02050172 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10300 CRESTON DR AN KY CONSTRUCTION 0205 72
r1W NER'S NAME: APPLICATION SUB DATE
,LYNNE RON HANSON 1923 EVERMONT CT 05/28/2002
ONE: SANITARY NO. CONTROL NO.
Ipp❑. (408) 234-2673
00 ARCHITECT/ENGINEER: BUILDNG PERMIT INFO
w- BLDG ELECT PLUMB MECH
a z LJ I_"". L_t LJ
a a Job Description
Z�N i LICENSED CONTRACTOR'S DECLARATION
Oto Section
7y affirm Division
of
dunderp ndPiofssinW ter 9 ode,an(comminuting
Fy p3 with 5enioresoilefDivisionloftheBusiness anePmfcssionsCode.andmylicense ADD 202 SQ. FT.
is intuit force and effect.
S p d V LutCClassLic.M
Date
De Contractor
u O ARCHITECrSDECLARATION RATION
gI understand my plans shall be used az public records
W= SEP ! 4 2002
c Licensed Professional
OWN -BUILDER DECLARATION
12 ER
m 1 hereby affirm that 1 am exempt from the Contmcmr's License Law for the
F'¢< following reason.(Section]031.5,Businns and Professions Cade Any city or county' BUILDING S s o 0 0 0
Y 4❑ which requires a permit to construct,alter,improve,demolish,or repair any strvaure
10t-� pn Ra its issuarano,alrequiresmgnd
tha applicant for such peut w file asstatement. ---------- --.
a 3--thaths is Helmand pursuant to thprevisions of the Communes License La (Chapter9 So.m t FI OR ea Valuation
(�C a inset gain) f6 ison3ofineBasjneis d� Imams Code) (v*._)NTg2.b3:7..048:'(7b�t-a.Z:, EO Ir
or that he s exempt therefrom nnJ the bass for the alk8ld esemp an.rsny violation
of Section]031.5 by any applicant for a permit subjects the applicant to a civil Ismadiy- �.7
of not room than Five ward dollars(SSW) 101APN F� ATI ON Occupancy Type
❑1,as owner Of the property,or my employecs wire wages as their wk compensation.
wilt do'the-work:and the structureisnot intended or offered for sale(See:7044, - --- --------
I Busimas andTroPossinns Coda The Contractor's License Law does not apply to an 103 - UFER Required Inspections'
owner of property Who builds or impwvcs thereon,and who does such work himself
or through his own employees.provided that such improvements an Out intended« _ _l 0.4 - REBAR._.__-�.
--offered forsale.if.ho ,n Wilding or mp em (is Id shin oneycarof '-' -.-_..
'completonthe owner-builder wilt have the burden of proving that he did not build or 105 - ANCHOR BOLTS
improve for purpose 0f sets) 3,06 - --_SEWER & WATER
owner of the phoperl Business
exclusivelyacontracting-lhlicensed he contractors w --" x!02 - UNDERFLOOR PLUMBING -l'
'Lissai construct she project(Sec ]Ota Owner
s and Professons Code)The ves the Contractor s
addwho,wed«anot,m,,sulytCanownworpmprowhownasordparanmernn 203 - UNDERFLOOR MECHANICAL
' .and who commas far such proKuts..w thn comracmr(s)licensed paranoid to me. e
302 TUB OR OROSH - - - — -
Connector,Licensew 4" ` "UNDERFLOOR :FRAME
❑1 m +enmpt oder 5 c B&P C for this reason
INSULATION
w e L OLRKLR S COA1P t TION DECLARATION
OWER
I hereby affirm Hades pendey of perjury one of following a<clamtinns:
303 - ROUGH MECHANICAL
Y; ❑ I have'.hit will mam,ain a certificate m"C aYnt to self-insum for Workers 3 04 - ROUGH ELECTRICAL
Compensation, 00 as provided far by Section 37mUthe Labor Code, for he
porfo�nhnee mf dW vmlk for which this permL is i....J..., 305 - FRAME
01 have and wilt r itimmushoWo ke'iCiiialsensaddi brsvrane regaii<a by Section 3 06 - HOLDOWNS
3700 of the Labor Code,far n Iserfmonersite of th 'work,far n ch his pe.I,is
isoaed.Mrworke`,C in ensaIt, Ins move.eamerandPolicy numberam:- 307 - INS_ULATION
pfh6t '.s-Y Pol cy No ' -�- - .. 308 - -. . .... -.: .. _ ... - _.�..«.-». ._.-.....
