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01100061 (2) CI steDI GDIVISION t PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 6354 BLACKWOOD DR 01100061 OWNER'S NAME: APPLICATION SAB DATE IAN OGLESBY 10/10/ 2001 PHONE: SANITARY NO. CONTROL NO. ARCH(IECDENGINEER: BUILDING PERMIT INFO U P BLDG ELECT PLUMB MECH y a i CJ LICENSED CONTRACTOR'S DECLARATION z'Hz Ihereb affirm that l am licensed under o'' f Chapter Job Description >�-0 Y a provisions o p (commencing p mFw is infectioneandefect. an3hftheBusinessanJPro(csnonsCode.andmyliccnsc ADD 479 SQ. FT. S m 5 is in full three and effect. / m a Date Clare Lic.tr / /CSP.G/`/ 0 n.t0- Dau S DECLARATION (// 'e "i m ARCHITECT'S DECLARATION ` O 4 I undemand my plans shall be used as public mcortlz / i F u z o O Licensed Professional l� _nse z OWNER-BUILDER DECLARATION w "' I hereby of0m,that 1 am exempt fmm the Contmcmr'.s License Law for the following reason(Section 7071.5,Business and Professions Code:Any city or county $S;8?2-5 zF o Ihirn requires a permit to construct,alter.improve,demolish,or m'.any structure i3m -Ann mitsisa.ance,alars"uites Ne nail forsuch lro file a signed statement- (commencingbat tiisitpsthe'refm�)ofD Division of he dgcdesLicenseltawonsCo e) 1-.,_ r a• _. 'i , Valuation q" � pa'. y prowsions of the Chnhacun _ �s hat he ii nd the wi ) ssaMiori Any Code) �,�i\113 1+F �.cB�u{ i,tt^i) 11.�+Ss., deicam In.Any violmion f of Section than any applicantfor apermit subjects the applicant toacivil penalty' of can marc lean Eva Wnarcaamlars rssOB)' 101Ap�h�FJC�#DATION ;� 'b% Occupancy Type 01,asoommol progeny,or myemplhyees with wages as,neirsole compensation, 102 PIERS -will do the work,and the structure is not intended or offered for site(sec.7044, 10 3 - UFER r Business and Professions Code The Contractor's License Law does not apply to an Required Inspections' owner of property Who builds or improves thereon,and who docs such work himself 104 - REBAR or through his awn employees.provide)that such improvements within not intended or + comple for sale.If,however,the building or improvement at Prov n sold within one year of -•'-""'--'--' -- -completion,the tM1e uwncrbuilacr will have the buNen hf proving thin he did not Wild or 105 - ANCHOR BOLTS � ts••'7'_2"'•' ", '�• v, improve for purpose of sale.). - 106 - SEWER & WATER or iue o;.wof.thePr.peny,a.;exclusivelycontracting:vilhiicenuacadacthato -202 UNDERFLOOR PLUMBING - ,- .:•':,i� .._ construct he project(sec.7044,Business and Professions Code:)The Contractors 203 — UNDERFLOOR MECHANICAL - License Law does not apply to an owner of property who builds or improves thereon. ":.1 dna who contracts.Liazts.tar such projec¢.wnh a contractor(s)licensed pursuant to the. . . 2 04' — 'UNDERFLOOR- FRAME- - -.. "i Contractors License Low.. "'-'---- plamenemptundc Ser:'/Il - `";B'SiPCfhrthisrcasan 205 — UNDERFLOOR 'INSU'LATION own�i- ✓:✓ Dzta '/o Zi B/ 301 — ROUGH PLUMBING WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER - Ihereby 011.and,penaey,ofp,mySpennnefollowing declarations: 303 - ROUGH MECHANICAL ❑ 1 nava and wan mamam a Cer ieeme of Consent t.self-i...m far Wh m, 304 — ROUGH ELECTRICAL Compensation,as pmvided for by Section 37W of rhe Labor Code, for the perr.m,a�e hr die work rot wmrn this r,ennh is iaa.ed. ., 305 — FRAME _ ❑1 have