00070030 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CON'T'RACTOR INFORMATION:
BUILDING ADDRESS; I'BRM I r NO
).
OWNER'S NAYE APPLICATION SUB DAP I[
0560 STOVES AV JENNINGS 00070030
PHONE. SANI'T'ARY NO. CONTROL NO.
JENNINGS 07/07/2000
p¢2 ARCH]'1'EC'VENGINEER: BUILDING PERMIT INFO
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LICI?NSE:DCONTRACrOR'SDECLARAnoN Job Description
z C I herby nlrrfa mat I Bin Ecm,md Inde prnvlxions of ChuPnr,9(nmmmncin6
rr_�J with Sermon7b0b)nf Uivisinn 3of,he Nusinet and Pmfcssinns Cute.al licence
t
1:ac
Ielidl l... rRcat.
m e, ])are Cl... - Lic,a
to 3 a N Iymc GDf;CIAf
F m O ARCfIITIiCr'S DLCLAkAr1UN 'j Z
g 1umderaandmyphosshallheumda,publicrecords ADDITION
c'o Licemed rrte,slonul
c w o OWNER-BUILDER DECLARATION
hereby elrrm that 1 ma a crop,from the Contractor's License Low for the O
G a fnhowing Sec,...rcamn. ectlon 7031 5.Iln,in„can I P Fr,sioos Core:Arty city or,o y
x e which rryuims a pentail,o crnome,,alter,improve,de tolinh,or repair ally,vucrre
Lap prior to its issuance,also y the applicant for ch permit ]!to signed sw,ment
'
rat he is iic,n,ipotu „ n .........rout the c inallor,l, la (C1agacr9 Sq. Ft. Floor Area valuat' n
hamoratneirl ',h Sect 70p)of Division 3 of the B . es d Poqcs%ioq,Cole)
or thill hc,s esemp,ill e..t and,bc basis for the alleged esaup0on.Any inlatima
of SeNnn 7031.5 by any applicant for a permit sobject,the upphront too civil peordy
of not more that.five hundred doom.(S500). A PN Number Occupancy Type
El L,e owner ofine propery,or my employers with wages an meh,ole cmmpe,meean, $45000
will do the work,and the amore o,nn,intended or olTcied for sale(Sec.TW,
Brone"and Po,fc,.mml Cock.:lir Copo-aeor,License I.aw mon,not apply ro nn Required Inspections
,weer ofproperty Who laild-anoprove,thereon.a adwIt.does,.,Itand,himself 3222648007. 00
or through his own employees,provided that such improvement are not intended or
offered for sale,IL howcv.+, It,building ur i,n,a'mcmcn,is mid w'nhin one year of
ompdeion,the nate,builder will love the burden of proving that he did not build or
mpmvefr"lrpo,eor,alet. 101 — FOUNDATION
A. r onhe rrol,err,am encwamay rnntmerng whh Beer,ce cammmors n, 102 — PIERS
timet the pmjecI(Sec.71U4.Business and Note—or.,Cdlel Toe Coloratura's
;Lice a Law doe,no,apply m art owner rI propcny who hdm,or inpm.es mercnn, 103 — UFER
and who contract for such project with a comrxmr(9 licenced pursuant In the
commewr',Licets - 1.04 -' REBAR
OIa"' ' d S E _ _'°,tape sury 'a 105 — ANCHOR BOLTS
owner u^ D:u, 111— 106 — SEWER &' WATER
IIHKEk'b CO 1'EN , PION DECLA ON
Ihe<by mrnr ruder penanyorperjuryono of me fn owing dochmmm,: 202 — UNDERFLOOR PLUMBING
0 1 have and will maintain a Certificate or Consent in self-insure for Worker, 203 — UNDERFLOOR MECHANICAL
cootpet,oner. n, provided for by Sor6on 3700 0 in, Unfair Codesur me 204 — UNDERFLOOR FRAME
performance offal,work for which this permit is issued.
