02030040 TINO
Cl BUILDING DIIVIISSIIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11110 SANTA TERESA DR MILOJKOVIC DRAGAN AND TP.TJANA 02030040
0W NER'S NAME: APPLICATION SUB DATE
1ILOJKOVIC DRAGAN AND TATJAN 03/11/2002
HONE: SANITARY NO. CONTROL NO.
Z, ARCHITECTIENGINEER: BUILDING PERMIT INFO
C BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION h z 1 hereby mBrm Mat Imp licensed under provisiom of Chapter 9(commencing Job Description
ti! with Section 7000)OfDivision 3 ofthe Business and PrabessionsCade.and my license REPLACEMENT OF WINDOWS .
in fall force and effect.
t:0 w U
is
Class Lic.a
3 3 v N Dae Contractor
o O d ARCHITECT'S DECLARATION
:Eat,� 1 understand my plans shall be used as public records F' E O
i p O 1-imnsed Professional
ueioLL OWNER-BUILDER DECLARATION MAY 0 6 2002
= 1 hereby o111.that I am exempt from the Contractor's License Law for the
L 3 a following reason.(Section 7031.5.Business end Profession Code:Any city or county $7 7 2 2
{F C which requires a Permit m cons ouci.nitea improve,demolish,or repair any structure
c3� . prior to aswaimce,also circuits be applicant hr such crnut to tile 'g dsarcment, ...
fans b'.icor.W ptivani m the pro ' ns of me Cmmmem s License La (Chapter9 p ��}� !'_ _ Valuation
(commencing with Sect 7f D'b son 3 of the Business and Professions Code t t
or thai he is exempt therefromm t and the basis fns Ibe alleged exemptim Any violation
of S¢tion 7031.5 by anY apPl Icunt for a Permit xub)eeu the applieam res a civil penalty
.of nest room Tian Eve hundred dollars(5500), l 0�&NqP8tMDATION ,'' I:." Occupancy Type
O 1,as owner ofthe property,or my employees with wages as their sole composition.
will do the work-and me simulate is not intended or oRerad-far arae(sec:70sa: Required Inspections
'Businics'and Profession Coact:The Cnmranor's License law does not apply to as 103 - UFER -
owner of property Who build.,or improves thereon,and who does such work himself 10 4 - REBAR
or through his own emplo)_ecs.provided that such imprmemema arc not intended or
offered for sale.If,however,the buildingi r- t is sold within one of .... ......_ _ .. ... ... .. ... . ... .. ... --..._ _ _ ..
omplelon,the cavoccWilaer will have the burden of proving that he did not Wild or 105 - ANCHOR BOLTS It,
improve fc"co'cseofsAe.). 106 - SEWER & WATER
QQLosow;d;nrm�pr,it'aq. m x<, sieirci,in-,oi With h,rumedoowldot;to .202 - UNDERFLOOR PLUMBING _._.
onstruct the project(See.lam,Business and Professions Code:)Thmmmmr's
Tic Cm1'
License Law does not apply m an owner of Propany who builds or improves thereon. 2 03 - UNDERFLOOR MECHANICAL .
and who contracts far such a commit rimmed moment to.the. .-. -.. ...204 - UNDERFLOOR-FRAME---
' Comrmmr's l.iccnsc law. Projata.with ._. -._.. .. — ..
