01070144 (2) CITYOF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22762 MAJESTIC OAK WY BASIC CONTRUCTION SERVIC SO1070144
OWNER'S NAME' APPLI ATION UB DATE
PAUL DAVIS 15197 DICKENS AVE 07/ 27/52001
• PHONE: (408) 369-0257 SANITARY NO. CONTROL NO.
M O O ARCHITELT/ENGINEER: BUILDING PERMIT INFO
w- BLDG ELECT PLUMB MECH
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5y LICENSED CONTRACTOR'S DECLARATION Job Description
ZO z_G 1 hereby affirm that 1 am license under provisions of Chapter (commencing
F„Fsc withSection'lOWlnfDivision3af,heBusincssmdP,ofesinnsC«Ic amyranrc BATHRM REMODEL.
,axz� in fail
$49 b1�3
ce F5 is' s C�I�+ Lic.a
O'-U men `�"D-tz Can ho fNL
3 v- ARCHITECT"S DECLARATION /A'
'Eso
.0 g I undersand my Plans shall be used as punli<mrord. I Q1
3 s O Licensed Profcuiowl /
OWNER-BUILDER DECLARATION
o, I hereby affirm that 1 am exempt from,he Contractor's License Law for the �
E Z i following Tea n.(Section 7831.5.Business and Professions Code.Any city or county- O p
E x which rcuimmit oon
q ,.perconstruct. fit,impmve,demolish.or of any orum
cm /O O
63 ,priuh,is isuance.almreyuiru the applicant fur inch petmn tLicimmLaw(sh.p,c,t - -
inoncencingwithSetimemo,hepf Division 3o the
IROut,,ad Prafiw(ChapterY t I OI ea I Valuation
(cammencingwithSmtrefr6i883af Division So fealfiiin<ssmium;.Any
Code) t' 34 B11$81. d'6-;
Or mm he is exempt tmy applicant
and the nos¢for,he sts the applicant to Any violation t
of
notSecinure
a than iv a u dre doll far a permit subjects the applicant m a civil Penalty
•ornotmarcmanfixennnarcddouarxrssoRl. 101APNIPb11IITZATION Occupancy Type
°1,as a%Off of the property,of my employees%its wages as their sole compensation, 102 -
-will do the work,and the s nscom is nor or offeree for sale(Sec.70,14, 103 - UFER Required [ns ections”
Buonot and'P1ol'es6ons Cade: nwq The Conuaor's License Law does not apply toP +'
owm
r of pmpeny Who Wilds Or improves thereon.and who docs such work himself 104__— REBAR _ __ _ _ _ _
or through his own employees.provided that such impmsmcnm arc not intended or -. __
offged for sale If.naw - di n iWing ar mPro.ement la ton one year of - ""- 105 - ANCHOR- BOLTS - ° •to-
io pinion the owner builder 'll have the burden of proving that he did not bold or I
mprove for purpose ofsalel. 106 — SEWER & WATER
— ---- — — — - — —202--= UNDERFLOOR--PLUMBING. . — ----- ----- —
°I,ax awncr of the property.am exclusively contracting with licensed contractors to
- onx,mc, he project(Sea.7(94.Busine,.and Profession,Code The Cant,°nor, 2 03 — UNDERFLOOR MECHAN•I'GAL:.': 1t
License Law docs not apply,o an owner of property who bulla,or improves thereon. `
': ..and who emaraco;for such.projects with.a con isamr sl.licesM pursuant to the
. - _ - 204-- UNDERFLOOR--FRAME------- -- ---- -- -- '-----
-FRAME-
Contractors License Law.