una'wJrmomtaiti worker's Com cation Gsnrsnce,is re rcd b Section 3 06 — HOLDOWNS 37MAnn qct' y 307 — INSULATION issue.My Lubar Code,forthe Performance of e, work for which this permit is ' issued.My Worker Campers!uo I sumnce comer send Policy donator cam t� r� jrr t.a'.xPal ay'Nn f` 3 08 ` SHEETROCK :�'— .' ( 1 -CERTIFICATION OF,EXEMPTIONFROMWORKERSI C•Ji51.3.09't-�iETERIOR.,:1LATH+: COMPENSATION INSURANCE `,' ''' ------- --3-1-0,---, INTERIOR--LATH— - --- — ., Cruisiwar.ntewnotbeLtjple'teainnePermitisforonehundreddollars 311 — SCRATCH COAT ' (EI00)or lca<) ' 1 of ta t m rr a wanM1 kr wni nm 313 ROOF NAIL • -• --. . .._.,r _. _.. . Y f2 .perm,is issued,I shallot employany Persian m shy-manner a.asi became subjectw thewgderf 501 — FINAL ELECTR`ICAli' ENERGY' T' Compensation Laws htCalifornia.Date 502 r FINAL PLUMBING. ENERGY APPI cat NOTICE TO APPLICANT OO APT1f rt making his CnincmearE pw , beesubject6the Workers Compensation p 'tionslib Codet,you must 503 FINAL MECHANICAL`'ENERGY mnnw,tnc�mplywithsaesprovuimusortarspetmhanallbaeecmcerev.ked ` _ 504 — FINAL BUILDING ENERGY 505 — FINAL ELECTRICAL ' F'•^ tis r" Cat$am is LENDING AGENCY for W;-. of l hereby waffirmhich this per is a construction lending agency for the perfortnance �,;,.., annework rr,rwmentmi y � 506 — GAS TEST ' L-O Lender's Name - " - IecnU matlnave 55.:eahsera�e9,at�,hac, Le - - r7�Z nder'.,Address507 — FINAL PLUMBING '�•'�"'�� 'V-O ,y t y•1' 1' ppica'nn n 508 — FINAL MECHANICAL e above information is k'✓"t.. c6rtaccl agree m comply iwithall city and county ordinances and state laws mlating 509 — FINAL GRADE O.r_7 mWill Will hemby amhorm rtprcsentatives edhix city a enter upon W ,heabme-memianedpropertyfor,inspectionparpses.• . 510 - FINAL PLANNING -L (We)ego&t.save;ittdemnify amt keep harmless the City of Cupertino against .� Rabiliiaes,jadgmema,costs and expenses whim may in any way arcme against said 514 — FINAL PUB C WORKS +Q.Z City in consequence of the granting of Nis permit.,,' APPLICANT UNDERSTANDS'AND WILL COMPLY WITH ALL NON POINT'I' - o SOURCE REGULATIONS,l'i c Issued by: Date Signature (-APPI caAC Zt t HAZARDOUS MATERIA1 r, 1 d�a `.. , Re-roofs ALS . Will he applicant rf from,Wilding ac p tat rhedl M1marou Madrid Type of R,t.o.of�.l f\ E VK^i4�l.r i.'Jf S. O as dermod byCpenno Mu p I Code Chapter 9.12.add the Health and Safety aCoat 255J2() .' J Yes 01sto O / d`tit All roofs shall be inspected.prior to any roofing material being installed.Will the dwimus applicant or future buifl ng me the fbr useequipmentp Quality M cax a,,mwhich If a roof is installed without first obtainin an inspection,Fagree:tolremove ,.it haeardous air chnuminants as defined by the Bay Area psi Qmlity Management g °iSnc° all new materials for inspection. Applicant understands and will comply with- ora a .,^ ❑rv. ,• - ,,, all non-point source regulations, , 1 -base mad'ihe hazardous atenels rtgwrcmen¢undo Chapter 6.95 of Nc ' Cabfol.Heahn&Safety Chdc;Sections 8505.25s33 end 25534.1 undemand,hat Ube building docs not curcn0y haveetenant,,nut it is my responzibilitymnotify orcapant of,he rc quirtmcnts which must bdrnn prior to issuance of a Cenifchte of - r'. Occuyancy.:',:.d .Y .. . ..n�: ... . .. .. >' Signature of Applicant Date owae pranm.daedogem,-": Date All roof coverings to be Glass "B"or better �. _ •r I OFFICE