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060800340C z. a% a� U V � OF FQ Use CITY OF CUPERTINO BUILDING DIVISION PERMIT " LEE MARK A AND GIEFER LIS BUILDING ADDRESS: PIMrr""'06080034 21561 REGNART RD OWNER'S NAME: PERMIT ISSUE DAIS LEE MARK A AND GIEFER LISA A TRIFNE: SANITARY NO. CONTROL NO. ARCHRECTIENGINEER: - BUILDING PERMIT INFO BO ELECT PLUMB MWH O LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that 1 am Renewed under provisions of Chapter 9 (commencing with Sudan 7000) ofDivision 3 of the Business and Professions Cade,md my license is In full tome andeffm REMODEL -KITCHEN BREAKFAST NOOK,MSTRBATH,BEDRM DaCOs`Ca"am Comranar Com D CLOSET,REPLACE 17 WINDOWS/1 SLIDING GLASS DOOR ARCHITECTSDECLARATION 1 wderuanJ my plain beuseshall he used u public aaords Licensed Professional OW NSR -BUILDER DECLARATION I hereby eRrm that I me exempt from time Committees License Law far Om following min. (Section 7031.5. Business and Psofesunot Cade: My City or county which mgalres a permit in canatrucL alter. improv, demsdlah. w mpir for atmcturt prior m its issuance, shit requires the applicant for such permit to file a signed strummer contractor. Llan Law (Chapter 9 Sq. Ft. Floor Area Val$&"000 dm he is licensed pursuant to the provision, of doe Profeastnns Cade) (commencing with Section 7000) of Division 3 of the Business and or that he Is exempt therefrom and the basis fm the alleged exemption. Any violation of \00000 APN Number Occupancy Type ,appy, Applicantpermit aub)ecu the appl'sant m a civil peroltyof tti..70 1.5 by msec hexa 35622006.00 ❑ 1, u owner of the property, or my employees with vngn u their mm ampcwdan, nst Required Inspections 9 P win do the work, and the suuadam is .1 intended or.ffead for sale(Sm. 7044. Buinall and professions Code: The Conutcroh License Law does roapply of M owner of pmpeny who buildawimprowa Nunn, and whodma snchwork hineselfar through he. awnemploines, provided that such Impodwanenu are not Intended wo(feaed for axle. IL however. the building or impmsemrat is mid within arc year o(completion. the owtmr- builder. will haw the burden of proving tial he did set build in improve for purpose of 9s�ale/.). 3gl m, ea Owner of tits property, am exclusively contracting with licensed coubman, ro ednstmet the Parma (See. 7044, Business add Professions Cade:) The Conaac7m'a LI - can Law dam not apply man owner of papeny who builds or Impmvex thereon, ad. who contacts for such projects with acontaanor(s) Hari pursuant m the Contnctofs License law. ❑ I am exempt under See _. 3& P C rot this moan Dam WORKER'S CfMIPENSATION DECLARATIO I hereby affirm under penalty of perjury one of the following declarations: ❑ I ham and will mainuin a Cutifnam of Connl w self-insum forwofte$Campen- mtion, re provided for by Section 3700 of the Labor Code. for the performenoe of the wants for which this permit is issued. ❑ 1 haw and will maintain Workees Composition Insurance, u mqulred by Section 3700 of the labor Code, far the performance of Ne work fur which this Farrah 13 issued. My WorkeYs Composition Insurance carrier and Policy number art: Cartier Policy No.: CERTIFICATE OF EXEMPDON FROM WORKERS' COMPENSATION INSURANCE Tire; Mellon wed notbecomplemd if the Permit is fortune hundred dollen (S1000 err lux.) 1 certify that In the performance of the with: for which thispermit Is Issued, 1 shall not employ any person in any m oma subject m the Worker' Compensation r n Laws of CallfaIs 0ete {t�- APPlieant yQ=awjng NOTICE TO AP Exemption, you should the mer eking this or th you must become subject ro the Worker's r. COmpnsslim