01030058 CITY OF CUPERTINO
tguu.orvc DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PIiRMI INO,
21710 RAINBOW DR 01030058
OWNER'S NAME: APPLICATION Stift DA'I'1?
STEVE CATHY RICHARD 03/12/2001.
'WINE: SANITARY NO. CONTROL NO,
Ozz ARCHrrECTAiNGINEER: BUILDING PERM[IF INFO
O O_ BL DG ELECT PLUMB MECII
CI 1=1 I=1 1_1
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N LICENSED CONTRACTOR'S DECLARATION
z 5 I mny,animt that I am license([under provish, of Chapter 9 tcmtnrnmrinp Job Description
ne
O]. O wilh Scaion70moul Division3 tmrllusincd and PrttfcuriohuC anA tiny licchae
' f°°f"r`e' 1 �yl� 0 � DRY ROT REPRIR @ DECK.
z
Via. is n se class a
OiO etc/'7in cei _
(I/ \RCHI'1'Ihc o S U"Hin. '
C= 1 unJCI'rahnol my Plain shall ho T'S as pnhlm runrde
w s 'p Licensed Professional
c. OWNER-HU,LUER DECLARATION
W 1 heresy of ino thin 1 inn eennu im n the Can.rucnn',Liaror Law fur the
C%< billowing rn:sun.(Son 17031.5.Ituximxr and Po l'somi n Cu1c:Any city nrcoumy
O which nipi tes a Penni,no von,trao,alter,improve,demolish or repair any structure
digpnon t L s Ill PPI'a tl cM1 pr 1, file signedut m
mann licensed p n ,heP - ftheC t t r l La ICh Omr9 Sq. Ft. Floor Area tl' ion
(sunno,ocin,withS 7(mo of D I it m Business ardP ,c. Cole)
or lh„he , c npl mcact n sad ma ones rnr it,alleged car tpl ,,.A ry vulafn. $1 5000
of Section 7031.5 by any applicant for st pennll.objects the applicant m a civil penally.
m
of nmom hanfsemmdrrddollars(s500). APN Number Occupancy Type
O I,as owner of the prnryny.or shy employees wllh wages as Ibrir sole con,visa,ion, •T,638001 . 00
will do the walk,and the amemre is non imendeJ or of1'e,ed Ibr sale(Sec.7044•
Business and[In fi ions Cdr:The Commemr's Tireme law docs not apply n,an Required Inspections
� r of pmprny Who milds o,imprmxs tnerton,and vet docs such work himself r through his own employers.pounded that such ituprovemems are no intended or 101 — FOUNDATION
offered for sale.If.hovcvcr,the buiming or improvement issoldwithin one rear of
�,nmlmhtn,Iseowner-budderwAl have It,bur den of grin,than he did o IHeim o 1.02 — PIERS
tpovefor,",enf:ale.). 103 — UFER
❑1.as owner
it the propeny.am cseladvely contrasting with sensed contractors to
L�nevun,bul c'(See.7(94,lus and Pinessions Code.)The Contractor's 1 04 — RF_BAR
ierme La,does,(apply o an own-of toacny whoa ldsor improves he re.. 105 — ANCHOR BOLTS
and who contracts for such projects with a comructons)licensed pursuant in,he
Cnnhacmas Lierme Low. 1.0E — SEWER & WATER
❑l am rxrmpt once,See .II k P C for this reason
Owner Dale 202 — UNDERFLOOR PLUMBING
WORKER'S COMPENSATION DECLARA1[ON 203 — UNDERFLOOR MECHANICAL
I hereby al rot al,r penally it per,myoe of me following deela,milns: 204 — UNDERFLOOR FRAME
I have and will maintain a Certifcam m Consent m self nsum lin workers 205 — UNDERFLOOR INSULATION
ompensmion, as provided for by Section 371q of the lah, Cole. for the
pemnmanre ohne work for which rens pennh is is.oed' 301 — ROUGH PLUMBING
,nd will lmhtaio wn,k,rs Cohn sanwhtin,lnaaramc,as reyuihed by Section 302 — TI.IB & OR SHOWER
