03040012 CITY OF COPERTINO ,�(' O Tina G�+T0R'1NF R'�,A",�QN
BUILDING DIVISION PERMIT ,,,"r,„�, r; �,r - "�,..' �• '�� xx.s? I .t'a'n
PERMIT NO.
BUILDING ADDRESS: "
21700 RAINBOW CT
MIT ISSUE DA
OW NES'9 NAME:
MITCHELL & DORALEE WINTRA B 15135 MONTEREYSANITARY NO. 0'
PHO
(408) 778-730
BUILDING PERMff INFO
ARCHITECTIENGINEER: BLDG ELECT PLUOMB O
'Z LICENSED CON RIACIOR'S DECLARATION Job Description rrr��
1 hereby sober Nn 1 em licensed under provisions Of Chapter 9(commencing FIN ' L IL n3
t with Section 70(g))of Division 3 ofdm Rutins.and Pr Inns Codo,endmylloweall + u.,U
I.fell force and rt
Iz Limit CIAO coma or POST/BRACE/TIE BEAMS/PIERS MAY 0 r 2003
• Dau
• ARC DECLAR
I undcnm yplane aM1all M1e usedapuM1lie nrde 1 p�/'
5 LicersedPmfcumnal BUILDING
" OWNER-BUILDER DECLARATION
I hereby AM m that 1 am exempt freer the Comndors License Lew for the
n O following lesson.(Seed..7031.5.Business and Rnfession Cade:Any city m county
S which own't,•Permit to e.asnYn•slur,imp ow,demolish,m mpsir any atmcture ValUELion
pdmmiuissuance,also ou,ni[.nhe applicant for such permiuu rile.signed statement $ Ft.Floor Area
that he is licensed pursuant t.the pmvielontnf the Comment's License Law(Chapter 9 q•
(commencing with Section 70110)of Division 3.f the Busimosa and Pmfessinm GMC)m
Sattloen170e311.5byanyAAppmuntforaperrmi is subkmughhee:PVIcPan sac ilviolation
penaltyof APN Number Occupancy pe
nm more than I've hundred dollars($500). 36638002 . 00
'
OL.sownerofwepmpmty.ermy^mPimecawithw*gasAsIKrwl.em^pe"tad"n' Eqq
Re uiredInspections
E]
will do thewerk,anthe d worctum it..tinunded w.ffcmd fmnle(SM.70M1A.BuM=a __
end Professions Code:The Con racmrs LJcense Law data not apply m an owner of 101 - FOUNDATION
property who builds or improves thermn.end whodocatuchwork himulfor through his 102 — PIERS
oweemployees,provided that such Impmwmmu art notima da@r
d oroed for tele.If.
however,the building or impreveme[n is wild within one year of completion,the owner•
builder wIB have Ne burden of proving dust he did an,build m improve for purpose of
104 - REBAR
sale.).
❑1,n owner of the Property,am uclusively contracting with Ilarued mnvuwn lit 105 - ANCHOR BOLTS
Mmtruer Ih project(Sec.70th•Business and Profusions Code)The Conlncmra LI•
come law doesnot spPlyman owner O(property who builds or improve thereon.and, lO6 – SEWER & WATER
who Co..,.much prejeeu withernntnno[(Ullcensed punuantmthe Contractors 202 - UNDERFLOOR PLUMBING
0I"Law, ,B&PCfmthismsson 203 - UNDERFLOOR MECHANICAL
❑e am exempt undtt gee.
Dem 204 - UNDERFLOOR FRAME
IkWORKER'S COMPENSATIONDECLARATION 205 — UNDERFLOOR INSULATION
Whitney effort under ponelty of perjury one of the following declarations,. 301 - ROUGH PLUMBING
❑I hate and will mom A,.Ccnificamofconserat mair.inmm furworecescompen- 3OZ — TUB & OR SHOWER
cation,ss provmcul for by Section 3700.f the Lehrer Code.for Ne perfnce ormaof the
work for which this permit is issued. 303 - ROUGH MECHANICAL
❑1 haw and will msinuin workers compmndon Insurance,As mqubad by Section 304 — ROUGH ELECTRICAL
310Dordm Leb'CT:(or Arte perrom,mce.f the wo[k err which thierem[h is issued. 305 — FRAME
My workers ComPensdon Invents¢carrier and PoNfypg �artQ`f7. Oj
c,rd , - PmIG a tlla 306 - HOLDOWNS
CERTIFICATE Of EKrMPT10N FlIOM WORKERS'
COMPENSATION INSURANCE 307 - INSULATION
mes,seednn need notbceompleumnhe Permit m form=hundred dollars($100) 308 - SHEETROCK
Ault..) 309 - EXTERIOR LATH
1 certify that lithe perror ejeca of the work for which this permit m Issued,I shall not 310 — INTERIOR LATH
employ any pec o l in any mannerm As It become subject to the Workeri Compensadan
Laws of California.Data 311 - SCRATCH COAT
Applicant
NOTICE To APPLICANT:if.after tusking this CeniI'cate of Exernption,you should 313 - ROOF NAIL
became subject to the Worker's CampcwU"n pmvpsions of the labor Code.you meat
�Z forthwith comply with such provisions or tons rm
ie peOshabe ll domerel m rdoe 501 _ FINAL 502 - FINAL ELECTRICALNG ENERGY
zit CONSTRUCTION LENDING AGENCY
RGY
i M1creby affmm the[ment eracn[utruNon lending Ivory fm the"roarnaneor 503 - FINAL MECHANICAL ENER
a> the wurkfor which this permRHissued(Sm.3097.Civ.c.J 504 - FINAL BUILDING ENER_,
G Lenders Name
Od Lanaen•t Address 505 - FINAL ELECTRICAL
U O 1 certify that i)caw mad this application and sum that the show information Is 506 - GAS TEST
U. F coom.I Agree to comply with all city and county ordinances end suit Tawe mlning m 7 - FI
0 U building construction.and hereby au[horire reprnenutives of this city m enter upon the —
W abme-mentioned Property for inspection Purposes 5 0 AW FIAL
W (we)agree m ssw•indemnify and keep harmless Ute City of C.PComo Agaiest y lobilititajudgmenu,coau and expenes which may In any wyarneagtinal satd Ny
in consequence of the grnti^g of this permit Date
APPLI UNDERSTANDS AND WILL COMPLY WITH A -POINT Issued by: 5 ER ULATIONS. ORKS
N
Re-roofs
s�gnu1. ppliesnVContnc[m m Type Of ROOF
HAZARDOUS MATERIALS DISCLOSURE
Will the Applicant or future building occupant atom or handle hazardous material
As defined by deiCupem.w Municipal Code.Chapter 9.11.and Um Health and Safety
Bore,Section 75531(a)7 �L�p1 All roofs shall be inspected prior to any roofing material being installed.
[Dy. (— ^
(— If a roof is installed without first obtaining an inspection,I agree to remove
Will the Apeirmt or future Wilding Occupant use equipment or devices which
emit hnmdnut air cenummuou Is dcfmcd by site Bay Arte Air Quality Management all new materials for inspection.
DistriaT `
❑Yat o
I have reed the hssaNan materials mquim annuunderChapter695ofduCAlimn-
ni t3calth&safetycode.Srcuau 75505.25533 and 15534.1 unec mord the ifthe Wilding
don t curet Nw a mnanl that it u my resporuihilltY mlwtify tM aceupant M the Date
rrqu' en [ muubeena or toissuanxofaCeruDcuc�a cup r. Signature of Applicant
\ ko efCs moi/��- O All roof coverings to be Class "B"or better
Owner or tut nmcd agent —�Oam