01 have and sill maimair,Woke"sCompcn,atioum,mmner.asrequired bySection 2205 — UNDERFLOOR INSULATION
37011 of the Labor Code.for the perfororance of the work for which this permit i, 301 — ROUGH PLUMBING
issued.My Worker',Compemation Inmrmcc carrier unit Policy number are: -
Carier: PolicyN.,: 302 — TUB & OR SHOWER
CERT I FICNI ION OE EXEM PTION FROM WOR k ERS'
COMPENSATION INSURANC303 — ROUGH MECHANICAL
I! '
(chis section need not be camplct,d if the permit B for one hundred dollars 304 — ROUGH ELECTRICAL
(slmlrle,,.) 305 — FRAME
I redly ha in he p.I....nanre or lie work for wrich this rcrmn is Issued.1 306 — HOLDOWNS -
,hall amt employ any person in any marier no as m Fl object In the Worker,
Compensation Law, ifca)mnnia.[)are 307 — INSULATION
Applicant
NHTHCETO APPLICAN7F,If.rare,cutting this Cenifirme of lFaculailm. .it should 308 — SHEETROCK
become subject to the Workds Compensation provision,of the Labor Gude,you mus,
O ZO
Bob.ill it lywith,act,prov.eiomormispe llo'hallbede,i,,lowokesL 309 — EXTERIOR LATH
Frr CONSTRUCr1DNLENDING AGENCY 310 — INTERIOR LATH
� > I hereby alimn that mete i.saconstitution'lending ugenry for lie mallama1eL31.1 — SCRATCH COAT
of the work for which this permit is issued(See.3197.Civ.C.)
i c Lemle,Adele 31.3 — ROOF NAIL
Z Lenders Addrcs
U O lcerifylbmlhavcrcmlmikappftcanonanshare thin due above immrnnaanis 501 — FINAL ELECTRICAL ENERGY
Pcorrect.I agree u,comply with all city and county ordinances and,late laws rela,htg 502 — FINAL PLUMBING ENERGY
V ntbuilding contraction. dh M1 tho representatives fth.city to ter upon
me above t r ,s ur pct ........ 503 — FINAL MECHANICAL ENERGY
tr„ y (N ) greet indemnify ,,A p 1 rink.. he Cil,ofCupertinoe ega aid /�
Um City in 1dg t. < , d bene, lin ynany y < against aid \x) 504 — FINAL PUILDING ENERGY
V Z C'ny ,const s I,hssttb' i y fW p.....t
f4N U -T11NI 'ANDWILLL"OMPLYWITHALLN WPO NT Issued by- 505 — FINAL FI Fp:TRTf'gLDate
nOb — URS TEST
SOI i yVV{` 1��.���
sign ureof Apphcanvcontor r Date Re-roofs —
BAZARI tS MArr:R1ALS 1"LOSURF. 507 FINAL PLUMBING
Win nue applicant or m e budding oce,y,mn mon,or Name ba ardrnty ntmcri:d 'Type of Roof
as defined by the Caperton Municipal Code,Chapter 9.12.and the Health and Safety 508 — FINAL_ MECHANICAL_
Cade Section 25532(a)7
Oyes 0 N All roofs Shull`[i39ispecde$pfP4Lto(DRMMting material being installed.
Wa Ifeapplicant rrfuture building ocemar,rolrrlury,memordevice,which If a roof is ins'5110 withgtglfRLotpLLP'll�h?4Pdl ection, l agree to remove
emit humrdtmm
oms air conninams defined by the Bay Area Air Quality Managcmcnt
Grind?
❑No all new maleri�TPpriusReQti�ApbgLntIIOndg y�and will comply with
all non-point source regulations.
1 have read the haenrdous material,requirements order Chapter h95 of the
Celil'ornia Health,@ Safety Code,Sections 25505,255]3 and 25534,I nndemmnd mm
if the building does not curendy have a mount,that it is my mcM,mibility to notify the
occupant(if the requirentaam
s which rota be tire[prior issuance Df a Cer ircale of
c`upan`y. Signature of Applicant Date
Owner oraumod,rdrge,t Date All roof coverings to he Class "B" or better
OFFICE