02030207 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR-INFORMATIO•
BURRING ADDRFSS: PERMIT NO.
7536 SHADOWHILL LA 02030207
OWNER'S NAME: APPLICATION SUB DATE
VDARYL & RODNA PRESLEY 03/27/2002
ONE: SANITARY NO. CONTROL NO.
t'
gW06 ARCHITECTIENGINEER: BUILDING PERMIT INFO
&u F BLDG ELECT PLUMB MECH
,« c -1 u u u
sF- LICENSED CONTRACTOR'S DECLARATION
O m z 1 hereby uNon that I mm licensed under pmAu.ns of Chapter 9(commencing lob Description
iyeC Ica.. KITCHEN/BATH REMODEL.
full;
's w uanae e "�}-/ LYt"� 5 3 7 3A.
7
�u Ot; $ v"ARCHITECT'SDr'�LAr 10 F1•V1�
ALE®
S 1 urmcmmd my Alms mall be uxd es public rtcoms
o o Licensed Professioml OCT 2 3 200
OWNER-BUILDER DECLARATION
tsar o I hereby affirm that 1 maeempt from the Contractor's L oma law for the
h a following mason.(Section 7031.5,Business and Professions Cade:Any city or county BUILDING 8 5 Q O 0
F D which requires a permit to construct,slier.impmve,denwlish,or repair any structure3$ prior to its iasmbm.slsu rtquirtsNe applicant ror such pemduo Ble..q.ed samment
that he is licensed pursuant ie she provin.r s of the Contractors License law(Chapter 9 �`gQ,qp,pt�f�qqt,,q,,I�{�7 Valuation
(comtancinB wait smion 70W)of Division of the Business lee Professions Code) • ;• j�a i ;3(J Gtl`r.;`,W.1tun-. ' .1,,',,.,. ;(j'',
or that he is exempt Nerefhan ad the basis fatale allegc8 exemption.Any violation ,
of Section 703 L5 by my applicant for s peanut subjects the applicant to a civil penalty
of nor mareNm five hundred dollars(SSW). 10]°PN l`�DATION Occupancy Type
01,As owner of the pmprrt,or my employees with wages as their sole compensation, 102 _ DIERS
will do the work;end the'swaurc is not intended or offered for sale(Sec.7014, -
Business and professions Cade:The Contractor's ucmx taw does nm apply to m 103 - UFER Required Inspections
owner of progeny Who builds or improves thereon,and who does such work himself
or through his own employee,provided that such improventeme are rot intended or 104 - REBAR _
,or
for sale:If.however,the building or impowem,m is sold within one year of -' ' ' '- -"" '" ' _ — - - - -
'cotr:plaion,the ownenwilder will have the Inmenofmoving thathedid not bandor 105 — ANCHOR BOLTS "• "l
mmovcforparpo:eM.a.). 106 - SEWER & WATER
.
0 1,As owncr of the Propmy.scal"Chasively contracting with licensed contractors to 202--- UNDERFLOOR -PLUMBING' ".7"�' -- - -' -
cmmaet the project(Sec.7044,Business and Professions Code:)The Contractor)
Llttnse taw does not Apply to an owner of propary who wile or improve meson, 203 - UNDERFLOOR MECHANICAL '
and who contracts for such projects with a mntrucams).1wented pursuant to she M):,•
e .. 204 - 'UNDERFLOOR' ,FRA
Contractors License law. ...
i ❑1amexemptaudit See p BAPCforthisrramn 205 - UNDERFLOOR INSULATION
owner "' "Datf 301 - ROUGH PLUMBING
i_ WORKER'S COMPENSATION DECLARATION
302 - TUB & OR SHOWER
IhembyaRim,undermnalryorperjaryunb9fthe feIlowingdecimations: 303 - ROUGH MECHANICAL
❑ 1 have abd will maintain f cbmfie.e of 37WCome.,tt xLabor for wakee
;..y-�` Compensation, n provided for by Section 3700 ar the Labor Coen for me 304 - ROUGH ELECTRICAL
performance of the work for which this permit is issued. 305 _ FRAME
❑1 have and will maintain Worker's Compensation Imuranas,w required by Section 306 - HOLDOWNS
:.
37M of the laws Code,for me performance of tha work for which this permit is
307 - INSULATION
issued. Wmkcr's Com nation Insurance carrier and Polic umberam:.
