01010010 (3)- CITY OF CUPE RTINO
CONTRACTOR INFORMATION: ,
BUILDING DIVISION. PERMIT
BUILDINGADDRBSS:
20967 FAIRWOODS CT
PERMIT NO. -
0101.0010
OWNIBUS NAME:
APPLICATION SUB DATE -
GRELLI VINCENT S AND SANDRA
L
01%03/001
IONS:
SANITARY NO. CONTROL NO:
ARCHITECI'1IiN WHER.
BUILDING PERMIT INFO
lILDG ELECT PLUMB MECH
LICENSED CONTRACT'OR'S DECLARATION
10b Description
hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Sermon 7030)of Di o.... 34 tic Ifmine—nd Ruf—imry Code,nnJ my license
is in nlu,re
Lure arta eys,at' /
.i«,hsr as
Date of
-
REMODEL
_t% em,lrn.76east
S DIi
ARCIIIT be
I unokn,and my plan. shall M usN ax public records
. mblie s'ecord
LiconsW P ......al "
OWNER -BUILDER DECLARATION
1 hereby affirmThat 1 am exempt from the Contractor's law for the
follow!", 70715. Basi Profcadons
reason. (Sccdon sesn.nd Cads: Any,ahy or rummy
wines, regdres a pemhi, ,a costumes..111, improve, demolish, m repair any strucmrc
prior fast, issuance, also ro pones the applicant for such pem,inn file is, grid smrtment
Sq, Ft.
Floor Area
Valuation
that he is licensed pummmnr the provisions of the Cmer.;clae, license Lnw(Chase, 9
(commencing3 of the
win 5therefrom and thCCLion 71l of e basis for eacmJ;on.lAn `ram Codq
,shut he is esam
$50017
the alleged
p 'h P y supermen
or notion 70315 fby ive ha mod applicant for o pemhit albjrrs the aPPlic:nn too dvil pcnuhy
m' not lnom nhnanvrltn"dreddofmmisstw).
APN Number
Occupancy Type -
❑La,nw"erohnepropeny,otl„yempwyrr'whowagrsasmehsam,anm nsmmlh,
3,591,31
1.4.00
will do the work. and the xraram Is not haendf,d m offend for sale (Sec. 7144,
,Nminns and Professions Codc: The Contractor's License Law docs not apply to an
Required Inspections
r of pmprny N'M1n lwilds nr improves thcnan, and who meas such work himself
n �
101
— FOUNDATION
,iso'lo his own employs,as. pnwid,aJ mal such ar,00semarl, am ant imunde l ,,
offered for sale. If, however. the building or improvement s sold within one year of
102
— PIERS
completion. the owncnhuilder will have the burden of proving that he did not build or
eve m"ametse of,:de).
103
_
— UFER
L as owner of property. am exdusisely ontm,adng. its licensed u;mmetora to
104
— REBAR
common he prupe, (see. 70,4, Business and Prorso.... cmle:) The Cmnmo,r's
I.ISa„c Law does not apply to;m owner if property was nuddsor lmpmoe, thereon,
10-9
— ANCHOR BOLTS -
.,ad who contracts for such projects with a comments) licensed pursuant to the
'
Can cities License Laos.
106
— SEWER & WATER
01onrl exempt under see. ,R& P C forthl, reuse.
-
.
202
— UNDERFLOOR PLUMBING
Owner Date
WORKER'S COMPENSATION DECLARATION
203
— UNDERFLOOR MECHANICAL -
Iherebyifion Wer Penalty ofp ,jury one ofbefwmwif, declarations:
204
— UNDERFLOOR FRAME
I have told will siahialn it Cerdn'ute m Consent to seB.insum lot Worker,
205
— UNDERFLOOR INSULATION
Colnpemanim. as provided for by Section 37W of the Labor Code, for ,he
Performanceoftheworkforwhichthispermitisissued,
301
— ROUGH PLUMBING
❑ I have and will maintain Worker's Compensation Insurance. as required by Section
302
— TUB &• OR SHOWER -
37(k) of the IaMa Code, for the performance of the work for which this permit is
slued.MyWorker, C"I„P.malit In mr,nreo..",andPoheymtmberu,a':
303
— ROUGH MECHANICAL
is crier: policy No.:
304
— ROUGH ELECTRICAL_
CERTIFICATION COMPENSATIONlIN URA(NCE OON FRM ItKLRS
305
— FRAME -
(This ,eetionneed not he completedifnnpennitisforonenundnddollars
306
— HOLDOWNS .
