02040151 (2) CITY
ofNO
NG DIIVISSIONPERMYT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
8077 HYANNISPORT DR 02040151
OWNER'S NAME: APPLICATION SU DATE
*RICKMAN WILFORD M AND HELEN 041292002
f� ONE: SANITARY NO. CONTROL NO.
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
F BLDG ELECT PLUMB MECH
de. I I r_1 L.') I I
E3 Z LICENSED CONTRACTOR'S DECLARATION lob Description
Z_— IherebytionTO fBrmthmitor 3oftheBusinensed under
sand Profof Chapter ession,Cods.
ad(commencing REMODEL 3 BATHRMS & DUCT REPAIRS
yi_ is in Section and fDivision 3 of the Business and Pmfessiom Code.and my license
m S_
is in full force end cf&n,
ee a Littnu Clnsa Lio.M
O Doteu S DEC tor
O G ARCHITECT'S DECLARATION
g 1 understand my pions shall be used as public records
E p Licensed Professional OWNER-BUILDER DECLARATION
1 hereby slfrm onshot I 70 1. exempt s an Ino C ssions o License Low for she
? following main.(Section 70313,Business and Professions Code:Any city or county $10000
I i❑ which requires a permit to construct,Blue improve.demolish,or repair my shoscome
°ui 3C$ prior toiurc
issuae_eWu
rtgpimheapplicanlf....ch permino Tdeaaigirodminimums
s1lal hen bttnsptl punuanlm lh pm islons of the Convenors Littnu Law lChequ9 _ t QQ�. tk.--� i Valuation
(commencing with Section 7W)of Division 3mf the Business red Professions Code) •9 _ ._ _ ;
or shot he R exempt tki fmm and the basis for the alleged eiampJori.Any violation
-ofSenim t031t3'by any applicant for opermitmbjecu-she applicant'm a civil-penalry-
'of n'ot mmrcsom five hundred dollars(S500). 1 O2IPN NPIDWDAT ION =IN!_!, Occupancy Type
_❑I.as owner of the property.or my employees%ish wages in their sole mmpensmion, 102 — PIERS
Buainas t Peovdik,and the structure is no,infected-ar offered for sole siro'70 4,
Vim' 10 3 - UFER Required Inspections' "l'""'I'
`nnd'Profaximns Code Thc Convenor's Littnu Lew der not apply m on
owner of puny Who Wfldx or improves thereon,end who does such work himself 104 - REBAR _
Or throe h his own employ provided th timprovement
suchimprovements are not intended or _
-.offered or axle vmer,i thebuilding --Improf e t n-' aswithin one year of r05__ — ANCHOR BOLTS \0.
ourr..ion,Ihe urposefads.).writ hove the buMen of provmgih shedid not build or 106 - SEWER & WATER
imMove for purpose of saleJ.
-----------.-----.....___._... . _.._...-----202- - -UNDERFLOOR_PLUMBTNG- _' _ ------
_ baa ownu o(Ihe propenY•rem axdusively comractin8 with licensed convectors to ,-iP\0''da•:!T Z.'r__"---- --
_ - construct she project(Scc.70M,Business and Professions Code:)The Contractor's ,,:
License Law docs not apply to an owner of Property who builds or improves thereon, 2 03 — UNDERFLOOR ME CHANT CAL p<T ,�..,
,.an Ludon,conwcu.for.such.pmjau.wsdr.a.samothrunato liecnsed�pontoons to she
Commnara reacted L.w,... ..:.. -- ___-2 04 ---UNDERFLOOR FRAM ---------------.___..---__ __--
❑1 axe
p a rs as c,ratnia205 - UNDERFLOOR 'INSULATION
_ o d`1i ' 301 - ROUGH PLUMBING
w eF.°r�lor do ON .._ 302 - TUB & OR SHOWER
I hereby affirm uMerPenialty I.perjury ope of the fallowing declarations:-� 303 — ROUGH MECHANICAL
,t ,3 0 1 hove red will inainuin'a Ceni6caie oaf Comm to self-insure for Worker's 304 - ROUGH ELECTRICAL
H'J Compensation.,as,provided for by Section 3700 of-the'Labor Chile. for the
performance of the work for which this permit is issued. ., 305 — FRAME
01 haJ fid ill'tinich Wu1,,isCompenad6n insurance as req ircJ by,Section 306 - HOLDOWNS
3700 of the Labor Coder me part rmance of the rk'f r which this porta it 307 — INSULATION
cunei \ i s < .R�po R a, . r ' ,3;081, .SHEETROC _ _._..,. .. •---....
