00090158 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERM I r NO.
OWNIVR'S NAME: APPLICATION SUR DATE
10700 LA RODA DR SCHILLER CONSTRUCTI IN 0009k15-0
)NE: SANITARY NO. COMfROLNO.
EDWARD/LITTLE 667 PETTIS • 09/25/2000
C zoO ARCHI'IEC7f/ENGINEIiR: BUILDING PERMIT INFO
HLI%1 IiLECr P•XMB MECII
�yN
(650) 940-1982 _I —I _1
z Lnto lialID CONandia DIiC1.A ofOvaN Job Description
m teach )Ilan mut con of thelicensed undcl r Chu a )luaInmcncin
<O�rw with Section70K))of Dirixionlof the Business rid I'rofcsainns Cade.and myliccnc
In full)Oros and e0ey�J..,. MM
LIC.k I ��•r�
i 3 . C l a.an wt .
ARGUE lti(Tre UECLARAI'ION
,-=° anaer,ana my pinna anau Iw used as wnbr reralda KITCHEN REMODEL
wY 3
a a O LiccnaI Iereby dorso
ened
OWNER-BUILDER DECLARATION
W1 herahy alrnn mm I am clb,a train the d 11 coic.am's License Law,a the
CZ followinguires.ISceaiot 71141.5, t,.1m_,smprove.ohaianx Gnlc:Any city foraoume
n'Fs C which its requires u permit re canswe6 idler,improve.h per it t for repair any 4mment
-m priarso'ns licensed
alsorequiresthe appllcant forotthe Contractor,
La,rovle a gad somlaimerm
a3— malmencin nwith sellllnl lamerramamn,m ole he
Lirenpr Lesion, ads) Sq. FL Floor Area Valuation
(commencing ing withtherefrom
and the balnn}ot the Hueal corruption.
Any
Codd
or that he i. 31.5 exempt tart'appli anal the busts for the allosubjects
the c¢mpno o Ani via natty
on
of Section 7031.5 by an)'npplic toolbars
,it a pennil xublena the applicant to a civil penalty
a.rm,I luorr,than ftaelmmm�a aminrx(SSHo). APN Number - Occupancy Type
01.as owner of the granny.or my employees wim wages as their sale compensation. P
will do the work,and the structure is riot intended or offered for sine(Sec.7144.
Hs
a,ka ,and I4s aldo,v Code: he Comrnelaf x License Low,doe_,nal ,dy to Required Inspections
owner of pmpeny who builds oremployers. improves Thereon,and wbo does such work:nimwalf
rr trough his own eploy ,.pmNded that such impms=mem.,are not intended or 36934 043. 00
offered Ior rade.IL hnwwer, he Building or imrnnvmvm is said imin one yen,of
imnnplcllon.lac owner-hinder will have the huNcn of pnaving that he did nm build or -
pmrefor pmplsoofsale.). 101. — FOUNDATION
01,av owner of the property,aril esdoc,ely conlmedng W in licensed aalnlmaaora m 102 — PIERS
instruct the p tleci(Sec.0(44,business and Pmfes,iona Cali)The Common:s
ueense Law toe,Bol apply,a a„owm
ner ar rpeny who IW Rat m improve,mre
ean' 103 — UFE R
ed who eommerc for suchprojects with a eonmisforf)licenced pursuant to the
ConmalaraU'a"Law. • 104 — REBAR
01 um exempl under Sec. .11.@ P C Iia thism
n on
Owner Date 105 — ANCHOR BOLTS
WORKER'SCOMITNSAIION ueCLARA'I[ON 1.06 — SEWER & WATER
l hereby aim,u„der penalty of perjury onenn me fellow ing declaration,: 202 — UNDERFLOOR PLUMBING
brie and will Inumed a Cendtealc of Conserv 10 self-insure for worker's 203 — UNDERFLOOR MECHANICAL
Compcnsaioaa, as provided for by Section 3710 of the Labor Cole, far the
rcrmroaderofmeworkforwmrnmiarer,ahisissued. 204 — UNDERFLOOR FRAME
