02030214 • GITY'OF CUPERTINO'
BUILDING Drvtsiov. '.. . PERMIT` CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22331 ;SANTA PAULA: AVE ^' 02 03 02 14
OWNER'S NAME: APPLICATION SUB DATE
WAHLER, JOHN 03/28/2002
ONE: SANITARY NO. CONTROL NO.
O ot�Z ARCH]TECT/ENGINEER:,
k o o - BUILDING PERMIT INFO
z adBLDG ELECT PLUMB MECH
h= LICENSED CONTRACTOR'S DECLARATION JOb Description
i Z y I hereby afinn Na,I am licensed under provisions of Chapter 9(comme$Crlencing p
_tg with Section 7000)of Division 3 of the Business and Ponfiessions Coal and my license PROJECT STARTED IN 1988 . PERMIT SUPERCEDE
is m f II f rce and efic,
z � ue< cine s r d. •:2ra 1988 PERMIT# 15940 ,. 11997 PERMIT# S0198
�` °=' ' Contractor
FOR SECOND``STORY' ADDITION
�LL 0 'r' .'IrTARCHITECf:SDECLARAlIUNj e d.,,.Y..d 3:'n
S oi99
y 1 understand my plans shall he used as public records f�D L�
1 i p O Licensed Professional
e that Ia .BUILDERexemptr DECLARATION '
I hereby affirm thin 1 1. exempt from the Contractor's CoLicense Law for the -
C?a following rcemn. ermiI Ito](IJLS,Business and Professions h dor Any city orcounty
, '
Eg F O which regmrcs a perm,, t toper P d 1'sh or repair anY,arvaua
K3= -poor tote ssvance.ale 9 th_applic tf s ripe uo ileamgrmw su,errunt ._ -__ -„__ _ -._--- . -
t nett_mccmw pursuent t dm Pm tens of the Co,ten 's L,ttnu law lCluger 9
Sq. Ft. Floor Area,”
(ammennpg win seen ]a3o> rD istan3erdm Bus tusy.od Proressman:cane) r,'_�;.,,'a'ti 9 i •Irt e.ef't.r":�.t,{ $160Vt§I(yation
or that he ii exempt,hebefmm and the basis for due alleged eaerdpnon.Any violation _
of Section 7031:5 by any applicant for a permit subjects the applicant to a civil penalty
,ref.m team than five hiodoxi dollars(s5m), APN Number Occupancy Type
❑1,as owner of the proper,or my employees with wages as,heir sole compensation,
-,will-da,fie'work,-and'the swcma.woof intended or offered for sale(See:70,s4,Boards and Professions code:The Connector's Laimse Law does net apply to an 101 - FOUNDATRWired Inspections''
Owner of property Who builds or improve,hereon,and who docs such work himself
or through his own employees provided that Inch arlotwearlats It notintended r 102 - PIERS
'.offemdF i le'Tf howe r the bolding or imptovennim,is `old withmon-yearof. ............_.-...-. .. - ..
-
'coinpld the owner-builder will have the burden<n of proving the,he did bud103 UFER
or
d
improve far purpose often.). 104 - REBAR
— — -- -- - ng _ _ ._. .. ..- - — -- 1
❑I:es comer or tire ""v yeantma0ng with ieenud een,nnarsm '05 ANCHOR BOLTS-.._.- ._ ..- _ .-......._ .
L..: :. pttTe Y.am e!tc us "J 9 fa'. ._f ...
.� Liccomense the throw
n face. to a Business and ProProperty
who
Code:)The yec them n. - ^
106 - SEWER & WATER
License Law does no,apply,o an owner of prnpeny who builds or improves thereon. ... .
and.who contracts.for such projects wi,M1.a.commnor(s)licensed putsuan,.,o the
Contmaare License Law. _. . . . .. 2.02 ..-_ .UNDERFLOOR—PLUMBING .._-...-...._.................... .........- _ ..
,. ❑IameaemptmidcI5ec. ,B&PCrorthisrcason 203 - UNDERFLOOR' MECHANICAL
tDate 204 - UNDERFLOOR FRAME
+ , RE
WQRRSCOMPENs�sTfON DECLARATION t -
205 UNDERFLOOR' INSULATION
0111
by a under pen lty o(p�Ory fie of th touo ngd I "eons 'd 301 - ROUGH 7,PLUMBING''
01 h a d wd1'manu C mfine f Consent to self nsum for Worker's 302 - TUB & OR SHOWER
caoniona, n he_ ulkfar for by Section nao or me ober code. for me 303 - ROUGH MECHANICAL
Connumxnee n, as work for which this permit is issued.
