02020112 CITY OF CUPERTINO . -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: -
BUILDING ADDRESS: PERMIT NO.
'10627 N 'STELLING RD. 02020112
WNER'S NAME: - APPLICIiTION SyB DATE
WILLIAM SEET t3 02/ 28/2002
(7- PHONE: ' SANITARY NO. CONTROL NO.
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nO'O ARCHITECTIENGINEER:"• 'BUILDING PERMIT INFO
z w C BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
-5 L= lob Description
>ZNC Ifics.7 fofDofrinno tla licensedude po ons fChaptn9lcocry¢cense SFDWL-NEW PERMIT REPLACES #53873 (OLD SYS
ml-u1 wnhS ct ]lro0)Df DI sn dot thB p JP ulc'.� CWe a ylm license
f-y Ism f 1)Rpa od e(fcit s / Y
'=a� LIe< cVFm t Ptlf P'' '� 5!3`l r QyyAALRLe INS PECTION •MUST BE ON NEW ,PERMIT 4020
IDa11lh 1 TSC Nra[IOY J W? rA." ��Wrn O�.�
3 u O ARCHITECT'S DF,CLARATION
1 ti demm�d my Plans shall be used as public record
]-,o AUG 14 2002
Licenced Profeaionel.. .. ..
o� OWNER-BUILDER farm
Connector's
1 hereby.(Toth on 11. exempt form the Cion, o License Law for the
h Z Q .following masa.(Semon]onstr B.alms, and Pocnve.demob Code:Any city nrruutny
I F O whrth requires a perm I I construct. II[r 'mp demolish.sh p y taNnum B 1'1 Di /�
z Pao t t ane also 9 $the PPlic tf hp in fl 'g dnmemenl I�IJ L 1 l .- ._ - .. _- _....__._ _..____.
a3- �lualnyel[�. aprsbapll mePmainp rtMc I tr'nL "'upon' S .Ft- FloorArea a a•rux Valuation
an gwmSpu ]nooi fDvisi 3 nn BF cs. JP r nncoae) {,�;B�.;j-N.'+•9 itis. t.'ar tiA t.. S_•_:; a, \:
or Thos he is exempt don from and the boars for the allegc0 c ran mn.Any violNion of Section 7031.5 by any applicant for v permit subjects IM1e applicant to a civil pansy
or not more than five hundred dollars($5001. APN Number Occupancy Type
❑Las owner of the property,or my employees with wages as their sole compensation. 101 -
'
Will'do'fim work,, ad the'structure'is a.,intended or ofered for awe(Secrnua, - 102 - PIERS Required Ins ections' t`
"Bhsineis and Professions Care:The Contractor:License Law does not apply to an q p •"
owner of,rnpcny,Who build or improves thereon,and who docs such work himself 10 3_- UFER
or through his own employees,provided that such improvemsrc entanot intended or
.offered'for'rate,If.F6wiver,the building or inipruv�mem is sold within tine Yn of " ' ---10
- --- ------ -'-'_"—"---'",-�.; _- - - ---
eompletion,the owner-builder will have the burden ofproving thin hedid act Wild or 4 - REBAR .'ra:;. •....
improve for purpose or dale). 105 - ANCHOR BOLTS
P u,Pmr fids with Iimnsc The
c to
:s: OLuowncrbiihe pmpcny.rvm exclusively 6wi - --construct the project(Sec.]too.Busmen$and ro, nom Wald,
or The Colnmc ton. 2 02 - UNDERFLOOR PLUMB1NG
License law does not apply too.owner of t no builJx nr int thereon,
..and..whocontmas.for such povjttss wnh.a.contractor(s).liccnsed.vunuant to lne. ._ . _-_—_203 - --UNDERFLOOR-MECHANICAL----
cmicannr's License Law. . . -
❑IameRemplanaef,sec. ' - " '' 'B'&Pefor thiartamm. 204 - UNDERFLOOR' FRAME
--
ower Mme u 205 - UNDERFLOOR INSULATION
r„, ORKeR�slco'MrENSAnoYnL+ RAVioN 301 =•t-ROUGH ''PLUMBING >
Inercby aro- vderp[n 11yl kw,'o fine fnlmwng aalamii ai'” 302 - TUB & 'OR SHOWER
❑ I he and will
maintain it Certificate f Consent to ale more for Wmm,*a 3 03 - ROUGH MECHANICAL
Compc s on, or pr v ided fmby Section 37W of the Labor Cads, for he
- - perfummnceofdicwork far which this ximiti:issued. 304 - ROUGH ELECTRICAL
❑1 have and will maintain Workers Cunpeniaiion Insurance,as required by Section 3 05 - FRAME
3700 of he'LaborCode:for the performorm of the work for whim this Permit is 3 06 - HOLDOWNS
Issued My Workers Carramosdo.luminance carrier ad Pail cy umbc
--. -307 _" .INSULATION._
_ . .- . .
