02060171 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
6365 CANDLEWOOD CT 02060171
LOWNERAPPLICATION SUB DATE
HARWOOD G AND WILLOW 06/26/2002
PHONE: SANITARY NO. CONTROL NO.
s
O O ARCHITEC'VENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
r—i u u 1u
sa.. LICENSED CONTRACTOR'S DECLARATION
"LEIhereby efforts that Iamlicensed uMe,provis.mIdChapter 9fcommcncing Job Description
with Section]000)ofDivision 3or the Business and Profeaiotu Code.and my license REVISION SUBMITTED FEE $222 PAID.
is in full force and effect.
3 5 ate License Class Lac.If ORIGINAL #01010017, NO NEW PERMIT ISSUED.
DCranston,
t• O to ARCHITECT'S DECLARATION
g 1 understand my plans shall be used as public records
Y
an O O Licensed Professional
a' OWNER-BUILDER DECLARATION
1 hereby M.that I am exempt from the Contractor's License law for the
I-Z< following reason.(Section 7031.5.Rosiness and Professions Code:My city or county
which requires a Permit to construct,alter,improve,demolish,m repair ony stmcwre.
Prions its issuance.also requites the applicant for such permitao Ne a signed statement
that hh,if licensed paobatto de provisions of Ne Contractors License Law(Chapter 9 ,Sp pt-Floor Area Valuation
(ronnmrn;pgwilh Seclioni70I of Division 3 of the Business and Prpf,sions Cnde) i' 1 ss^^C7 f t�- j.a' y/Y
or that he is eienirNemfromand the basis for the all): '-�A+• 1a.'•:a•- dLjA'. ti4:t"t..i .j..:f� f.5-. +:
p gut e6unpdno Anyviolation
of nor mar 7031.5 iv any applicant fora Pertain subjects Nc applicant m a evil penalty,
of nor more than five hundred amlatr lssony urn er, i e! Occupancy Type
01,as owner of the progeny.or my employees with wages mlheirsme compensation, i ni _
will do the work,and'the'swcture is not Intended or offered for sale(See.70441 - n
-Businessand P f Code The contract License La does t apply to an 102 — PIERS Required Inspections
owner of property Who builds r impiove.s thereon, d who d c s ch work himself
or offered
through h' cowl yrs.provided th t himprovementsa t trended or 103 OF ER
completion,
o ler -le tt however,ldNebuilding arip emsold wuhm one year of -" l O 4 — REBAR '• /r improve
m pl uarImo ter buena willhave ine burden ofproving Ne he Nd std bund or 1' V
tap errpuryouarale). 105 - ANCHOR BOLTS
___ _ --C1 Lim a pNepropertyantexclusively- own contracting 106 - SEWER &--WATER i '�-� ✓
co w t he Project(Sec 7044 Business and Professions Code)The Contractor's ,,..) ,,
-
License Law does not apply t nowner ofproperty who builds orimproves thereon, 202 - UNDERFLOOR PLUMBING
and.who eontracts.for such projects with a contmea (s)licensed pursuant to.the. '___. ....-.._.
Contractors License Law.,, 203"' UNDERFLOOR MECHAN3CAL'
'ZI ameumptpaunder s,,v.' ,B&P C fonhis reason 2 04 - UNDERFLOOR'^'FRAME''
over (,�yp� A D�,te�j b^'AG^�'�• 205 - UNDERFLOOR INSULATION
�WyOkKER'S COMPE.IQATION DECLARATION 301 - ROUGH PLUMBING
I hereby aRnn under penalty offptper'jury one or the following declarations: 302 - TUB & OR SHOWER
❑ 1 neve and Will maintain a Comficn¢of Comcnt to self-insure for Worker's 303 - ROUGH MECHANICAL
_ _ Compensation, aro provideddor by Section 3]00 of the Labor Code, for the
-. _ _ ~''. Performance oftheworkforwhichthis Permit isissued.; 304 - ROUGH ELECTRICAL
_ D 1 tnm4 and will maintain Worker's Compensation Insurance,as required by Section 305 - FRAME
3700 of Ne Libor Code,for the performance of the work for which Nis permit is
' las ed MyWorkers Compensation Insoranc mer and Policy number are 306 - HOEDOWNS
.. - .........-..u,..-Trac>.c..�.xavmo+•-...,.m. ..---
cathri er' ! CkTri t "Policy No,
307 - SNSUliATION - -
1 QTRTIFICATIONOFEXEMPTION FROM;WORI(ER$'t" t C4' ? + 'Yt +" k "f`s 't
308 -' SHEETROCK L ° '""
COMPENSATION INSURANCE• a' . „ - _l, ,-
_ _.. __309 ="';EXTERIOR liATH __ _..._.__,�._ . . ._.t,.
