01090092 (4) CITY
DING DIVISIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10531 S FOOTHILL, BLVD 01090092
OWNER'S NAME: APPLICATION SUB DATE
WERNER GERTRUDE A 09/20/2001
PHONE: SANITARY NO. CONTROL NO.
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or°Z° ARCHITECrfENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
L:.I
LICENSED CONTRACTOR'S DECLARATION
5„3 Job Description
Z_ eIhereby0ffi.)of that oftheeBsinnerp d Provisions chapter ad mmeaing
at� withS lfirec 00)ofDmismn3onneBa¢mes¢andPMess{anaead:anamyli=ax INTERIOR 'REMODEL
::e I ism re Cl rce erM eF<n. : ..
aa< Dolenxcla:¢ � 'sictr ORIG PERMIT 52183 ' FILE DESTROYED. VALUATI
Date SDECtA DETERMINED OFF OF OLD PERMIT APPL.
(n ARCHfIEe use DECLARATION /f q
•y s. 1 undemmnd my plans shall be used as public records
V2 2 O O Licensed Professional
'e'e� OWNER-BUILDER DECLARATION
=m I hereby affirm that 1 am exempt from Bs Contractor's License Law for me
I- an
Z G following memo.(Section 7031.5.Business d Professions Cade:Any city or county
wit h requires Cres ,oryin to construct alter,improve,demolish,or repair my structure - .,r
t°6d pn t t ce,dm mi ifir(the Wheat for such pmnina Ble a signed uvement.. — - .- q: . -
that h idlic mss punumi io the provisions of the Convenors Licence Law(Chapsr 9 ,a, - s t FIOOC,"A�ea cation
(commencing with Section 701))of Division 3 of the Busipess and Prpfessions Code) { 4 - r.,St, a —{�. -s'� t • $120
V V
or that he is ehemprthetefrom end the basis for the alleged exemption.My violation s Z7�
-of Section 7031.5 by any applicant for a pemut subjects the eppbcann m a nvtl penalty P1 p Y
of not mart than five hundred dollars($500). 34
�A WW f� OCCU C e
12 1.ns owner of the progeny,or my employees with wages as their sole compensation, 61 rf-+�•
will do the work;end the structure is Out intended or olfercd for silly(Sec.70-6.
Biamess'and Professions Code:The Contractor's License Taw does not apply to an 101 FO ]!�tlire ❑ ectl $
owner of prop<tty Who builds or impmvcs Homan,and who does such work himself
or through his own employees.provided that such improvements am not intended or 102 S _
,'otieaM(or sale.If,Sowever,the Wilding or improvement is mid within one year of 103 — UFER .
'completion,the owner-Wilderwill have the harden of proving that he did not Wild or
improveforpurposeofule.). 104 — REBAR
❑I,as owner of the property,am exclusively contracting with licensed eoatrocious m 105 — ANCHOR BOLTS
consuucn the project(Sec.70,16,Business ad Prof ions Cede)The Convector'¢ ,
Ciccone Lew does not apply no an owner or property who builds or improves mention, 106 — SEWER & WATER
end t,f�wach projects with..sammue(.)licensedpurmant m me 202 - UNDERFLOOR PLUMBING
Olem exempt uadcr gee. 0&PCfor this mean 203 - UNDERFLOOR'�'MECHANICAL
no, 'Ib '4„ ..:: bd s ,.r. i,.. < . .. .. 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
1 hereby alum undo penalty mf parity one pf the fo0owing declaromns: 301 - ROUGH PLUMBING
❑ 1 Nava end wiH ar:ihwn.Cenllias of Curial to self mum,sur Wadmra 302 - TUB & OR SHOWER
Compensation, as provided for by Section 37W of the Tabor Code, for me
perfomnal
iao c awart for which,flus permit is issued. „ 303 - ROUGH MECHANICAL
El have
ond will maintain WAer's Compensation brommce,u equiad by Seation 304 - ROUGH ELECTRICAL
37M of the Tabor Cade,for the performeme of the wart far which this sandy is 305 — FRAME
s _ Issued.M Workers Com,aranc
non Insue cartim and Palic tuber ere: ”'
Carne, 1 V' '- '''Polry No.: ✓ •1
30.6,.:, .HOLDOWNS.. --
CERTIFlCATIONOFEXEMPTIONFROMWORREI{5. - ss v � 3O7' '-- r'INSULATIOI� -
COMPENSATIONINSURANCE i
(This sectitin non
need not W comPlard if the permit is fm e hundred dollars 309
'— _ a •'''�
a..> 309 - EXTERIOR LATH
•'I'EINTERIOR "LAPH,
truly matin me Iiedom,anEe ohne work for which oris"p<mth is issued,T ... .310 ' —"" - - .
