02090072 (3) CIBUILDING DPvsoNO
ttNPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: APPLICATION SUB DATE
_ TOENSFELDT HANS W AND LORRAI E278 CASTRO ST 09/11/2002
HONE: SANITARY NO. CONTROL NO.
` (415) 968-83'18
u O p ARCHITECT/ENGINEER: a BUILDING PERMIT INFO
Ig u BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION F 0�t.l A LE
•5„� JobDescri do
Z_ I hereby vias%Iwl 1 am licensed nnd< provisions of Chapter 9(commencing P
._CLL wimseel�o ]0mlaromision3°rlheliai s.a ad Professions Code.anamylicecxe KITCHEN REMODEL
x f_ ns m r a an recti. v
th ec a Liccnso p Z
t a u t” D°
ARCHITECT Spy ARATIDN NOV 12 2002
m
''-•O,Nat b 1 under%and my plan%shall be used u:pAblic records
3 s Oueensen Pr°ms',ionm
ce BUILDING
�1111 ®�l>,i�f±
OWNER-BUILDER DECLARATION BUILD NG
u a
n 1 hereby athna Iw,1 am exempt rrom me Cmaracmr's License Law for the
?Q fallowing reason.(Section 7031.5.Business and Professions Code:Any city or county
Hsiwhich requires s Permit to conomat alter.improve,demolish,or repairystructure $14000
i 3 Prior m t c I q 're.the ppl cam f n Perm Oo fl ignetl t mment - .._-. ..._. - --- _"_
math I seep n they n fth C Contractor La (Chapter9 .L,r, Sq 'Ft:.FloorArea.' ,.�. Valuation
(cam g with i ]000) fDivision 3onne Bus dP res nos code) :'e•`"a 3'2"64 T003')00's =a`-:f'..t e.'•
or that he is exempt thereriom and the basis for the alleged uemption Any violation '
of Section]031.5 by any applicant for a pemm subjects the applicant to v civil penalty
,of a.,mom than file hundred dollars($500). APN Number :n �'rl Occupancy Type
01.as Owner of the n.«m employees their solecom tion, 101 - FOUNDATION
Toter temp y or
peso
-'
will me' Professions
me Yuucmrc C not ar'sintended or License Law does hot"(Sec:'to an -
tebii«as dna Wmn',case:Tse C«nncmrs.aria Law does naw apply ro an Required Inspections" - '
Owner of hhisOproperly who employees.
Wilds or improves thereon,and whoa«s such work himself 103 - UFER
or through m',awn cmplayecs.promaed that mien improvements are not intended m or .__ .1.0 4____REBAR--- "... -
-brccred Fortuna.Jr.lu3wcvcr.me building or improvemrnt is sold within one year of� --
completion,the owner-builder will hasemeburden ofpmvingmanedidnolbaBdor 105 - ANCHOR BOLTS
mprove far final of I )
SEWER-.&—WATER.
ED is as owner of property am coolinowely contracting with licensed contractors to
and 202 — UNDERFLOOR PLUMBING
c License
me proles Sac.]IMS B Professions CMe)The eanthinium. .' ..
Einem Lvwd«snfor-suyman owner arpromilmoonw0dnrimproto t 2-03, - UNDERFLOOR MECHANICAL t
_und.whn contracts far h intricate wash. mmmorlsl Le used pursuant en the.. . . .._ .._" . -.-UNDERFLOOR_ __
c"%not°rale"".e 1° 204 - UNDERFLOOR. FRAME„
❑I ame pt under - ' ;B&PCT this revsan 1. q
o-n Daie 205 — UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
Ihereby affirin under Penalty rPe3 y ormefollowing al tions: - 302 - TUB & OR SHOWER
rI have d will noinhin a c m fi,.m or Consent I.s lr .ure for workers 303 _ ROUGH MECHAN I CAL
cJpmpe t as Pro d e f r by Season 3]00 r the Labo code.-for the 304 ROUGH ELECTRICAL
perfo f the work f r 'h ah Isis perm t od r
r' 305 - FRAME
❑1 have and will ine;niain workers Cmnixnr um'naance.'ga regJirea by Sonans 306 - HOEDOWNS
c 3]00 oLthe'Labor Cdle,for the performance of the work rdr which this permit is
issued.My Worker's Compenuwion'Insunnce easier anE Policy number arc,' "
,..,.• ..,. 307 - INSULATION
WORKERS' 308 �•-jiSH-,EETROCKi. 1 G va�CERTIFICATIONOFEXEPU
COMPENSATION INSURAN . 309 EXTERIOR
i
1'aa.a•'n- .
