01010106 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS PERMIT NO.
10448 VISTA KNOLL BLVD 01010106
OWNER'S NAME: AI'I'LICATION NOR DATE
KUMAGAI ROLAND N AND BETTY J 01/23/2001
PHONE: SANITARY NO. CONTROL NO.
Oct
Q O ANCHITIiC'r1liNGIN1?I?N: BUILDING PERMITINFO
IILDG IiI.ECI' PLUMB MIiCH
zu
mL LICENSED CONI RAC'OACS )FOARATION
z z y f thereby afrr;a that 1 am fcen:�d under pn„i„on,ofChapter 9 tcommendnF Job Description
�m_ with Section 7(XA)nfDlsision3..l the R.,ine.amml Profewions Code.and my license
mm�fnr.'eandcfr.'ct. ADDTN TO SFDWL 101 SQ. FT. LIVING SPAC
Od W a License cors Li..x
Date Cmamnar pI N A LE D
IYil 3 a y ARCHIrII,mJ m r
S OIsCLAHAI ION
I undcatmnd my prem,hall he epublic coNa
px Lren dprNustnnal NOV !,1 2001
OWNER-BUILDER DECLAHAl10N
=m 1 hereby am.That I ane o,eapt from the Contractor's Licence law for the
”] Ii llnwin,rearon.(Seedon 7031-1.Ba,,incxn and Professions Code:Any city or county
a' O which requires a permit it,eommn r,alter,holoov.demnl sh,ur tepnir any structure
thus he s liveuanc<•,�ho rcyuirc, o Ba wch penm�n Breve L w(Ch pl eat
t.3— thmbei,sin, on Section 7(X )provisions,tinf the UmmnoJa Lancia lawln,Clsc) r lee VillnilllOn
a.,.. t la,I,exclo sccdan 7a);I ofn,b.oi, l or Ina R,di c, and Par..ion,code) 49661
of
ha is 31.5 b t.,I,I,n.and Ino bu,i,Gar the alleged c ngminn.Any vl..larion
of Seedno lolls by any dred d ll for a p<•rmit,ubjms the apPlieam m a civil penally
nrnmlt�t<tnanreenundmadounm(sstro). APN Number Occupancy Type
❑I....ownerofthen•o,dy.mmynnnpinyce,with w:.gexz, Iwi,,maca.....mns"don. 32613061. 00
will do the walk,and the nl ucmrc is not intended nr offered far,ale(See.9144,
Business mad rmr„b,n.Cude:'nm cammeta.,Leense Law due,not apply to an Required Inspections
r of pa)Nny Who Budd,or improves thereon,and who due,such work himself 101 — FOUNDATION
mhrough his own<rnployees.provided that such myth v eat.are not intended n
,it through
tot am. IL however,Inc Wildi..g o i..mnweueoai.n,am within are year.,' 102 — PIERS
completion.the owner-budder will have the burden of pro.'ing that he did not build or
mw fm pmrpo,e ofame.). 103 — UFER
oflhv no,IIy,am eauwsivul.. n,tlug wiu hc,o,ed c...ttra.mn m 104 — REBAR
L,naruclwthe project Sec.71"4.Busine.0 and tPrnfcsxions C(dc:)'fue Contmctor'n
icense U.ones eta apply to an owner of property who builds or improve Ihercon. 105 — ANCHOR BOLTS
and who commcls mr such projects with a<nntmangx)licensed pursuant to the
C...nra"ors Lice,e Law. � 106 — SEWER R• WATER
❑I land. a ,]I&]/ beflo,reason 202 — UNDERFLOOR PLUMBING
s - 7 0/
"Bull U1111"IAnaN rnlcLnanru)N 203 — UNDERFLOOR MECHANICAL
fhercby:mtnr under penallympenury one acme mn.mmg decmmtiun= 204 — UNDERFLOOR FRAME
❑ I have and will tmtintain a Cenilinuc of Consent In.self-insure for Wndcr'.v 2205 — UNDERFLOOR INSULATION
Compensation, as pnrvlded F®r by Soo.,.. 37k) of the Lubar Calc Fn the
penia,aneenfhework rorwhiclnmi, ruotI,issued. 301 — ROUGH PLUMBING
❑I have and will muima ll Walker's Compcavtion Insurance,its required by Sectio 302 — TUB & OR SHOWER
3900 of the Labor Codc,For the pcnunnanca of he ward.,for which thisperoul N
issued.M,Worker',Caupcn,ad( m,urance earlier and Pancy numner,are: 303 — ROUGH MECHANICAL .