issued.MyWorker's Compensation Insurance came and Pulley mumbo rc. + K
rx IicYNo .' I1 : nitlFl`
CERTIFICATION OF EXEMFnVN FROM- 0 S " "' 3 0 9 EXTERIOR LATH
t
r coMPErsPnDNINsuRANce; --310 -c-.--INTERIOR- LATH _ _.. ..__.__..._-----____._._ ._
Tl i. nlon need not W mm luted if permit is for one hundred dollen 3111 - SCRATCH COAT
f5100)or los)
_.
-,I"„ I Cash y Nal in dk peH nn'n: of the ork'fm ch p n b sued I
sh 11 ani aTPIo y.perwnt ane m e e ia�vtu�n 501 - FINAL ELEOTRICAL'`;ENERGY " �
cam mahnn s r u a 502-_., FINAL_PLUMBING .ENERGY____._ .
cam - _. _.- _ . ..
N CE TO mokingthis C,enlfceaofExemptiu:youshould 503 - FINAL MECHANICAL
` ' -
Z 'oide'subjec o;Ilse Wind Compcnsetion previsions of the Labor Code,you resect
O O rtmhwidicomplywithsuchprovisionsorthisPermitshallordeemednvoked. 504 — FINAL BUILDING ENERGY'
.r .. .. _ .. _ _
" ' " "';coesTRperIDNLENDi nAcg cY 505 — FINAL ELECTRICAL
a.7 1 hereby aRitm shat(here see conswnion lend n agency fo,die performance
506 GAS TEST
.. :" _ .'L• F'
bone nrkrewhiamm�pem,hnssnedlsee3097c1.c) -
507- FINAL PLUMBING 1
...- .
rti,Z LcndusAdGrcsss. `. :..•- .:. - ,.
U O "" 508 - FINAL MECHANICAL'
t,,r,, v.;p, 1 certify the 1 h crud this applicet on end nam theuhe oho a mfonnotion is
is V corkct.I agree Io coPsply with II my and county ordiRenccs and nese levee raising 509 - FINAL GRADE
O mbildingconn <I!onenehrctiyeuthbna
ter Upson 510 - FINAL PLANNING
.W the abo e-memioned properly for jnspection purpaea. -
-Oi IWe)dgrte io hive:indemnify entl keep humlas's sac City'of Cupertino dgeinad
iid 514 — FINAL PU IC WORKS
y' liabilities,judgmems,ensu and ea coos wh ch mays any w y acme agenn sa
V City' ''donxqu nee oR gnnuaf tris pennia `:
AP t T 'DER AST) \�R'ILLCO\1PLY\\TfHALLNO\-p0 --Issued by: r Date �J
n.
A���
bT—
'rc' f he X�A7.AR'R USMATERIALSDISCLOSUREr�' t RB-rOOfS
Will Ne ippllcam or future bidding attupant note or herWle harudous mme d _ —__ .....
es defs ed by,the Cupcnmo Mu-a Code Chaps Safe,,i)12aridthoHalth and Safe '�'Pe Of-ROOF
All roofs shall.be inspected prior.to any roofing material being.installed.__ _
IWJINe epplitutuf m ebuJdinga e Bay
p ntot Management If a roof is installed without fust obtaining an inspection;'I agiee.I 'remove -
!t navaraous sir am inanis u defined by the Bey Arca Ad Quality Managenunt
toter
all new materials for inspection_ Applicant understands and will comply,-with.
q _
ovaa . tNall non-point source regulations;, .
k•" a ,\1 ham rFad'the M1axa)d..a ma enals ibqusremaou vildwChapter 6 q5•ol the
Caldoml Hdalth d'Safety Cad"s illom 23505,25533 and 25534 1 understand that
4P P of shonapd ogeut whin.` Ii net poor to issuance`or!a!CDe�a a tiny the
Uthe 4nlldso tloea not ey IlYhave atmant thin it ism responsibility to notify the -
tio Y P Y
$ �• F7 of
Signature of Applicant ,. . .-- _ Date
All roof coverings to be Class'B'or better
P.
OFFICE