00080159 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
ISUILDING ADDRESS: PERMIT N0.
OWNER'S NAM ' SANTA TERESA DR ADF '-TRUCTTON APPLICATION SI 5WII -
(INE. —SBN HE—ENHARD D AND 2 SHADELA NDb_ D SANHARYNO.
C aeZ ARCHITECrIENGINEER' BUILDING PERMIT INFO
z w_ BLDG ELECT PLUMB MECH
`GAG o 1.1 r� r-I
F N LICENSED CON'I RAC POR'S DECLARNPION Job Description
z_ I hereby arum mat I am licensed under on,ou na of Chapter 9(commencing
Cwish Section 7flv0)oI Division 3nflhe Business and Prnfesimw Cd=nndmy license
se '� Is in 1.111.....and clike, '
se is
I:iccnw Cla. Lica�d'G305
oar Bat= �� Contactor REMODEL BATHROOM/WINDOW CHNG OUT/ADD f
w s u a ARCHHE I'x I)ECLARrcnON
t'=°J l understand bar N:mz znml M Isle ax pvnhc m=oNn
a r m.
Llacneed l'ndasinnal FI NA LC®
(OWNERant
or th.Contractor
�r
IKi''4—' I hcrchy.(Scor....
that I am exnnpt ftnm the f—j,oanC a LiAny Law for the
F Z followwhichingmat uires a($mill cols5.tru t.alter, l t deall0h Code:Any city ar cronry
F D whish rryuira a permit as construct,alter.im�nrve,Jenudish,or rcP:nr any swnmrc MAY 3 O 2001
a T,Q poorban,voanee,a]...rcyuime the applicant for such permit n file a signed statement
th.,he is hanw.I on,unnmthe nmwoio i,ol rise Comm.aorw Liaan.a L9w(Cwp"r q Sq. Ft. Floor Area . Valuation
(commencing with Section 70(itp of Division 3 of the Business and Professions Code)
or that he is exempt themtram and the basis for the alleged exemption.Any violation
of Section 91315 by any applicant for a wnnit nuFjccle tat applmnn to a civil pemdry11
,if aottnomthan rvahundred dolim,($5tg). - APN N C79114R0cCup36PfRW--
CI.useownerof lire IF...olof my am19a1ccs will,wages 11 1h1 sale nnnpcn,aian.
will do the work.and the stmnure is not intended or offeed for sale(Sec.7044, r
Business and Professions Code: Me Contractor's License Law d,w.not apply to an 6 red Inspections
owner it Pmpany Who build lir in, a,llu mon,and who doss wen work himself
rthr
or offered
for
own employee.. budded that such vement menti me not me your or
offend ror sore.u,nrw'ever,the wading or improvement ng ho he bate year or 1 01 — FOUNDATION
�mnrov.llm,the owns-m��mcr will nnae the harden nr proving urn na Ind nal nand m -
mpro.=f pomo,M o 7.02 �— PIERS
El 1,as owner ol,he poo,cu,,,:un..clomluely columning with hi,emed con,acorxn 1@3 — UFER
Lnnstmcl the project(Sac.74M4.Business and Profession,Gdep The Contractor s
icense Law does not apply toanownerofpmpertywho wd(sortria athereon. 104 — -REBAR
and who.antmnxfor such Projects with n wntraclou,) licensed pursuant to the
Cantmctors Llcanse Law. 1@5 — ANCHOR BOLTS
0 l am aempt under Sec. .It&P C for this mason 106 — SEWER A. IJATER
own`(' are
WORKER'S COMPENSATION DECLARATION 202 — UNDERFLOOR PLUMBING
Ilsmby slum under froalm of i+ermy one of dm following declaration, 203 — UNDERFLOOR MECHANICAL_
I 1 have and willimain a Certificate of Consent lu sell-insure for workers 204 — UNDERFLOOR FRAME
Compensation. as po:ided for by Section nal of tire Labor Ccale, bur the 205 — UNDERFLOOR INSULATION
Performance of the walk for which this Permit is issued.
