01020115 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10461 SCENIC CL 01020115
OWNER'S NAME: APPLICATION SUR DATE
ON KEVIN AND CYNTHIA C ET AL 02/21/2001
r- PHONE: SANITARY NO. CONTROL NO.
q 8 zG ARCHITECTMFIGINEERBUILDING PERMIT INFO
BLDG ELECT PLUMB MF-CH
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fan
Z S m 3 LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby a0irm thin 1 nm licensed under provisions or os Col e.and mmecense
is in Sectionorceand affect. on Jofthe Business and Proressions Code,and my license REMODEL EXISTING BATHS FIXTURE FOR FIXTUR
6 is in full forte and cflca.
License Class uc.. NEW FRONT DOOR & REPAIR ELECT PRODUCTS .
s�3 a U Dam Contractor
F= g ARCHITECT'S DECLARATION
O
0 I understand my plans shall W used as public records tom: p p p
r II� p�y/p°S LED
se i n O Licensed Prefcaa:omal
OWNER-BUILDER DECLARATION
n ad u' 1 herebyaffirm that 1 am exempt from the Contractor's License Law for the I
following rcasm(Section 7031.5.Business ess and Professions Cab:Any city Or cuumy' SEP ( 4 2002
E s O which raptures a permit to construct,alcor,improve,demolish,or minor any swemrt
are 1-
W3$. prior to its issuance,also requires the applicant for such arnuno file a signed statement - -
is. theaheisliceoodpursupntwthcpmvisionsOf the Contmcmr',Licarroa aw(Chapter 5 S Fh, Floor Area-, ®®1,pyy{/ �� a osteon
(commencing yim Section7000)of Division 3of,ha Business and Professions Cole) I, i,l-'s t i�_iSq.- ,.IFI or Area!1 'd:7 V11�
or Ihot he is esempt therafom and the basis far the alleged ekemprion.Any violation -
of Section 7031.5 by tiny applican(for a permit,ubjttna the applicant m a civil Penalty
of not mom man five hundred dollars(SSW)
umber �I nv t Occupancy Type
❑1,as owner of the property,or my employees with wages as their sole compensation,
will da the work, ad sson,e de:T e"'nor intended s Lice a feredLaw for sale(see 7o a,' -- 10 2 PIERS Required Inspections -"it ,:t
Beim ss d Piot sdo builds Cale Th C uo er s, cox La d t pply m m _
owne f p pent'Who eep th d h d h k himself
orthrough h empty provided or r improvements notintendedmr . . 103 --.LIFER.. .- . . .-. -
_ 8 improvement is ld m none Yeu of ...._..._ .-,... .....
completion,i I Ir eow - rn- building 104 - REBAR "
comp)! n,me owner-W tlder will have me burden f proving that h did not build or ,
improve for pamose oranla.) 105 — ANCHOR BOLTS
----
consumer
on sowner of Ne property am BMus elyeomracfg 'iCoeemsTh-e Contmrsto 106 - SEWER & WATER .t 1r
i constt theproject(S 7(WJ Business oJ se ty ns Code)The improves
the thereon.
uan.e Law does not apply man owner of propemy who bona,or improves mereon 202 — UNDERFLOOR PLUMBING
'. .:. end who,contmco for.such prujccts wire a,conuanoldeLliccnsed.purstant.to me. ....-. _._____..__._ .-.-- _....._....__
Comrawas,license Law.., .,. ----- 203-- UNDERFDOOR- MECHANICAL'
❑Into exempt ander see.,T' .e�Perormis reason, 204 — UNDERFLOORr FRAME`"H
owne: Date' 205 — UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
- 301 - ROUGH PLUMBING
I thersby affirso under Penalty ofp!Umyd.eo imallowingdreltratima: 302 - TUB & OR SHOWER
(r I have oder ;u maintain Canific;m or consent to seleinaom for Worker, 303 _ ROUGH MECHANICAL
omperenion, se provided for by Section 3700 of the Labor Code, far the
_ prromaoneOftheworkfarwhichhispermitisi„yea. 304 ROUGH ELECTRICAL
❑1 have and will maintain W'orker's CorroPmam or Insurance,as,required by Section 305 - FRAME
t- 37M of the Labor Code,for the performance of the work for which this perm”is 306 - HOEDOWNS
l ",.ad:My K'orkeri Compensution Insurance ll .carrier and Policy number arc:
came .- . s 1PoliicyN:: .— 307 „- tINSULATION`.. hM .
