01080130 (2) OF
TINO
CI BUILDING DIIV�'ISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS:. PERMIT NO,
10565 GASCOIGNE DR 01080130
OWNER'S NAME: APPLICATION SUB DATE
RONALD & CAROL PUCKETT 08/27/2001
/ PHONE: SANITARY NO. CONTROL NO.
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
x w FRLDG ELECT PLUMB MECH
w« LJ L.1 I_J I—U
ss-- LICENSED CONTRACTOR'S DECLARATION
{z�2'y Iherebyeffinn,hi l am licensed under provisions of Chapter 9(comis ' n
erating Job Descript
m t=rwish Sciti.7")af D' un3ofthe Businexs end Professions Cade.and mylicenu DEMO.
I,in full force and a t.
OU License lass_� Lic.l
Dam 2,2{./ Cora
M LL O t; ARCHITECT'S DECLAR O
Vg 1 understand my plans shall t,used as public records
i a�T.
I'Y O O Licensed Professional
'K o OWNER-BUILDER DECLARATION
w=w I lureby off.that I am exempt from the Convacmr'x license low on she
t?< following recon.(Section 703 1.5,Business and Professions Code:Any city or contrary $8000
ce F o which Crequims n permit to construct.alar,improve,demolish,or¢pair an strcwrt
ou (camrr its issuance.also rtquias die applicamfor such pemJuo Ill...grad -
e3- ij heca d'porsdfr0 Mattie piovi5om of the ComuncrIs License Ww(Chaper 9 $ g
m .pnor,a ��'IpppDrr{{��,,Trga
sting wins Section 7000)of Division 3 of tM Emma,mod Profmsionx Code) Valuation
or thai'fie'is diempt Minifiari end the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for o permit subjects Me applicant o a civil penalty,
0notmorethanfive Wndmddollars($500) NOAMi D INSPEC IONS t r Occupancy Type
❑Lasr ofthe property,or my uwages
ndryees with as their sale compq
cnsatio ,
wiil*dpnthe work,.and the strocu..is not intended or offered for sale(Sec.7N4. - - - '
Bnvihc,v and Professions Coda:The Cnmmctnr's License Low does not apply Mo an Required InspeetionS,,:,:: R '_
owner of property Who builds or improves Nveoa.and who does such work himself
or'
r through his own employees.provided that such improvements are no,intended or
bffc¢d for sale.If.however.the building or impmvmant is sold within one year of - ' ' - ,,.•7;I`' . - .t " -- --'
complet on.the oxnet W Ids ovII hnve,he Wrdcn of p,onng thin he did not Wild a
improve for purpose of sale.). r
-
O.I.as owner of the. n -...-..__. - . . .. _ .._._
pope yam exclusively and
Camaorsm - T _ ILL' -
cnnswa the prosect(Sec tto a Business pod property
who
Cade)Theses the to r, -
oil we Law docs not apply m an owner of property won builds ord.imposes a thereon,
send who comruts for such.projems with u.consmesortU licensed.pursuam to.the
-
Contractor's License to _.. ..._...
01 c p nder3 I'' ,9&PC fur this rensmn ':stir 'fid' itl(?I lfl(t��
C S COMPENSATION DECLARATION
I hemby afBm:undetpenahy of perjury one of,he following dcdaations:
0 1 hove ord will mafnairi Certificate of C.,b sa f-imine for Worker-a
Compensation, aa.provided for by Section 37W of the Labor Code. for the
performance or the work fm which this permit is issued.
❑1 have and will maintain Worker's Compensation brsmdnce,as required by Seciian
'37W of the Cabor Code,for the perfomance of the work for which this permit is
sscd MyW kr'C tape tat i Tirsurancet carrier andyPoly number ore.,r
}'
w �lPolicy No..�S�.Z7 7 DLb/
Ctvs CE ON OF EXEMPT ION FR OM WORKS S" ..j • Irf ltM : r`r�t,sa-�1
' COMPENSATION•INSURANCE'
.____..............-...__..
hh's sedrod heed not be,completed if the permit is fa one hundred dollars i,e •. 1 i i "t vs: (::- I j:1 '' r',iv:
MI W)or less.) 1
I . 11
. - 7. .._-�..-.._. ._... . . . .� --------
issue
__ rr.....—....... .
` 1 en fY that to parfam nee nhheork fo hich,h pe us issu d 1: p tU f 't' -` -- - -~ ~'- -
iRdi no,employ y pe many mdn a sa a-an become .sect m the Wo kers, ""A
Compen;atmr lows of Cafifomia.Dam
ApPbcmT
NurICE TO APPLICANT If.after Maki Bth C ni m
Ecate ofLempti n you sh Ids
Z 0 Wromee bjecuothiW rke? Ccmpensutonprovs:ons of th 'WW Cod.yoam in
forthwith' comply with such p ns or Imo permit shall be d emeJ res.ked.
.F^ VO _ N M CONSTRUCTION LENDING AGENCY - - - _ .._- __ J •._ .- _-..
a '
I herebytififiran,hu,hert'sac nit n 1 d' gaB yf M performance ..
r
of di rk f rxnieh thi peon t s slued ISec iU9]'C C) "
Lendershhmc
Lender'i`Add ress
V-
14s:P: ., I certify that 1 have read this applica,imM awoe Most Ne abme information ist '
codec,.l agree to comply with all cityand county ordinances and state laws relating
'C.r, Oo building consuunion;and hereby outhorim representatives ofthis city to enter upon
phe above-mentioned property forimpectiun purposes.. ,. .
Fa-L (Wel agree to save,inderradyand keep harmless the Cit'of Cupenino
wegains„
.� liabilities,judgments.costs and expenses which may in anyway accrue against said
Cityy in nmuquence ohhc m��ine of this permit.''-' "
:APPCIC(sNT U'sixo
ERST SAN WILLC PLY WRH'ALL NONPOINTe
soukCE Ano' - Issued by: Date
.' ppbcanVCon tar. s.. ., f pace Re-roofs
HAZARDOUSMATERIALS DISCLOSURE"
-Will Ise appliam a futwe Wilding oicupam orae a harWe houNbus Fwedal
as defined by.the Cupertino Municipal Cade.Chapter 9.1?and Ne Health mal Safety of Roof�t;f..: it_.h . _ —.•.. .--_ ___,:..- ',_
'Code,Section 25532(a) • :s Type ' , ' k *''',� •. ,: -_ _ ..
_-.All roofs shall.be.inspected prior to,any roofing.matenal being.installed.. _..
s}Wil Mh-a o toe fmure Wilding occapam use cqupmem rdevices which If a roof is installed without first obtaining an inspection,,( agree to remove
_1
El Yet, 'IYIq 0.
' _ all new materials for inspection. Applicant,understands and will comply with
Cal1i m o Health&Safe Cdde:Seel ane 25505�25533sand 25534.l understood than
nb lYet s nmmn Mad a by the Bay AreaA rO QualityManagement
all non.. otnt source Ie lllatlOn S.
I 0c read the
P g n .
r.
qspier'
tithe boiling no,currently have a tenantthat myresponsibility rooufythe-
,
he
m of @ rlh co nnust be Fat pct m issuance f�C rtifate of
nty '
Ota pa . _ _ .
Signature of Applicant Date
w o men m
no, All roof coverings to be Class"B"or better,
OFFICE