00070103 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
Bm1.DINGn2 .S'LR5 LINDY LA P`"M"NO00070103
DwNBK'S"RAOPP JOHN AND KAREN ni1LILn11l I
Ko
PHONE. SANITARY NO. CONTROL NO.
a0Xp ARCHITECT/liNGINE121t BUILDING PERAtn'INFO
_ RLDG lECr PLUMB MACH
U
F<N
O in y LICENSED CON'rKACIOK'S DECLARATION Job DCSCCIpIlO❑
OZ=p I hcrehY alRrm that I an,IiwnecA tatter pnrvisinn,of Chapter Y cc cmncing -
p_5u� with Sec0a;,7un0) miri,mn3anhe uu.me,anmlPmrendan,cada,;;ml;t,r'"`n' WINDOW REPLACEMENT -
a in con mrre;md def. ,e
`dW ,mea. Gas, —Gel'4 Lir.a_S�1
LL s n U Date Z_/j5-" Conlrunm_Ny—/'p�aL Ys�G
ARCIDI'IICr'S DECLARAHON
F� , I untenfmd mY Plato shall M u.aJ as public ravod, `/
w�p O LicensedI'nnc.,ional /
P'o OWN'EIt-11I111.UER DLCLAIt Al9ON
— I hcrchy nlRnn that 1 am exempt final dm Contnehn"Llccn,a law for the
C
/
?< following reit n.(Section 7031.5.Business and Profess err Care:Any city or county
em,it
x p which requires a pto conurvct,alter.improve,de polish.or repair any sm
omore
a3$ prior to its issuance.also require,the applicant for such permit o file a signed statement _
that he is licensed punuunt more for ore,of the Commerce,License Ww(Chapter 9 Sq. FL Floor Area � 0
(commencing with Section 7000)of Division 3 of the Ratios$,and Pmfe,siom Care)
s that he f,esentpt thcrctrrn,and the has,$for the ulleged care far I Any violar am
of Section 7031 9 by any applicant furs pertain sub'nats the applicant u,a III it portly
oftritium,firm fivehm,dretlddh,m($50n). APM4216"14. 00 Occupancy Type
01.as owner.(the property,or ory amployem with wages..,their sale cm.formation.
will do the work,and the sauature is not intended or offered for sale(Sec.704L
Business and I'mfcsiam Cale:The Contractor's License law does not apply m an �rpr��sQtljfs�r�}�.�� sp,,uons
r of p,openy Who builds or in,pmnx,thenen.and who does such work himself 101 — FOUIV UFi 1 1 UI4
orrthrough ria awn employee..rare,died that such im,lnarcreem'are rat etraded or 102 — PIERS
olfcrel to pule.It,however,the ballding or Ir,pnwenuu is ,,It within oar year of
inmri pl, the owaar.huidar will hare tee name,of patch.than lie did sat hand(r 103 — UFE R
mprove farpurps—
❑I.as intoner ofthe propamy,am exclusively contracting with licensed contractors In 104 — REBAR
L,tranet the project(See.764E lw.ina.,and Pmmomn,Cale:)The Contractor. 105 — 'ANCHOR BOLTS
icense law does not apply to,an owner of property who builds or imphoc,nhereun.
and who contract, for such pmjecn with a conlracmn,)licensed purwent to IM 1.06 — SEWER & WATER
Convaetors Earns'Law.
0 l xm csrn,plrnder Sae. .R&P C lartni.rra,m, 2202 — UNDERFLOOR PLUMBING
Ower* Date 203 — UNDERFLOOR MECHANICAL
WORKER'S COMPENSATION DECLARATION
Ihereby affirm under penalty(If forharrone orth,fauawingdeclaration, 204 — UNDERFLOOR FRAME
205 — UNDERFLOOR INSULATION
0 1 have nut will rminmin a Cenihanc of Conscno ,, wilra,ure for Wnrlore
's
Campcn„nrma. pavdm lit by section 3700 of lie Labor Cade. too the 301 — ROUGH PLUMBING
performanewffhework for xldmtthls,cnniti.ismed. 302 — TUB & OR SHOWER
❑I base and o'ill mtimein Worker,Compensation Insurance as requ rad b��iion 303 — - ROUGH MECHANICAL
3700 of[lie Labra Cook,for the rfnmance of the work for which this n i.
