02050060 (2) TY OF
CI BUILDING DIVISION P RMAICONTRACTORINFO
BUILDING ADDRESS: PERMITNO.
21785 HYANNISPORT DR 02050060
GR THOMAS R AND JACQUEL NAP�ScHT{Qysf9D�ip2
ppp' PHONE: SANITARY
JNO.
/ L 11 CONTROL NO.
00 ARCHITECr/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
S = LICENSED CONTRACT'OR'S DECLARATION Job Description
5n5 1herebyafifthat1amlicensedunderprovi,ion,afChePon,9(commencing BATHRM REMODEL
o t with Section]000)o(Division 7 of the Bu vi z and Professions Cade,end my license
is in Poll r end n. .a
� < Lren v o 06 �IIVs �F®
O V Da SLC/�if�g((ppr
LLO A CHITECT'S DMRATIO
y 1 understand my plans shall be used as public records r
foo L1aen dProfexaianal JUN 2 4 2002
6 A E OWNER-BUILDER DECLARATION
to
1 hereby ARrm that 1 em exempt from the Contactor,License law for the
t?< following reason.(Section 7031.5.Businessand Professions Cade:Any city or county I LDI NG $7500
O which requires a permit to construct alter,improve,demolish or repair any sanctum
j $ poor tot ssuaom.also requiresthe applicant for such permit to file aSigned statement ...,.. . .
trothe,.i licensed pursuant to the provisions of the Contrut.e.License Law(Chapter 9
(commencing with Sat 7000)of Division 3 of the Bmme,t odd Norasiona Cade) .'3 501144r,Ep'Qa Valuation
or that he t exempt therefrbm'ohd the basis for the alleged exemption.Any violation '
of Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty
.of not mom than five hundred dollars(3500). 10 7API5I 3C5NDATION Occupancy Type
°L,as owner of the property,or my employees with wages as their sole compensation, 102 — PIERS
will do the work,And the Structure is no,Intended or offered for tale(Sec.7M, 10 3 — UFER
Business and Profession.Cale:no Comtrnsnoh License law does not apply t°on Required Inspections'
owner of property Who builds or improves thereon,and who does such work himulf 104 - REBAR
or througr his own employees.provided that such Improvement aro nm intended or
".offered far tale:TL however.the building or improvement is sold within one year of 105, ANCHOR 'BOLTS
completion,the owne>bullder will have the burden of proving Nat he did no,build car
improve(or Purpottofeale.). 106 - SEWER & WATER
°r AS net ofthe'ro r ""-' - " ` i- ' " e"', 2'02 - UNDERFLOOR ' PLUMBING --
p pe yam exclusively convening with licenud contracmrsm "--"
construct the prajeet(Sec.70".Business and Professions Code:)The Common's 203 - UNDERFLOOR MECHANI CAL:.':
License Law does not apply to an owner of property who builds or improves thereon,
and who eammcts far such.pmjacts.with a contmetorW licensed pursuant to the 204 ..UNDERFLOOR FRAME._. .
w.
mnapune cc 205 - UNDERFLOOR' INSULATION
' oro exam�pytusidersa" B&PCfor Nis reason
owner \L- + S �01-
WORK 301 - ROUGH PLUMBING
ER C PENSjTION E /RATION 302 - TUB & OR SHOWER
harathy.frionanderpnatyarpgaryaneaftherauawingd luenane: 303 - ROUGH MECHANICAL
.. j ° 1 hove and will maintain a Certificate of Consent to self-imum for Workers 304 - ROUGH ELECTRICAL
Compensation. AS provided for by Section 3700 of the Labor code, for the 305 — FRAME
perfarmanse of the work for which this permit is issued.
❑1 have and will MaintainWorker'ACom cation Insurance,as a 306 - HOLDOWNS
Compton which
this
permit
is 307 - INSULATION
3]00 . the Labor Coda for the performance of the work for which this permit is
'�- issued.My WoherY Compemetlon InsuaOce carrier Policy,number arc;
308 - SHEET-ROCK
Cemcr, tPal CERTIFICATI614NMEManoNFROM WORKERS'. 309. = �'EXTBRIOR LATH.
(sato) rte.:'_... '.COMPENSATIONJNSURANCE ^. ..._., .._ ..-3.10 INTERIOR LATH ... _ _ _..... ....._..... ..
a (Thi section need not be completed if the permit is for one hundred dollars 31 SCRATCH COAT
) ,
. 11. 313 ROOF..,NAIL.:..
