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euanwc n[v[sior PERMIT
CONTRACTORq it INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
822 STENDHAL LA
BATHROOMS BY REMODELING
SPEC 02010100
OWNER'S NAME:
BOYD THOMAS C AND JANE P
1422 SARATOGA AVE
APPLICATION SUB DATE
01/24/2002
�PHONE:
(408)328-6700
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
IJ L_J L _J L_J
i LICENSED CONTRACTOR'S DECLARATION
her that
amrmmatlamranam,ir.,, under (commencing
I am of Cs
Job Description
LL ction70eby
with S<1 b0001ot she Busineasand Props
Code. mylicense
ndPion:°ionsCcervse
'
REPLACE
BATH FIXTURES & TILE
no
in full force an c
< Class jYi L Lie. as 0 3
_
Date d!A n Contrxwr
9
0r AR HITECT'S DECLARATI
5 I understand my plans shall be used as public records
OLicensed Professional
OWNER -BUILDER DECLARATION
11 1 hereby affirm that 1 am exempt from the Contractor's License law for the
0
a following mission. (Section 7031.5. Business and Professions Code Any city our county
$12442
.. which requires a permit to conxtme alcor, improve, demolish, ores air any structure
$ priora
manse ce. alsoaqubhe shi for such PermittoLice Laved statement
- iiitoils
wisio s o se
of the Conuacmrs Liccnsslaw(Chapter 9
that He enIicros.it Pursuanttotheyro Division Cone)
(c"mmhei with Section•T000) fDiviasisorm
�f�a p p,��q t'I •
"3'�J; ti
Valuation
E.
V,llt:',U V]"%',t
'
aeueddomdProfessions
of that is ...rept my pplit on$ for basis for the alleged eiFinant to Any violation
of Section )OJI i by any vpplicant for a permit subjects the applicant m a civilPenaltyj�ts.ba"a}a,a�
'of net more than fi-o hundred dollar, (SSW).
10 �'PN - L"C.9b DATION
Occupancy Type
❑ 1, as owner of the propeny, or my employees with wages as their sale compensation,
will do the work. and the structure is not intended or offered for sale (Sec: 9044,
Business and Professions Code: The Contractors License Law d«s nes apply to an
103
- UFER Required Inspections'
owner of property Who builds or improves thereon, and who docs such work himself
104
- REBAR
or fhroupW his own employees, provided that such improvements am not intended or
'f - .
" 'ANCHOR
-- - -.
offered (or sale. If, Howe-"" the W t1din r t is sold within one ear a(
gob imen of pro r
completion, Jrc awne"W elder will have tW W Ncn of proving Wt he did nes build «
105
- _ ._ .._ ...... _. _.. _ ..... _
— BOLTS
improve forpurime.fsile.).
106
— SEWER & WATER
O I'n owner of th. propc,y un cxciusi-dy comma ing with llkrnscE contractors to
- 2 02
— UNDERFLOOR PLUM E ®� '
eonsouct they ojec, (see. 7044. Bull" a and Profession, Crede:) The es Contaactors
License Law docs not apply ro an ow., of property who Wilds or improvtMreon.
2 03
— UNDERFLOOR MECHANICAL '
. W .who convects for.such projem w.id, a eoataaetorfa) licensed pureuam.to the
Gona,nta sLicenseLaw
-'
- 2 04
-- UNDERFLOORFRAME-
2 1-2002
olam.aemvr unaib sec, a&Pefor his r�on
205
- UNDERFLOOR''I•NSULA
Owner. Date
301
— ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
302
- TUB & OR SHOWER BUILDING
Ihereby Affirm under Penalty ofPerjury one ofthe following deelaratiots:
303
- ROUGH MECHANICAL
0 1 ha -e and we msmut a a Certificate of Conant to mIf-incur" for'Worker's
3 04
— ROUGH ELECTRICAL
Compensation, as provided for by Section 377 of the Labor Code. for the
performance of the work for which this permit is issued.
