01070049 CJ BUILDINGUDPERTONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
6298 SHADYGROVE CT 01070049
OWNER'S NAME: APPLICATION SU DATE
Ask SHAFER DENNIS E AND FARIN M 07/1212001
PHONE: SANITARY NO. CONTROL NO.
M O O ARCHITHCT/ENGINEER: 'BUILD PERMR INFO
BE CI' P UMB F.
ai
IX L L J
yaa
S Job Description
H LICENSED CONTRACTOR'S DECLARATION /
.. that I am lic<o>cd undo.provisions of Chapter 9lcrmmencing
'yf5 I hereby affiwith Section 70(A(dmDi,Num3nf@=Businer,malPrure,ima,CWe,andmylicense REMODEL & ADD.
is in fan force and effii ADD 643 SQ. FT. &
s a License Class Lic.g
odD Dat= Contractor REMODEL 1532 SQ. FT.
3 D I-i, ARCHITECT'S DECLARATION
g W«tenamypmne,d,auneused a,public records FINALE®
n p o Cicenud Pro(essiowl
iOWNER-BUILDER
DER ATION
1 thereby tem that I.,A exempt from dr,Contractor's
os License low for the
J U L
2 2 2002
ng7031.5. si...Codc.A,city o
whichrequiresa c ,a In< truct, ❑at,imprve.delish any strwrtura
Piton t c Iw requires mapplicant f h person i flea signed statement _.. _ _
_ .............c. mm beiij I' rico p titrntcala issrop0mas of flam C ti rs License
L (Chapter
9
q,Ft Floor Area' . on
atom amgWmsea fman' iof Thebai T nn l ndw..An,Professions lation`` tir; .S .. ..x;2;1 F.!?.4` "
At that he 7 31.5 b any appl i and the basis fns the subjects
the axemant to Any violation
-of Senior a than by any hundred
doll fora permit subjects me applicant w e civil penalty
of hot more mon.frve hundreJ Dollars(SSW) Occupancy Type
❑I,aser of the ppeny,u my employee with wages as their sole compensation,
'will do them'work:And he stool c is Act imended or offered for sale Ig«:aa+at 101 - FOUNDATRd*red Inspections' .''.
(Businees'and Professions Code:The Contractor's License Law does not apply to w
owner of pm p my Who builds or improves thereon,and who does such work himself 102 - PIERS
or mrouh his own employees.pm,rded oat such improvements are not intended or
-;offered of sale.IC however,the building or improvement is sold within one year of� _"" .--�-
,.prover for the owner-builder will have the buNcn of proving that he did not build or
103 - UFER
impro.erorpamnKor.al<.), 104 - REBAR
- - - — - - -._ . ._._ .-.. - -- . . _ .. .... _..
r.o[me pmpcny,a sclusivcly contracting with licensed contractors to TO5 ANCHOR- BOLTS ,. ., .. ,
_ 'guff ane project(sec.nwa,Business and Professions CA10 The Contractors 106 - SEWER & WATER
License Law does not apply to an owner of proper,who builds or improve thereon.
.and who.commca.for such projens.with a.comm toot).fcensed pursuant to the.
Contractors License Low. _ -_- _..-. 2 0'2-----UNDERFLOOR-PLUMBING
.
❑Ise WersKJ 6&P•Cfmmis..A 203 - UNDERFLOOR% MECHANICAL
q of 204 - UNDERFLOOR FRAME
wORKER's COMPS SATION DECLARATION 205 - UNDERFLOOR INSULATION
Inereny arum,under Penalty or pe:juFy oda or the following aeelnmtmna: 301 - ROUGH PLUMBING
•
01 have and will maintain a Certificate or Consent to self-insure for worker'. 302 - TUB & OR SHOWER
Compensation, az provided for by Section 37W of the Labor CWe, for the
_ p on n of ire wo.k fo worm mid p rnh is i y e. ,. 303 - ROUGH MECHANICAL
0 have aW.vdl maintain workers Compensatmolo,urncb.as required by Sultan 304 - ROUGH ELECTRICAL
J]W of the fal,or CWe,for the peffic manca of me work for which did.permit,s 305 - FRAME
Cid,M(=k C)m , tion Insurance carrier and Policy n sure m: "',t
y o pnsa a :-
issa 3"06., `-� HOLDOWNS '.
e 'sr. CBRTIFlCATIONOFESEMIPolicNo,'
r1'IONFROM.WOR%ERS, '- f'3'O7"- ' INSUliATION` N
o.
hi3.ernon n<a not b rd,n l<md am< or 1 J 3'0'8': =•"SHEETROCK--_.' _....