I c'.flify shut I.she nR argn��h�ror which pa issued,ia,aea,1 503 - FINAL MECHANICAL
ENERGY pt employAP LICANT Ifo. o A,go ser m se.Ceti iedcram of Exemption. o�shaultl — ENERGY
Applbecomoon�M�EM�eu((��hj��jact m Ne Workel Com nsauon provisions of the Labor Cade, ou must ENERGY
O z fonhwih complywNmch provisions or this ermish ileo damption.yoE. :. SO4 FINAL BLUMBINGAENENERGY
O . . . . - . ., .. BUILDING ENERGT.
" -'CONSTRUCTION LENDING AGENCY`- - SOS = FINAL ELECTRICAL
F+ I healthy aRrm Nat there Is a convection lending agency for the performance 506 GAS TEST
of'hework for which this permit i,issued(Ste 3097,Civ.C)
Lemdar.Nme Pe .,507...- FINAL PLUMBING ... .._ . . . . . . . .... ..
Lentle Atltlrcss• -
U p " - 508 — FINAL MECHANICAL '
I sen fy,that 1 have need this application and state that[be above information is 5 0 9 - FINAL GRADE
cortecL 1 agree m comply wird all city and coun.y Ordinercn and state laws reining
.Wild in,ronvrucoom and hemby authosiu representatives of this enter upon
y (aj Ne above-nootionadproperty for Inspection 510 — FINAL PLANNING
ka ps (We)agreeiosamindemni(yandlxpharmleutheCiiyofCuperimo,against r�514 - FINAL PUB IC WORKS
fUr V] liabilities,judgments,rota and expenses which may in any way acerae against said
zCity in consequence of Ne granting of this permit,
APPLICAM'UN STANDS AND WILL COMPLY WITH ALL NON-POINT'" V
q U EREG A N $— 1 Issued by: Date
ignomrc of Applicant/ qlargramor' -'- ^Dom - Re-TOOTS
HAZARDOUS MATERIALS DISCLOSURE'
Will the applico t or Jorge Wilding Occupant store w handle h ,Type Of ROOF
es e n the soma Mum Code Chem 9.12,and the H
ealth and Safety .. P y ._ g. _�-' g ..,.
Code Section on 233321e) .. -
°Y` All roofs shall be inspected nor.to an roofin matenal em Installed.
Will the applicantm Tu210
ld ng Occupant ate egmpmen,or device,which If a roof is installed without first obtaining an inspection, I agree to remove
em t hm adou,air contaminanfined by the Bay Area Art Quality Man.gemeni
District? all new materials for inspection. Applicant understands and will comply with
❑Yea all non-point source regulations:.
terials requirement under Chapter 6.95 of the
Cabfomta Health @ Safety Code,Sections 25505:25577 and 25536.1 understand that
if the building does not currently have a tenant that it is my responsibility to notify the -- - -
occupant of the requirtmenti which must be mit poor m issuance of,Certificate of
�Qp:ap.ncy. Signature of Applicant Date
Owner or aathonge agent I 1Date All roof coverings to be Class "B" or better
OFFICE - ..
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• IN ACCORDA%,;F yvITH THE CITY OF .
CUPERr)iLAcc AN ORDINANCES
;RTE
SILNEC _
Th;;<sot of plans arrd sperificalions MUST be
keot on the jou at.a8 times snd.it m unfawtul to.
,. .. . . rPaKH My,mangae Of•Afle(atKln6:
yitM
Ut' w6tten Perntjssldfl IfU[n.t'fla bUl!'1'I
g.
0. 270[@1.: ."- �` ' :•� ' . -
plendnd'gpo6fikationa
st
8HAL1. NOT be held to perrnif Of to be'an
a9proval of ft-violation 01 anY pr0nsons of .
any Gty Ordinance or Stdte Law
MAY 0 9 2002
I copA�
i
T
4
SUBMITTAL
1 #1
x .
OF
CI cut
BUILDING DIVIISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21785 HYANNISPORT DR 02050060
t? R THOMAS RAND JACQUEL N APa1Sc��syg2DeT52
/.-. PHONE: SANITARY NO.
CONTROL NO.
