00080112 (2) CITY OF CUPERTINO .. „
BUILDING DIVISION PERMIT CONTRACTOR INFORMATIONY
BUH9-ADC? E s BERRY DR PERMIT NO. 00080112
O`��2255 APPLICATION SyB DATE
��1n"hRI OLAVI A AND ANJA S 08/ 16'/2000
/F HONE: -•. .. .... .. .. .. .-.•. . . _ ._ SANITARY NO ......_... CONTROL NO.
E�0:z0 ARCHITECTIENGINEER: -BUILDING PERMIT INFOas
BLDG ELECT PLUMB MECH
w0 LICENSED CONTRACTOR'S DECLARATION.
_�Z e,M .• I hereby aflon that l am licensed under provisions ofcha,mr9(ammommong ADD WINDOWS �2�7ob Description .
'tin with Section]000)ofDi o3of the Business dProfessions Code.and my license
�aU =t - a -
r z m a Li n CI r L g „
3 4't- Data ,� .. . . . ...
p ARCHITECTS DECLARATION
� < ntY PI h II h d o lir �nma
or
£ r
y se O 1.i d Professional
'
o OWNER BUILDER DECLARATION
i
w-m Ihereby ffinn that I am exemptfrmthe Cladora,lmr,License or for
$2'SOO
z> foll ire le i ]on 5 Bualt J Profession,' Code e Y all,n aunty
E C which q permit wr aIle improve.demolish,n rep Y n ct ra
pn t ¢ 1 reg re.Ili PPl ca It ch oPermit Ne hays't a m,t -
- Ili phe Ic adp mmtti pro slop of Ile
li Cmotor's
na mr C nse Ld fChapm 9
m menrnpwnhSecton70(10) fD"l .a3 lib B I ee r.. nacae) k ='f' 3 L"3'��• � r��r t,a h'il Valuation �
or that he Ic exempt therefrom and Ibe basis for the alleged exempt an.Any violation
of Section]031.5 by any applied.,far a permit subjects the applicant to a civil'famby -
:ormtmakwanawhundred donara(Veli). ' 101APNMOLYIDATION h.. Occupancy Type
DLaaownerof the properly,tinny employees with wages os their ante actual=malmr, 102 - PIERS '
"Bilin the work; the avucmre is not imended inLice License Law
for said apply lou,'- 10 3 - UFER Required Inspections
'owner f and Professions CMG:The Commctor's Licence Lvw apes ll apply m
owner of propmy who hood,or imp
vided t menton and who does a n work nor 10 4 - REBAR -
onM1 ghti ply he provided that h'improvements tintendedor '. I
I-pfr er -- 1 vn .M1 building -'p m . le`widondneyarnr'. .. . 105 = ANCHOR :BOLTS __ .__ . _ .. .. .... . . ... ..
io pl=tio y the owner bu Ider will have the burden of proving that he Gia not build or
mprove for purpmeor sale.). 106 - SEWER & WATER- -
•Di asowner ofthe property,am exclusively contractingwrh licensed contractors to 202 UNDERFLOOR PLUMBING
-I
construct the project(Sec 7044 Business and Professions Code)The Contractor's 2 03 - UNDERFLOOR MECHANI CAL-
'
License Law does not Pply t an owner of property who builds or Improves thereon, r
projects with a comraroras)licensed pursuant to the. .. ..._. 2 04 --- UNDERFLOOR-FRAME Contractor
o who for such
01 a.tura License La 205 - UNDERFLOOR"INSULATION
❑lam exempt urNer See' " ",B&'PCfonhis reawn:
'o Date' 301 - ROUGH PLUMBING
rlJ WORKER'SCOMPENSATIONDECLARATION 302 - TUB &„AOR SHOWER .
