00080009 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
43 'FALLENLEAF LA' JONES MASONRY 00080009
OWNER'S NAME.'. � APPLICATION SUB DATE '
Y KAREN: 1058 DELL AVE 08/02/2000
HONE: - - SANITARY NO. CONTROL.No• .
4683777512'
p O C ARCHITECI'IENGIN'GER: BUILDING PERMIT INFO
rA'vp BLDG ELF.C'i' .PLUMB MECH
a 4
u
ti2N � fJ `O CI fJ
y LICENSED CONTRACTOR'S DECLARATION
O 9 0 I hereby alilmt,ba,I am Tice do major provisions of chapter 9 mommcrem, " ,� Job Description
F,:� with Seetion]1101p tir Division3 cline Rmiacss mA Pmfecsinns Cnde,nnJ my license - - -
ay�� is inlonforce andeffect. 'REBUILD FAMILY ROOM CHIMNEY AT SHOULDERf
-�a L"orw Cln" Lic,k
cc Q mU
w 3 O rn Date Contractor
ARCHUT1 1
` ARCHITFCI S Dh CL1RATION - -
C"ei aJ 1 understand toy
pl hall be : I as Public as
25 go LicensedP f ^/
OWNER-BUILDER DCR DECLARATION aV
6 ad C Z>
Iothereby ff m ri l 1r ,h CannotL' L for nthe
fall 6 S 11315 Balos d Professions O y Dut
wInch
tl Farm,, t inaL p Lrepair t core
prat I. I y m I f permit t signed lme
mint sl Ip , n theprovisions tin C , , r License
is 'IC, mfg c g 11 Norman he n 3 h re and Drodexs ons C()de)
-
Sq'
Ft. Floor Area
®Val t�gor hot no s therefrom and the basis for the alleged exnnpnAny violation 5
rfSectin 7031.5 by any appoll for n pormit subjects the applicant to n civil penalty
argot m()fa(Iran fivenaAend dollars($500) APN Numbewpaney '
Type
❑I,a,nwnerofthe pmpeny,enjoy nnpmyoeswjob w.,caasmehsomc()nmenmdam 35928037. 00
will do the xierk, and he p1are is it.,inforded,6,offered to, (Sec.7044,
Busipg�.s and Professions Code The Contractor's License Law does not apply in,an Required Inspections
f prpony Who h Idimprovessth a h a h kllnself
ora yl h:ovinmpl y : provided thin such co,owenensam an intendedor 1.0]. — FOUNDATION
offeree for sale:If,however,the building or.i,npenvement is sold within one year of T
onmpletime,me()caner-haild,r will have me lmpka of provirx mat he did no,brold or 102 — PIERS
improve for prance crsme.), 103 UFER ' "
°I,as()wnorafthe pfopeny,nm exclusively conlmcting with licensed contractors,to ] 04 — REBR R
construct the pi jest(see.7044,Business and Pmf..rues Code)The Cnmmcmr's
License Lodoes
esznor ,ply tact,owner()I property who builds onmproves thereon, , 105 — ANCHOR BOLTS '
and
dCmiwhoc License Lew. projects with a contractors) licensed pursuant to the
01 am exempt under Sec. B&PCR,rthisto...n ].06 SEWER, 8 WATER
Owner Date 20297 UNDERFLOOR PLUMBING
WORKER'S COMPENSATION DECLARATION 203 — UNDERFL-QOR MECHANICAL_ '
I nerehYnffinat under pearly of penury ono at Rai()wins anmwartons' 204 — UNDERFLOOR 'FRAME `
hebo and will nmmmn a Certificate or convert to self-insure for Worker's - 205 UNDERFLOOR INSULATION
performance
ae work for
For by Section 3700 or the Labar code, far me 301 — ROUGH PLUMBING
perfonrrneeof the workfor which lois pemotis i00 o t
n.
