01090102 CITY
DVSIONO
IiPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10614 STERLING BLVD. JOHN OLLILA 01090102
OWNER'S NAME: APPLICATION SUB DATE
JOHN OLLILA 09/24/2001
PHONE: SANITARY NO. CONTROL NO.
C x z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
005,FOF BLDG ELECT PLUMB MFCH
5yi LICENSED CONTRACTOR'S DECLARATION ]obDescriptio
>Z:D 1 hereby infirm that 1 on licensed under provisions of Chapter 9(commencing
with Section 7")of Division 3 of the Business and Prornsions Codc.and my license PATIO �`.
C,z� is in full force and effect.
3 ed 6< License Class Lic.N
3 3 0 to
to
Cl
ARCHITECT S DECLARATION
u o g 1 understand my plans shall her used as Public records c4CD(�p�/L.
/�
u1 a E c—
1 O
i z<o Licensed Professional
G OWNER-BUILDER DECLARATION
= 1 maim affirm that 1 1. exempt from the Cessions o License Law fur the
!'z a following mown.(Section]031.5.Business and Professions Cade:Any city or county
$9000
Y F o hichorquirs,2 pemlil to construct, ❑r,improve.demolish,or repair any structure
pinhorusitS issurnacCalsona,dreliflarappoiCrom farsuchpamlua file.ugrwdmamment-
that hes licensed p fsuam to the Provisions of the Condon es License Law(Chapter 9 Valuation
(coo r gwthSeeu ,7000)of� sion3oftonBu;tpeaaamPms:
reomcode) '�1 . ,'rf,;'_r.. i
or that he is exempt therefrom and the baits for the alleged o:empdon.Any violation `
of Section 7031.5 by any applicant for a permit subjects me applicant to a civil Penalty
-
ofnotmoueban rvchundred dollars(5500)., 10 YFPN 1��AT ION !•' Occupancy Type
❑I,as owner of the property,or my employees with wages as their sale compensation,
will do the work,and the structure is not intended or offered for sale(See.7044. Required Inspections'
Buiiness and Professions Code:The Contractor's an License law does not apply a. 103 - UFER
owner of property Who builds or improves mason,and who docs such work himself
or through his own employees.provided that such improvements are not intended or 104 - REBAR.
offered for sale.IL however,the building or improvem al is sold valid as year of 105 - ANCHOR BOLTS i •' '
completion,me owner-Wilder will have the Widen of proving mm he did nut build to
impmrvefmpurpooeafsme.). 106 - SEWER & WATER
oi-asowmroftWfor apcny.aim6aclisoodycomorsidgwith licensed eortnmmr:m 202 UNDERFLOOR PLUMBING
construct the project(See 7044,Badness and Professions Code:)The Co mardor, 203 - UNDERFLOOR MECHANICAL !
License law does not apply m w
an owner of property.1W Wilds or improve thereon,
- end who contracts for such preci with.cenwctur(s)licensed pursuant a me. 204 - UNDERFLOOR FRAME - --- -
Contractor's License Law.
❑Iain e.cmptmndcr Sec. B&Peformisredw. 205 - UNDERFLOOR- INSUd�UTiIOI� ��.®
Owner Bate 301 - ROUGH PLUMBING Y�'''6"A"�aY" X
WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
Ihereby affirm under Penalty ofproveyone ofinefollowing declamdons: .303 - ROUGH MECHANICAL NOV 2 0 2001
EI L have end will mmmun..renin to of Consent to sdbut,am for worker, 3 04 - ROUGH ELECTRICAL
Compenxmion, as novided for by Section3700 of the Lalor Code for the
pafarm.ncc,othe work far,whlchthis pemmisissrrol 305 - FRAME BUILDING
0 have and will maintain Worker's Compcnmt pun Insurance,as required by Section 306 - HOLDOWNS
3700 of the Ichor Code,for the performance of the work for which this pamI,is 3 0 7 - INSULATION
issued.My Works Y.Co D< lit 1 uwnce aamv aM Pobry be art
¢ ;- ,SHEETROCK
Can f sty CERTIFICATIONOF.EXEMPTIONFROM WOR KERS" r. 30 `r c. +, t t
COMPENSATION INSURANCE' , "3101
EXTERIOR• LATH"
'.; ......_,- 31'0";;=;' INTERIOR...-LATH__.., — _ ..._.- ._._.. ..
