00070183 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMDNO,
OWNER'S NAME: APPLICATION SUB DATE
6052 WILLOW GROVE LA VANNI BROTHERS CONST UCTION000701.83
PHONE: SANITARY NO. CONTROL NO.
HOHENNER MARIANNE D AND H RRO 433 TOPAZ ST 07/28/2000
O m Z ARCHIT[CI'/IiNGIN1i13R:
BUILDING PERMIT INTO
'2i�g (415) 369-2997 BLDG ELEcr PLUMB N+ECH
Hay
LICIiNSIID CONfRACI'OR'S DECLARATION Job Description
z p� 1 hereby uffnn tlmt I mn licensed under pmviaiulu of Chapmr Y Ieonunnming
—ec wish Section]IXXpof Divivioni nl the lluninesv'vnJ Prnfec ion>C,x10.unJ my licctuc
zin full fnrcc and ellco.
z ce a Licemt Class Lm.a
ii O baa, Canaaaor
3 a.C N ARC 1l1'I Ibe S UECLhliw rvION
=O undershoot illy pl.m shall he used I pu611e IGN BATH REMODEL
vo Laovd Proresxlnnal o .
OWNER-BUILDER DECLARATION - X�
ce 1 hcrcby uffir Ihat I uur,frons the Comns
oro.",License Low for the V
zee a following me.on(Section 7031.5�Msines,and 11n,fes,ion.CIWw Any city or county
2 O which requires a fiction to consumer.alter,impmve,Jen oludE..f repair any suuvmre
a3- prior to ilx r.u.nce,also reltionev theapplicant for such permit to file a signed statement
that he is licensed par.aantt,,the to,woinn.ofineCial.loe,Live claw(Chapter9 - Sq. Ft. Floor Area Valuation
(cnlnmaining an SeenT 70(XBof Division to fine Bdiies,and Preccdnm Code)
or that he is exempt therefrom and the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for a pem,i,subjecu the applicant to a civil penalty
of.m mom than five hundred dollars(6500B. APN Number Occupancy Type
01,as ax'net of the prol,ery or my employee,with wages as their sine compermmion. $15000
will Jo the work,and the structure is not intended or offered for sale(Sec.70U.
Business and 1'mfessians GMe:The Contractor's License Law d«s no,apply m an Required Inspections
owner ofpmpeny Who builds or improves thenen.and who does work himself 37538022. 00
r though his own employms.provided that such improvements are not intended or
offered for ole.IL have,to,the building or i pion ennent is sold within one ycu of
impletion,the ownerbuilder will have the burden of proving that he did not build or
ntinvefmparpn.eof,:de.k 1.01 — FOUNDATION
r of the popeny,am exclusively contracting with licensed contr ,leers to 1.02 — PIERS
f1h,'
twthepmjc0sec7194,Business and Professions Cwle:I The Cnnlraeor nLaw does an I'Go,In an owner of property who..add,or improovs there..., 103 — UFER
sronrtacu for wah prni,o,will,a courvtur(0 licensed.......t a,the
I aµ'tme..rX License 1.aw. 104 _ REBAR
❑1al.esen, i ,B&PCllrt thi.m.en, 105 — ANCHOR BOLTS
�t s 1 s 'Don Decl.nen71��� � 106 — SEWER & WATER
I hereby union land erpe.1l,y nrperittt>mle of the following declartai(1: 202 — UNDERFLOOR PLUMBING
❑ I have and will n Ilmhlln II ceNreltte..f Consent at off-inure for Worker's 203 UNDERFLOOR MECHANICAL
Cnmpeloon on, as movided tot by Seelion 3700 of he Lot, Core "" the
,cfirmarveoflhe winkfn,luehlbi,permi,is issued. 204 — UNDERFLOOR FRAME
0 have and will lo:Iinlain Worker's Compensaion honorees.as required by Section 205 — UNDERFLOOR INSULATION