O l havcand will maintain Worker's Comrvnsalion lmurance.as reyuired by Section 205 — UNDERFLOOR INSULATION
3701 of the LaMn Cede,for the perfomerncc of,he work far which this pennies is
,sued MYWorke,sCarol+nsaaoolnsmomccarrivrr]nand Pynnfirrynuumbbearc: 301 — ROUGH PLUMBING
number
'Pal
S%ArrF�rO Palie'so.:-pp,!F —1 302 — TUB & OR SHOWER
CERTIFICATION OF FXCkIF7ION FROM WORKERS*
COMPENSATION INSURANCE 303 — ROUGH MECHANICAL
ohis station neednot M1e cmnplaedif the permit is iia one hundred dallan 304' — ROUGH ELECTRICAL
Mlxnorlws.,I 305 — FRAME
I eemly that in the perbarr ance of the work liar which this permit i,k%m d.1 3tZ16 — H01_DOWNS
,hull not employ any penom in any mm anner as to become wi as me Workers'
CompensadaaLaws(of cahfomia.Date 307 — INSULATION
Appladid
NO]ICETOAPPI.ICAN'CII:after making lois CenHicate of Exemption.you should 308 — SHEETROCK
Become subject me worker',Compemation provisions ohne Labor Code,you most
p C fanh sah comply wim aorh pmsbimo or for,peril shall be deemed re—km. 309 — EXTERIOR LATH
Fm CONSTRUCHON LENDING AGENCY 310 — INTERIOR LATH `
a ; I hereby affirm that there is a construction lending agency for the perforant
y paI ae work in I,i,hd,ls pennll is ,,act (S..3097.Cis C') 311 — SCRATCH COAT
Lender's Name
.7z Under',Address 313 — ROOF NAIL
U O IecoilymatIhaocreanhi,nppbcaioncold ale,halo,eanaorinlornanooi. 01 — FINAL ELECTRICAL' ENERGY
�• t.. rorrea.1 agree ,,camply wish all city and county ordinances and ame law.,relining
ov tobuildingcnmamction.andhemhysahonrc¢praentaivesofthiscitytoenterupon 5 .2 — FIINAL PLUMBING ENERGY
the abnvo-mcotamid proreny Lor mstos ellon parfoo—.
F y (We)agreetosave.mdemnuyadd ervpharunI...In,ChyofCapaflnoagalnsl ,.03 — FINAL MECHANICAL_ ENERGY
h liabilities.jadgmcna.costs and espemses which may in any way accrue agaim,said
U z clay in rori,r�Inrnre ohne gra nM.lam,it. 504 — FINAL BUILDING ENERGYq_Z4rf
APPLIC DERS' SA AMPLY ETH ALL NON- IN ISSLI y: C 5 Date
SOU T S.
,Igo rliranl7.omrael„r - Dar/QQ Re-roofs 506 — GAS TEST
HA%ARDO115 MA'1'I?ILIAL' SCLOSURE
Will the applicum or future Wilding occur I4rim or handle hamNai-neurnal Type of Root' 50Q7 — FINAL- PLUMBING
as defined by the Cupertino Municipal Code.Chapter 9.12.and me Health and Safety 5Vt8 — FINAL MECHANICAL
Gale.Seen 25532(:)'!
OYes CNo All roofs shall 15blypec:teld r Lo'IwIF�ng material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is inst• l with, bt' 1 ection. I agree to remove
unit I iardmis airrnmunainanly a,drfned by it,Hay Area At Qualify Managenaeld �I I'qAQIV�h�.,iL F❑�'r Fi7S114J 4b
iatnrf! all new ntateria�i'J insp��ec..gd�t,.,LApp1Uc I`��t t�r crtil�I,g.(�, gd will comply with
C Yc.
ON'
all non-point soukk reguli9 r C WUrcn
I hie read the hvallou,mmrriNa ,upon,acot,under Chammr 695 of he
cidlo.ain Healed A Salcey Code.Sections 25505,25533 and 25534.1 undersand that
if the Building does not cunendy have a comm,in.,it is my responsibilay'a m aify the
wcupam n' regairmnc Irh It If he incl prior to i.' c of o Certificate of
— Signature of Applicant Date
eo Owner Oroomoaac ,fol Darr I IAll roof coverings to be Class "B” or better