Nw:
9CERTIFICATIONOFEXEMPIONFROMWORKERS - '• I dagt'308v�}I'SHEETROCKII'�' ^'• l -11
COMPENSATION INSURANCE'
+--.,.._ .:. .; ...;, .....;. .,. . ._. ..
(This union need not be completed if the permit is for one hundred dollarsr.., „ 1.•.t.,_ i __
aloo)one.a.) 310 INTERIOR LATH
-•311•„_.,'SCRATCH-COAT _
1 cert fYihat in the per(rmance of thCwork for which this pcmut ii ssmed,1 1
•droll-of ply any Person m any manner s ;,to become subject i the workers 313 - ROOF NAI li `'' ' - ' - ”' r
compet ragnorcmtfom.,Dam Aprilmom _-. .. , . . 501.--...FINAL ELECTRICAL ENERGY __ .. __.-
NOTICE TO APPLICANT If,after making this Ccnificate of Exemption,you should 502 - FINAL PLUMBING ENERGY '
become subjectto the Workers Co nNisalion provisions of she Labor Code.you must
n
O 0 forthwith comply with such pravisions or this laws t.shall-be.de.emed reo.ked. 503 FINAL_ MECHANICAL. ENERGY _
,s "CONSTRUCTION LENDING AGENCY 504 - FINAL BUILDING ENERGY� -
.' "'t 1 hereby affil (hat them a con wmm�lend ng age cy for the performance _ -
L'QwtheWork for whichlhis permnlsl wdse,3N7CisC) 505 FINAL ELECTRICAL_ _ __ _ __.Lauder.,Nlme•:. , . .._,._. .,. -r..�. ..
Leda neakI.i.. - -" 506 - GAS TEST .
-V-0 1 nrythat In athis pvrpt astate mptthbu r„natiomi. 507 - FINAL PLUMBING
.):orrcn l grams'.omply, thall6tydnd' my rdmons, alldstate law;odim, 508 - FINAL MECHANICAL
( O r,J to buJdmg construninn:and ncreny amhonu rcprcAM.ipev of th5,cny roamer upon
W the abs a moralmctl plopefly f wins on purposed } .�' - '; 509 - F I NAL'.GRADE
0. (we)agrea to mve; ndcmnify and keep harm less the Ory of C.'mrio,timst -
-y liabilities,juE,meat'.anis gId cxpenus whim may int any why accrue againn said 510 FINAL PL I NG
. Ute Gny.n eonagaeme ser lne granting omnia Pel,nit.' 514 �. N WORKS
APPLICANT U, ERSTANDS AND WILL COM PLY WITH'ALL NON-POINT Issued l�'O Date
SOURCE REGULATIONS:' -
. ,.
signature ufApprcantiContrallorDate . Re-root6f7 - ROOF BATTENS
y - :(
HAZARDOUS MATERIALS DISCLOSURC ROOF IN-PROGRESS. - -
tolllhcapplicot "Tut ebmkimg occupant stow or handle haivdous materiel Type 01`1C(1®f.
''defillr4 by the Capscomm CaperM icipal Code,Chapter 9.12,and the Health and Salary - I f r,i S .
Coad S cl on 25532(e) s't I.
_art ;. �oNp. I"a tyf- _All roofs shall be inspccted,prior_to-any roofifig material,being.installed. _ __ ,...
Will thapplicant or future Wilding occupant use egmpm nl ordevices which If a roof is installed•without first obtainingan ins ection, agree ree to remove
:mth ao air contaminants as defined by the Bay Area Air Quality Management p g
Dintncl all new materials for inspection. Applicant understands and will comply,with
❑Yea ory k - ,, ; all non=point source regulations .,
i' I have
hazardous mmcnvls req"r<mcnts under Chapter 6.95 o(.the
Califon"."obb&Safety CddcSecuons 25505:15533 and 25530.
Ifshe snitch,Jncs not eumenlly hvveamnan6 thauus my responsibility to notify the ""
sacbpans of the rtquir<memx which must be mei Dior m issuance of a Ccnifirase of
Ob use t`Y' " Signature_of Applicant Date
'" r ow.gprw.amodzeaagapt, o.m All roof coverings to be Class"B"or better" ,
�,r e t. :.. .: •- . ,. .. ... . - OFFICE . -. .. ..