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