CERTIFICATION OFEKEMPTION FROM WORKERS t- 1- ' t 308' I_� SHEETROCK
COMPENSATION INSURANCE' ,,,,_,_,--,,,- ...._. .
.. ..__,......-.. _ . 3'09; -- EX-T'ERIOR"liATH ' ,v.�
(This sectmn'need not be morpletN a the arm t is for one hundred donors t l •" 1 -
sLo 310 — INTERIOR LATH
311' ` SCRATCH"COAT
I mft'mt mer pert - crrthe rkf which thsarmt srssudl "; ..;f.:,, . ...
•¢'rail i employ any person any,ate-cr s to b come. hl a t theWnrker's' 313 — ROOF NAIL '
NOTCE TO APPLICANT Comationsition Laws cat California,
If naD, _ "- - - - 501 - — FINAL' ELECTRICAL—ENERGY--" - " '- —� --'- --- —'
Apphceol
making Certificate afthe Exemption.you -
z bechiwitheomplywithsuchr.edi...orm,aprnvi.ishallWdLabercnolved, rmaa 502 — FINAL PLUMBING ENERGY
O p form»+meamplywitnsampm.mm�sormiaamitanauxdecided rc,nkea. _ _ - 503. -- FINAL MECHANICAL- ENERGY.
Z',-y :CONSTRUCTION LENDING AGENCY " 504 — FINAL BUILDING ENERGY,.',-'
w, •
I Ih by firm that there'. consuu t led g agency y r th arforman<c
of di k( which th arnrt ad(Sec 309]Co.C) r
Norm.' . . : . 505_. FINAL_ ELECTRICAL___ _. . _. .. .
Lenders 506 — GAS TEST
LendersAddle sv " �- ,- � � �� � �-
VOIccnfyNtlha cdth.appiato dttethattheaboeirormitio�ix 507 - FINAL PLUMBING
(yF kbricnlagret, •m,ply 'mauhyand, ty ordinances tl.tmlaws rdating 508 — FINAL MECHANICAL
OPV toWilding construction:and hereby catnorze monarmadves of this city to enter upon
the above-mentioned loppeny ror inspection parraves 509 — FINAL GRADE
F S (Wc)iigde iia sxve.indemnify and keep hamaess the City or Cupeninm against `
V) liubili ias.jadoomal,nags and ex,.,w,which may in any wey,accma against said 510 - FINAL L I NG
U Z city in cmwarucnce ofthe granting of permit. . .. f
t"t APPCICANTUNDERSLINDSAND WILLCOMPLYN'ITHALLNON-POINT ' 5514 !- C WORKS
SOURCE RFOU1 ATIONS: t Issued by: Date
Signature of AppncanVCommcmr - :^ .s ,Dam:: Re-roofs /
HAZARDOUS MATERIALS DISCLOSURE '
.�llltM'ppli.c"t6rfotwildigiauvants;cieorhandicWoceaticos rimriaf .Type of Roof.. ....... ......_. �_ . .,_w.. .. -. ,.„. .. . . .... ......
as risfirsed by the Osterman Micamilicel.Cod Chapter 9 12 turadheHealth ad Safety -, S
Cline Ove xs�3 iyj 1 ' (, h_All roofs shall I , :�� :` 5 t ; -. _
t ,-,- .i ' be inspected prior 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 inspectititr, Itagree.to remove
emit hazardous air cnnmminnms ns ddined by the Bay Aren Air Quality Mariag<mcm
:Dist t r _all new materials for inspection. Applicant understands and will comply with
❑Y ONn all non-point sourceYegulations- �,. •,I;,., - --
t -
I be
se mail the hazardo i mmeriaI requ renters under Chapter 695 of the
California Health&Safety Cotte,Sections 25505,35533 and 3553x.1 understand that
ifthe building does not currently have a mmra,mat it is ra,m, omabiliya rodyme ---
oceupant of the requirements which must W met prior to issuance of a Ccm ricrac of
'
Gee,....
Signature of Applicant Date
Dw aumo,izemaga., Doti All roof coverings to be Class "B” or better
.OFFICE-. _ ... . ... .