02070104 (3) F
Y OP CUPERTINOBUILDING DIVISION PERMIT ;.CONTRACTORINFORMATION:ING ADDRESS: PERMITN 14 FALLENLEAF LA BROOKE RAHN 82070104
:BROOKE RAHN APPLICATf00./1 /T�2OO2
PHONE:
SANITARY NO. CONTROL NO.
a aez ARCHITECrIENGINEER:
O O BLDG ELECT BUILDING P LRR MIB INFO MECH
U
Z .
IJ CJ L "7 U
v to LICENSED CO,NTRACTOR'S DECLARATION Job Description
z.z lhertq-amnttmarSamrcensedinls,00kionserehapter9lc9mmmcir, KITCHEN REMODEL p
yam with Sat ion]000)ofDivision lofShe BusinProrcssionz Coee.and myliccnu
ne P j ism fol lou and e(Ten.
O c u Liccnu Lic.
3,a-v a Cont
ARCHIT beloo DEC TION NOV
E:
O I I understand my plain shall be used asp lie rtcoNs 200x1
i 6 p 0 Licensed PmmO,imal L
's�rEOWNER-BUILDER DECLARATION
ur 1 hereby a1Brm tum 1 am encmpt from the Connevor's License law for the BUILDING
{��
r i< following reason.(Section]011.5.Business and Professions CodBU
e:Any city or county ILDING $25O00
F D which requires a permit to construct,otter,improve,demolish,or repair any structure
F3� -prior to its issuaae.also requires the epplicam t forsahparmiuofileasi maumenr. - - -
thath sled ed pu ni n9 deo malidans of the Contractors Lccnu law _-------- __ _---------------------(Chapter9 36 Valuation
(cam
with Securer]000) ID' is on3of the Business and Prgfess ons Code) t-,q e�011. _. , J y ,v;k�stt�.j fk q .
or that he a exempt therefrom and the bass for the alleged exemption,Any vmission . "' .
"Of Sccaen]031:5 five
hundred
u applicant ror a pemut mbjttts the appliom to a civil penalty- 1 0 3NPN 1`h 'DATION 1,q;
mrdnrmn2tnehBinnereaamlam(tsar). .if , Occupancy Type
o 1.a'owner°fine property,or any employees with vagea a,tneiraele c°mpens.nmr, 102 - PIERS
"\villa.the work:and thestructureis hot handed Or brf mdfan sale(Secf]0a4,"'
`Business-mid'Professions Cods:The Contractus License Inw does not apply to an - Required IRSpEChOtls m.... . .
owner of pmpeny Who builds or improves thereon,and who does such work himself 104 - REBAR
or thr°ugM1 his own employees.provided that such improvements ort not intended or
-:offered for sale.If.however.the building ""'-'_
e improvement . . - 105 -= -ANCHOR -BOLTS ...... - --...---...
'improve for me owner-builder will haus the burden of that he did not build or ^'`' 'f' -''�-r.0^.'•'
improve for pumme of sale.). proving 106 - SEWER & WATER '
_.-_a_._.._v-,-Pa�Y.am exclusively contracting wish licensed contractors to
--_ -- ----- ----- -
-"--. . , ---"--UN
emm the of ro DERFLOOR -PLUMBS-NG-- —
v icewathe rosin(Sec. toanBusinessanded,whonseine: Thecemmorm, 203 - UNDERFLOOR MECHANICAL,;_, l.i_,,•
., c
License Low pact not apply to an owner of progeny who buttes or improves l-lo.t e.
..and-who. ma.mnsuch.proja .wim.a comm m :).uan e.pa a t-m.me. _.._._'--. ___2.04._.- .UNDERFLOOR._ FRAME_
C
vapors License lv r ` —__. `---,_---
-': dem ptaat " " BseCfortniamnron 205 - UNDERFLOOR) INSULATION
o' Date ' // // 301 - ROUGH PLUMBING
KERSCOMPENSA DECLARATION� 1302 - TUB & OR SHOWER
I hereby affirm nndq fertility of Pietist on;ohne following declarations: 303 - ROUGH MECHANICAL
❑ 1 n:.e a dbm mainum St C' of Ceaq t to H.maare rex week a 3 04 - ROUGH ELECTRICAL
cOmpenasr.,-,. provided fee by Section 3700 or the ober Code. for She 3 O S - FRAME
pirf ion of the work f h h to s pc s i sud. ,
❑1 have aitd will meilmd WOA Comp;into i.-umnce as icgmred by Section 3 06 - HOLDOWNS
3]00 of the Cabo-Cad r the pefom,rice of he work r which this permitis 3 07 - INSULATION
smell My Worker's C pi tit o Insurance f d Policy number
Cam V Na �3._'kPoliryN r- - .
