00100133 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADIIRF_SS: PERMIT No.
10500 RIDGE VIEW CT RUDOLPH &• SLETTEN IN 00100133
OWNER'S NAME: APPLICATION Still DATE
HP 989 E HILLSDALE BI_V 1.0/19/2000
ONE. SANI'T'ARY NO, CONTROL NO.
(415)572-1919
BUILDING I'LRMIT INFO
�OO ARCHrrECI'/IiNGINEER: Ip.UG ELECTBUIL PLUMB MliCll
tee
tai IJ I_I I_l 1 =1
N LICENSEDCONTRACTOR'S DECLARIMION Job Description
11 hy.lr II I I I I " f Chaplvr 9(romme,cng
O/FJ lits t 7000) fD 300m 11 _ JI r..-'nv C,de. nd mY license
�� of n� QfjD(pQ G AC UNITS
,LL C
soil V UI { 1. o-� G t t
t-LLOQ ANChll e S of AR Al 10 icroeN /
3 ,n 1 unJemm�d my plan shall be mad u.public roeNead
ce
p O Livxnsed I'mfesional O
a. OWNER-IIIIILDER DECLARATION /
n= 1 M1emhY affim,Ion I an,exempt from Ibe Contact Lleense Law lin the
t_ following mason.(Session 7031.5,Business and Proev%ions Gdc:Any city rcounty
`t t d which requires a permit a)construct,alter.improve demolish or repair any shuaure
i3m prsrt t 4 'lie applicantf h perril file
:bed.sense
son l I : Ip II the s ofd C t nsi U (Chaptrr:9 Sq. Ft. Floor Area Valuation
m
len nernng with Sewn 7")ol Divsmn l,l the H : nss dY f.. is Cole) $80000
or that he is cscmpt therefrom and the basis lin the alleged exemption.Any violation
of Section 7031.5 by anv applicant lin a permit suhjecu the applicant h,a civil penalty
of moedwnlive hm,deedd.lhns($500). APN Number Occupancy Type _
01,as owner of the property,or n,y employee.with wage,%as their sole cnmpen.ation. 31 G0G042. 00
will do the work,and the structure is not intended or offered for sale(Sec 71Jd.
[I re,:lel P fic...on,Code:The Contmetnr's Licen.x Law does not apply m an Required Inspections
owarrof p,openy WI I,adds or it c,firmon.:nm win,thur, tmll wo,k[ii elf 301 — ROUGH PLUMBING
or through his own employee,provided that.such improvements are our intruded or
offered far eme.If.however, hehunifngorimprovement islaid.itemoneycar of 303 — ROUGH MECHANICAL
ncompliance,the ownerhvilder will have the harden of proving that he did not build or
m,rmc for plapose of ell.). 304 — ROUGH ELECTRICAL
01.as owner of property,mil exclusively contracting with heen.ed contractors to 501 — FTNAL EL'ECTRICAI_ ENERGY
a,nsaue the projttt(Sec.70sW.Businea and Professions C.de:)'ILe Contractor's
Liecese Law does not upply to an ow ner of crojvny u a)builds or improves fiencon, 502 — FINAL PLUMBING ENERGY
soul who eonuams ton such pmjecls with a eunvuemrld Ilcemed pusuatu m the
commcou"Lwemac lw
w. 503 — FINAL MECHANICAL ENERGY
01 am exempt under Sec. .B&1'C for[his mason
505 — FINAL ELECTRICAL
owns WORKER'S COMITNSA'I'PON DIiCLAItAT]0N 507 — FINAL PLUMBING
I hereby 0rrn tinder penalty of perjury one of the following declamtionve 508 — FINAL MECHANICAL _
I have rod .'ill coulliflon n Ceniticetc of CnmmIft b,ec11-looLm for Worker
morm Ice., tae pnwif r for by Stenions i... al' the Labor Code. for the
performance.1 the wad bn which[bix 1:<mmit is issued.
❑I Mie and will ma;ut.I;o Worker's Compensation Inwmnce,as mefuircd by Section
3701 of the labor Code,for the performmxe of[he walk tor which this permit Is
s- ed.My Wodxrs C open s.[;nn Insmncc canis and Policy number are:
NERaW,w 2uf[c�o1M11ONW34`
CERI'lIgC COMPENSATION
ATION INS RROMANO WOR IRS'
COMPIiNSATION INSURANC1i
(This vection need not be on,deml if the permit is for one hundred dallun
(S1no or Iess.I
1 century that In the performance of the work lot which this permit is issued.I
shall not employ any person in any manner Leo as to become eubj«t to the Worker'
entnpen,amn Laws of ealBbnriu.Darn
Appl leant
N[mCB'U)APPLICANT:11,aflcr making this Ccn;ficulc of Excnyvi.m you should
become subject..the Workee,Compensation novinimm of[he Lrbtn Code,You us
mt
0 forthwith comply wmh srmh provisions or this Permit shall M deemed revoker.
FCON SfIZCC'FION IJINIIINII AGENCY
aI hereby aftimm thin fare is u car,mcion;c.ding agency for the performance
of the work for which this permit is issued(Sec.3097,Civ,C.)
❑ Isndcr'n Name
Z Iamders Address
U C 1 certify that I have mad this application and slam that be above information is
4 F
correct.1 agree to comply with all city and county ordinances and state laws mining
Q V ul banding eonshaction.and heathy authori,m,aec ma.vcu,frhis city,o ever upon
y the above.tnennmmnlprnpeny for insialnion pnyu,ma.
(We Iagree Ili save,Indemnify and keep hermlessin,City ofCupertino against
ZI liabilities,juJgrrems,costs anA exile ses which may in any way accrue against.mid
V ti Ci,Y in cnl,.eyuence of Ia gran b -this permit
AND UNDr D Lf.CO I- If ILL NON.POINr Issued b Date
Cii Rccl LI_/S O0. Y:
nr pph IUc rector — Date Re-roofs
IIAZ RDo1JS MATE'AC ... .L(if
Will the apI"Wun,While builmngtecalsI Wore or handle allUnk—oeLmmil Type ofRoof
as defined by the Culertino Municipal Code.Chapter 9.12 and the Health and Safety
Gale.Section 25532(a)7
C1 yes 13 No All roofs shall be inspected prior to any roofing material being installed.
Will the apph,tin[o,r.mr.holJing,ecapa,nmee.filirvoenrordcvi,s,which If a roof is installed without first obtaining an inspection, 1 agree to remove
-arit nomad m air conmminems as defined by the Bay Area Air Quality Management
son all new materials for inspection. Applicant understands and will comply with
( ❑Ya 0 No all non-point source regulations.
I hove real nhc hunJous mu¢riak rcyuircmctav under Chapter h.95 of the
California Health&Safely Gde,Sections 255115,25533 and 25534.1 understand that
if lhehuildingdne.enot curcully I un, tit is n,y mspnasibilimy In nosily the
cupum of the«yui em Ina I he t prior m isxnunw of x Cmlticme ul
"e' 11 y. Signature of Applicant Date
��- All roof coverings to be Class "B" or better
.,it ton nil Dam
OFFICE