Z rc0 o ARCHITEC tENGI,NEER: BUILDING PERMIT INFO
z BLDG ELECT' PLUMB MECH
LICENSED CONTRACTOR'S DE LARATION
I hemp rrrm teal I am r cooed nnaerJob Description
gi_ yrs provisions of Chaprcr9(commencing BATHRM REMODEL
._t
with Section]OW)of Division Sof the Busvi ss an a Prokssituw CWe,anamylicense
0 S ixinrnB[pr and s. +/" 4v0006 ��
u Licensss555 CJ311 Lica A�
y. Da tl Con`tae(ar
a LL y _ 1 1` A CHITECf'S DF.�LARATIO p R wi!
y 1 undemnn y plans shall he used as public records ,t
i e p o Licensed Promsslonal 1 UN, y. oa�
no i OWNER-BUILDER DECLARATION �f
I 1 herchy affirm that 1 em exempt fmm she Comracsor's License Law for the
(_?F< following mamn.(Section 1031.5,Business arta Professions Code:Any city or county $7500
F C o t require,
q .su a permit to constructalter.Improve,demolish,or rapaa any structure BUILDING
3$ pn gsed pum rcgmmsthviscronl for Contractor's
onLicense,
Law
thin he Ic witpScmmmXhpl oiavision the Cnmmnmsl.menu Lew..mCod9 v � •" f3D�J Valuation
(co cinwnh Secso ]O(1(od thebas Division Busmex andionl Anyvi Code) �;J s44 , t y_s„a e.t1 L�.4.4S.li t$tv f.�"
or thei he is 31:5 bylany ap li and the basis it s the cts the exempuo o Any violation
-of Salton]031:5 iv any doll dollars
($50 mil subjects the applicant ton civil penalty 10 7APN
idr oat mom than five nnmrca aoltms(ss110). Pptm[gBIDATION Rt' �'• Occupancy Type
0l,as owner of the propcny,or my employees with wages as their sole compensation. 102 — PIERS
will En the work;and the ode:Tstructure'C not intended d'or'oeLawered for sale(sec.toa. 10 3 - UFER Required Inspections':, >'"'
Business and property
Who
Code:The Contractor's License Law does ten work
m an
owner u h his
who bairns or improves memo,and who a«a such work nor 10 4 - RE BAR
or Ihmu h sit own however.-
provided that such impmvemems arc not intended year
or
--oRerdd de Tule.ICh6wever:the building-or impmvemem Ii sold 'within one�ycar of 1 ="ANCHOR B LT -- - -
�mmpleeifnJurposer-buil.).will have the burden of proving that he did not build or
mprave for raryou of sale.). 106 - SEWER & WATER
- -' 2'02"-- UNDERFLOOR PLUMBING -- -
01; s flit property. m 1 si 1Y I I g With J< I a Io
ctin"ItArt te r jee(sae 7(U4 B 1meo and Professions c a )The C°l.t a 203 - UNDERFLOOR MECHANICAL - 'u
License Law does not apply man owner ofproperty who builds or Improves thereon, 'i,
.and who contracts for such commcmr(s)Ecerlua.porsmnt.ro me.. ._. ._..._ 2.04._ ----UNDERFLOOR.-FRAME ......................_._.....__...-_._.
C nameoraldfend8rSw. 205 - UNDERFLOOR'' INSULATION
° _ am exempt unaer,Sec" " ,B&P C for this reason
3wrer S' �pi - 301 - ROUGH PLUMBING
WOkKER. C 1PENS R F. ARATION3 O2 — TUB & OR SHOWER
I,eemhy-affirm ander penalty or p<r;e;y nye of the following declaration,:- 303 - ROUGH MECHANICAL
\f 304 - ROUGH ELECTRICAL
Al 1J ❑ 1 hats and will maintain a Certificate Se ti of 37M o so self-insure for Worker's —
1��7+ eaf-commtmn.'as he forwhich by Section moo °f me Inbar ansa. for [fie 305 FRAME
- perf rtes c f ih 'wort.for h¢h,this Permit s .teed.,I
❑1 ha c and w II moi t n W k is Compen aeon Ininmace us quina by Section 306 - HOEDOWNS
37M of 11mi Labor Cosa I.,the perrormance of the work for-which this permit is 307 — INSULATION
[ -
issued-My Worker's Compene tion 1 ursand Policy n tuber ore-
1.
