00070131 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
RU1LDING ADDRESS: Pli10,111No.
221907 SHATTUCK DR 00070131
OWNER'S NAME: APPLICATION SUH UNIT
. BROWN DAVID A AND PRUDENCE— H T 07/21/2000
11ON13: SANITARY NO. CONTROL No.
1 - BUILIIING 1'lilibtl'I'INFO
^z z ARCHITECT/fiNGINGER:
tn00 - BLDG ELECT pLUAIH MEC!
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LICENSED IUCON'n2d undc;rUEionsof 'apt lob DCSCI'IPIII❑
1I ne" aRirm Ina I an licensed uiWer provisions of Chapter 9(commencing
K�CQ wnb&,Bars7nla)Inrlyivlxinn3 of the lfn,inexs and Prufc..io I,Cn It,and my liecnxe
,.inrNfmfanaeH� 601/9 j BATH REMODEL
z rc 1' m C � Lic^ro
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ARCH]I'LCT'S DECLAR 'll0 Q
C=O� I l t d ypl hall be 1 pbl,. da /'
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nZ+nC O h ttnaeJ Pr Ic'.' ��
z OWN1 N BU11 DIM DI CLARATION /
e w vo 1 hereby ffr th t I pt 1 theC , our. 1' n: 1 far the
following reason (Smitten 703 LSH as adPro! ic,Codi Any riyol county O
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which I innalt III loolnUll, I, . 1 Iixh p' Y v ucmre
C Anon t e .so rc
l9 rc the applicant) hj,conitt fl .g cu
J:,acen,
e.s` m:t o licensed pur,reatoolhep a,,)fIhc Contractors Licer.LiceLa (Chapter9 -Sq. Ft. Floor Area
maminfnair 13 of meBr6d, atmrrorew„onsC...W) Valuation
,r,nat he is ceemp,theretrnm and tee baxm for the alleged c,en,ptinn.Any violation $2500
of section 7031.5 by:o,Y appheent lar a enot wubjeeb me applicant to u civil penalty
of no,more than five hundred dollars 1Silgh, A PN Number OCCUpilncy Type
01.n aIJlnpn,p....... .try c:m,loyfe Isilhwagu.axmer,sodecmnpca,mlr,a, 35614007. 00 will do�mwwork,and the structure is not intended or one,ed Inc sale ben.7144, - -
Husinc,.s and Professions Carl Tu,Cotmmno:s License Law does not apply it,no Required Inspections
o, r of property Who no Ids or :npravex H,Creon,and who doe,oel,work[I inc11 101 — FOUNDATION
through his own emplayefs pmahled that such improvements are not mtendm or
olrc,ed for calf, If.however,the building or irip rovo,nent is sold Is one year of 1.02 — PIERS
omwplelion,the I v,,hulldr,will bmc Ibc burden of proving that he did not hard Cor ,
hnprovc for puBx,se nrsale.). 103 — UFER
01,as owner oftneproperty.ant escfu,ivclycontracting with licensed contmaor,to 104 — REBAR
mnstruct the pmju:,the'.7(W4,Business and Profesntons Call Contmetor',
ice e_aw dote no apply to `�f properly who hands or loprocs,hCrcon. 105 — ANCHOR BOLTS
and who contracts for such projects with a rontmemr(a)licensed pursuant m the
conot'ha,LieensC Law. i.06 — SEWER &, WATER
01 no.esen,p,ander sfC. .B&r C n,.ods rcao;n
202 — UNDERFLOOR PLUMBING
Dwnm WORKER'SCOCIP1GNSMION DECLARATION 203 — LINDERFLOOR MECHANICAL
I It...by III!a,"Inder penally Cor pertary mleat ne muowlog deeUndions: 204 — UNDERFLOOR 'FRAME'
1 have :nal will maintain 1,Certificate of Consent to self-insure lar worker's 205 — UNDERFLOOR INSULATION
contpen,ta r, as provided for by section 3760 of Inc Labor Code. lar the 301 — ROUGH PLUMBING
per4nmancc of,hc work lin which @ie pem,it i•i.wfJ. ..r
0lhveandwillmaintinWarker,Coinpcosatmnlnwtaaec.awrfguiredbySection 302 — TUB & OR SHOWER
3700 of the Labor aro,for the performance of,he work for which this permit is
ufd.n�rworyerscno,pysati�,mm.uraoene:I�:Indpo3 9`: 303 — ROUGH MECHANICRL
Caoie/ [7�ro1i<YNo GN }� 304 — ROUGH ELECTRICAL
cE H:ICAJON 012EX3M1'T[ON FROM WORKERS
' 305 — FRAME
COMPENSATION INSURANCE.