lamexemmp oar en:' " " " -e&rerormisteas°n 205 - UNDERFLOOR' INSULATION
{ncf� Jog t�I .2�oZ;. 301 - ROUGH PLUMBING
Dae
WOR R'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
* ' Ihereby afrtrmunder penmt1 .YprPednrymn�nr,tnernnawingaeaaraenm: 303 _ ROUGH MECHANICAL
° 1 have and will maimain a Cemrcae of Current or self-insure for W'orkeis 304 ROUGH ELECTRICAL
Compensation, to provided for by Swtimn 3700 of the Labor Code, for the
performance if the work for which this permit is issued. 3 05 - FRAME
°1 have and dill maintain Worker's Compensation Insurance,as requited by Section 3 06 - HOLDOWNS
37W of the labor Code,for the performance of the work for which this permit is 3 07 - INSULATION
issued.My W k I-Compensation Insurance carti<r and Pol cy be
Pnbcr Nm . ..,_ ; 30`8.. .- SHEETROCK, .-.: .-
Cum CERTIECATIONOFEKEMPTIONFROMWORKTRS - S.1 w'i t li 11'
-,—COMPENSATION INSURANCE ' - 3O9 EXTERIOR"�LATH� ,
-IN
TERIOR`liATH- - -- —
' " (Th s sod on need mit he cminplemd f the genii t s for ane hundred dollars 1 - -- ------
ssloolnness.> 311 - SCRATCH COAT
if ran .t ma which, 31-3' ROOF -NAI-L
certify he 1 in the pert nuance of th k f pc ...-..
non teem ro on one. become n Ito he Workers501 - FINAL ELECTRICAL 'ENERGY
m.Date
ATlicamatlmn Laws of cmuwm - .. .. ... 502.- - FINAL PLUMBING .ENERGY--... . ._ - -
NOTICETOAPPLICAN'Blf.aftermakingthis Cenificam of Exemption,you should 503 - FINAL MECHANICAL 'ENERGY
become subject to the Worker's Compensation provisions of the Labor Code,you must
O, rnnnwitncmm I with rexmkee. .504. - . FINAL BUILDING ENERGY .. . . _
comply wi permit shall be deemed .. _. .
.� "• '' ^'" ' ' �CONSTRUCnONLENDINGAGENCY' ' " ' ' 505 - FINAL ELECTRICAL
-' -" " I hereby allirnthm there is aemsuuctimi lcodiri age,2 for the terforininc<
�.� ofthe work forwhich thispornittis issued i Sec.7097,,Co.C.) `' 506 - GAS TEST -
QLend- N me - •.-. .. ,.,.... _ .. . _
p, z Lena Address 507 - FINAL PLUMBING ,
v-0 �I«rriiythatlhmmicedfaisapplication animate lhe, he above information is 508 - FINAL MECHANICAL
f+x'(✓. correct.1 expire to comply with all city and county ordinances and state laws relating 509 - FINAL GRADE
V to building construction.and hereby riuNmiu representatives,of this city to enter upon
p j the above.mentimpedpm,o,for impacdmnpyrpose.. 510 - FINAL PLANNING
t�.pix r (We)bgreetocove,indemnify and keep hannlesa the City of Cupenino against
t�r.N liabilities,judgmcma,costs and expenses which may Ia any way am me against said 514 - F INA PU I C WORKS
fJ z City in consequence of Ne granting of this permit." ""' .1
A5PPCANI[TE UUND4ETRIOSTAJDS'AN WIL COQJ PLCYWITHALL, POINT'
Issuedby:SNDate
'gwtum ofprcan✓C�ontntr�racctmr., Re-roofs
HAZARDOUS MA ERIALS DISCLOSURE
IsGL;tIbaiiPpficam or future building bectiant state or handle hara;a —,a- .Type of Roof . . _ .
as defined by the Cupertino Municipal
CN Chptl912dtht H:;Ito card ( f •'.r L
Ciri Section x)'b fV.,
it 1 '4111
11 yes
-- -_
roofs shall.be mspected_.pnor to any_roofing material being,installed._...-
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspectiorl agree to remove
air hazardous air conlitarrinarms asdfied by the Bay Area Air Ou1ty M- gement
Dist t+ all new materials for inspection Applicant understands and will comply with
I(L� yes e re,d " all non-point source regulations.
I b the hxxaamis maerials requirements mid r Chaprtr 6445 d the
California Health&Safety Code,Sections 25505:25533 and 25534,1 understand that
if the Wilding does not curuntl have a tenant;that it is bilin to omit hc"
8 Y my
Y to
cup 't f Ih e9ut ni H h S 6 I p to", f'C nifcxlc'uf
1^ � t Zod Signature of Applicant Date
ry' y' -negnr mnrssdagent1�fL ogre All roof coverings to be Class"B"or better'
FFICE