02070180 OF
CI BU DNC DIIVC'ISSIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20598 SCOFIELD DR 02070180
OWNER'S NAME: APPLICATION SUB DATE.
FRANK WADE AND SALLY LAUTEN 07/29/2002
PHONE: SANITARY NO. CONTROL NO.
0 m Z ARCHITECTTNGINEER: BUILDING PERMIT INTO
0
BLDG ELECT PLUMB MECH
aH
of LICENSED CONTRACTOR'S DECLARATION sofChat JobDescrition
Q z=o I hereby affirm Division
I am licensed under provisions of ns Code.(commencing p
�_tu+ wansttdoreadefect, n3orthe Business and Prof,mm�acoee.and myfierna, WATER SERVICE-REPIPE
m Y m full force end effect.
a i U License Class Lic.a
Dam Conuacmr
u�LL i.to ARCHITECTS DECLARATION
F- 5 1 understand an,plans shall be used as public emend.
w S p O
Licensed Professional
°LOWNER-BUILDER DECLARATION
tyii 's' I hereby.sera that 1 em exempt Business an the Como,Co License law for the
C? following reason(Section]OJ LA . mr. end massive.
de iom Code:Any city or m county $800
E F❑ which rest a permit m ronstmct,alter.improve,demolish,or repair any structure
a3$-priamlmissuance.alson ims lhcap,licant forsucn pesmiuo Bleri.,imdstammed -- -- '-
thinheis licanred puoulydmthe pmvisionx of the Contractor's License law(Chaser 9 \ s. �fk Ft.pp�jryY�Orpp,,��eaa,•. a Valuation
(commpncingwith Sttthm 7")of Division 3 ofthe Business ad Profusions Code) �:f?'t !3;5,§Yl ,b 1"St..'l7D ,i!'� t��1,;
or Out he;i exempt thhefoa6 and the basis for the a11egW<acraptian.Any violation
-of Section 7031-.5 by any applicant fa a permit subjects the applicant to civilpenalty-
;of not more than five hundred dollars($5Bo). 202APNL FLOOR PL B`ING"' Occupancy Type
°1,as owner of the property.or my employees with wages as their rale compensation, 203 _ ROUG-14 121 UMR INC
will dome war-and he swcture is no,intended or'minted Y,sal,(1e:1o44: ---- _-- """-- --
(Busirieai and'Prdfessions Cade:The Contractor's License law does not apply to an 502 — FINAL P0@4t9B(tnsERFE,MY:':l'`
owner of pmpeny Who builds or improves thereon,and who does such work himself
or through His own employees.provided that such improvements Sure not intended or 507 — FINAL PLUMBING
,offered far sale7lf,however.the bre Idme p amen,is sold within one yea of "- ------' --- '- --- - -- -�---— - _._ _.......... .--
completion the owner budder will have the burden of proving that he did nm build or \'i
improve for purpose of
- ____ ,_-.__.._....__...__-....._- __._ _.._.__..._ ._____-.....__.__.___..._._. ._..__.___._.._..__.._ _I__._�__._.............___._._...._.__......._...__
ti ii
co L as owner.of the property a xdiness Y d Prof slows Cadc:)mhe Crmmors to BD!!Id':(Ii.S]I,f C:•(i
^s - me
License,the project IStt.]to an Business and Professions Coded The improves
themor'a Us• [I B i{
r�. License Law does not apply to an,owner of property who builds or improves Ucrcon, ® _.___._.._._1_.t'
_ .. .. _and who,contracts.for,.such.projccm.wnh a manat n(s).liceitud pursuant m the. . ._._.__..�- _._..___..___ - --------.---------- - -
C�o.'m t r License
e a�zAF ndeOr5ER S'Ct O-MIPE\NH�; i"NDEUCLAVO TION AUG L 1 2002
,
thereby eRirtn underpcnelry of perlurY1one tA. th<(ollowin8dedantiom:- BUILDING
° 1 have and will'inainmin a Cenificau of Concent to self-insure for Worker's
Compensation, as provided for by Section-3700 of the Labor Cade, for Oe
Performance of ilia work for,which this permit is issued. i
°1 have and will meintairi Workei i Compensmimb nsra6ce,'iii'requlmJ by Setiou
37M of the Lidort Code,for the performance of the work'for which this permit is
issued MyWorker's C mpe salon linsumarics,cairier andPolicy n robe save: _ ...-.,—... __ _ ... ....._�..,w-,.:...
