I The Co.u.no',
nndd.or hnprnva. mereou.
105 —
ANCHOR BOLTS
iieens"L"wdo,, net apply to anodoc,of proper, who
and who eoan..is m, such proje.lx win, a .ovtmao,(,) lieen,m hu,suant to m.
1.06 —
SEWER & WATER
Concoctoe,Licens,t-g,
❑1a,n eaemp, ander sec. .Bx lie for this tea°""
202 —
UNDERFLOOR PLUMBING
Owner 1J1f
'03 —
UNDERFLOOR MECHANICAL
WORKIiR'S COMPENSATION DIiCL\RATION
r—
204 —
UNDERFLOOR FRAME
I hereby I Yo elP",Yunco
',nHider
21105 —
UNDERFLOOR INSULATION
dcnjarconfthu,f'oaodiagdeclamlioro:
❑1base red! still ate 10 elf_in,urefor Workers
r e
compensation, as provided for by Sc tion 3701 of the Labor code. tam
301 —
ROUGH PLUMBING
,erlihnnoncc of me work as which Ike pertain is issued.
302 —
TUB R OR SHOWER
ave amt will lnaintain Wnderi Compensation lnsunnce. nz nyuired by s«tion
.rise or rhe Labor coda, roc ma permrnttmee of me wore. tar wmm mi. permit is
303 —
ROUGH MECHANICAL
iso ed Me�vv,w�,v�t,,�Cnnpencnioll lnwl;umc carrier and l'ulmy numhr ora
304' —
ROUGH ELECTRICAL
drier:
cr:RnFlcArloN a�Ew:I,IvnoN rltoM w°Bxltxs'
305 —
FRAME
(.(IM1'EN$nT1ON INSURANCIi
306 —
HOLDOWNS
mij, section need not be annpleved if,hc pvirdl is for,,. hundred dollar,
SIM) es.l.
307 —
INSULATION
1 cemfy that to ate tierfomtrne, or be work for whim mi, penoh is,,,ued.1
308 —
SHEET ROCK
shall net employ any person in any manner so a, to become ,ubiest to the Workers'
compere,;monLnw,orcllhrmhr.oale
309 —
EXTERIOR LATH
Applicant
NO'nClITOAPPLIGWI: IL after maAing this Cenilica¢ of lAcmpiion, you should
310 —
INTERIOR LATH
hecnmc ,object hh the W'orker's Cono emminn provisions of the Labor Code, you mm,
forthwith comply with such provisioloo,m',, tientril shall liedeenlw revoked.
311 —
SCRATCH COAT
CONSTRUCI ION LENDING AGENCY
31.3 —
RUFF NAIL
I hereby ufhmt Iha ,here is a cmWhuaion lending agency forth, tierforou nne
ENERGY
oohe workcar which Iii, penoto,limed(See . 3097, Cie. C.)
501 —
FINAL ELECTRICAL
Nature
—
FINAL PLUMBING ENERGY
L.crdc,'�
ender's Address
502
l,,oily maf elate rend nm,apprcaion amI lane, than dwah—eiaft noaro,t 1.
503 —
FINAL MECHANICAL ENERGY
correct. 1 .gree to conn,l, with all city and .ounty ordin;u cc, and ,are lads relaing
504 —
FINAL BUILDING ENERGY
to building eonnnucaon. and hereby auntnd.erepreentatives of this city n, enterapon
the albove.m.naoned prapeny for inspection purpose..
(We)nsm"rosav,:.lod,urrity and keep home.,. he CrynfCulprit an;,saint
505 —
FINAL ELECTRICAL
linbilinics, judgment,. cost, and expense, which amy In tiny way Imams aguino said
506 —
GAS 'TEST
City in conscyuamc of the grami., of,hi, pcii.r.
S Py�l.l( '+'I'�u11NI) ('AWDsi D 'I L COMPLY WITH AI.I Nr..I'OI
JI
Iet lc
Issued by: - —
FTNAI PI UMBING Date
s snap—Ad li n1I
litrl - _r � �
Re -roofs S08 —
FINAL
HAZARDOUS MATERIALS DISCLOSURE
e al,phcno,hner, oldng.a ..... 2,rol,orhufleha,aulurn,rha
Will mra
Type ofRoof 509 —
FINAL GRADE
see d.fined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
510 —
FINAL PLANNING
Glc. Section 255320.17
Dye, El No
All roofs shall t�pligspectlFd pNolito &rt)ihtO6fig ioifkiiiaEbeing installed.
Will the applicant or future Molding occupier use eyuip:ncnl or devices utricle
If a roof is installed without
first obtaining an inspection, 1 agree to remove
emit luimdoux air contaminants as defined by ,he Buy Arca Air quality Management
Di,oierI
all new materials for inspection.
Applicant understands and will comply with
oyes 0 N
all n n -point sou ce agulut
S.
1 Iluve read ,he haradous mmerims orporcreen,s under Chapter 6,95 of the
Cnlilontia Iledm R Safcfy Gdu, Scaini,25505.25533..1125134. I uM.rsmnd that
it mu: haimiag doxy Hol mol' ply naves mno", In y l a,ibihty to noltfy du
nee
C Qai
«atian, or l e myuircme Is w n must I : l pn t° or a c((nma Ie or
�,.VI/ ��GD
����"II((JJ--"��1tt `(
Signature of Applicant
All
Dale
roof coverings to be Class `B" or be er
Oxmner ser aumoriim ,gem Dae
g
OFFICE