ued.MylIWoIrrkersCompensationInsurancecarrierandpolicynarmerare: 304 — ROUGH ELECTRICAL
arrier`Mgr�O/_j_Policy No.:G:e7�3L 3'—
GIiRr1FICATION OV MUMPT1oN FROM WORKERS' 305. FRAME
COMI'I?NSAriON INSURANCE 306 — HOLDOWNS
fmi.,creon need not ha completed if permit is for one hundred dollar, 307 — INSULATION
($10(horless.)
IreniIylist iathe ped„rataneeofthe wark lorwmchmisrecant isi,,ucd.1 308 — SHEETROCK
'hallcall....plo,anyper,a,'nwtymnt a
a r, .tsa,1%4aaemnb'lecttotheWa,ke� 309 — EXTERIOR LATH
Compamnaa;,Law.of Calif ria,D:ne
Applicant 310 — INTERIOR LATH
NOTICE,)APPLICANT:IL ager making this Cemificme of Exemption,you should
O Obecome%object In the Wmker's Compermmian pm„ime anhe Labor Cade.you must 311 — SCRATCH COAT
forthwith cungdy x'ith such provisions or this permit%hall he deemed revoked
F (A CONsrKtJCI4 N LENDINn AGENCY 313 — ROOF NAIL
mf the,'rhet,h allhaaohm nem i,a an.tmrtian leading ngm,cy for the pmarm"aeC 501 - FINAL ELECTRICAL ENERGY
r a,ieh this pencil is issued(see 3097.Cir.C.)
y p Lenders Name 502 — FINAL PLUMBING ENERGY
D Z Isndcr's Address
U O 1 certify that I have read di%application and state that the above information is 503 — FINAL MECHANICAL ENERGY
Pcorrect,1 agree In comply with an, or it.. .and.m,e law.retain, 504 — FINAL BUILDING ENERGY
O
U. u,building construction,and he ;mfhoi,empra, wire.orad,dor tocnler uqm
m rotamwr-nurflomdprap1,. arin.rumlrn 505 — FINAL EIEC ICAL
d IW4 ugrecu sov adcn '- .au vp hnmd ,s he Goy(f Cupcnino against
� cn liabilities,judgna ,ts expe . ,hah,as in,my way actme agaiaot said S05 — GAS TEST
U Z. City in co qu a hunting rah permit.
APPI C-. . DAN S D ILLCO PI WITHALLNON-POINT Issued by: 507 — FINAL PL M Date _/Kti
$ism, a p roar Dae Re-roofs
HAZAROouSM ; 1AIS )I CLOSURE 509 — FINAL GR E
Wiumn if or future b,radiagtcco'can ea, amllel,mnnnommmcer) Type of RoofS10 — FINAL PL NNING
as ddined by he Cupenim,Municipal Code.Clwp,ar,9.12,ant the[batch and Safety
Care.Section 25532(a)R
O Ye, 0"( All roofs shall P iltspectFdTjWAkoFhy46dTffng WAIN Pbeing installed.
Will the applicant or future building tecupartuse eguipmconor device,which If it roof is installed without first obtaining an inspection. I agree to remove
",at.........
thvntntts air contaminant,as defined by the Hay Arca Air Quality Mnnagcmcm
Dlon"r all new materials for inspection. Applicant understands and will comply with
❑Ye, 0 N all non-point source regulations.
1 have read the Is q nudes Chapter 6.95 of the
California health sections 25 .255331 25534.1 undcmmnd that
ifthebuildi d oily have a to n than if in y esptmulbilh,K,nosily the
(attract f its which ort ,m into I rrrwcrf.Cvfut1,,oa,.f
Oce Signature of Applicant Date
Q car - cd, eat - „,— All roof coverings to be Class `B"or better
OFFICE