section need not be completed if the permit is far mm huddre i dollen j'-
(sl00)orl�.s.) , 311 - SCRATCH COAT
1 ccA;ry that o the performance of the wok for which this pemdt is IssuM,l
313 ROOF NAIL-
,'hall not employ very person in any m.nnv,so...become subject to It.Workers' 501 - FINAL ELECTR I CAL' ENERGY
Compensuki Laws of C.lifomia Date
Applicant 502 - FINAL PLUMBING ENERGY -
NGTICETOAPPLICANT:If.aBermakingLhisCenificaeofEsemplion.youshould 503 - FINAL MECHANICAL ENERGY
bec oms subjauo me workcfs Compmmuun provisions a(Ihc Labor Code,you must
Q C) forthwith comply with so ch provisions or this Permit shall Wdeemrdmvaked. 504 - F.INAL BUILDING ENERGY
�.M 'r -CONSTRUCTION LENDING AGENCY " 505 - FINAL ELECTRICAL ,,,
_54 ' I hereby tifoo d m there is a convection lending agency for the perform.n —
ormewnrkrn,wmrnmi:permd�,i,wwlser.3097.cv.c.) 506 GAS TEST _
-D z LedU.der,rvame- 507 - FINAL PLUMB bNG.
Rt Iander's N... .
UO I cernify mat l have real this app0cmlan.ad sum,mat mo.ba.e information is 508 - FINAL MECHANI CAL
kct [.+ correct.1 agree m,mmvly with an city and county ordinances and state laws rela ing 509 - FINAL GRADE
0 mbuildinge nlruini :tial hereby mchonze representatives of this city to enter upon
'he aWvementioned popenyfor inspection parposes.,, 510 - FINAL PLANNING
t-y (We)agree to save,indemnify and keep harmless the City of Cupertino against
Zi liabilities,judgments,costs and expenses which may in any way accrue again said 514 - FINAL PUB I C WORKS
U.Z City in consequence ofthe granting ofmis pemdt.' '
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1;'NON-POINT IssuedDate
SOURCE REGULATIONS: y
Signature of ApplicaMCmorscmr. ' Date' Re-roofs
CMe;
will
n25S3HAZARDOUS MATERIALS
accept
DISCLOSURE' '
., Win the applicant nof Curt WIdidgle. ,rant core2.handl haiallousmmenm Type Of Roof
as defncd im me 321 y?no Muni,- <pel Cad Chepm 9.12.and the Health and Safety
255321 y?, t:j , r- ; i: f 'rr, tG f� a ,,.i•: ` r.9.71-S��.t
❑res " ' ❑rvdr'. .... All roofs shall be inspected prior to.any.roofing material being installed.
Will the applicant or future Wilding occupant'use equipment or devices which If a roof is insialled without first obtaining an inspection; I agreeto remove
emit hazardous air cmorcro ants as defined by the Bay Arta Air Quality Managemem
Tommy all new materials for inspection., Applicant understands and will comply with
❑Yes. - ❑No. ;, all non-point source regulations.,
.- l have read the hazardous'drucnms requireman under Chaptc,6.95 of the
Cali humid Health&Safety Cole,Section 25505,25533 and 25534.1 understand that -
if Ne building does not currcntiy have a tenant,that it is my responsibility to nmify the
occupant of the"coaments which must beniet prior to issuance of.a Cenificate of
«`.p?"`y' - Signature of Applicant Date
Our der,moumanaee agent Deno All roof coverings to be Class"B"or better .,
OFFICE