00070178 CITY OF CUPERTINO
BUILDING mvtstoN PERMIT CONTRACTOR INFORMATION:
BUILDING ADI12849 SRN FELIPE ROAD PERMHNO.00070178
Dwnr:RSNAptMRSTINGS,y MOLLY FLAMMER APPucAlV)Z BPfT /2000
IONIi! H SANITARY NO. CON'I'RGI.NO,
BUILDING PERMIT INFO
0%O ARCHITECI'/ENGINEER; HI.DG ELECT PLUMB MITCH
uwEE / /
U
L F o, LICLNSMUCOL'TRACIOR'S DECLARATION Job Description
at_C I heteby athrin Ina I:un licensed under pruvi.irn..rf Chapnr 9(cmnmencing
w
with Son..700l)of Division 3 of the Bti%iiic%s and Profics%iono Co,le.and my license GARAGE REPLACEMENT
CC is in full fametunaelren.
e K d 6 U'rn.c Claw Liv,a ///� .y{' 62
a a a.fn ARCHIL-UCS DIiCLARAI]ON ///, (/ !YY
g 1 understand my plans shall M hired as public ren,Nx '
Ri
u i O O Licensed Profnsional
OWNER BUILDER DECLARATION
=m I hereby of inh bar I an,excmpi I the Cr lorcus License Law fo,the
t7•(a following ry n.1S<zflon 7031.5.Business
and Poor. ha Code!Any city o unfy -
`S 7 whichreprises Pc I I construct,alter. p dcolukh.or repairy:l sere
eu it m prionto Is vautarce,alma requarstheapplicant lormch comil I tile .g d t I ,col
Inane is licensedp - t to flo provisions ofn Contractors La (chapter 9 Sq. Ft. Floor Area V•IOYI{U6vi0
(commencng wish SectonTXXII of Division 3 of the Burne..and Profc..tn.CNet
„othat ho is exempt therefrnmh rend the basis for the alleged esenhptien.Any violanion
fSeen on711.11,.5 by any uppneem Pure I'<mlil.afjoa de uPPllcunl to a civil Pommy
of aril mom than five mored bill...($500). APN Num.aCr84. 00OCCUP1 •Y YPe
0 L as none,of the pmpeny,or my employees with wzge,a.their sole eumpenullnn.
'll-do he work, he orcure I, or intended or client for I (Sec.711.
Business J Profession,iC no Contractor%Li does not apply()a
1. {� a peCllOns
I p ,cry Who n Id r : frOcon.and 1ho does such work himself 101 — FOUN
or plv l Idol I ' P t r' I Ilor
" s" — PIERS
rc II IIM1 hl bind' s p ennfs.ala 'th }mor 10C O
completion.,u nnmrwinnavemend of proving 103 — LIFER
improve firs prhpdh.e ur>aM.I. __ 103
I,its ownetoftherm,arty,ani eacluaivcly contracting with licensed contractors to 1.04 — REBRR
natwct It,rmj h(Sou.71144.Bmimr The mn
isa:ml Proles.ahs CodeContur. 1.05 — ANCHOR BOLTS
Luso I.uw does non
t p1'.Ply on owner rfpru .perry on,,uJI o,in,prn c.Ihcreon,
and who ennt.hh for such prajecl,wise a cunt.eon,)hcun.vm po,ran ,,the 106 — SEWER R• WATERContractor.License Law.
111..c@diel un hr Sce. _ _ _ H.E PC or this mnaon 202 — UNDERFLOOR PLUMBING
WOR I:I<': NPH Al ON DECLARATION Owni - �t �oZUD 203 — UNDERFLOOR MECHANICAL_
-(
I hatch}alrmt miner rymmfyoffer.,oneofle h,00w'mgaeomatio., 204 — UNDERFLOOR FRAME
kI have tuad will .alnmn.a Conifieme of curve.to err-marre for W kc,*. 205 — UNDERFLOOR INSULATION
ompen...imt, m Provided for by Seniors 37W of the Labor ewe. for he 301 — ROUGH PLUMBING
m
'if,).m�cc r1'the wed B,r which this permit i.i...ad.