O l have and will maimaln Workers corapedsaiion insurance,as requlmd by Section 304 - ROUGH ELECTRICAL
3700'of the Labor Code,foi the perfoimance of the work for which this permit is
_ - issued.'MyWorkers Compensation Insurance cancer and Policy numberam 305 - FRAME
r. .l . tpauaF _ 30.6 ,- HOLDOWNS"',_• "
CERrIFlCATION OF EXEMPnON FROM:WORKFRS : I t
COMPENSATION INSURANCE'S i307' ' 'AmINSULATION+�'%`'
__... ... ,.SHEETROCK..._
•-" .a' e e t be uempletea nh p<w,t s ra a e nunarce aeuars ..308--; .. ..
° « 309 - EXTERIOR. LATH
- `
Ic nfym tin,n xK mance at�n okfu Leah,h,i pcmdt ms mssuwl :_ •-.' 31-0:. -
"' shin act employ any pc so ,n any manner soatim become subject,.me Workers' 311 - SCRATCH`COAT
--
Comps t n u sof Cel f m,a D,
.. NOTApplicant � .._..- _ 313 ROOF -NAIL--..-
NOTICE TO APPLICANT Water along th Cenf teofE pro .you ahold -' - -'"" — ---- - .
Z been ubjeculheWokese pens, Retransmits ofthe Labor Code,youmst 501 - FINAL ELECTRICAli "ENERGY
Z C ronhwM amply with such provisions or des puri,shot loddttmw okw. _ _ _ __502 - .-FINAL, PLUMBING. ENERGY.. -._,
F„ "` .r `- CONSTRUCTIONLENDMGAGENCY "' :
a. "0'P 1 hereby thin tnanh s a consw t n le d'ng agency for th-perf503 — FINAL MECHANICAL
ENERGY '
1
W.,~ atm okmr hem p mii's 504 - FINAL BUILDING ENERGY
Z tine Ade ss 505 - FINAL ELECTRICAL
U10 I cmity thin I ha red the epplicat ore end stain,hod the above inlorm.,I.is 506 - GAS TEST '
ta+=.F: cm,ut.1 agree to comply with.ell city one<oumy ordinances and soda laws miming
507 - FINAL PLUMBING
0 f, m W Idmg w i dn, d heretiy th ria p nu, cs Df th s ty to tupon
boent t dpmpnyt p to pnryo: 508 - FINAL: MECHANICAL
F., y .. " IWe) grtt to 6Pve ndemmfy and'keep h2rinless the Cuy,ofC perimo againsi
habun,<s,rvagmenu,costs arta expenses wmrn mar.n any way ae<me against said 509 - F I NA `G E
[J;y' City in mnsequerma of the firming of,his pcmet.: `•.'.
APPLICANT UNOERSTMDS'AND WILE COMPLY WfI'H ALL'NOF-POINT't' 510(`.- IN NG
sDuacE RECDLAndlus: Issued bg:, Date
.. ;.r Srg,umrcofA,licimUcpmmnor .,.- '.. .. ,. .. . Dine
A ... Re-roofs
HAZARDOUS MA RIALS DISCLOSURE"."' "i° "' 's'
ie II we appl cant or f Lute mall ng eavpa Chapter
or haodl h endows d Witt l
ay dcfnw by the 3 pen Municipal Code Ch Pte 9.12.aM the H wane attic, - Type of Roof
Code Sat onk255J2(a)? I,t! - F _ Y
❑Yes - s ❑Ne' l � '' ! tis - :`� s a s v •.
All roofs shall be inspected nor to any,roofing material being installed.
'.
Will the eppl t future bu ld'ngby a n, equ prem li devices em nt If a roof is installed without irst obtaining an inspection I agree to"remove
t haaawo v corium n , as dcfnw by Ne Bay A Air Quality M ageme ,
_ all new materials for inspection Applicant understands arid will comply with
OY rli: ❑N ,_ all non-point sourcer0gulahons- : -
e re d,the harambOus m renals eq ,rements under Chipter fi 95 of the `
Califorim a Health&Safety Code S cions 25505.25533 and 21511.1 undersand that
` dine building does not currently have a tenam.that i,is my responsibility to notify the
ocriipwI at the tegoir mems which most be me prior m issuance ote Cenific°m of - -
?
-
-- Signature of Applicant Date
ownerer,u,nemeaag<�t D„<, All roof coverings to be Class "B” or better
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