00080097CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
RmL(Ie n1`ghys�0 RUCKER DR
CLEAR OAK
DESIGNS
PERMIT No. 00060097
�r
OWNIIR'S NAMES:
MACEVICZ STEPHEN C AND PfILLIP
1723 B ROGERS AVE
API'I.IC\TIONS RDAI
a�/14/_OL
ONL'
SANITARYNO CONTROI,NO.
(408)436-5446
2= ARC)11'rI1Cr/F.NGINEER:
BUILDING PIiRMIT INTO
RLUG IiLECT PLUMB NECII
•
l=_I 1_I IJ C.I
j LICIiNSIiD CONTRACTORS DI!CLARAIION
,lob Description
I hereby ul Orin le i am liccnmd wader provisions of Chapmr 9lcommcnemx
ce with Section 90X0(1 cohmsum 3oftheRdurs,, and Pmf.,,bmsCudr.andmy license
I Ar
KITCHEN
REMODEL
—j is in fill force and effect. 6 •
l.ium,e Lic.»_ 1
Calc_
Da,e y ,�pT� c '
/
G ARCHITIiCrS DIiCLARA I 1
sh
i,
j 1 unJen,:ms Y plan..hnll he uscA nn puMio rccoNn
vynC/�ZZ '
Licenced Profc,omal
ce OWNER-RDILDER DIiCe ON
C... I,icemc law the
nca.•by .(Sera inn a1. .Bonne firm the Contra..
...
Ce, An, mmy
g (e f 90115 R II CW
-
e
, t , h P demolish. M Y.t aunt
Oahic n
whichrry
e, shelf c Isigned.mmnem
prion t I requires
n 'lie es Ian Contractor 'I 1� (Chapter
Sq. Ft. Floor Arca
VyI��Ll)�0
aapplicantf
gulp sious
)P tile I., n,Calc)
Na Section 70W) Ill
I�
co
bloiso thef alleged exemand ption.
or chic he iz actnpt mcrtfmm and the iasis for Inc alleged eaanp,iun. Any violation
or that he
Y
of Section 7031.5 by my npphema rnr a permit subjca, the applicant m a civil penalty
A PN Number
Occupancy Type
of net roue nava me hundred 11.111411 ($500)
35Er 1.4.25.
as
(ripe Y ) P Y g pensv
01, mownerorthe rt.ormcruloeo with woes as their sole compensation.
Required Inspections
will J fir oRL al fur talc (Sec.
the work, toad Zhu ,wcuhrc is not loa
tIAds
I
"throes. and ernfaions ill,Code:, 1'he me,fluoea Llccn,c Law dose urn orl,rp,lyh h, an
ne
m,e,.aenwintniedor
torporisownemloee,.prvided arrsuchmp
101. —
FOUNDATION
ruhe
o, through his own ctnpbyccs, provided that soca imp mints fie nm one or
is
1.02 —
PIERS
year
o1.. d for .ale. Ir. er r, the nn'aseax aimprovement hold he din one tea or
iompmann. nae owncn"file.er will hnva the n,aen:,pmvins rant he Jw i,�t haricot
1.03 —
UFER
mprove rot purpose or sae.).
[11, a, own,, ad the p,oplItI, lin mclu,suly counnain, with li,uawd onatwoo, m
1.04 —
REBAR
onstrucl the pnrject (Set. 7111,1, Rushuss :rad Proev,ions C dc',) The Contrav,r',
i.icvmc
1.05 —
ANCHOR BOLTS
Law does no, appy m..owner or p,nprny who build,or improves thereon.
ami who contracts for such project, with a coneemrls) beenmd pursuant m the
1106 —
SEWER & WATER
Contractors License Lu..
0 l am exempt under Sec. '. I)& P C for this reason
'202 —
UNDERFLOOR PLUMBING
Owm=r Date203
—
UNDERFLOOR MECHANICAL
NSAON DISCI.ARATION
' WORMER S COMPHD
-
204 —
UNDERFLOOR FRAME
hereby affirm tinder penalty ofpehmryone onherom,wingdeclaration%:
205 —
UNDERFLOOR INSULATION
1 have and win ululation a Curmc:ne of Consent a ,Wl:h„,,e for worker.
ompensation, as provided for by Section 3700 of the Labo, code. for the
301 —
ROUGH PLUMBING
erfannuncr of,he wad bassinet this Penni, i, issued.
