01010029 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
HuETIf16DNIR'UPPEL.L PL KRETCHMAR HAROLD G AND ®FIE'RTA01010029
DW�IWRallatHMAR HAROLD G AND ROBE TA AI'I'rGrl1/0OI/1,V-001
PHONE. SANITARY NO, CONI ROL NO.
BUILDING PELEE I'INFO
qQp ANCHITIiCI'/ENGINEER: IILUG ELES ECT PLUMMCCH
��i IJ IJ L✓r t._t
Gad
v LICENSED inothtIrCON'nNACnderpDEionsof ION Job Description
I hereby affirm mm I um licensed under provisions of Chapter 9 ial my la,en g
ate 1,a.1.11iorelandctte,, .in;nnnheHnxine.andrn,f .;m,er e.nndmylie ;, ADD WASHER & DRYER HOOKUP IN GARAGE, GAS L
iiiz z st Liaen,e Chis" n Lk.a
%%O i V Dae Cammcun
W S a h ARCHITECI'S DECLARATION
C t`
food... my plans xhml M1v,acd us public rcrord, _
to ae
m
i p p LicccA I'mfcsional
.'.'o m OWNIIR-BUILDER DECLARATION
I h—lb,amen Ihm I n lop,hall,he Commnur u Linn.'Law fu;,be
t z< 4dlowing,ca,11n.lSeaion 7031.5.Bminesx and Pri ccsions Cute:Any city a counly
Yeo which requires a permit tt t Iter.improve.demolish. p' y vervachnic
3$ pear t ane 1: y :thppl' t t h p. tl t 1 g d,la Dent
math 1 II I lo'llm,nooloul oftl C t .l I.,oVCu.Ld1I9 Sy. Ft. Floor Area Va�jtion
Rot nacac ng with Section 7111101 of Divikion 3 al me Linville,,and I'm]...ior,Code)
or that he i,escmp mertfrvm and the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for a armit;alb,iemr @e upplieam ma civil penally pp NL Inb
mf Del oath man live hurdled d11uarx ts5an). 6'1 tIIIL 44er01Zl Occupancy Type
3t7�~,. 114
171,as owner of the Property.or my employees with sager a,their nle mmcen,n,ion.
will do the work,and the structure is not intended or offered for sale(Sec.7W4,
liminess and p,ote,,inn,Code The Cnntramor'n Limnc I,uw Aocs nal Imply to an Re SpeCt10I5
)%net,dpmpenyWho Wilds orimprove,themrn.and whodoes.such ,orl,himsdf 106 — SEWER tC� ��lt�'
or through his ow employees.proviJul that such improvements are not intended or
offered]or%mr.It.howeverthe building orimpms<mentissold within one year of 202 — UNDERFLOOR PLUMBING
otrccli meowarlib„ild,rwitlha,en,cburde,ot rv,ia,dtuhedid
mahaildor 301 — ROUGH PLUMBING
n;pnnx for P-laws of,ale.).
I”".owner of the property.am eaelu,bely contracting will,licensed contractors to 302 — TUB & OR SHOWER
Lra„ et e l,r„ ac,jevt(See.mwa,H,oiDad Prolbxx,,,Code:) e comru.,o.. 502 — FINAL PLUMBING ENERGY
m
iamse Law doe,not apply to e,,.,mr or propcny whn�build,or improves thereon.
sad do contract,for such Rrojees with a ernnmeogx)licensed pursuant to the 506 — GAS TEST
Contractor,Liceme Law.
❑1con e.etnInnualeSe” &PChor his reason 507 — FINAL PLUMBING
XOwai Due
C - WO GH'S COMPENSATION D[CLANAf10N
I e an w;It m under it Certificate
elty of perjury one of following reelfor Wor
ul� 01
❑ I h t II maintainC i f m f 3Consent t self f Worker
Comp t provided I l i by l ( 17(X1 I'0 L b Code, for the
ON
,daular,ic oftl ntwhichtb:perm J.
❑00 J Labor m or k r C ape t 1 . c I his Seit I,
3700 MorkC,J f th ,In , f the k f hub his lit A q
sural.My W'odcr s Cnmpcnen,io,I lin ranee,nrn,r and i'uL,y nu nM1c'are:
Currin: Policy Na:
CIIRI'H ICAIION OP EXEMPTION FROM WORKERS' 7
COMPENSATION INSUkANCI? ,
('lLi,rection need nm be completed if the hermit is for line hundred dollars Q-
1$1al)orlc,r) 1 01 0%lit" O V
I cenify that in the performance of the work for which this permit i,issued.I
shall not employ any pcersrm in any manner..as m bttome subject e,the Workers
Compensation Laws of Cadillnniu.Data
Apply;
NOTIC17 TO APPLICANT:II:a0cr tnaking,his CeniGlme or Exemption,you should
7
become subject to the W arkefr Compensation provisions of the Labor Gale,you must
O O ILnhweh comply with act,p sur this ,oil hAI be deemed rooked.
FCONSFIREM[ON LENDING AGENCY
CL > I hereby uffnn that then is a construction lending agency for the perlortnance
of the wore for which this Penna N issued(Sec.3097.Civ.CJ
1 Q I<ndn:,Name ---
;D Z lender',Address
U O 1 cenily that I have read this application:and state that the above information is
law, [,., a free.I agree u,eanply want:,If city,,,,,rourtty ul Lane us and on.laws relating
O feel Ia building comnaftion.and hcrcby omhnrire rcprocmmnives of this city to enter up,n
} the above-tneminnN property for inspection parry,¢,.
F y (We)allies,rosact,iademniry and keep h.,.Iess,he Cityof Cupertino against
r fn hubllnic_r,jud,u,u,,,111.1'and exp ex which may in any wary acente a,cin,l said
U G City in mnmyuencc of the gamin thispermit.
APPLICANT UNDERSTANDS )WILL.CO ALL NON-POINT Issued by: Date
SOURCE,REG��Jt�'.AT y'
Sigoamrcnf Ap.T'un Cnt unor Uma Re-roofs
HAZ IMUS h,Af13R,A1 ti DISCLOSURE
Wllmcappiic nrfuwrcbrilding,wv:upmnsmrcurhanJlehaeWouemmedal Type of Roof
,s deby,Ire Cul )inn Municipal Cndc,C'hxp,cr 9.12,unJ me IIcJm Inti Salty
Calc..Section 25533001
E)Ye, 0N All roofs shall be inspected prior to any roofing material being installed.
WI dle,y,PEem,or more huudiIf o,.npart use eyuipme„or deeie%which If a roof in installed without first obtaining an inspection, I agree to remove
snit hatallov,air ameminant,as debiu i by me]in,Aruu An Vmliy Managnncn,
Diana all new materials for inspection. Applicant understands and will comply with
O Ye: 0N all non-point source regulations.
I have read the hunmdous marcriau rey,d cements under Chal er b!)5 of the
California Health&Safety Crile,Sectio 25105,25531 and 25534.I understand mat
ifmclauldingdne.,aotcummly have muni,mm it is my resgmnibiliy a notify the
ecupam of'he,al,,iminetnx whirl a be,oat prim
or ,,iswm,,of a Cerldire of
Ov'a'racy' Signature of Applicant Date
D—eml,,,tte,l a 1, All roof coverings to be Class `B" or better
OFFICE