r•'' _ °lcon emirptundcrScd'1 D'&1'Cfar thisrwwo 205 — UNDERFLOOR"'iI-NSU�LATION
owMr ' Dat2 ' 301 — ROUGH PLUMBING
,• ; ' WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
Ihereby arermunder Penalty of",fpn�lof,mefouowingaedaraoo°.: 303 _ ROUGH MECHANICAL
at
° 1 halve cad wiR maintain a'Cenifiear CO.,.,to sof-lawsc for Workers 3 04 ROUGH ELECTRICAL
Corpse...too, ax Provided for by Section 3810'of the L,bor Code. for the
- - ' peaormaneennne work m,whi<n nits r!'^,ph i.I...ed: , 305 - FRAME
❑1 have nos dI maintain Worker's Camp."zown hristipag.,tox pre rca by Section 306 - HOLDOWNS
inro of,he Lanor'Code,for the performance of'tn work for which In.Pat 307 - INSULATION
iss J My W' ke1s'C pc Lion Imuranc nil Pol y mM rc
_ -tr•
G lav, In N . Wig it-58aL 308y'= SHEETROCKr T
l CERTIFICATION EXF I'I'ION FROMWORKERSf" - 3O9 EXTERIOR'-LATH
COMPE SATI INSURANCE" -
_..-•, -- —3T0—.v`INTERIOR LATH;'---,i .---
's` %' �jThiS union nioa oibecmnplet<d also permit is faro.hundred dollars 311 SCRATCH COAT �l3tt`t •-' Iy�
(51801 I ,
1 cerrf Npt"n th2 oro me of the brk f hich m tis issued.1
313..._ .ROOF ..NAI-L---.
's'ri n nq empi y ayy P<rsn°`�any min a.m Became 63<u m tnp,warkeR 5 O 1 — FINAL ELECTRI CPa'•ENERGY
Aprh<am. " -' - '•- .—. -- - ..502 --.-...FINAL--PLUMBING.-ENERGY
NOTICE TOAPPLICANT.1:afrcr nicking this Certificate of Exemption:you should 503 — FINAL MECHANICAL ENERGY
Optiecome sugen m the w rk r.c f+ret p relict Luno code.r° st
fdnnwun<ootrlywhn.-<npro . ooh pen,r,.n,uned M ,kea. _, ,,_ __"- - "504.,....- . FINAL_.BUILD ING-ENERGY_-__-..
z'4 s`f ''CONSTRUCTIONLENDINGAGENCY 505 - FINAL ELECTRICAL
1 oi, lhy affirm that enc¢is a construction IBM ng agency fords."forn sface _ , 'I •'-k
of me work m,which misp.it is . ..,.- "a,- ...- ,:..
a 507 — FINAL PLUMBING..,,,, '„
. Q;z Lender,Aeemn'.' - _ .,
WanO I certify,hat I have read this application and stem that the above information is 508 — FINAL MECHANICAL"
W' donee".1 agree to comply wish all city and county,ordinances and state laws remong 509 — FINAL GRADE
Orap a Wilding construction:and herebyauthori=era eseptatimsofmHcitytoenterupon i 510 — FINAL PLANNING
,h ho a ti cd.property for n pect on purposes.0.
(We) ge to d ify and kmphomeless the City of Cupertino gist
n hon 1 r juGyi a is t d pence n h may n any way accrue agog,said
514 — FINAL PUBLIC WORKS y qqq
U`Z City nil . h - c fthe g i at this permit. �� /-6 /
APPLI 'sTUND. STA\DS . DWILL COMPLY WITH ALLNON-POI Issued by: Date /
3f u 'e c 3 .li^•f ( Y
,a rpiiean✓ - - " ;Pam Re-roofs
Cade.'SMion n I ca t future I u Idia,ocAL5 DISCLOSURE
Si t IA �HAZARDO ga.occupant sort ar hanele h- Nous mamonl , -Type of ROOF .... ... .-. ".. .... -_
AT
W II ins - ...
' useftied by theCpens M pal CM Chapter912.and the Health and Safety
❑Y zss3,wl ,tl, °Na _-All.roofs shall be inspected prior to.any-roofing.material being installed. -- -. --.
Will the applicantfuture building' p ,' s cq p , devices wh n' If a root 15 installed Without first obtaining an'inspection,lLagree;to remove
,not h d air co, ri as defined by theB y'Ama Air Qu 1',y M,ma ,
District? all new materials for inspection. Applicant understands and will comply with
Py".- i.:..l J . °N all non-point source regulations, - .,1.;. --
1 have r mit,"h 'huxallou.i.ma,eriala rcgiiircmenu under Chapter 6.95 of the
Cat Heuhh&Safety Cul$Site ions 25505;'3533 and 15531 1 understand that
i file building does not cumentIN,, .mram. ht it ii my msperro,bil ity to notify the „
` List bent ,!�- nifi'c'a,e al
ottupom of,he res�u c e ,. Iuch P ire, Ca Ce
Oeeu ane . ..
I. i o D Signature of Applicant . - Date
owm,Ora mor:ednt nate . All roof coverings to be Class "B" or better
_.-„ OFFICE