02060147 OF
CI BUILDING DIVIISSIIONN� PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
10398 WESTACRES DR BATHROOMS BY HANS 02060147
OWNER'S NAME: APPLICATION SUB DATE
SUSAN LONGDON 4986 TIFTON WAY 06/24/2002
HONE: SANITARY NO. CONTROL NO.
(408) 978-3053
G 0 zo ARCHITEC iENGINBER: BUILDING PERMIT INFO
K BLDG ELECT PLUMB MECH
trea-i I_] I- t - . L_I
z y Z LICENSED CONTRACTOR'S DECLARATION Job Description
O z y 1 hereby urfirm that 1 um licensed under ovrtloac of Chapter 9l commencing
I=_F 8 witn seryot�000)aromi:ten 3 none sa=ine find ,m, mo%Code.and my license BATHROOM REMODEL.
6 y y j is in full cc a eIf dp I�
c a ca 6 License lass I.it.N T O H'�P''"��
x O i u Date CantttaaCCl1pp__ Y
totl� ARCNffECT'S DEGI/ARA ION N O V 1 6 2002
g errand my pl...hall be uud as public rtc.m,
Y
ce se p O Licensed Pmfcssimml
OWNER-BUILDER DECLARATION
1 hereby affirm chat I am exempt from the Cnnwnor's License Law for the p /�
L Z a following reason.(Section 7031.5.Business and Professions Code:Any city or enunry BU I L'�y"1p,%0
o V V
O which re a roll m comWct alter im rove demolish or mind, n iWflurb
t giaseper p piray
a. pnono ficeuedpursr,r9uiine meappiicant(m suoM1pwme License ga (Chapter pmviziomo p Nj Valuation
mwheielianad pursuant (the the Brines and Pr taw(Cha ur9 S FL.Floor; day, t, ,
athmlhsingwhh,,hs.f.cBudfDi,dsmneon, flgdekerndics; A.oaseode) .f:(3i'r.(%35941t40e14';� e.r.'+3:1•:taxi_.. I
or mat he tt exemFs therefrom and me basis for the all�gdl efemprbh.Any violations '
of Sntion]031:5 by ony applicant Tor a permit sohjnrx the npplicam m a civil pmahy-
-of nor mom than ave hundred dollars($500. 101APN UUNN�`Ig BAT I ON Occupancy Type
D 1,as owner of the Property,Or my employees whh wages as their sole compensation, V
will do the work:;and the structure-Is not intended or Offered for sale(Sce.-70s ; -
Bininess'and Profession,Code:The Can rieno,Li=civa Law does net split,m w' 103 — UFER Required IDSA ections,' �
owner of property Who buries or improves tncremi,and who does such work himself
or through ms own employees.provided that such nnpmvementx are act imoended Or. - ..--- -104 _ -_REBAR -._..--.--- ..-..._I_
-offered for sale.IChowevei.the building or improvement is sold within one yew of Fit
completion,the owner-builder will have the baNcn of proving that he did ria build or 105 — ANCHOR BOLTS
improve for parreme of sale.). ._ SEWER .&- WATER-_-- ,
- -D1.mowner olthe ject(Sec.70am lBusinlssandlnactingwith licanudenmmractm 202 — UNDERFLOOR PLUMBING
icense Law project(Sec.yin a Business and Profusions Codio)Themrx Contractor's F, t
ndwhLcwtmetsfapply manownarmfprapenywho naild.,arimpmve,mer=an. 203 - UNDERFLOOR MECHANICAL
„and. h contmets fl- h projccs,vvim:.ca vmnur(s) liccnsd Pursmm m the -
204 - UNDERFli00R FRAME, •„
oi` t pt`and,,Se BgPcmrmureaan 205 - UNDERFLOOR INSULATION
o`"nCrDa" 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
I hereby ifbtder penalty oficnitry one of the following declasurns: 302 - TUB & OR SHOWER
m un
E.El 1 have and will maintain a certificate of Consent to self-iasom lot worker': 303 — ROUGH MECHANICAL
Compsconinn. as provided for by Section 3700 of the Labor Cee, in, me 304 - ROUGH ELECTRICAL
pefformance of wars.for which mi.Prior is issue.. 305 — FRAME
D I have and will rolintain Workat's Compensation Insurance.as bwmrsd by section 306 — HOLDOWNS
3700 ofib Labor Code.for the performance of tate work forwhich this permit is
-.
issued.Myw kr.c pe . c Insuranceea a mIPa1 y x : 307 INSULATION_,_- ,•.,,
.. ............ Ire
reaSidji IIS✓NT .palryv 1• , 308 -,— SHEETROCK.c, ,,,.a•,
;CERTIFICATION EXES 09 FROM WORKERS' a+. 'sS.1 .
