01030047 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUII.DING ADDRESS: VERMiT NO,
7988 PUMPKIN DR 01030047
• OWNER'S NAME: APPLICATION SUB DATE
MCCLANAHAN MAYBETH M 03/09/2001
PHONE: SANITARY NO. ' CONTROL.NO.
Q el Z ARCIII'I EC IIiNGINHER: BUILDING PPRMI'I'I
13LUG i?LECr I'LU MECH
r— I� LJ I—I
LICENSED CONT'RACfOH'S ofiCLARA'1'ION
Job Description
O Z— semby nmol nml 1 an.,v 0a,ed under prod Prow,resCall Y ai nu license
wllh Section)IXXq of Divi%ionJof lbe l3uvine,s and i'ro(es,ionnPWe,anA mylianno
le isin full brceand effe INSTALL WATER SOFTENER.
au Lives ,mClo, [.it.M
° DateConvmun
a,u.N ARCIII GiCr'S Of CLARATION
C u�°g nndcrsfeud Illy plans nbnll be used as public ternrds /
w 6 a Licensed Professional
yob OWNER-BUILDER DECIARATION
d_
to 1 hereto aflin,four 1 am evemp'from the Commour's License Law far that V`
t[Q following roamim (Section mils,Iimmes,and Prifis,inm Code:Any city or amity O
F p
'hich requiresaIennit ' ' d her n nliel p y ,,uncoil
p/. t Ilw quir—the ap,l...a bn,tiOb pema,,o file—griedlaticall,al
bar he is licensed pr.0 't chpookent,cifffic Conaracove,L W (Chapter9 .Sq. Ft. Floor Area Valuali(In
(fonn.mmmg with Section 7000)of Division 3 of the Business and Pnde,siam.Code)
one hill he is escal therefrom and'he basis for the alloyed esempdari.Any violmion $tt7
of lection 703 1.5 by any applicant for a pcomil mhject%the applicant.o o civil Wral ly
oom'......e roan live Ila tired enure,Issw). APN Number Occupancy Type
CI.a,ownerof the pngen,,ormyaaployec,with wages as beirsole corral inn. :3F.203001 00
will An the wad,and the amcmre is not intended lir offered for all(Ste.]IID,
Business and Profession.Coll 111e Contractor'%Liceme Law does not apply so an Required Inspections
of properly Whit builds or tapowcv lhCrenn,and who dulls such work bnseir 106 — SEWER & WATER
letter
Or 1,hi%,wit en"'o vs,situvidcit atm.uuh Iarpto bol in, n
offered for site.If,b,wever,me htdlding or intintocmentcis solid within one year of
`impletion.the ownerbulder x ill have the burden of proving that he did not build or 202 — UNDERFLOOR PLUMBING
improve fm pmposear.k,.L 301 — ROUGH PLUMBING
Pl.,
,t he property.an,eaeln,ivnlyehmmetmgwith Ien.edcoiurvi r%m 302 — TUB R OR SHOWER
L .rao he pmjc,(Sec.7(P4.Imsincss and Flodr,iois CMiu:)The Ca 11nmtnr'x
icense Law does vol apply lit an ower of property who hadd%or reproves thereon, 502 — FINAL PLUMBING ENERGY
and wen coltfor itch projn+ with a,m.rxu.ds)licensedpurzuem lin the
Con'mcmr%uan,C law. 50E. — GAS TEST
Minorca.np,u Se x_.11 NrPC for this reason
Dwmr _ c6 t, 507 — FINAL PLUMBING
W'ORKh 'S CfIMI'IiNSAI'ION UECLARA PION
I thereby affirm undermiry of f the following declarations:
pe pe jury one u g
❑ I have and will annul, a Ccrlificme of Comer' to self-inenrc fill Wader's
Cmnpcnacion, as Ivovidcd lot by Section 3710 ..l the Labor Code, for the
,flonna.1r of the work for which Iii,Inrhnit i%.,mN.
❑1 have and will maium.W'oher',Compensation Inmvrux•a,renamed by Section
3700 of the tabu Code.for the pcd..nnance of the work for which this tenant is -
med.My Wader,C...npens:uion.....lure currier laid Policy..,,,her arc:
Carder: Policy No.:
CERTIFICATION Oil EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ill,%cOj,,r uv,l n..I lie.'.......lied i1'rhu Ism.it is for one hundred dollars
IS10(i or Ich J
I cenify ma'rude performance of he wort:far which this permit is is,ued,I I
shall am employ any person many manner sit a,It,become,nhjen to.he%Vorkcri
C....lrco-lion Laws illCalifornia.Date
Appli,InI
NO[K ETO APPLICANT:If,ofIcr mulim,This Certificate..f Iaun.ption,you should
be,mm,ubjccr m We w,dcr'%CmnpcnwGon provisions of the u.b.,Code.You mus' _
Q O fnnhwi'h comp[,with such pra,mam or his pem.it shall be demned revoked .
ia CONST R1JCIlON LENDING AGENCY I hn'eby allit In flat mere is a con,amrion lending agency Marla perfuotmmec
of all work to which lis pe,all, ,is ned IScc,NOT.Co.C.)
D. Q Lcoda's Name
7 Z Lender's Address
U Q I cenily that l have read this application and state that me alarve inforn.ation is
kit re,,I agree va limply with Ill city In.d coan'y I'd lnuncc,anal sloe laws relating
Q U folwiWing,,murn (ion.and a,cby anal imm,ar,enmuvesof'blenymcmcr upon
the arve-mentione,I property tar inspection porpoms.
tom„ 4 b(We)asrecm Uva indemnify and keep ammdes,'he Offal`Cupertino a gains.
V: liabilities,judgmcm.c,emus and expenses whmh Hwy Inn way accrue.,aim"said
U L city In comsviptan a of the griming ul'I�jI pvnnl'. —
AI'I'LICAN'I'UNDIiRSTAN AN i U 1' IH ALL NON.IYIIN"T Issued by: 2 Date 1
SOURCE REGULATION Ge,
Signature of Applica Comme... - Doe Re-roofs
IIA%\RDOUS MATERIALS DISCLOSURE
Will the applicant(it ram,ebuilding.cenivitsure ormmdlehmmdouamaterial Type ofRoof
.s ddincd by nae Capenino Munidpal Coda Chapter 9.12,all the Hcnl'b and Safety
CWT. . n 25532(.)"YesO No -
All roofs shall be inspected prior to any roofing material being installed.
Will file applicant or future buildin,vas pan.a,,equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mel'haaaalous Er enntalnimnu'es dcfmcd by'he Bay Arca Air VuuBty Managcnmm
Di,ldelr all new materials for inspection. Applicant understands and will comply with
0 Ye, oNo all non-point source regulations.
1 hos read the harordnu,material,nNaircmenu audit,Chapter 6.95 of the
Cal i lulu Health N Slee,Coale,Sr,ions 25505 15533 and 25534.I undersand that
II nae haddmgdoes in moren'ly I:rvu a tcnanl u n in nay respon"Bali.y a.nouty the
ccupan.,f Ih cyuir '' cs Ina Pdnr'o issmua of a Ccnificu'c of - -
""'upa"`)' - Signature of Applicant Dale
Owner I,,antharved.,cut 4 D:,te All roof coverings to be Class"B" or better
OFFICE