302 — TIJB R OR SHOWER
37M.1 he Lamd bor,
Wader'.Co..rance oft In he workior;is rush c,ahis Section 303 — ROUGH MECHANICAL
3)W of the lub,r ChsJc,❑hr the perlinnence nr the work for which his permit is „r :,
iswed.MyW.kersCotnlKuwtionlnsttm.ecarierandPorcymtmnnwh; 304 — ROUGH ELECTRICAL_
Cadet: Poreysh, 5 — FRAME
CERTIPICA'I'ION UIT EXEMI'1'ION IR ,0
ONI WORKERS' 3 [� -
COMPENSAIION INSURANCE 306 — HOL_DOWNS
(Ihi.section need not fecompleted it heprman isforma,hundred dollars, 307 — INSULATION
(SIO(B nr Iec..) -
I cenify that in the perfom:ame rf the work for which this panne i.issued,I 308 — SHEET ROCK
shut.,at employ nay Iwnrn in any manner.o e.u,become subject u,the WodcrJ . 309 — EXTERIOR LATH
Cmupeoamlo..Lawsuit CnGr.nla.Data
Applicant 310 — INTERIOR )_ATH
NUTICC:TO APPLICANT':IL lifter making this Certificate of lisemption,you slu old
2 became
wbjecttothe Waker.Cumpen.anrnpmvi.inn.onheLabor Code.you roof 311 — SCRATCH COAT
O t.ehwith comply with ouch pmvi.ior,or this pemti✓.hall be droned revokal.
F O CONS'I'RUCH ON LI IN DING AG MNCY 31 = ROOF NAIL
hm
embyaffrtlhardiveis acan.1.nionlending abnhcyhem
he 501 FINAL ELECTRICAL ENERGY
of the wad for which this permit i.Issued(Sec.34197.Civ.C.)
$
Leader's Name 502 — FINIAL PLUMBING ENIERGY
] 7 Lenders AddmN. -
U O 1 cmfy netIhavemndod.aPpfin,14 are rue 503 — FINAL MECHANICAL ENERGY
fa. p". corme,I risme m comply with all city ami county m]"he cus and.tae Law,.mladng 504 — FINAL BUII_DING ENIE RGY
O V to budding con.wnino.mod hereby authorise repro.em:nnesrl'this cit)u,enter rpm
y
the ahs,ve-orentlonwproperty for inspenlonpurposes. 505 — FINAL ELECTRICAL
6. (Wo agree I. am.indemnify and ke<R nemless the City of Cularmo against
h liabilities,judgme fs,costs and..,,me,which may in any way accrue asain.f Naid 506 S TEST
V 7 City in um.cymnec ol'ihu grin' d,his unit. ,// L7�IJ �f
^ ePP tl'INyPbe UWI COMPLY WIT AhhN N1'OINT LsslCdl)y: 507 ,FII L PLUMBING Date
Israte« app rcaSnzaiixius reser 1 IS Utsc tl�� Da Re-roots 509 — FINAL GARDE
Will the applicant nr lintrre bnildo,scuupnn,whe fir handle hoarder.....6.1 Type of Roof 57.0 — FINIRI_ PLANNING
a.dented by the Culwn'mo Municipal Crede,Chapter 9.12.:md the Heuhn and Safety . D p� zr �p�
CnJc, 0Yes 255324($)'1 El No c1' L 1 W ❑n �laltrf
All roofs shall bb Trt'specteFd���to.n� o g MUNI-being installed. �
Will the applicant or l more writing dw,.p..f use ryinimical or&.vice.x hiuh If a roof is installed without first obtaining an inspection, I agree to remove
emit hvnrdous air commoinam%a,defined by the Hay Area Ar Quality Mrnagenhcnh
Di.trh,? all new materials for inspection. Applicant understands and will comply with
M Yes FJ No all non-point source regulations.
1 have read the hv.dou..meriul..requirements tondo Chapter 6.95 rf the
California Health K Safety Code.Sections 25585,25533 and 25531 1 undemmoJ In.,
if the building me%not curmnlymocamt rel,hhalitismyw%nnsihilihytonufifythe
occupant of the myuimmen or mot Prior n,issuance of a Cenificute of
O'cuponc
Signature of Applicant Date
a d: — ,—b1- All roof coverings to be Class"B" or better
OFFICE