°I have and will mainland Workers Cmdpmude()m Disarmer,m tc,.i;,d by section 302 = TUB 8 OR SHOWER
3700 of the Labor Ctxie,for the performance of the work for wore)this permit Is
isnaL.My Workers Cmnpansaaon haanmce comer and Policy another are:. 303 — ROUGH MECHANICAL
Camey PohcYw,- 304 — ROUGH ELECTRICAL
CERTIFICATION OF EXEMPTION FROM WORKERS' 30S — FRAME
COMPENSATION INSURANCE
(This secammneed cal becompletedirmepermitisforonehundreddollar. 306 — HOLDOWNS -
tsloolones.) - N
307 — INSULATION
I mmpl than in the pe in
my ice of the work rbecome this permit a issued,1 '
Como nos anon L any person io any m so a,r thecoma son;eel m me worketk 308 — SHEET ROC♦;
conpenan,ianL:,wanrcaliramia.uyne°
AIironL 309 — EXTERIOR LATH
'
NOTICETOAPPLICANT:If,after making this Certificate arExempaol,,rauan°"1e31.0 —t INTERIOR LATH
z become subject to the Worker's Compensation provisions of the Labor Code,you mush
O
zG rnahwoft comldywith such previsions orthis permit daubedonncdinvoked. 311 — SCRATCH COAT
aherebyffrm
CONSTRUCTION LENDING ACI?NCY 31 3 — 'ROOF NAIL
()f the „
LLFsss I hereby uthat them
ere iis s a m construction lending agency for the performance
work for which this peamh is isued(So,.309],Civ,C'' 501 -FINAL ELECTRICAL ENERGY
W Q Lender's Name
z 11adc19snddress 502 — FINAL PLUMBING ENERGY
I certify that I Late read this application and state that(he above Tnfompa'ion is 503 — +FINAL MECHANICAL ENERGY '
Fy correct.I agree to comply with all city and county ordinances and state Taws relating
o 1()buildingeoas,mcd and hereby,mthoozerepresentatives ofthis city toenter upon 504 — FINAL BUILDING ENERGY
�y [� 'the nh m f edpr pen}f .pecan,prop
b a (w) g 1.sa intionair, ad keep n ,m c,the Cityofemperfrm ork, 505 '— FINAL ELECTRICAL
(in liabilities,judgments,c , and pe s e which may in any way nein a against said
U Z City c q ennn granting fmisp t 506 GAS .TEST
APPCANT SOURC8 REGULATIONS..
AND WILL COMPLY WITH ALL NON POINT Issued by: - 507 — FInLAL PLt ma-TNG -Date
Signature ornppficmWCbnnnctaf • .Date Re-roofs 508 — FINAL MECH
HAZARDOUS MATERIALS DISCLOSURE
•
Will the applicant or rmdre building oneopr a state or handle hazardous mmu;ml Type of Roof 509 — FINAL GRADE .
as dennw me CuP(32afdn()Municipal Cods.Chapter 9.1 z,and me Henan and safety 510 — FINAL NAI_ PLANNING
Code,Section he 6)'1 - -
°Yea El No All'roofs shall b ecce
Will IM1c I""emptor fmurc IN filing occupant use equipnmnt at advices which ��� dFPSrP1AQan3'19�1f16gJttWQfBKl�ing installed.
nit hoznnlnu1 air coma onrnacadefined by the Be,Area Air Quality Management If a roof is installed without first obtaining an inspection, I agree to remove
stdel9 all new materials for inspection. Applicant understands and will comply with
°Ye'` 0N all non-point source regulations. pp P y
1 have read she hamcdous mwedek requlmmens racer Clnpnr 565 of It.
Cali forma Hoild 6 Safety Code,Sections 25505,25533 and 25534.1 understand tlnt
if the building vice,act ntmn,ly have n,Cmm,that it is my reepon4bilitr to codify the
ccuPan,of she requiremem,which must be met poor to lasurnco of a Corti ficate of
oacapanry.•. Signature of Applicant t Date
owner or nam()raeeaxen,. lime All roof coverings to be Class "B" or better
OFFICE