(This menton need not hf cnn,pincd if the permit ix lin one hundred dollar, 306 — HOLDOWNS
,$I00)orlso) 307 — INSULATION
1«nify,hs,to the wifi rinainv of he work to,whim his permit is issued.I 300 — SHEETROCK
,hall not c:npiny any IMDOn In:my manner vo as a,become subject to,he Workers'
Compcnsatinn lots,of Califomla Date 309 — EXTERIOR LATH
Applicant 1, p should 310 — INTERIOR LATH
NOTICG'I'0 N'I'LICAN'I':11,ullcr nndln Illi,Cmtillc'nc of Exnm tion,You a um
belittle subject or the Wnrkcr's Colnpen,mion provision,of the lam
labor Code,you ust
O 0 laebelittledmimcon,plywimauchproviwronsonmspemJlsnminedamedmvoked. 311 — SCRATCH COAT
Z Z CONSTRUCHON Lfil AGENCY 31.3 — ROOF NAIL
' Ihemby hdot Ihemliac..ed(See Icndingagency fnnhe performmmf
ohne work fur sunt<n n,'Is permit i.,>aaed Igoe.3097,civ.c.) 501 FINAL ELECTRICAL' ENERGY
FLender',Name
Z Leader',Ado..1 502 .— FINAL PLUMBING ENERGY
U O r,:,t 1 nave cad alis a,fieaoon and v,ne,hal the anave orfnrm:moo is 503 — FIN MECHAN I CA ENERGY
enrr,o.1 Cosec m comply wab ail oily:,lad comity o,dinamfs and ,all laws relators 504 — F i1NRL U I I_D I NG ENERGY
O U m building conswaion.and hereby-amhud,e represfmatives of this dty n.enter upon
}F yIhn at commhinned pro',lar inspection purpom,,
welagreemscyan,eemmrvanakfepnan,IosstbeatynfCapcnim,egaln.t 505 — FINAL LECTRI L
V1 liabilities,'fail gn,ents,cost.and eapcmcs which may in any may accme against sail 506 GRS T ST
U Z
city In nmm<ucnnc nl'IhC • n'ng
of'III'
pcnnh. Date !!!
PI T DERS NDS NI I CO 'LY
WITHALL NON. I Issued by: -;M7 101P
Of CE NEC
.'s�Al ,eanvcont. ,r Lia Re-roofs 506 — FiN MECHANICAL
unzAR1 sus ATERIALSDISCLosultr: 509 — FI L GRADE
Wsn the applicant m future
n,'ddmg refapa,n aarcmnanalf haaatrous",atfr:d Type ol'Roof
asdellned by
th caperlina mm�ieipal c,ale.Chapter 9.12.and the Healfu and Barmy 510 — F IAL PLANNING
Code. 0 yes 25532110! 0 No
All roofs shallE§44ts1e° - @G0L1OPlDHtLrVDgWt7tR4CEbbeing installed.
wiH me nppream orfmme boOriagoccupam am eH,Iipmmn o,Jevinos'hill' If a roof is installed without first obtaining an inspection, 1 agree to remove
emit ha rardovs air contaminant,as defined by the[lay Area Air Quality Manugcmem
I,,,r,epi all new materials for inspection. Applicant understands and will comply with
O Yes 0N all non-point source regulations.
I have rout the LaarJons malvdal,reyuimmcat,nndur,Chapter h95 ,I the
Cvlifumiu Health&Safety GWC.Sections 2550.5,25533 and 25534.1 andetsmnd that -
itlhCnuildl at nurentlyhove atenana,hm it i,my respm,inilhymnotify the
am the ml talo is Ich m Iw inn prior to ix,u , tit
e°°p' ey. - � Signature of Applicant Date
owna -afd igen Date All roof coverings to be Class "B" or better