370 of the Inter GNe.lin me tarrmnoance or the work for which This Penna is
issued.My Worker's ContpemnhonInsurance carrier and Pnrnamberam. 301 — ROUGH PLUMBING
Policy
carrier Policy Na.: 302 — TUB & OR SHOWER
CERTIFICAT[ON OpIiXEMITIONFROMWORKERS' 303 — ROUGH MECHANICAL
COMPENSATION INSURANCE
(Thi,section need not W cumpined ifthe permit is far one hundred dollars 304 — ROUGH ELECTRICAL
(alralnrle,..l 305 — FRAME
1 verify that in he peffonaance anise work for which oris permit is issued.1 306 — HOLDOWNS
shall Dat employ any Penna in any manner so as m become subject to the Workers
Contpemalion Laws of Cal ifornia.Dale 307 — INSULATION
Applicant
NOTICE TO AITLICAN'Cif,uOer,making this Cerifcale of Exemption,you should 308 — SHEETROCK
became subject, lnior the Worker Clans provisions of be Labor Code.you must
O O fordwith conatily with such powrsiors or this rerari,dall or created re, ked. 309 EXTERIOR LATH
Z 7CONS'i'RUCTION EITNONGAGENCY 31.0 — INTERIOR LATH
7 1 hurchy fill...Ihal hone IX a coo.n.clion lending.germy for the perfmn.mee —
W
of rrrni
otkowIrvh ],iseI ,i......I(So,3097,Cao.c) 311. SCRATCH COAT
ALendct•s Nlnne
U z0 Le,der',Ar,].... 31.3 = ROOF NA Ii_
cerityo,:,,I aocrexdfin, Ippheadonand ,a,.TIE a, heabooeinformaa..nis 501 FINAL ELECTRICAL ENERGY
w P aori I agree To.n,uply whh;,If city and ,,Only nrdimnce,and,late lawn,rel,i"g902 — FINAL PLUMBING ENERGY
O C.7 to bonding vnrstmeinn an,)h.by,nthorim represemaeves of this city to enter upon
P W the above io entioned properly to,inspection purlx,ses. 3 —
1 0. (We,agree in a,..rodentolY,ad keep Worries,heCity ofC.permoagahnt 50 FINAL MECHANICAL ENERGY
rn ludiitien.j.d,moon.coa<and expenx,which toy inaa., ayarcroeagah,.s,said 504 — FIhIAL BUILDING ENERGY �•
f� Z_ City in consequence of the grunting ,1 this peon,.
sOURCEN U DERSNA' .'A WI COMPLY WrrH ALLNON- INTO ISS dby: 505 — FTNAI FI Fr TRTrALDate
06 - GAS TEST
Signature of App Dat ' OPS `
BA]1Ru0us s+,vrRIAIS DIscLOSURE YP 507 — FINAL PLUMBING
APPLC
wdlmeapphea.,ormTamn.ildingaemnpant>tmm�rnaneleM1 �Tao..,,,aterial Type
as defin"by,heCupeninn Municipal Csxle,CM1ap¢r 9.12.unJ the Heahh and safety 508 — FINAL MECHANICAL '
Code.Section 2553200T- 0N
0 ye, All roofs shall%ogispectFclptP4LtoaRADJBing material being installed.
Will the applicant or future buildi ng occupant use equipment or devices which If if roof is insqo withpUjlfjALol:pjil}gjl k&ection. I agree to remove
aril hvaNrn,o,sir comaminams as defined by The Bay Area Air Quality Management
I i,me7 all new materi!§l,4)r.'Ds
jlegt� Aj l SL1Itedf�ifatAx and will comply with
( royes oNn all non-point source regula tons.
I roc read the hvnrdoas mweiels regniren,enn under Charter 6.95 al the
Coli fnrnia Ile:JIh N Saba,Code.Sections 255115,25533 and 25534.1 unden,und tbut
ifthehif dingdoesnotcurrently hoea eat that it is my re,pmisibllity tonotify list
erpur,or he requimmens wlifelt nnul M,me prior m iswnncc of f CculRcme or
oa:tmamy' Signature of Applicant Date
(),act or lm0ori,ed agent baro All roof coverings to be Class "B" or better
OFFICE