308 SHEETROCK .: __. ..4_ ._.
1 'Y L'ERTIFICATION OF.E%EMPTION FROKWORKERS f 1-�=(\ " !3 0:9,, Il EX'T'ERIOR.:LATH•
-tcorneF3{snnorvwsuRAr{cEt 31.0._.-..,INTER IOR...LATH.-- ..__.
recd not ba completed if the permit is fm or¢hundred dollars F-- ' - Pt 1•:- - r •--- ----
(5100) less) t
311" SCRATCH COAT
.,3.13._.__..ROOF_NAIL_..-.
d al Y shits m to in c of tM1 o k bewhich th t
atoll not tams dI oif eta -man e u l beta eaub)ttna she Workciz 501 - FINAL EL'ECTRI CAL`r:ENERGY "
Compcnsayon s fyabfom .D /7 O Z "
Appl t t � � .—_ _ 502 _ - _FINAL PLUMBING ENERGY _
N TO L A—; ,,am mak gm CerrrcteotL pin youShould 503 ---FINAL MECHANICAL.--ENERGY
Cab It the W rices Co-
$ pc ton pro Cao sof theiabor Cod you t
O O roanx c pym such . er.m perm nob.d ma 9k a. 504 - FINAL BUILDING ENERGY
F'h 'il tt er i .. . _ .... ... _....
,,, CONSTRUCTION LENDING AGENCY t " SOS -FINAL-FINAL ELECTRICAli'-' " ---- -- - -
d. I hereby Rini th t the s consuua c. I ridg sgrnry fo the perfo a ' It
k7:" ohne work par-htcHtmspc +t s s eels 3W1,et 'c,) 'I '-e� 506 - GAS TEST
w•.0 'L eta w 507 -- FINAL -PLUMBING —' —
UZ Lend sAaartss _ ICAL
O 508 FINAL MECHAN j!
1 c n ry that I have mad'hi-application and st t mat the shovef mtation is 509 - FINAL GRADE �---
OtT+ omit.i gree zo comply with all city and county ordinances and state laws missing
V tobuldngco wed or,
ayfarS monde p umuesofthubrymcmeropo^ 510 - FINAL PLANNING
j e_k7 the above me t o d_pmperry ro 'penia p.pose
,y] We)egrectosobe,iademnifyand Lee,hamlhsthe diyofCupe'ninoegeinet 514 - FINAL PUBLIC WORKS
IA liabilities,judgments,costs and xpcnse which may in any way accrue egainm said
C.2 Z City .. .quem fth R ung Si - ..,...:.
APPITCA.\T"N RSTA.\ SAS CO'1PLYW.HALL NON-POIINT h" ISSUed b
SOURCE-R -S y Date
C 2
. . ma yx an m ••'r t Re-roofs
z ? , HAlJsRDOUS MATERIALS DISCLOSURE
I the ppl cam o f Nu building acupant time o'handle hazardous tentl Type of Roof - _ _ _
as def N by th C penmo M pal Cod Ch pie 9.12. d me Health and Safety - -- "' - '- '------ -• -
CodiSecuon2553Na) 'I e t \f 'IRt tsyY,t lr 4 .... # _''. :.i'( \z ;.'vi 1-'•- '.�Ir;'t r'rt!7 .
oY ...All.roofs shall,be inspected prior-to any roofing material.being,installed,_._ _
I t
W11 me Ionto rtrtb Ido or. t
PP a Pat s;equipment t dee which If a roof is installed without first obtaining aninspection;I agree to!-remove
Wit hazudo o tamrna t defined by me Bay Ama Air QualSty imi"intru
all new materials for.inspection. Applicant understands and will comply with_ -
7 all on-poi t source regulauons
7.' M a readithe hazmdsus'maienals rtqutrtments,uiidv Chap¢r 6.95'of Ni '
C Ne buil 3 and 25530:PuMeria nd that
alif fa H '&Selnj CoE e2uons s roll 2553
rf d s nm .. a tanant LOW i s y responsibility to notify the
—._
octopa t aqui sois ch' it be mei prim ro issuence of a Certificate ofocco '`�t• -"
770 Sign
atpre_ofApplicant _ Date
— _
.1 ziutlmnasd agent . Dat r,t. All roof coverings to be Class "B" or better
t
>, .........OFFICE" . .. .
ii sic ,114 , .._.. I .. .._