—
:fC ., My m
,. ,3'08 - �.SHE�TROCK : '
f CERTTFI:ATION OF EKEMPTTC3N FROMWORKERS'." l a.J'` ; a309� =�'`EXT�BRYOR"`LATH
COMPENSATIONINSURANCE:'^-°^" '
7-1` _3.1.0...._..:INTERIOR liATH— `_. .; .. ..:_,..
`(s'I'(1lftei�axaion tieed'not be'compktee if the permit is far one hunered collars 311 - A1 .11
SCRATCH COAT
or
.,. _.....�. . . . -- •• .... :- .."313 --. ,ROOF'-NAIL.-:. .
l"1 certify Nat in me pufomimce of the work(or which des permit ix issued,l - ,
,hall..oIF mploy any person m airy manner so sato become subject m,thi,Workeri 501 - FINAL EDECTRI CAL"ENERGY
Cumer¢auon tiws o(Cabf6rrite.Date "'
.Applicant. 502 -. .FINAL-PLUMBING ENERGY
,NOTICETOArpuCANT:If,arse.making this Cre iBeata ad Earmini...you should 503 — FINAL MECHANICAL ENERGY
become object to the Worker's Compensation provisions of the tabor Code,you most
0 fan hwfNcomp lywidtsuch provisions nithis pman itshall hdecried revoked. 50 Y',4_ .-.. FINAL BUILDING.'ENERG .
•'"CONsrnUCTIONLENDINGAGENCY'
505 — FINAL ELECTRICAL . '
1 hereby Africa,that Nae on construction lending agency for the pedornenec I '
of die work for which this permit is issued(Siad.3W7,Civ.C.) "' 506 — GAS TEST
syeq .finder's Names :-...:._..._n.... _ -.,.._.... .. ..... ..:.-. .. r._
DLZ landcr'.Addms,^ 507 - FINAL PLUMBING
G O . ,•., ...,. -" 508 - FINAL MECHANICAL
•I cewy Nat 1 hove tad Nis application and au¢Wt Ne above information is )
LIi'.F correct.I agree to comply wit all city and counrypminame and stat,laws relating 509 - FINAL GRADE
W th aboingconstrocuogkne hertbyauthtionpuptexdduw o(this city to mor upon
W thea.(We) gmato niwpbvd.huufy And inspection purposes..., 510 — FINAL PLANNING
M es,j agree to save:indemnify and keep hvmlain the way
Of Cupe,.Sai st l n d
r W Cabilin co sea,umsts,costs aM eponxs which mey,in my way a«mc against said 514 - FINAL PU I C WORKS
VL`Zs City,in consequence of Ne gsmting of this peanut. �f
SPP A,`rl'UNDnWSANDWILLCOMPLYNTfH^ }NON-ro'Brr'" Issued by: Date 7
Fe of Ap?Bcm✓Contramnr Date .. Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
1 W II
an,applicant or form,building accuplarn fort or nandk Hamm renal Type of-Roof
_a"tdtptMum pal'.Co:d.e,Cham 911 an,dy Ne tHtea1N and Sof ry ` ' -of Ro••of
Coda.S&u. 2553I4y? ,
IOWA. N ,(. 7 n-f't ',-•:y A .. -.".'. _ .
.! All roofs shall be inspected prior to any roofing,material being installed. _
•. .,N'ili`N,.ppBcmrWrauw,waei «cnpaa7tr.e�g.,P.,ar devicas which If a roof is installed-without fust obtaining an inspection;Iagree to remove
,tit herardous air cantaminmts as dean by the Bay Are Air Quality Management
iiia? all new materials for inspection.. Applicant understands and will comply with
❑res p affnon-point source regulations; . .
\y I he "read the hermdousrgamrials mquirtmenu andChaptci 6.95 of the
Califorttie Hni &Safety Code,Smucns 25505;35533 and 25534.1 understand Net
if New ren
e a tenant,that it is my respomibilit to notifythe
er or euNonx<d age - missumtt ofe Cenifcate of t
«tt t f me K uiagmen a
- --• ''__�.� "•4,. Signature of Applicant Dale
�Y:a t '::•. Dae; All roof coverings to be Class"B"or better
me poor
._.
r—. . � .t.; . ... � .�:. ,.. _.. ,.t. •..�. OFFICE .... .. -
OF
ct BUILDING DPERONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7536 SHADOWHILL LA 02030207
OWNER'S NAME: APPLICATION SUB DATE
DARYL & RODNA PRESLEY 03/27/2002
1HONE: SANITARY NO. CONTROL NO.