''rI Ili br ram a rxityorptyryf0;etolmwngamlarenons. 303 ROUGH MECHANICAL
D I base and will radiallim e Cartificand of Consent to set Insure for Work=r'x 3 04 - ROUGH ELECTRICAL
Compnnsauon as,provided for by Section 3700 of the Labor Cade for the
'performance of the work for which this permit Is Issued. 3 05 - FRAME
D I have dud will maintain Worker's Cannibalistic.Insurance,as required by Section 306 - HOLDOWNS '
'37M of the Labor.Codv,for the'performance of the work for which this permit is 3 07 - INSULATION - - -
Capp,Mvw k c P {u 1."„rrieit— , "a'" p_11 iz
x°Pot yNo. 308 :' I SHEETROCK
,u r, r.rt ' y ,
„ CERTIFICATION OF EXE.MPDON FROM WORKERS” - `Iii'' - 130,9,(. �IEXTER'I ORa•LATH, '
COMPENSATION INSURANCE 1
3.10------INTERI'OR -LATH
Crnla a'pt nn need not be Mmplatea Irene Pprtn t is r one nuneree emlars 3 11' - SCRATCH COAT l I . - .
_.313 ROOF-•NAI-L ...
s tanloyatytheperformanceoftheworkf wbhmspemuusWorke1 501 - FINAL EiIECTRICALi"ENERGY
"shall not employ any person m any manner so as m become subject m the Workers',
Compensation, Ldwadrearramia.Det= - - ,_ ., 502 - -FINAL .PLUMBING. ENERGY__,.
.Apel oa t. -_ -. ... ._.,.
n'"NTO APPLICANT.
fee,making ths
Certificate ofExemption,
should
become
sm to the
Worke' Compensation p ns of the Labor Cad',youmust
503
03 - FINAL ME
CHANICAL..
.'.E....NERG_
Y
fwthwiih comply wIli sinchp nn pe YemMrevkea. 504 - FINAL BUILDING 'ENERGY,_
CONSTRUCTION LENDNGAGENC505 FINAL ELECTRICAL
-a I li ehy arrtn that thee nro u lending agncy f the errurma ed
of the work for hie this permit d is 3Cv.C) 506 - GAS TEST
eaer Ndr ' iP. Le de Address 7 , M
508 - FINAL MECHANICAr •-
...._ _.......
P
V'0 c 1 rt e that I have read this application d maddest the dsabove information is
(w+[r boot I acoa to
co PIY with all<ity.d a ry Ninances and state 1 raising 509 - FINAL GRADE
O V '•mbdangconwcti dh ebyeumoriz rpesemativesoflmsmtymenmruPan 510 . - FINAL PLANNING
IT' the above mem ailed properly for spection purposes.
P, ' (We) g t bdmifyandkecplr 1 �Ineatydreupenmhagama' 514 - FINAL PUB C WORKS
'.W Jimilitics,judgment,costs and ex,mixes which may in any way accrue against said
C„> Z 'City to consequence of the g doting of this permu -
APPLICANTUNDERSTANDSAND WILL COMPLY WITH ALL NON-POINT IRSlledb
SOURCE REGULATIONS y: Date
Sig ac re of APPlicanpComrarol:,':'.:;• . ' .. Da-7 Re-roofs _
HAZARDOUS MATERIALS DISCLOSURE
!: WII Ile applicant future building pat tore or h dle n Nous material ype of Roof ' .:::
_...__ .
as d f a by Ili Cupen o M pal Cod Ch pt 9.12. d the Health and Safety
cna sect nzssizOA
If a roof is installed with .t 1
DYna -
LIN
y u ty n equipment 11 newmaterials installed
forwithout
prior b any in rg a ninspec material being, t celled _.
Will dthe applicant future building g pan ua q p torte lea which out first obtaining an ins ectlOn,I ce 7ee t0.remove
LI Yea - ... D N'. Menag em g P g
.,the d Area Air tial ty
'DI t ct inspection. Applicant understands and will comply with
nc contaminants
}` all non-point source regulations.:
I hive'read'the hazardous malenals requ rements under Chapter 6.95'of the
Califonor Health&Safety Code,Sermons 25505,25533 and 2557q,1.understand that -
if the building
g does not currently have a tenant,that t is my responsibility to notify the -
„dc p t f me odepu u which most be t p ono issuance of Cenifca¢bF
/. "Oc Pant
Signature of Applicant Date
or, xeaage pate, All roof coverings to be Class B" or better "
OFFICE---'