308 :- . SHEETROCK-....
fPolcy No.: 1: \ail�.) 1, - ...-. .
• sChRTIFICATION.OFE%EMPCONFROM WORKERS t 1:I 130,'91=? -EXTERIOR.SLAi
COMPENSATION INSURANCE' 3 . :-INTERIOR-..LATH
°i (flus see ndneed ern he mmplercd f dIe perms s f one hundreJ dollars _... -__ s ,— .,;t 1,`t.,I;t x•
(sloe)
311 ' 'SCRATCH COAT '
-p_ mry that the,1 c oth rklrhlchthspermfissued, ...:.313..- ROOE_.NAIL,_:.
I
1
'vhml�t pl yanr pe n Yon. A�ko�jeel Inewnkn 501 - FINAL ELECTRPCALI;ENERGY
cam aI rC,aMom D 502 -_ FINAL PLUMBING ENERGY
Apel c I iA nv. 7-1 f _._ .. _
I
NOT fir LICA -IT31 n I. g cnlem -r Exempt r should 503 - FINAL MECHANICAL-
'ENERGY
z bee e q Ito 1Im W k C'pees.; p i ons of the L l r CbJ you"'uss
OO fannwth amply with suchp tmnsmbil permit shall be deemed re.ked. 504 — FINAL BUILDING ENERGp_
_ -.
Fs� us +CONSTRUCf10N1ENDINGAGENCY '" '• " SOS — FINAL ELECTRICAL
a_y 1h by frimthisth - a st e . 097.CagcnryfmNeperformance 506 - GAS TEST
o,nd work for which this --. ._.. 5.07_...._--FINAL 'PLUMBING ...
{i7 Leaders hued(S 309] Civ.C) -
1<
a Name . . . .-...... . . ..... .............._ ..
U:0 ' 1 ' .Rf ' _ 508 FINAL MECHANICALI ''
1 cendy11111.1
hm 1 have mail this application and state that the above information isW. 5 0 9 - FINAL GRADE
cl a :a buil:1 agree tr comply with all city and county amino«ca and mite laws relating /o
- O'.0 mbilbovegeonsuued pursnaecmtiyvuection purposes.
es of this city to corer upon 510 - FINAL PLANNING
gT] the ebo(we)agioned ptopcnyfor ify.nd Ime,hsnea.
,pa: (Wclogmem,costs and
mayinthe way Cup.mm,.id 514 - FINAL PUB IC WORKS
z st
liabilities,judgments,fossaand expenses which may in any they eccrvq against said
"C.3: Citym NTUNce ofshegut ng ofWIp COM
APPLICANI'UND $TANDS'AND WILL COMPLY Wrm ALL NO 'POfNT"'
REGL ARS a IssuL;Qed by: Date
_ •-SipasumofApphcantiC mracom .4•••oarc 4-- Re-roofs.
'i HAZARDOUS MATERIALS DISCLOSURE Tye Of ROOF p
ill thc applicant mI f build g« pa tfo
cere or M1a die hazallou m Ig10f l _ -- ,._
as defined by theCupertino Co Chmpte ten
9 l2 d the Heahh o d 5 f,y vv - - '"'- '
Code SectionQk532(a)11kI 1 t. ( v •�, . fit as 'y,..a:+`. 1 !S Its .' .r.
w I °" tF`'n' ' All roofs shall be inspected poor to any_roofing,ma[ertal being installed.
WN theappI a t it building«c pet equipment roe las with If a roof is ins"called without first obtainingan inspection, Iiagree to'remove
m t h b r nu t fined by the Bay Arca Air Quality Management P
• stye+ all new materials for inspection, Applicant understands and will comply with -
❑v a o all non-point source-raguladons
") I,have Ir ' the hazard s•mmeriel regmromems and i.Chapter 6.95 of.the t I 1• '+
CaliforniaHealth&Safety,Coda Sl<flmm 25505:25533 and 25534..l undennadtha
'if the building d«snot purten[ly haveatenenr. s that it is myrcsponsiof aymnmify the
-xc p m of Ne requite cots wMch m s[M m priono iss ate of e C nifidmdaf
pa ey `h nr Jo Z Signature of Applicant I _ Date
own rn mbnriuagem "' Omie All roof coverings to be Class B or better "
.r. 2..
- ..
:i � ., .;. . -'"-�- - - OFFICE