00080198 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BOtLDING AUDRISS: PERMIT NO.
OWNER'S NAMui 0621 N PORTAL AV AI'PI.ICAIONS
soONE HAMPTON GORDON P AND MARGARET SANITARY NO. lAa .
iD0 0 ARCHITI!C 7ENGINEER: BUILDING PERMI"1'INFO
m U F Rl.n(1 17114,1' PLUMB MliCll
�7L
y j -LICENSED CONTRACT'OR'S DECLARNNON Job Description '
✓� I hcahy alfi, Ihm I mu Iicnl.W under prnvisioits of Cnanturq(....It itch,
FZhw Wim Section 7)(10)of Division Sof the Business and ProtcW IsCode. ndmylicense
a. is in fall force and effect.
zce License Clnss Lie 4
°� "°'e G""'rt""" KITCHEN/BATH REMODEL
d u y ARCHI'I'I'"CI s ULLCLARAfION
F g G? I andersmnd my slam shall be used as public teu,rda
neY
a p O Licensed 1'role,sional
OWNER"BUILDER DECLARATION
e.W I hereby affirm thw 1 sun cBarin from the Cotiannots I.iccosn Low lira the
CZM
following uiresa(Section( ]031.5.Businessand
ve.deimrs Code:Any city or county
e,S O whish it,mu a pemso In n,mmrcl.alter,impnn'a,d dern,n,or lea,i,onY,audure
Fo thou h1.eslur,owd...N...Ito helhcappheant for mchpenn'a mllkasiawe Cnemam
ecrourer Bcemedp"'hou tomepf[)iion.oflho eontranne,,acemelaw...Cor) Sq. Ft. Floor Ar ea nation
tcammeneis c with seninn our n of Division 3 of the 1lwincs end untProlAny sic Cade)
or that he is 31.5 by hemfmm and the hal,Iia tM allege]cxcmminn.Any violation
it not'nn 'I'I.5 by any applicant for u pemti'evbjce's the upDlicani m a civil pewl'y
nntnt n,oro luno five ltoodrod d+�ua"(Ssoo). APN Number
ccupa
01,as msnet of the pmpeny+or my onployces with wages as their sale compcmation.
will do the work,wall the structure is not intended or o0bred for sale(Sec.7(1
Easiness amt Prams+innmm
.Coderll e Coemra Liwc,a Law do .o 1.63�0
e,ma apply an 5ERegfted Inspections
r of prnpeny Who milds or Impmvcv'tbctcoo,and who dal,such work himwif '
owner
his Dina enggnyec, pmvmcd mat such intpnwemeau are not intended or
oRered for site.If.hn,cvm,the building or improvement is sold within one year of
completion.the owner-builder will have the burden ofproving that he rid not build or 101 — FOUNDATION
improve fins....M'sWe l" 1.02 — PIERS
0 Lasoxnc ufthe pm,wrt,am exauavelycontracnng with liren.edcantmnms to 1.03 — UFER
conswn the pn,jea(Sec.7044.Business and 1'mressions Code.)'Ihe Contractor's
License l.owdoes not apply towtowocrofprnpany ,ho buildso,unproves'Hereon. 1,04 — REBAR
and who countries lir such nolects with w sonuacmr s) Ilcensnl panaant to the
m
Contcmr.ucenseLax. 105 - ANCHOR BOLTS
0[.in" rynand Bsp •fnrthi.rcaun 106 — SEWER & WATER
Ow.'I �/ Date r/s'P/e
WORK1. 'S COMPBNSNIION DECLARATION 20� — UNDERFLOOR PLUMBING
I hereby aftimt under Penalty of perjury one of the following declarations- 203 — UNDERFLOOR MECHANICAL_
1 1 nave and will aomttoin a c:rBnale it Comcra to scicimore Inr Worker's 204 — UNDERFLOOR FRAME
Compematldn, a, provided fm by Section 37a1 of me Labor Code. Bn ate 205 — UNDERFLOOR INSIJI_ATION s
performanec of the work for whicn'his permit is a,ued.