302 —
TUB R O R SHOWER
1 have sad vch mainmin Worker, Coralaromion m,umncc, av e,eied by Sretnn
IC370I
0of the Lanni Code. for the performance or the work for which ani, permit in
303 —
ROUGH MECHANICAL
mcd. M Wnrit 'r Cnnhpe, off Insurance carrier and Palo number are.
!
6
304 —
ROUGH ELECTRICAL_arrie
Urn Uel Poll, ^/�
CERTIFICATION OF pxbMPI'ION FROG WORKERS'
305 —
FRAME
comfrltNsn'nuN 1NsuxnNcr:
306 —
HOLDOWNS
(Ibis section need not be connpleed if the permit is for one hundred dollars
307 —
INSULATION
($ I IYb fir len.)
I cenity that in the perllmnume of the wad fill which 11 permit i, bored. 1
306 —
SHEETROCV -
shall no, employ any perv,n in any manner so as u) become wbject m the Workm'
309 —
EXTERIOR LATH
Co,npens:nihm Lns'efcanburrea.Dsle
np,hcant
NO1'ICETO AI1111-ICANT. If. a@rmakingani, Cenilicartnl' Hn®np,ion. }ou snouW
31.0 —
INTERIOR LATH
Z became subject o the Workers Compensation pmvidomof,he labor Cede. you mm,
311 —
SCRATCH COAT
O mmownhemuplywill, os+pmvwiouv a,h.partni,ahall nc.deemedrevoked.
313 —
ROOF NAIL
A CONSTRUCPION I.IiNDINGAGENCY
7. 1 hereby affirm that teen is.0 coaametion lending agency for the performance
501. —
FINAL ELECTRICAL ENERGY
h
ill tewOil, n,, hid, Ink Eaton rdisin,ed(See 3097.CIv.C,)
Q 1-undcr,Nane
502 —
FINAL PLUMBING ENERGY
z Landcr', Address
ink
503 —
FINAL MECHANICAL ENERGY
0 1ceniry,tha,rhnvecadn,1,appFrn,ionOne uh,,hatthe allu„morotra
1.., come,. I agree to comply with all city and county ordinance, and,lan law, renting
504 —
FINAL BUILDING ENERGY
t0 building conswnion, and hemby anchorite representatives of this city to enter upon
liunbwu-rah,,h,iom l propur,y fir inxpuetloo p,trpo.es.
505 —
FINAL ELECTRICAL
6. (We)asee m,ava.iodehanuify uad keep nnrinlen, nae Ci,yel Cupertino ugaim,
v� liabilitiesjudgmen(., eons and eaperoc, which may to any way aecme aga)nw said
506 —
-
GAS TEST
7 sty in eon,ttlnena onnu grantn,g omni, permit.
APPLICANT,NDERSTAND.' SED WE
Issued by: 507 —
FINAL PLUMBING Date
/
Re -roofs
Sag —
FINAL GRADE
Slµnmurc, A plicanV.nmrnnhr e
uA'J.ARDOUSMAniwnls DlSCLOSuIUS
us n the applicant, orfuture buddiagrcrupam ,mrt or handle Nouldnasmamrim
Type of Roof
as dcrned by the Cupertino Municipal Code. Chapter 9.12, and the health and Safety
510 —
FINAL PLANNING
Culu. Sconon 255321h0! ICp
❑Yc, ❑No
All roofs shall �I�SpLccIOUWPf1to
(1 r(--'1 {]��� p�.ff�� 11��,,��gqVk[Gp
L11I�sRII)rll)g 19)AgRKFi)eing installed.
Will the applicant or future building occupant use equipment (it deviceawhich
If a roof is installed without first obtaining an inspection. I agree to remove
geent
s air is nhnntmm ddiued by the buy Area Air Quality Manam
knit haanrdoums
M1„dctp
all new materials for inspection. Applicant understands and will comply with
b .Ye, ONO
all non -point source regulations.
1 have rend the hazardous omter,Lb epulenehns under Chhgnrr 6,95 of mu
California Ilualth & Satter Code. Sections 25505, 25533 and 25534.1 understand that
if the building does not currently nave a moan,, thus it is my espnnsibil'Ly a, nattily the
enpan, of the ret renmnt, whle ant be met prior m i ,hau,v of a Cenilicme fir
°CCOp°n`y
Signature of Applicant
'
Date
-
All roof coverings to be Class "B•' or better
own,.orauhw ttu,tag<o, .,,
vrrw