sluil'ngt employ any person in say memory m"as in become subject to me worker' 311 — SCRATCH COAT' 't `
Compenaddn Laws of cal mini.Data
Applicant 313 - ROOF NAIL -
•NOnCETOAPPLICANT If.after makingshis eminate of Exemption.you should 501 — FINAL ELECTRICAL ENERGY
become subject stn me Workers Compensation provisions of the Labor Code,you must
00 forthwith comply with such provisions ar mid parody shall the decmed revoked. 502 - FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCYfiam mn I. d503 - FINAL MECHANICAL ENERGY
`I hereby tlot thea..en .lending agency for Nnnee pcifo '
beth wak(mwhitihthiap mltisissudBec'3097,cm.c.) 504 - FINAL BUILDING ENERGY
z pit "A Lime"Name- - 505 - FINAL ELECTRICAL ,. ..
,0 ,yi• !I certify that 1 hove read this aPPliation end nam rbutahe above Information Is 506 — GAS- TEST
tL [y cored.T agree m comply with all city and county ordinances and state laws mleting 507 - FINAL PLUMBING
�. mouldingeonsvuction,and hereby authorise representative of this city to enorr upon
W
the above-mentioned prop ny For inspection purposes. 508 _ FINAL MECHANICAL
gk, (We)agree to save,infirmary aril keep baroness the City of Cupertino against —
h liabilities,judgments,costs and expenses which may in any way acme against said 509 F I NAL G
V: City in konuquence of Ne granting of this pemilc. " ' - ''
APPI,ICANTUNDERSrANDSAND WILL COMPLY WITH ALL NON-POWT'
Issued NG
lO 22.
Date
SOURCE REGULATIONS.
Signdmrcof Applicaro Contrectbr' "" .-Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the appbant or future Wilding accupam store or.handle I0I8N(Na mateoal Type of Roof
a defined by the C.p i. M nicipal Code Chapter 9 12.and me Health aM Safety s�: .,s h,,v- a t •;".5 4 i
Code Section 2513207 . Ii .. 1. ,.
Dyes'..'i'" : ',' .dNa "IF,,• . , • • I IAll.roofs.shall be.inspected prior to any.roofmg.material.being installed.
,.t Will the ePplicant,orhome Wilding Occupant use equipment or devices which If a roof is installed Without first obtainingan ins eetion,,Ta ree to!remove
mit heard..,may contaminants as defined by me Bay Area Air Quality Management p g
fav=7 all new materials for inspection. Applicant understands and will comply with
°YeS bla all non-point source regulations.
1'have tend the mountains materials raquiements uMer Chapter 6.95 of the
cairn
.is Health R Safety Code,Sections 25505:25533 ad 25536.1 undersand that
if the hallding does oat conatly have.reason,that it is my maponsibility to notify the
.cup...of the rtquiaemems which must be ma poor to issuance of a Cmifiate of
Occupancy. Signature of Applicant Date
F:., Ownerm-aboimd.gem t' Dna All roof coverings to be Class "B"or better
t.
OFFICE