C.Q o ARCHITF.0(ENGINGER: BUILDING PERMIT INFO
kL"u- BLDG ELECT PLUMB MECH
N z b
LICENSED CONTRACTOR'S DECLARATION
'Z y z 1 hereby !firm Ihm I am licensed under ser Chapter 9(commencing Job Description
S y-G o provision P B
_C, is in full 0ind Division Jofthe dusinnxand ProressionsCWlc,and xran=< KITCHEN/BATH REMOD �PJA E®
in red ana arc 7
's0 para«eke` , `(f-/ Con / S3 3
33u„ .J( s��-7wv RCHITECr'SDEtS.Ar 10 OCT 2 3 2902
'�=-O I understand my plans shall be vane es public reem s
iOYf
i p
Licensed Professional
'.aye
OWNER-BUILDER DECLARATION
tw BUILDING
1 hcmby.(firm Ihm 1 1. exempt from the Conv.aor's e:A,<L.w far the BUILDING
F z< following rcz a.(wont t 'loss.Business ane Professions Cade:Any city sr rounric $85000
ce F O
which ts e. 'I t c mi� p i npmve demolish,or repair any stm<tum
s m ,prwrt u arca el req vas the pPl cantfw such pcrmumfileaugaW uatemcnt
d 3--
Inas hk s I en is p , am to the Provisionsi of the C e Business
License Law(Chapter) Ff�, A,
(cam rtnswmsery rove) fDw Division IM1e Ousmess#rd Prete-xsmns Code) i" i\ 1';.3 b(7 Z�;;V6a' -t> er''''r ', Valuation
or that he is exempt thertrrom'and the basis for IM1e alleBellciamptieu.Any violation '` v - _) �-Al•'%^_. L.�
-of Section 7031.5 by any spplicant for u permit subjects the applicant to a civil penalty
of not moa than five hundred do][.($50)). 1024P NXT1YFrDAT ION .41,'.r Occupancy Type
°1.as owner of the property,w my employecw
s ith wages as their sole compensation.
will da'the-work;and the structure is not intended or offered for sale(Sce.7044,
Business and Professions Cade:The Contractor a License Law does not apply to an 103 - UFER Required Inspections
owner of Property Who builds or improves thereon.and who docs such work himself
or through his own employees,provided that such improvements are not intended or 104 - REBAR
,offered for salC lChowever,the Wiavetheiimenof is sold within one year of 105 - ANCHOR BOLTS
ionipletion,the ownerbuilJer will have the burden of proving that he did not build or "
mprove lw Vuryose of sum.), 106 - SEWER & WATER
CI.oso:nwhimepinany.amaxelwieyvonwcdnBwimica dconvacunsto 202 - UNDERFLOOR-PLUMBING _
„r,t.h,�. ,•,,,
construct the project(Sec.7044,Business and Professions Cade:)Tbc Contactors 2 03 - UNDERFLOOR MECHAN•ICAL''
License law does not apply to an owner of property who builds or improves thereon,
contracts for such.projecta.with.a cormems(s).liccmN.purs
ase who uam.m.tne .. -.-.__ _ -UNDERFLOOR---FRAME
. .__..__._..._.._..__ _..-___ _. . .. .... ..
. - cano-a<mrsuc<nanLaw. `204
❑lath excmplmnder Scc. " 6 .B`&PCfor this reason205 - UNDERFLOOR' INSUL'tATION
o«aa, 1 " '"irate 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
IherebyaRlmanderpea.),Y .ofoarjwywf,.fhefonawingdeclaations: 303 - ROUGH MECHANICAL
s1 have and will maintain.C<nifitita of Consent to seB-iinme for Worker, 3 04 - ROUGH ELECTRICAL
Compensation, as provided for Sectio 3700 of the Labor Code, for the
. performance of the work for which this permit is issued. 305 - FRAME
°1 have and will maintain Worker's Compensation Insurance,as required by Section 306 - HOLDOWNS
37W of he Labor Cafe.for the Performance of the work for whim this Penn,is 307 - INSULATION
iasucd My W k r s Co pc t Insurance Carrier and Policy bei e
m$S . _. 07StF$.15 ;.SHETROCK
s .. _ sass . ... .. ... .. ..._.