ISIOp)
(This uMitinrneed not be completed if the pcnnit is for one huntlrcd dollars 310 - INTERIOR LATH
31-1- - SCRATCH COAT
I m(y that in th'e omance of the work for which Na III is d,l - t -
4h II n t employ ony person ony mann r o as tq beanpt,subject t the Workers 313 — ROOF NAI Lc' '
Compenset n Laws t f C Date A 'I8^O A
Apps= a
- 501---- F-I-NAL -ELECTRICAL,
NUn TO�ICAN'I If ler making the Certificate of Esempton you should
z bee bjecttothe Worker aCompensation provsionsofthe Labor Code,you most 502 - FINAL PLUMBING ENERGY
z 0 Innhw th ply with ch prow slots o th permit shall he deemed revoked.
z _ ._,- _ _ 503_.=-EINAL-MECHANICAL -ENERGY_
.:;Vf 'r='•II' •cotthemisacoNLENDINGAGE.NCv 504 — FINAL BUILDING ENERGY
1 hereby aRmt thin nhcre is o construction lending agency for theperformance' 505 - FINAL_ ELECTR I CAL
w Lead ark f hich tht ion s issued(S c l09].Civ.C)
Q
-Lender a-N � - - ��- �--� - - - -
z Lends Addre 506 - GAS TEST
Icertify that Ihave ad this application and as da.the above lurn stints 507 — FINAL PLUMBING
w F
concoct,1 agree to comply with all city and county ordinances and state laws relating 508 - FINAL MECHANICAL Q.V mbund ng comwction,and hereby authorize repnatrves ofthisc tyrom
eerupon
s:w be cba -n annw Property q,r in.pertion purpose,... 5 0 9 - FINAL GRADE
-,0. [Wel agree tome,indemnify and keep harmless the Cityof Cupenido ugelnst
_(A liabilities,judgments,costs and expenses which may in any way accmc against said 510 - FINAL ING ,(
E.).� City 1ncommilacnceof Ne gmmm,m`1hi,,man, fr r{C/J•
AP EIClsNTUNDEftSTANDy AND WILLCOMPLY WITHALLNON-p0I9T 5514 1 ' !,EA WORKS
)RTE REdl .ATI NS' Issuedby: Dale
Sign. 4 of App cant/CPvc<: Re-roofs r
l ' HAZARDOUSWilding
MATERIALS DISCLOSURE
_ W IIldse npplva t f tare Laing a pS t sonam handle laureation,maType of Roof
terial J
as d BnW by4h Cupen M ictPal Cale Chapter 9.12.and the Health and Safety -' " '-"" "'^' `^' --• •^_ �_-_. .
code s cttnns3xal f',•-o k '^ ,Fa
o ye,1 r �TNo (f= -; g material being installed.
Al] roofs shall be inspected poor- any
WII th pylic to f mre building occupant use equipmentor deuces which If a roof is installed without first obtainingan Ingree to remove '
em t,I erdous air cunmmm t is os defined by th Bay A¢a�r Q ality Management
Dianmd ' all new materials for inspection. Applicant understands and will comply with_.
all'non-point source regulations.
fhas'e mead the hatsobus materials requirements under Chapter 6.95 of the
California
q Wild,&Safety Cod.Sections 25505 25533 and 25534 1 ndersand the t
—^ h
dthe building does'not currently have amn then my respdnsthltyttl nmdy the
occupant of the requirements which mon b ma p- r m issuancef a Certificate ser Y lldlt d V
Occupancy.
6 Igo ture of Applicant bate
rauthonsed agent Date All roof coverings to be Class"B" or,better
OFFICE - - - -