. SHEETROCK
VOI 1'CERTIFICANON OFEXEMPTION FROM WORKERS -"EXTERIOR LATH
-'' COMPENSATION INSURANCE - _
(Tni.'cea net aed nCtMcomple,ce tone perm, .Trane Hundred aanar. 3'10 INTERIOR LATH ' :�.
alanCrle_s.) 311 - SCRATCH COAT
cert m pone lir h i<h thit larma-11 ill. d r r3-----'ROOF r '.I;
- - -
.Hell t , lay an Y,P n - m ole t th-ws k s
'cq P< t dcppr 501 - FINAL ELECTRICAL ENERGY
1.APpI` ' �Ff - 502' - FINAL' PLUMBING -ENERGY
WD ETOAP CAN If, ft meld ion of r of Eecmpuon you,youm Id
0 bdhw Cnjmect toply new k c oceh:t provisions Cnnehnarcaa<.Yaa'm�.t! 503 - FINAL MECHANICAL ENERGY
� Q forthwith omply
a;m.such .7.Crth' ce rt Hausa reed 'o- 504 ---FINAL BUILDING.-ENERGY .-- . - -
v) I ', 'coNSemisacoNIENDm'GAGENCY 505 - FINAL ELECTRICAL 1 I l l
Ihreby'trmith,mrtsa<onn t ding agencyfonhe per(ormance ,
W,> of me kf which this permit .issud(Se< 3097 civ.c) .' . .50.6....- GAS TEST
Lende'r,Name ..V pcold Ada ... 507 - FINAL PLUMBING I
I ceniry'rho,l have mad this application and no a snm she anove informntlon i. 508 - FINAL ME CHAN I CAL
core, 1 g t comply,with II city and countyordinances' d.t t I enter
upon V
Q V rob led' g o.w tiC ahercbyautho p tit es fth.city to ,rupon 509 - FINAL GRADE
W 'the bo cats ppoison,f tapes, prpa. a. 510 - FINAL PLANNING
�.0. (w ) grc .t- d 'ify keepaadl 1 ss iri
in Cityof Cupcno ugan"
Vl liabilities.judgments.costs'ad expenus which may in any way acerae against said 514 - FINAL U C WORKS
U Z City hence ofil g i g fin permit. - r
'APP TUNDER TANDSAND WILL WITHAL NON-POINT" Dille
st c° PGuL-AT t �5 _9'0L . Issued by: �J
Sig.s f "(mirth nmr«wr, ., ; L .Do - �.
HAZARDOUS MATERIALS DISCLOSURE "' "c- Re-roofs
1
'' W1l the appl¢a t if to 'buildmy« pa t core Crh dt hoard us smote al --Type.of Roof..-..
gas defOd.bym<Cupert oMntapol Cd Chapter 9.12.and the Health and Softy
-Cod S ton 25530 . " t v rt 1 1 '. s
❑Y 13Qd' t 'r I 1 r l __All roofs shall be inspected.prior to-any roofing material being.installed:
Will m applicant Or future Wilding dfihsdOccupant ay All, eat devices which If a roof is installed without first obtaining ori inspecuon;d agree'to.remove
�emthamd a mom t as defined by rhe Bay ArmAirQ Quality Management t _ _
District? Yeall new materials for inspection_.Applicant. understands and will comply with_
" : t all'non=point source regulations.
1 have read the hazardous thati,"nall requirements under Chapter 6.95 of the
'California Health&Safety Code.Sections 25505.25533 and 25534,I undersmnd that
„ sOutc dy have a ten , tht , my responsibility lin notify the ---
_.
occ lit ,h
mudr t wM1 ch mu.t h t p ro isz e M o Ccnif¢ate of
a p a emL Signature of Applicant Dale
-ante :d,agent . Dave, All roof coverings to be Class "B" or better' "
w .. ...... . . _.... - -
OFFICE -..