C �� Aw/PlicyN O� v. .v.3 O.8 _ RJ
2' - CERTIFICATION OF E%EMVITON FROM WORKERS QI`EXTER1ORt'LATH'
COMPENSATION INSURANCE.
. _ __3.10 - - ._ V
,INTERIOR-=H �..._ _. . --
_ - -
rNv;unimn'need nal be eomplered if the permit is for one hundred dollars 311 - SCRATCH COAT l ,\ l'
($100) le ) „
I enrr@ ninth perrarmancealth �n'roswmrnm Penwt s sauee l ._ 3.13 .,- -ROOF-NAIL"_ -. ._.. -.
shunof employ any pe nn.any manner sowto become sub3e<t to IM1e wprk r. 501 - FINAL I'"I+N-'Crl'RI�'AIi 'ENE'RG'Y
campcnaauon LowaafC lramm.mm ..-. -FINAL -PLUMBING. .ENERGY -. ..... ... .. . ..... _..
-APPlicani. ... ._.SO2
NOTICE TO All'CANE If,sOcr making this Ccnincare of Exemption:you should 503 - FINAL MECHANICAL'-:ENERGY '
become subject to the Worker's Compensation provisions of the Labor Code,you mann
Qz O .- `. __ 50.4_ r. FINAL BUILDING. ENERGY . _._.. .-. .
,r forthwith amply with such provisions or this permit shell be deemed revnkcd
- V, " CONSTRUCTION LENDING AGENCY` " 505 - FINAL ELECTRICAL
�.7 1 he hY IBrm that then, '.- euctbn lending agency far the performance
-
ofthkro n yNtPe t issued(Se<309] C c) ' 506 - GAS TEST
W A LandttsN me - - . .._ ._ _. _ . ___ . ... o.. .-. .,. ... — .. ... . . ..... ._. _
5z a dApe a 507 - FINAL PLUMBING
U O m ry mat 1 na a re.a tats appbeaeon ana stole that me above tiro minion is 508 - FINAL MECHAN I CAL
correct.1 agree to comply with all city and county ordinances and state laws relating 509 - FINAL GRADE
Q [) to Wilding conswction,hnd herebyauthoriu representatives of this city to enter upon
W me above-meti0nedproperty for inspection purposes., 510 - FINAL PLANNING
,.y, (We)agate w save:indemnify and keep hormlesi the City of Cupculdo against _
h liabilitics.judgments,rusts and expenses which may in any way acerae against said 514 FINAL PU IC WORKS
U,z City in canseq...6.of rise granting of this Permix"' ' ' "
APP X UNDCRS . 9DSA��N1D� WILL COMPLYWit, ITHALINON-POINT" Issued by: Dale
HAZARDOUS MATERIALS DI ,. are'• ''I Re-roofs
- DISCLOSURE .'
!Will the applicant nrebadsnigOccupant storeorrhomil Heard at 1 Type of Roof .- - . .. •- ,
dirt d by the C.P rt Mum pal Code Chapter 9,12..nd Ne Hcalm and Safcry t
Code S ert 3ssJz(p) Y ', n tv - t• 1 ` -'hall
'.l
°Ys •• KN- t 1 4, Hit'- , - avis- _All roofs shall_be inspected pT.rior to any roofing material being installed.
(\
w'11 th pPbcant future_b lding Occupant equip I a ccs which If a roof is installed'without first obtaining an inspection; I-agree to remove
sit
al
contaminants as deli ed by the Bey Adm
ou, a Arr Quality Manageent
'inr<t all new materials for mspection. Applicant understands and will comply with
°9c "all-"non-point source regulations,,
•.1 nave rend the haioidous'mmcrials iequiromems ander Clo de,695'6!the .
Caliromia Hbahh&Sdfcty Cade,Semions 850x,25533 and]x534.1 undeatmalmet _
if the inn dua not initially have a tenant.that it is my responsibility to notify the
occuP t f the mqulrsmn hbh mann rte tact p m'ssuenm of a Ccn!tate of
!> oL
' . �¢z•� Signature of Applicant Date
c.
''- <rorauthorizcd'agent., ',�- ' All roof coverings to be Class "B"or better
OFFICE ....... ..... . ..- ...