301 — ROUGH PLUMBING
C31 oveandWillnwintuilWnikersCnrapml,winola.tnaaee.n."quinanysection
3700 of the 1afor Club.set he ladi.ollme of he work bar whorl,la,permit is 302 — TUB & OR SHOWER
issued My Worker's Cnmpensatinn Insurance currier and Poli,numMr,arc 303 — ROUGH MECHANICAL
Cwrcr: POLICY bar. 30A4 — ROUGH ELECTRICAL
CIiR'1'IIBC 1 ION 14ROM
COMI'liNSATI(1N IN.SURANClW11kKIiItS' 305 — FRAME
(l hi.ucmpl
'ion need not he coeted if the permit ix ror one hundred dollar. 306 — H01_DOWNS
S[00)orlexs' 307 — INSULATION
I certify that in the perlomaence of the work for which this return is issued.1
shall not employ any person in any manner so as m become,ubjecl m the Workers 308 — SHEETROCK
cmmiL npeaLaw, ,ICaifnml..oatc 309 — EXTERIOR.
Appfiw
ct .� LATH
NOTICE'TOAPPLICANT 117 aIle,making this Certificate of Exemption.you should 310 — INTERIOR LATH
because mbject an the Workers Compen,mion pmvi on,of the LaM1nr Cad,you most
O fonhwnh comply with such provision,or this permit shall be deemal revoked. 311 — SCRATCH COAT
.N.a CO,the.is a cON I.ENUING lending
agCY
— ROOF NAIL
Ifthe work for wM1 nmis`an i its sued user°ani:gs.C.) rmthe perroananee S0` — FINAL ELECTRICAL
ENERGY
;D z
Leader's Name — FINAL PLIJMBING
o z 1<tmarxnde=„ 503 — FINAL MECH ENERGY
U O Ianif da.,l nave readmit upplicmio i and,aminal be xMwe inronnaum is 504 — FINAL BLIILANICAL ENERGY
Loa 'r'�i correct.I agrec,+cattily with all city and county ordinance.and state laws relating D In
O U to btmdiascoo,troninrI,nmDareny aothodaar7,re,cuative,of Ill,city to ere... �.. 505 — FINAL ZB -' ENERGY
y rW thea ,ve.menromrd property tUr hr,,edn parpn,e,. 506 — GAS 7TR C L
F, S
(We)agree a+save itWen+nify and keep Harmless me city orcapenmo against"ab.itics,judgm507urinream NaFINAuvu'C �/yy�NDCRSTA ND 11,1,0 PL1'WITHALI,N Nd'OI T ISSUCd b 08 6 Date
OURCL'6y[�UI.A'I'J/'NS��/rr5 y
Signawrs til ApphcanVcomr set Da'e Re-roofs 510 — INAL RADE
fIALAN DONS Iddln, l,, DISCLOSURE F
Will me appueam or blare lauding�+ecanattt,loro or nanmee harorenu,ntatcaal Type of Roof 514 — F PLANNING
as defined by theC.,rinu Municipal Code.Charve,9,12.andtne Health Dad Safe,y' IN L PUBLIC
Code.Section 25532(a)t
C Yex Cl No All roofs shall be inspected prior to any rooting m. being installed.
Will the applicant or future building«cupam tis,equipment or device.which If a roof is installed without first obtaining an inspection, 1 agree to remove
earn narurdou,wh'ronminmanu a,defined by the Bay Arca AtrQnalny hlanagearem
District? all new materials forinspection. Applicant understands and will comply with
Cl Ye, C3 No all non-point source regulations.
1 have read the hazardous materials requirentoms under Chapter 6,95 of the
California Health k Safety Cole,Sections 25505.25533 and 25534 I understand that
If the building does till currently have a en:or that it is my re,,ri,ihiluuhuuu�����yCCCCCto notify the
kcuPUIts W tiRan
'int rn uirnncnb whirl+n+ml b inn Prier , ,old a litiam of
`k`aMI I/� '�' SignatureofApplicant Date
r1� 0•
ow.+rr Orr atl+r rise largos, Date All roof coverings [( be Class "B"or better"
OFFICE