3 05
,
- FRAME
have and will maintain Worku's Compenvtion Insurance, u required by Section
3 06
- HGLDOWNS
W of rhe Labor Cod., for he perforanance of the w.&J.b which hila Palms is
'I/
3 0 7
— INSULATION
issued. My Workers Compensation Insurance carrier and Policy number are:
Carlen STRitiivl�
_-.-. _.3.O.B;
$HEETROCK':. .. .............._..,....'- '..` ..
iCERTIFlCATIONOFE%EMPTIONFROMWORKERSSOT�
x'309''_''EXTERIOR'
LATH
COMPENSAnoNmsURANCE':_.:..:
_ ... ..3 TO'
--IN.TERIOR LATH _.... ._ .. _...... _ .
1'(rhis section, need not he completed if th. permit is f« ane hundred dollars
3 11
— SCRATCH COAT .. , ... �.
(510(7 ar less.) .
candy
3 1'3'
— ROOF -NAIL
Imat m the perforinnnc. of m. wort hkh the: permit'u issueE; I
shall nes <mploy ony, person m, manner so subject to the Workers
501
- FINAL EliECTRI CALENERGY
f "im o¢ '
Compensation laws of'
Applmant. -: /'...
502
503
— FINAL PLUMBING ENERGY ...
— FINAL MECHANICAL ENERGY
NOTICE TO APPLICA, Ifeller making thisCmificate of Eacmption. you should
subject to the Worker's Compensation provisions of the Labor Code, you must
jbecome
forthwith comply with such provlamns or this permit shall be deemed revoked.
.504
— . FINAL BUILDING. ENERGY
i CONSTRUCTION LENDING' AGENCY
SOS
- FINAL ELECTRICAL -
I hereby affirm that then is a construction lending agency for the performance
' of the work for which due Pem0isissued (Sec.3097,Civ.C.)
506
- GAS TEST
Lender'shimns"... .. .. .. _. ... ..: ..
Lmder'aAddrear
507
- FINAL PLUMBING
Iemify that I bxwe read this application and stale that he above information is
508
— FINAL MECHANICAL
correct.I agree to comply with all city and county ordinances and stere laws r ing
509
- FINAL GRADE
to building convection. and hereby autho izerepresintatives of thii city to enter upon
theabovementimcdpropertyforinspectionitrPose,.
510
— FINAL PLANNING
(We) agree to save, indemnify and keep hamdess the City of Cupertino .,at
0 liabilities, judgrMnts, costa and expenses which may in any way accrue against said
514
— FINAL PUB IC WORKS
C City is consequence of Ne ren ting dfthtspemar
y SWR'APPLICEREGL\DE S.•DSANDWILLCO)IPLYN'ITHA�Kfy�POJ\-r
Issued by:
Date l Z5_
Sigoamr"'o ApplicanVConrractor ", 'Date
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE
Will die applicant can home Wilding occupant store or handle haiadous minimal
Type.of Roof
.... -.. -.. __..
M defined by Ne Cupertino Mun' spat Code. Chapter 9.12. and the Health and Safety
•' s
Code. Section 25jR(a11
0 Yet';' "°`'
_All roofs shall
be inspected. prior to any roofing materia] being installed.
Will the applicant or future building occupantme equipment or devices which
If a roof is installed
without first obtaining an inspection;'Pagree to remove
.coir haaardous air mummancfined by the Bay Ares Air Quality Management
Districtt, '�J
all new materials
for inspection. Applicant understands and will comply with
r.a No ..
-
' 1 have read rhe huardoui materials rtq°iremmti underChapter 6,9i of the
'California
all non -point source
regulations.
Health & Safety Cade; Sections 25505, M533 and 25534. 1 understand that
f the Wilding dues have atenant, that it is my
ria curirnfy responsibility to notify the
occupant of the rc which must beta", prior m Issuance o1 is Certificate of
Signature of Applicant
Date
All roof coverings t0 be Class "B" or better
pwnr or auNorizcd agent -' Data
' " " OFFICE