carrier: I'nlivyNw: 304 — ROUGH ELECTRICAL
CIiIOIICATION Oil CXIiMI'I ION FROM WORKERS' X05 — FRAME
COMI'I!NSA'1'ION INSURANCE `�
Ina%.cation need not lx completed ifthe pemnit is for one hundred dollars 306 — HOLDOWNS
15100)alex,,) 307 — INSULATION
I call that in the wooduance of the work for which this(enot is issued.l 308 — SHEETROCK
.hall not anploy any permn in any canner.w as to Mame subject to the N'orken'
Cannpenxad.ml.awsafCallmr..ha.Date 309 — EXTERIOR LATH
Applicant
NOTICETOAPPLICANT:IL alter making Ibis Crodleme of lisemplin I. ,it,should 310 — INTERIOR LATH
becmnesubect to the Worker's Conapeasadon pro,iioa oflhe"fall Code,yan oro,.
C O fnnhwift ccrad,with such pet, ion,or this pennil.hall be dttmd 311 — SCRATCH COAT
ed revoke
FCONSIRUCI'ION LENDING AGENCY 313 — ROOF NAIL
ai > 1 hereby affirm that thea is a con,u iowin lending agency forme performance
of the work forwhich his .it I,issued(See 3(191 Ci,C.) 501 —
FINAL ELECTRICAL ENERGY
A [,cad,,-,Noma ,.a —
D z 1<nder',Addrex 50c FINAL PLUMBING ENERGY
V O 1 certify that I have lead this applic,dion and state that the above infounratio.is 503 — FINAL MECHANICAL ENERGY
W E.. Curr"'.I agree'.amply wiu ill'quad mum,ordinnrov,and ,are hnwx relalm,
O v to Wildh.gIt....cd...I.and het,hy nOhorve rapm,emadw,ar tld,city to rule.upan 504 — FINAL BUILDING ENERGY
IT, Bac alloc mentioned purely list inspect......o"ves.
.}�'. (We)agrccrosme,indernrifyaadkccphiadc,stheCat afCnpeni.u.,.in,t
an — FINAL ELECTRICAL
li:bilities.indgntnus.Gori,andcspensowhich.nayinan,way aeemeagainst aid GAS TEST
U .7J- City ina.nxequen.'u of the P,uaringd thix permit, —
APPLIC STUNUERSTANDS AND WILL COMPLY WfrIIALL NONroIN'I' Issued by: /'11 Date
SOUR HCGUI ATIONS _ y' — FII II tb RLIJMB I NG
X 508 _ FINAL MECHANICAL
sig e " m, c, avaaur — u:.Ie Re-root's
AZAHDOUN MA'1 IALS UISCLUNUHE
W511 the ap uam orlumrc tuilJing arupam scare or hamlle hmaNnus mmedW Type of Roof 509 FINAL GARDE
as defnel by the Cupenmo Municipal Calve.Chapter Y.12,anJ the Health aha Safety 510 — FINAL PLRNN I NG
Code,S,,Coo 2551200^
ID yes L1 No All roofs Shall be j3UNcted 01)"ALnl LnaVB9ltly Jtg installed.
Willda,applicant or let..building.ce.panl use eyupticul or device,w hill' If a roof is installed without first obtaining an inspection, I agree to remove
emit hvuNou.Bir co tall.-N ns defined by the Ha,Area Air Quality Managumem
. District! all new materials for inspection. Applicant understands and will comply with
❑Yes 11 No all non-point source regulations.
1 how tcad the h:nurdous materials requirements under Chapter 6 9 of the
Calilbrniu Health Pe Sutety Cn Is,Seoi..nx 255115.25513 and 25514.1 tool—lae l mut
I""Wildmy does nor cmrendy have a tenanf Out it ix my responslbil'ay In nmily tha
acupam of the rcyuiremcnt,which moa he me prion..iuuunce of a Cenifca¢of
° Signature of Applicant Date
All roof coverings to be Class"B" or better
OFFICE