.__.___--_.__.
Tmm',canon oced nmrte compleleA Ifth<permit is rm one hundred dollars 310'-1'-, .INTERIOR LATH( •:
drool aness.l.. _ .
311 SCRATCH COAT
17-
e n rr mat m me peffnm,ance or m rk'r men th pen% a
;ssu<a.l 313 - ROOF
shall not employ any Person in any manner w as to become subject m the Workeri
Co501 - FINAL ELECTRICAL ENERGY
mpo t laICalifornia.for
' e a Date '
NOTICE TOAPPLICANT If. ner making thctirnt of—ExempOonyousnnma 502 -- FINAL PLUMBING ENERGY` ` --'-
Z
become subjectt the Workers c penal provisions onndi.admv you mus' 503 - FINAL MECHANICAL ENERGY
0 ash c in ply with s h provrsmns or m pe l sh 11 bed ed k d.
Z :` 504 FINAL--BUILDING -ENERGY
ons
E•,'� 'f nal CONSTRUCTION LENDING AGENCY
(hereby vff that herc itocnnxtmt nlend'ng agencyf m'perfonnance 505 - FINAL ELECTRICAL
y ,.., or the work for winch m permit t s.stied(Sec 309) Civ.C) -
Gp Lrnaer.Name-.,,- ,. ,�,:, ___. ...... _ -..__._. .._.506---GAS T-EST---
p Z Lease Ada ,.i „ _ 507 - FINAL PLUMBING
U O anify tmc dm' application and caand
n arm than binformation' 5 (NAL MECHANICAL
agree
GTa-F+ coir'en I g toe ply m all cordinancesand state t laws Icing
O U to bolas t Ib dhembyamnoi p iaaveaofthiscitynoenterupon 5 9 — INAL DE
he aboe.memimsd piopcny! .pecan prpose
p.a a two)ogree Ib live:indemnify rte keep n les me City-or c pen rte aNgainst 5 0 - INAL l '
., z Cliabilities.tconseg enci ant lii pontes pa h,may any way m<agatnm said 51 INA RKS
U Z City m conn gment of the gram x en this pard%% V t/
APPLICANT UNDERST NDS AND M' .L COM0LY MITH ALL NON- ih '
so :e ntif; Issued by; Date
gnmureof'Apphca omramr"M';.'i � ," .,« Do Re-roofs
HAZARDOUS ATERIALS DISCLOSU ' '
M ll th -pplicaht Or home wading occupam score«handle haraNats material Type
of Roof
as def d by the Cupertino Municipal Coe Chapter 9 12 and the Health d Safely
Code 0",2557 (q1` +i ,� ,'1 i
q .
All roofs shall be inspected prior to.any roofing materia]being installed.
Will the pplianlo future molding« pant q v t de mIf a roof is installed without first obtaining an m9pectton,'I agree to remove
m
It h endo s tam a is as def ed by ti Bay A A; Qua.ty Management
all new materials for inspection Applicant understands and will cord 1 with
r t all non-point source regulations i, ,,,• 1, „
1 have mad me'haxard s ,¢rials req mems under Ch pie fi 95 of me
C61118mm Hearin&'Safely Core.Seaiom 25505.25533 and 255341midermand that
-,rtlne,building does not carnally have a tenant,that it is my responsibility to notify the
.cup t ff the n be metprior to Mud f a C oificam of
Occu c -
���' Signature of Applicant_,_„ . . -. Date _
t cJy�jy/�
gw^< a ,mar ode
Zen! ' S Data: All roof coverings to be Class "B" of better
' . .OFFICE. . .._. .. _.... . -
� - 1 ill ', , . -..