(M00)"`less')
307
— INSULATION
1 reify the, mite perfmmanm of the work for which,hi, permit is i...ed. 1
308
— SHEETROCK
'hall nnI employ any 1„can n nay ulmmrr,;,, a tc ,hlhirrt In die Worker!
Compemahon L.wso1 CG 1 P�
309
— EXTERIOR LATH
Appicmh, ,��uc
- 3i.0
— INTERIOR LATH
NOTIC' IDA PPI.ICAN'Lll; afterr�,.II in tis crnir,a.tean?..empnan yea sM1hwd
herons xuhjeci m the Worker's Compemamlon pmvleluns of the L.hnr Cwle, you ants,
forthwith complywithsachprovidmi,orthispronh,hallhedeemrJnvel
311
— SCRATCH COAT
CONSTRUCTION LENIIINGAdENCY
313
— ROOF NAIL
1 hereby oeires that then is a construction lending agency performance
for the perfonce
of he work for which hi.pennhisissued(See.3n97,eio.C.)
501
— FINAL ELECTRICAL ENERGY
Lender's Nunn
Leaders Address
502
— FINAL PLUMBING ENERGY
Icemylh:nlhavam.dela, apoli'adnoamf„alydhal incubate inronnadmhi,
503
— FINAL MECHANICAL ENERGY
�omeet. I agree to comply with all city and county ordinances mal state laws refusing
building construction, and hereby authorize representowes onhis city m enter upon
'
504
— FINAL BUILDING ENERGY -
me above -motioned prepeny for inshecann purposes.
(We)agree to save, indenififyanti keep lh.rmfessthe City ofCupertino against
- 505
-
— FINAL ELECTRICAL -
liabilities, judgments, coos and expenses which may in any way acerae against said
City In m
' 506
— GAS TEST
cnm,cqusnce of the gramin, Its porous.
Ng�TUtNDAAPPLICATKNSNDn AND WILL COMP%�N�ON�O INT
[slued by5017
— GTNA1 pl 11MR Tn1(y Date
SOURCE
f� /
Re -roofs 508
— FINAL MECHANICAL
g".nuenrnornpp`II:11'/ci,m;m % ` >at
HAZARDOUS MATERIALS DISCLOSURE
Will dm applicant or future buildingoccupant stoic or handle haaaNnus material
Type of Rom9
— FINRL GRADE
t2553: ;r�"o pale,de, ah.mer 9.12,and me Health and s0fC1y
510'
r FINAL_ PLANNING .
Code Section
❑Yes \1 No
All roofs 84I4be-4'nF4*44[pria3(![gjpI(3)oF>Srial being installed.
Will [tic apph,aart or future building°r'u'lo, ase tspai nt or desires will,an
If a roof is installed
without first obtaining an inspection, I agree to remove
Femi,bunrdmi,mrcan,amin%L,defined by the Bay Area Air Quality Management
Dtmneo
all new materials for inspection. Applicant understands and will comply with
res No
all non -point source
regulations.
1 have `cad the hvmdous materials requirements under Chapter 695 of ,he,
Colifnmh; Heallh & Safety Cndc, Sections 25505, 25513 m d 2553understand 4. 1 uerstand Ilia,
if the building does not currently have o tenant, that it is my responsibility to noidy the
orcupam of the requirements which ram, be mee,, Prion, to issuance of a CcnlGc.tc "f
Signature of Applicant
Date
All roof coverings to be Class "B" or better
Ownrrora tori edagen, r
OFFICE