00070020 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS', PHRM1'1NO,
1272 PRIMROSE WY 00070020
OWNER'S NAME: APPLICATION SUIT DATE
HOGG JACQUE A AND GLENDA L 07/06/2000
.IONC: SANITARY NO. CONROL NO.
0-1 ARC I i I'I'PC FENG1NHER: RUILDING PERM1'I'INPO
WWC C n HLUG 17I.FC'1' PLUMY MECII
F
io rtin
SH z LICENSED CONTRACTOR'S DECLARATION
5❑ I hereby affnn nn,,1 ant licensed under pmdlrinnn orchapter')wommencing Job Description
mem with i 7000)of Uivl.lon3eftheliusinc, nII'rgl` CuAc,and mylicunsa
sYY,; Is ll,lull li,rcc anAe ' I.
pas Licen.eelaaa_f � uc.«_�Z �C�_ FURNACE REPLACEMENT
G a v DocCon}}PPryryor
ARCHITECT'S DGL2AR — —
a O g 1 mrderaand mY Plans shall be mrd us public s
.
m ip p Licensed li�
J rs.dollul
n y OWNER-BUILDER DECLARATION
m .000
--s v. I heareby afEnn tm 1 am cacmPt from @c Commcmr's Liccn.a Law for clic
>_a following mason.section 703 L5.Business and Professions Code:Any city or county
F C which y retail t 'I after.improve,demolish, p fracture
,u w Prnr1 t Ino 1 It, pp'Ic: I ' 'hl ni1l II y d amnio
mato 1c dp tett thep m% n1 c t i License i (Chapmt9 Sy. Ft. Floor Area Valuation
(commencing with Section 7010)of Division 3 of the Bu.ini and Proresann%Code).
or that he is exempt therefrom and the basis for the alleged exemption.Any violation1 A L71 tilt
of Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty
of me m,re than live hundred dollar,(s500). A PN Number Occupancy Type
❑1,us owner o1 the property,ur in,cmph,yee,win,wages a,Iheir,nle entnpe..lion.
"3661817119 OL71
will do the work.and the structure i,not intended or ofRred for vale(Sec.7014,
Business and Profession%Code:The Contractor's License Law docs not appy'to an Required Inspections
x net of property Who builds or imprnves themon,and who does such work himself
or through his own mnpe
loyces.provided that such ltoprovmenrs are not intended in 204 — UNDERFLOOR FRAME
otremd for nide.It,1n�we,c,,the hoildmg rna In,provemcol is"old will....otic y",of
ma,n,pletion,the overrhaidder will have the burden d proving runt le did not build or 301. — ROUGH PLUMBING
provC for parposc of sale).
303 — ROUGH MECHRNICAL
❑I,as owner, the property,am exclusively contmeinguwith sh:)The C ormi%m
,nsmucl the Pr1jeo(gm.71.14.owner of
and proru%1n,n%code:)The ce,n eco.., 304 — ROUGH ELECTRICAL
Limmo Law doe,nut L'pl,such
man ownsrtf apro,artycorlo who built oe Ito pursuant
tenth.
and who I-wel,E,r aneh projectswith a ne1,Irl,emn+)hecto=d paranant tu the 505 — FINAL ELECTRICAL
C I am ex's License Law.
❑lam exempt under Set. .B&Pefor his maw,,, 507 — FINRL PLUMBING
Owner Date 508 — FINAL MECHANICAL
WUItKlill'S Cllh11'I.NSAnON DECLARATION 51.4 — FINAL PUBLIC WORKS
I hereby affirm under Penalty of perjury one nr the following decelerations
,$1 have and will maintain a Certificate of Consent to self-inaure for Workers
Comet, bine. u, presided for by Section 3701 of the Labor Code, for the
pets...muw,of the work In whch Ihi, ar I is i..ual.
❑1 have and will maintain Worker',Cs i,sensmion Insurance,as mgnired by Section
3701 of The Labor Code,for the Rcrfnnnance offtthe
[)work forwhichthis permit is
is
nsation
CancarN El Il ICAII(l�i Insurance
1'4MM WORKERli-,
COMPENSATION INSURANCE 7
(This section need not M completed if the pem0 is for one hundred dollars
(51(1(1 or le")
I eerily that in the pertinhmnce,of the work for%Inch this permit i,i.,.sued.I
shall not employ any person in any manner se a%to become subject tu the Workers' -
Compensation Laws of California.Dam
Applicant
NC TICS TO APPLICANT:If,after making this Cenilicam of Exemption,you should
hecntnceubj,,,res I be Ar kco ,Cgmien,,aIuc pmvi,ion,nr the Lubar Code,you..met
Q O forhw illi co...is ,ah,uch,00kion,or thispconilsollbcdccmcdrevoked.
CONSTRUCTONLENDING AGENCY "
CL I hereby arfm,that there I%a construction lending agency for the Per uchance
W of the work for which Ihi,wrout is i„uad(Sce.397,Cls.C.)
Q Lender',None,
a 7 Ichul Addmas _
U Q l certify that l have mad this application and state that he above inrarr cation is
Is. E,. comet.1 agree to comply'with all city and county ordinance,and stale laws,Cluing
Q U %building cno,tmetior.,he harehy am It im repremmmivcs at his city m enter nim
the above-toenmned pmpery 4n'inspection Inor el,
[tea S (We)agree to ace.indetnnily and Kiel,In nnies„he City of Opecien uguno
N liabilities,judgment,,costs and expenws whch may in any way accrue again.,said _
U Z. City in convergence of the Starting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: G' C/ DBIC
SOURCE REGULATIONS.
Signature or Applieant/Comractor Date Re-roofs
IIA]ARDOUS MATERIAIS DISCLOSURE
Will the applicant or future nosing nccupanl some m handle haardom mammal Type of Root'
as defined by the Culp iso Municipal Code,chaplet'9.12,and the Draft and Safety
Code.Section 2553200'
oxen E-1 No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit baaarduus air contaminants as defined by the Baty Area Air Quality Management
District? all new materials for inspection. Applicant understands and will comply with
O Yes ClNo all non-point source regulations.
1 have read the Iarallou,nmmriaN myniremmnls under Chapter 695 of the
Califmnia Health&Safety Code,Sections 25505,25533 and 25534.1 undcrsmnd @at
if the holding dins,not currently have a tenant,that it I%my msponsibilip to notify the
cuPam of the requirements which must be met prior to iouanm of a Cer ifcmc of
O'cup on” Signature of Applicant Date
owner ormodrom d,gent Dale All roof coverings to be Class `B" or better
OFFICE