pmv9iom of the Labor x provision, rued rCode, faMwith comply with anch provisions Of this Permit shell he deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby dot there iss lending agency for the Performance of ich issued ' Newark fur which tits pamil b issued (Sec, ]097, Civ. C.1 Lender's Name Lender's Address 1 cenify that 1 haw read this application and sum that the above information Is carrier. l agree to comply with all city and county ordinances and tum laws relating to building convection, and hereby aunhorim mpresentatiwa of Nis city to cnmr upon the alwve-mentioned pmpny far inspection purposes. (We) agree to save. indemnify and keep husnleu the City of Cupenino against j liabilities. judgments, costs and expense which may In my waymcme, against mid City • in congwna of the 'n of Nis 11. al ANT U STAN S WILL COMPLY WITH AL NON -POINT Issued by: Date SOURC TIO Re -roofs Type of Roof / $'iglu rt o man uaerar � ate xAZARDOU AIS DISCLOSURE Will tite apFlianlwfuwn bis tng=upmtuommhandlcha owmamdal as dofmned by the Cupertino Municipal Code. Chapter 9.13, and the Health and Safety Section 255324)7 All roofs shall be inspected prior to any roofing material being installed. ❑ Yex XII, If a roof is installed without first obtaining an inspection, I agree to remove Will the applicaal of future Wilding Occupant n equipment w devices which emit hazardous air contaminants u ufmCd by Lou Bay Arta Air Ouaiily Management all new materials for inspection. Dismin7 ❑yex Nu I hew mad the bvaadnus maW61 irtmenu undcrChapmr 6.95 of the Califon nu Hcalthds ectyCode, 'au 23501, 3uu1235N. I underWnd that irk building does net e9(renlly h a remark dyl it' msp9 Illty m fatly the Pan, of the nt `is roust heor n ° ° Signature of Applicant Date All roof coverings to be Class "Bt' or better Owner aathon ,ant Dam 0C z. a% a� U V � OF FQ Use CITY OF CUPERTINO BUILDING DIVISION PERMIT " LEE MARK A AND GIEFER LIS BUILDING ADDRESS: PIMrr""'06080034 21561 REGNART RD OWNER'S NAME: PERMIT ISSUE DAIS LEE MARK A AND GIEFER LISA A TRIFNE: SANITARY NO. CONTROL NO. ARCHRECTIENGINEER: - BUILDING PERMIT INFO BO ELECT PLUMB MWH O LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that 1 am Renewed under provisions of Chapter 9 (commencing with Sudan 7000) ofDivision 3 of the Business and Professions Cade,md my license is In full tome andeffm REMODEL -KITCHEN BREAKFAST NOOK,MSTRBATH,BEDRM DaCOs`Ca"am Comranar Com D CLOSET,REPLACE 17 WINDOWS/1 SLIDING GLASS DOOR ARCHITECTSDECLARATION 1 wderuanJ my plain beuseshall he used u public aaords Licensed Professional OW NSR -BUILDER DECLARATION I hereby eRrm that I me exempt from time Committees License Law far Om following min. (Section 7031.5. Business and Psofesunot Cade: My City or county which mgalres a permit in canatrucL alter. improv, demsdlah. w mpir for atmcturt prior m its issuance, shit requires the applicant for such permit to file a signed strummer contractor. Llan Law (Chapter 9 Sq. Ft. Floor Area Val$&"000 dm he is licensed pursuant to the provision, of doe Profeastnns Cade) (commencing with Section 7000) of Division 3 of the Business and or that he Is exempt therefrom and the basis fm the alleged exemption. Any violation of \00000 APN Number Occupancy Type ,appy, Applicantpermit aub)ecu the appl'sant m a civil peroltyof tti..70 1.5 by msec hexa 35622006.00 ❑ 1, u owner of the property, or my employees with vngn u their mm ampcwdan, nst Required Inspections 9 P win do the work, and the suuadam is .1 intended or.ffead for sale(Sm. 7044. Buinall and professions Code: The Conutcroh License Law does roapply of M owner of pmpeny who buildawimprowa Nunn, and whodma snchwork hineselfar through he. awnemploines, provided that such Impodwanenu are not Intended wo(feaed for axle. IL however. the building or impmsemrat is mid within arc year o(completion. the owtmr- builder. will haw the burden of proving tial he did set build in improve for purpose of 9s�ale/.). 