COMPENSATION INSURANCC'• .. ._. .. - -. _ ......... ...._____......_...._..__._.._..—_-__
c p permi ane hundred dollars
309 - EXTERIOR LATH
INTERIO
manner m o or whit.iub'en to me worke 3101 V 'SCRATCH'
LATH _......
1 ienify,thai in'
performance of the work for which suis perms is issued,1
:naireot empmy am IK�^A am - ) - COAT
comp t a arch Dt .313" •- ROOF
. Appl t .. .... _._..._ _ .. .. _ ..
NOTICETOAPPLICANT If R mkosm cr'rram nrE vt nyoa anowa' 501 - FINAL ELECTRICAL ENERGY "
become sub3cn m the Worker s Compenwuon prot.sun of"
Iabo Code,you must
O arEss,cmri wim wen pwvt ion,or tm.p<tmd"a',tie deemed re>oked. 502--.-.- F.INAL_ PLUMBING ENERGY
^ V] `v 'CONSTRUCTION LENDING AGENCY, 503 - FINAL MECHANICAL ,ENERGY'
of m ' re n rni that m .tmcilending t, y f )h p f.mance
Lenders naeresffrnm IK nears 3oB1 c,c) 504 _- __FINAL BUILDING ENERGY
C U hereby
a —: 505 - FINAL ELECTRICAL-
5 ._.
naert
:z _ . . 506 — GAS TEST "
U0 '1 read y that 1 have read this applcation and state that the above information is
coiiedcl agree to comply with all city and county ordinances opo state laws relming 507 - FINAL PLUMBING
0.IS
to Wilding rWomctibn:.mfherebyaumonzc'represcmaticeaofthiscity to enter.,A 508 - FINAL MECHANIC -
Ashe b met ed property f pectin po p r
(w)Agrc to'windemnifyandkeephar,ile,sfacCity'ofC ,m ;against 509 - FINAL G E
rn' lob I t dg u.costs An dexpco.,which U t min
any y said
z City yy f this pn ' n •
qmg
gi ( - N N
'AP IATUNDERSDSAN WI COKIFLYWITHALLNON-POINT _U
GUCOr Issued b /
niilure.f APPlicanoCWamctor
-;he11, Dact
Re-roofs
HAZARDOUS MATERIALS DISCLOURE -,W 11 pplType Of Roof F -_ .- . .
asd fSdbyn Cupertino Municipal
se) Chapter trit Health and Safety
Cast
s N i'o2S�J1e) ..•.•'• ,, t(t
'
❑Y '0 No -. -.All.roofs.shall be inspectedprior to any.roofing.material being,installed.... .... _. ._.
s Will meApplcantorful subuilding occupant equipment d witch If a roof is installed without first obtaining an inspection;'I"agreeao`remove
emit hoz dem arc namtwnismdcfined N)me Bay ArutA.Quality Manag<mem
Dmrt<r _ _ all new materials for mspechon. Applicant understands and will comply,with ,
• oY i", � `all non-point source regulations; ,• .) ;,,I,.•,f.,
1 ha e, adlme hoz Nous meanalrequirement,under Chap err 695 of tie
Ciliforriia Heabh'&Sato CWe,'Seations 25505,25533 and 25534.1 understand that _
•if,'Wildingd. not currently have a tenant,that ntis is myrssuanceofity to notify the
b'1
At
f m quircme Is ti h niait tie t p S rrficam ur
IX. SignatureofApplicant Date
'_- seg t Dater All roof coverings to be Class"B" or better
w
OFFICE..... --