01 have and will maintain Worker's Compnsatlon Insurance,as required by Section 301 — ROUGH PLUMB I NG
caro of he Labor Code.foe he perfunuarea oI the work fm which this permit is 302 — TUB & OR SHOWER
issued.My WorkeLv Compnm: arn
nion Inxnce carrier and Policy number am'.
Comer;RCCr✓ �( [ryS Policy No:8
Iu3@3 — ROUGH MECHANICAL
CHK9CAr10N OF EXEMPTION FROM WORKERS304 — ROUGH ELECTRICAL
COMPENSAgdON INSURANCE
305 — FRAME
('Itis section recd not w campleil it ocrout is for one hundred dollars
(Sugnorlc,,f 305 — HOLDOWNS
1=eniry that in rte periannamce of work for which ibis permit is issued.1 307 — INSULATION
shah not employ nay person iso any lemma-ax n bee sObject la ane Worker: ^218 — SHEETROCK
Cnmpcnwaion Law.of California.Data �+
N0IIApplicE 309 — EXTERIOR LATH
NOI'ICIi TO AI'PLIGN'I':If,ulmr nmking this Cenllicma al Exemption,you should :+
Iwcnme%ubyect to the worker.Comicalps-viaonw of the Labor Code,you must 31.0 — INTERIOR LATH
O O fat with comply with such provisions or this pcorit shall be deemed mvood.
Z to CONSTRUCIIONLENDING AGENCY 311 — SCRATCH COAT
� I'•' I hcrchy or that there is a consuu<uon lending apcn<y for the performance 313 — _ROOF NA I I_
at he work for which thN pernut is issued Sec.397.Civ.C.1
y p z Leader's Addles ade:sAtom 501 — FINAL ELECTRICAL ENERGY
U O 1 annify that I have real this application and Otate that the above information is 502 — FINAL PLUMBING ENERGY
W. F.t correct.I agree m comply with all city and county ordinances and stem laws relating 503 — FINAL MECHANICAL ENERGY
O [J m building construction,and hereby truth ori'a'a"O andivtn ul this any m nor,upon
w
>, W the ava-mentianelProl<ryrminxpecamfapaxex. 504 — FINAL_ BUILDING ENERGY
.�„ a. (We)agree 0 auv=,indemnify and keep larale.x the City of Cu1'catina against
Um liabilities.Jadgmmns,co>1,and es noir,which n,ay is airy way accrue against s:dA 505 — FIN I_ ELECTR I CAL (, -Q ,-I
G City'in consequence of the granting of this permit. 505 — GAP T T 3 :2--J �GV
APPLICANT UNDERSTANDS AND WILL COMPLY Wrol ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Sigmaare of A,plic,.,Uomuatar Date Re-roofs
HAZARDOUS MNFERIALS DISCLOSURE 5@8 — FINAL_ MECHANICAL-
W'al the awlmavt or mom wilding occupant wore or haan
]handle hm)au, utedal Type of Roof
adelinedhy,haCaForhooMtn,icip:dCode.Chalner9.Iznndthe Healthand Safety 509 — FINAL GRADE
code.Saaiom 25532(m?
oyes 0 N All root's shall a9�-r(f NtAAIdfaterial being installed. _
Wmme.,la,alu, rotrehhldingn«upnmtu.eequg,mcmoracvireawhirn If a roof is instaffiki4,vitholff BNAllbutPtUelad lbsIWoW,9 agree to remove
nit hazardous air c rmamimm�.as defined by the Bay Arca Air Quality Managemcm
o,trhty all new materials for inspection. Applicant understands and will comply with
❑Ye, El No all non-p int source regulations.
1 lima read the hazardous material,requirements under Chapter 6.95 of the
Cnlltmnia llculth&Safety Curie S,,, 255115.25,5)3 and 25534.1 wall mut � �X00
ifthe wilding does nn currently have a arum,that it is my ra ll"Illity ounity the
ecaNnoI at rcgninarre which mint he.,at prim to i.wance nr a Cerrifiame of
`ase., cy a Si tat re ol'Applicant Date
-6� $Lp All roof coverings to be Class"B" or better
o n nmriva agem IIIc b
OFFICE