3gl m, ea Owner of tits property, am exclusively contracting with licensed coubman, ro ednstmet the Parma (See. 7044, Business add Professions Cade:) The Conaac7m'a LI - can Law dam not apply man owner of papeny who builds or Impmvex thereon, ad. who contacts for such projects with acontaanor(s) Hari pursuant m the Contnctofs License law. ❑ I am exempt under See _. 3& P C rot this moan Dam WORKER'S CfMIPENSATION DECLARATIO I hereby affirm under penalty of perjury one of the following declarations: ❑ I ham and will mainuin a Cutifnam of Connl w self-insum forwofte$Campen- mtion, re provided for by Section 3700 of the Labor Code. for the performenoe of the wants for which this permit is issued. ❑ 1 haw and will maintain Workees Composition Insurance, u mqulred by Section 3700 of the labor Code, far the performance of Ne work fur which this Farrah 13 issued. My WorkeYs Composition Insurance carrier and Policy number art: Cartier Policy No.: CERTIFICATE OF EXEMPDON FROM WORKERS' COMPENSATION INSURANCE Tire; Mellon wed notbecomplemd if the Permit is fortune hundred dollen (S1000 err lux.) 1 certify that In the performance of the with: for which thispermit Is Issued, 1 shall not employ any person in any m oma subject m the Worker' Compensation r n Laws of CallfaIs 0ete {t�- APPlieant yQ=awjng NOTICE TO AP Exemption, you should the mer eking this or th you must become subject ro the Worker's r. COmpnsslim pmv9iom of the Labor x provision, rued rCode, faMwith comply with anch provisions Of this Permit shell he deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby dot there iss lending agency for the Performance of ich issued ' Newark fur which tits pamil b issued (Sec, ]097, Civ. C.1 Lender's Name Lender's Address 1 cenify that 1 haw read this application and sum that the above information Is carrier. l agree to comply with all city and county ordinances and tum laws relating to building convection, and hereby aunhorim mpresentatiwa of Nis city to cnmr upon the alwve-mentioned pmpny far inspection purposes. (We) agree to save. indemnify and keep husnleu the City of Cupenino against j liabilities. judgments, costs and expense which may In my waymcme, against mid City • in congwna of the 'n of Nis 11. al ANT U STAN S WILL COMPLY WITH AL NON -POINT Issued by: Date SOURC TIO Re -roofs Type of Roof / $'iglu rt o man uaerar � ate xAZARDOU AIS DISCLOSURE Will tite apFlianlwfuwn bis tng=upmtuommhandlcha owmamdal as dofmned by the Cupertino Municipal Code. Chapter 9.13, and the Health and Safety Section 255324)7 All roofs shall be inspected prior to any roofing material being installed. ❑ Yex XII, If a roof is installed without first obtaining an inspection, I agree to remove Will the applicaal of future Wilding Occupant n equipment w devices which emit hazardous air contaminants u ufmCd by Lou Bay Arta Air Ouaiily Management all new materials for inspection. Dismin7 ❑yex Nu I hew mad the bvaadnus maW61 irtmenu undcrChapmr 6.95 of the Califon nu Hcalthds ectyCode, 'au 23501, 3uu1235N. I underWnd that irk building does net e9(renlly h a remark dyl it' msp9 Illty m fatly the Pan, of the nt `is roust heor n ° ° Signature of Applicant Date All roof coverings to be Class "Bt' or better Owner aathon ,ant Dam