ilii,Palo
Na.:' ,:, -t ., f ''v-147!iE .i's I { `\'..a lYs. '
ilii 1 'pfsCERTItICAT10NOFEXEMPf10N FROM WORKERS',' „I -
COMPENSATION INSURANCE - .,�„• _-,- ,_-„ „_ ,,,-„._. ._. _ '
.,. _ _ _._._._._.. _ _. ...__.. ...........
'ti' (Tho mnfon need not be complete fine perm tis far one huMrtd dollen \t'� �I.; .'.'`i: �---- I• \. t ICt II�IiLL'` �'.�C
151001 or leu.),
1 ... .. - -
�,''I 1 I c n,fY th t In the peAorm c •of the rk f i whir¢this.pcmut is issued.( - .:..: _ �; 1, .._ ... -
shall litemploy-ny persony'1�/Vi b e Wo ken -'
Com
ottomVnsnpa
µNeh /`Q1D` Iaoo Cod you must ___tf ry�Tt b act to inAPAT
orkers ConaperSaitirs.pm�mmrav of the
LI SIT IfArftte k gth Cn! le of Earaptr yo shouldO provisions thispc ,.hall be counted revoked. .-
.
V] 101d \ o^ CONSTRUCTION LENDING AGENCY
ai y I hereby IdEarn that th rt -nurua on lending agency f the performance ( ` '
forty' ofkf whchth pe t'. cO(Sec 3fN].C'v.C) ” .. .....--.. ..._...._. -""
-Lenders Stamm'
0..Z Lentler's Adduai"i
., .u.. . . .. .............. .
it
J' V'� u l cmify that l have�rtad this application end state thatiM1e above it forrnmion is
�3E. toric¢.Bogue to comply with all city and county ordinances and state laws misting
D;fJ ,m buthing emnandctioo,and hereby autnonte represemerives of this city m enter upon
�sW Oe abuve-mentioned property for inspection purposes.
., tly (Wel'agrec to sa.r,indemmfy and keep hamss
lettie City of Cupertino against
rn liabilities.judgments,taxis aid exp,nses,which may in any way aceru,against said
U..Za Chy a quence of the granting of thisPermit, - - " s
'APPLICA`r11UWERSTAY SAND WILLCONPLY W'ITH\LL VON-P( NT Issued r Date
s uRcr �eo�ir 2W 11 lz;o � z9�0 y:
sign rApid MC 1m7.E an i r .I' ,'., It Drop _ Re-roofs
�( HAZARDOUS MATERIALS DISCLOSURE app „
io, Wlltlie Int t ft talking cupant store or�andl,hazaNmammal ammal _Type Of ROOF— ...... .. -... .� ....�.. .,..,•„��._. .,.......
s defed by the Construct Mannddl Code Chapter 9.12.and the Health and Safety
Codes a 35572(l
It t tit ♦ o T ` v It. ' rs ssrl (
uAll roofs shall be inspected.prior to,any roofing material being installed.__ --------
Will
-_,._,W Il theappLcanto futrebuilding occp _q p t de e" hien. If a roof is installed'without first obtaining an inspection bagree to remove
count haaardo comem;nant.as defined by the Bay Ama Air Quality hlanaBemem I
;tori .,all new materials for inspection. Applicant understands and will comply with
0 YittI No
non-point source regulations Br
1 have mad`ihe hicandinuo,materials mqi unn nm,under Chapter 6.9$of the
Calirorai3 Health&Safety Code:Scin.dS 25505,25533 and 25534.1 undemdmid Nat, ......
it the bolding dg not cuumenlyh have d Nadir is my responsibilityt notify thea
occupant of threq arae is h must he mutt poo to ice ance of a Ce f m of
occupantd 7 / _ St na_ture_o__f Applicant Date _
4 T till, �Ly b g All roof coverings to be Class"B"or better
�5 '1N-ser madu ria itl dJ Date
„ M z; .. . ._.. .-_ OFFICE
N . ..._. _. . . . _
114,