01110025 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
19752 BIXBY DR MAM DESIGN CENTER INC 01110025
OWNER'S NAME: APPLICATION SUB DATE
1676 MONTEREY HIGHWAY 11/06/2001
PHONE: (408) 298-8668 SANITARY NO. CONTROL NO.
�-,^� ZO ARCHRECI'/ENGINEER: BUILDING PERMIT INFO
c - BLDG ELECT PLUMB MF,CH
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N 2 LICENSED CONTRACTOR'S DECLARATION Job Description
I z-C I hereby ti irm that I am licemad under provisions of Chapter 9(commencing KITCHEN REMODEL& p
with Section7000)of Division iodine Businessan�ressinnreode.ane rq�:�"'me
is cefall nseC anaefree 7 7 NEW SKYLIGHT & PATIO DOOR.
Om K¢ License Cm. — Lic.#
y U Data �� Comractso
'3'=v
ARCH ITHCfS DECLA A �'����®
.u O I understand my plans,hall be used as pub)c records
1 �L
I a O O Licensed Professional
- =� OWNER atIameBUILDER
romtheDECLARATION JAN 1 4 2002
1 hereby affirm thin I am,Bump,from the Contractor oniono License law for,he
following reason.(Saran 00315.Bulinus and Professions Code:Any cit)or county
'E E O which requires a permit,o construct,alcor,improve,demolish,or repair any structure '
i 3 _ tlu ppl'c ,f hpemino fl< 'gxd ,umem. -. - _._ - _ - - _ -__ -____
thah9arc:ycdpuimninubkprevsio nncnvactenLce La (cnather9 .,r Sq.-f(
or
N Valuation
(tomo cry with Servo 71it fMuslim' 3 of the B sine. dP fest.. Code) t Iry I fx.:y,�, (,fig - ,y fir-61-'r. ..t,..
or Nat he s uempt,herefm n and the basis for,he al&ged aaemption.Any swhromn -
-e f Sec ..7031:5 by any appli.t fora Fermi,subjats me applicants..civil penalty'
3690c)017throat mora than Bve wmr<a dollars 15501H_,., APN Number ',c.,' Occupancy Type
❑Las ownerof,heproPert,or my employees with wages ss eau
their sole compenon. 101 - FOUNDATION
-will-do,,he work.-and the amcmrc is ho,'imendedon mpercd'for'sale(Sec.7014,- 102 - PIERS
'Bminesa crul Professions Coda:The Contractor's License Law does no,applyno an Required Inspections'' ^ '°
owner or propeny Who wiles or improvex thereon,and who does such work himself 103 - UFER
of coed fu his employees.provided that n improvements a i ,',tended _
Doff elf -le w h d b ave t p - t l0 to a ycm of - - 10'4---- - - --- -- -- ----
--' - -'REBAR' -
aom la on,the owner builJer will have the burden ofproving
v matneamno,bulam 105 - ANCHOR BOLTS
improve for purpose of sale.). '
_—_.. ... ...._ .._._,-.... exclusively
.-"nsedcomm_.. rs_.._
OLeeowne Projtheect
P(SecnXam exclusively<onrfessins Craenaedeontaaoato - _____S.EWER--&r-WATER----
construct
ie,meaw the oesn (Sec.7044,Businessanderofcuions Code:)Thevemacrors 202 . UNDERFLOOR .PLUMBING
License Lew aces nm apply ton oowner of progeny who wdJ>or improves,hereon, -
aea.who.cumaarc Lowueb.proja,a with.a eons mr(a).G< W.paan,.,o.n __-'- '----203---UNDERF-LOOR'-MECHANZ CA'L----'------ ------------
_ '
Contractors License law.,. ,
❑lam exempt under 56e. ,B&PCfor this rcamn204 - UNDERFLOOR�3 FRAME'r')
owner Da ' " 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
.� -1 hereby affirm under Penalty ofpyjumo�gar she bellowing de<laaeons: 302 _ TUB & OR SHOWER
❑ 1 have and'wal maintain a CertiO<a,e of Consent m self-insure for workers 3 03 ROUGH MECHANICAL
CmaFersaion, as provided for by'Sec,ion 37W of the Labor Code, for the
Performance of the work for which this permit isismeA., 304 - ROUGH ELECTRICAL
111 have and will maintain Workers Compeusatlon miuradee.a:rwdined Gy Section 305 - FRAME
3700 of do,labor eine for the pert rma ce of the work.m n n mus pen,m is 3 0 6 - HOEDOWNS
@ucd My Compc , I an«<nm y d Pol y. ter are .. . .