COMPENSATION.INSURANCE_ 0-9 .....11-s1EXTERIOR_LATH----_._._.-
' (This sectionriced not W completed i1 the perma is for one hundred dollar, 310 INTERIOR LATH
(sl Wl or leas.) _ 311 — SCRATCH COAT
. . - _...
Iamfy u,aimme pedammnre sone work far which,mi,pee,tie is,aed.i .. 313 - ROOF`NAIL
shall not employ any"C"i in any mann<r un as to M"We ubjett m the Wmken' 5 01 - FINAL ELECTR I CAL ENERGY
Comp rmaion Wats of Califomia.Date
.nppncaat .. - - - . - ---- -- -5'02- — -'FINAL" PLUMBING -ENERGY. .. ..---._.-..--- — --..-. ....
NOTICE TU APPLICAYT:If,after making This Ccnificme of Exemption;you
should
Z Womsesa"ecnobeworkers
CoreasmamnprovidanIoftheLa rCale.youmust 503 — FINAL MECHANICAL ENERGY
Q O
forthwith comply with such provisions...his permit shall W emitted!revoked,
— 504 — -FINAL -BUILDING ENERGY
fir= •'' CONSTRUCTION LENDING AGENCY
F' ar n 'Ihereby armor inatuecmi.nconxtmcdanlending agencyfor the perarniatice 505 - FINAL ELECTRICAL -
kr n' Ihis pe r ea(ser3o9yCis,e)
... 7.--GAS-
506 .. TEST .. _ _. __ .. .... ._.. . . ---..
p.7 W d Mbm's ' 507 — FINAL PLUMBING'
UO Icertifythat ln head bus application and state that the W information is 508 - FINAL MECHANICAL
inscrann 1 agree to comply with allaty and county ordinances and.tt law,matng 509 — FINAL GRADE
mbu ldng construction:and hereby'.authorize represcmaves of rh,cty to enter upon
Y m 'he ' 'dp p tor 'p`" P m s 510 — FINAL PLANNING
y. Ik 7 g ms dennify and kepi ss the fCupertino aganst
h t�h y. 3gdg,tib,s t a d pens¢ h ch mry i tiny y ttme aguina said 514 — F NAL WORKS
V'Z City nm. 9 c it t he gmnA,oftht I t
epi LI CANT USDERST S R WILICOMPLY\VITHALL NON 'DINT Issnedb Y Date
sou _'.P'cLLnrrn .
ignafAplic — ate Re-roofs
Hiv!ARDOUS
MATERIALS DISCLOSURE;
WilltheCulant or futMuni Wilding e.Chapter
store or had the
Hehaualth
uand Saf ty ,f}'pB Of.ROOf..__.._. _.___. . ...... .. .. .. - .__
as defied by the Cupen Municipal Code Chapter 9 12 and the Health and Safetys '..
CW Section Allroofs.shal
255]?(aTNo, f !}'A r ( :'..i"s 0T11 +.7):�yly. ➢ � 1t:,,•,
' I be i
Dnspected prior to.any roofing.material.being installed.,
,
wit.n p dr t f t bnlmi g p t ,e q 'v t e i<e= nirn If a roof is installed without first obtaining an inspection, Pagree to remove
cm t h d a cot t.i as defin d by,hB y A`� m
Quality Management
•Di t i all new materials for inspection. Applicant understands and will comply with
Elya WNis all non-point source regulations.
I base read he haeardl materials mormo mems under Chapter 6.95 of the
California Health&safety Code.Sections 25505,25533 and 25534.1 understand that
Bill building does not currently haseateruut,thatitismy rcspon bit to no tify the
occupam of the requirtmen¢xbt))((rr��,v be met prior to sen c of a Certificate uf.
Occup cy. / 1 ,
G vey-�/ Signature of Applicant _ Date .
woe raamanxedagenr' - `,�-� All roof coverings to be Class"B•' or better''
-_.- ... OFFICE .. .. ..