71X1 the Lahv Code,lits she parlimnance of the work lit,which this permit i.r
NotM1 kcr, D
Yp;aaonmmranm
ceerir,andPohcyou D 303 — ROUGH MECHANICAL 2K Policy No � / 304 — ROUGH ELECTRICAL_
CHR'IIIICAI]ON 017 1: EM19 HD IR(M WORKERS'
COMPENSATION INSURANCE 305 — FRAME
(This section need not henonplctedifthe Wili for 306 — HOLDOWNS
laloo)n,lrss.) o307 — INSULATION
I cenify that in the permmrmm of the work lin which this permit is ismed,1
shall not employ any ,,at in any manner sn as to become subject aide Workers' 308 — SHEET ROCK
cn,tpensahml Lan,ofE
California Tom 309 — EXTERIOR LATH
Apphcro
NOTICE I O APPIACAN'P IL after nuking this Crnilieme of fannpfmn,you should
necesunject to the woken compensation provisions of me Labor Code.you man
310 — INTERIOR LATH
z0omfonhw;mcomply with such provisions orthis permit shut]nedeemed ra—ked. 311 — SCRATCH COAT
t
CONSIRUC,ION LENDING AG17NCY ROOF NAIL_fn" I hereby affimrthat throe is a cmol.,liou lending agency for the IcCo,munre 313 —
? of mu work lin which etispermi,is i.aued(See.3I197.Civ.C.) 501 — FINAL ELECTRICAL ENERGY
0. Q Lender's Name
D z I.,aIor',Addm,, 502 — FINAL_ PLUMBING ENERGY
v O
1 cemy that I have read this UPpictition and state that the above information is5 ? FINAL MECHANICAL ENERGY
La. E... mree
t .I ugme ,,comply v uh ail nu
city and cmy orshumbees and oam laws relating
O U a)hailing ctmoraction.aml hereby anheri,representatives of this city in cntera,mn ..04 FINAL BI _DING ENERGY
W
Ibe abovoo...morad prnpcny for mepecnlmt pumasrs
F 0.s (Wjudgme t%,rovets and xpenod keepwhich
h may finnan way are per against said
50 — FIN _ E CT R I CRL
W City liabilities.se cranes,arses and it of
cs which Isar in any way arsine usaimt Baia
U Z cy in cause cr nnnr tn,ing nnhi,pr,rht. - 5 E T
APPLLCAN IDC•R,l'T )S AND WILL COMPLY WITH ALL NON-vvv55gINT Isslledb Date OY
Sou e 1 .c,.Arlo 0, �l�0 Y'
i aturet ppbeanveomciDane Re-roofs � 508 — FINAL_ MECHANICAL
DALARUOU. ATERIAI ti DISCLOSURE
Will the applicant in future l,nfiling oueaput scam n,handle baaadous material Type ofof 509 — FINAL GRADE
o dunned by the Cup,h In Mnniuipul Cade.ChW,mr 9.12,oud me H,nI,I:and Salary
Code,Se,dmt 25532(0? 51.0 — FINAL PLANNING
0 Yes 0N All roofs shall be coed n n a pmt a installed.
Will me applicant m mom noimm occupant use a ui t o devices which ��piYfJ .y�Pf3L �' ' ort,.,b
pp building v prices If a roof is installs without Irst o am mg an inspection, agree to rem
chnit humnlnus all nota nans it,cdined by the Bay Amu All QuAllly Mant,gunanl
,iNdaa all new materials for inspection. Applicant understands an omply with
OYes ID No all non-point source regulations.
I hasr cad Ibe hazardous mmcrials mgnhcmm�ls under Chapter 6.95 of the
California Health&Salary Code.Sections 255115,2553?and 25594.1 unJem,and Thal
ifI all ing Jots non current vhave a bonen.that it is toy,espnn,duity to many the -
1 upon f the ree,ui cots'Bich Inas,he mr poor m ixsuunre of a camfirme of
sesm i 7 A� Signature of Ap I' Date
owns n age /'T"L D All roof coverings to be Class `B" or better
OFFICE