c 6 b T "PolicyN /le..;3 , ��
-307' INSULATION
tl !iCERTIPICATIONOFEXEMPTIONFROMWORKERS'i 'f•�asI13OB :'='iSHESTROCKLa3-- 4• t ' 1
COMPENSATION INSURANCB� -•"T __
—' 309------EXTERIOR—'LATH------
f+h set, neednmthe comylnedtithePermit isfor due hundred dollars \ 310 s.-` .INTERIOR LATH
5100) 1 s)
_. -.-.311-----SCRATCH
r -,GOAT
�.• 1 ury,hail'.th pertrmanc lk of for-h hm pc- , sMl
',hall , p1y'.4fa ay mann aimbecome hj �,pIh!Wmkcrs 313 ROOF NAIL'>r''' ' '
cop ,to arCalifornia.'D, 50.1_-_ _FINAL_ELECTRICAL._ENERGY_. _
O .NOTICE OAPT1f,after making this
rnd t f E -Pt y u.sit Id
Z become sublecn6'the Worker's Compensation w cm yuum',
502 - FINAL PLUMBING ENERGY
e a
0 forthwith Ply with env a northparrot n uhee ea soloed
503 -__-FINAL- MECHANICAL ENE GY
F„ ^' rnLENDING agenigen . ' 504 - FINAL BUILDING ENERGY 1 ' '
0.. Y 1 he try fim Nmara, csiniwci bn lending d cy for me Fedren nee ,
W:. nrme okfo :hchthisperm, s.ued(S 3097ewc) 505 -_ FINAL ELECTRICAL
0..Q Und Name __. .....::.....-
506 GAS TEST — -
7Z IFnecrsAdarc
U ----
nY thmih < emapplication " 507 - FINAL PLUMBING -
-„ ", Y od alae mat tit w rs
F+ corn , I agree 10 imardy 'th II city and cote ty m4ma nco d sur laws relating _ ._-SOB- .-FINAL.-MECHANICAL-..
-
. �.V ,o raiding construction:and heaby authorize represmnatives of,hiz city to enter upon
�+ W, the,wve-mppdo�edPuperlyformso<c,mnpu�ps<s. 509 - FINAL GRADE
ly, judgment,
crom n cooly res,which
h may is,he Cray arc is again'[
nit
_
C rn liabilities,judgmens,toss teal expenses which may In natty way,arae age;'.:,aa;e 510- - F I NAEP I NG
U zCity - UNDERSTANDS'
A IeA.YTUNDERSTA.NDS"AND WILL CONPLY'N7l'H'A[L1'jN-p011T" 514 r NA WORKS
CE RGZ1LA s Issued by: Dale -
signat -by a p I c , - . t Re=roofs - -
Cmr, _
HAZARDOUS MATERIALS DIS RE
.` Wil me aPPGe4ato hum building ,ores 1 haeaNusnut a1 Type of Roof.-
as deforal b the Cu nt oo M Code,Chapter 9 12 d the Health and Safety
-
CodeSee, 25532(,) - - v .p fsy �s +„. i ?.-a ;l,
OY ., a ON. ' p-1 "'Ix F1 t 'f,' 1 tt } tS 1 . . a . . .:
11,be inspected,prior.to.any-roofing.matenal being installed.
r, i Will thapple, , f t�building epi ,use equipment de' s which v '_ -----
All.roofs sites
emithvaMo air conu runts aseefinedby'he BayAonsAirQuahiyMana'gement If a roof Is Installe'diwithoutfirst obtaining aninspection;-I agreetdremove
°i" `^ all newmaterialsfor inspection., Applicant understands and will coin 1 with_
qY Yes I oN II hl. t all non-point source regulanons - p y
�-•- 1 1
halt"
' d,he here h materials qu amems under'Ch Fu 695 of the ({'. _
Celifom a Health'&Safety C de,Sardinia,25305,25533 and 25534..ruad,rsund,hat
i if toe wilding does not currently have a rancor tha it ism Fes '"
y ponsibiliry,o nouythI
ocduPa"of rite regliremcnts which-must wme,pdoi,o issuance oda CmiOce,dol
O -. _Signature of Applicant _ _ Date
m riva agent Da All roof coverings to be Class B 'or better
'` ` -OFFICE ---