00080013 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILWNG ADDRESS: VERN11'I'NO.
22384 RAMONA CT 00080013'
OWNER'S NAME: APPLICATION SUB DATE
UHRI MICHAEL A 08/02/2000
PHONE: SAIB I'ARV NO. CON'IROI,NO.
n re A RCI I I'I IiCIIENG I NEER: BUILDING PERMITINFO
BLDG 171.11,1' PLUMB MECII
aLW
�Ni LICENSED CONTRACrOR'S DECLARATION Job Description
I hereby af0rm than I am licenenl under Pmviainm of Chapmr 9(a,mmeneng
G4=B wbbSccdna7000)ofD/� on3orthcBu,inc..andpror�e.�,m^n,Codc,Luavylicense ADD 160 SO. FT. BEDROOM
n l9dl lame anJ uI IlU(`t ._(J__Z�
z ¢ License Class Lick
U Ece Couch"
LLO I-i, ARCHITECT'S DECLARATION /
gI understand my plans holl be used as public records a
i p O b"an"al pool..slnmd
o UWNER-BUILDIIR DECLARATION /
1 hereby affirm that I am exempt form the Convector'.Licemc Law for the /
C e a- following reason.(Section 7031.5.Business and Pmle.sion.Cadr:Any city or county
e
Q< which requires a p.•rmit to conswct,alter,improve,dnnnlish,or repair my,vat
ucre Q
a 3 m priorto itsalso requires theapplacratfo h periodt rilc asigacdstatement
marl dp r,a tt d p a, nn C t t '.L l' (Chapter 9 Sq. Ft. Floor Area V' io3
(annmeneng with Sect into 70()0)111Division lot lar litx' c .,sI I'atl...iom Lode) 19427
m But he is exempt Ihcrcfmm and the basis far the alleged escnnp(ion,Any violation
of Section 9031.5 by any applicant for a permit wbjets the applicant to a civil penalty.
of not mom than rive hundred dollar.(s500) APN Number Occupancy Type
El 1,a nf,hc prnper,o at,cmFlo"O sold,wO,c,a,a,ci t sole cmulam'Itie" 35701.065. 00
win do�llienwnrk.and the amcmre Is con immnded nr"lotted o,sdc Sec.7044, Required Inspections
Be,... ,s and Prnfc..ino.Cock:The Cnntmctn,%Liaen.w Law dors,ooI appy m e an q P
owner of prosperity Who Nods or improve,theorem.and who does such work himself 101 — FOUNDATION
or through his own employees.provided that such imprnvcmems arc not imended or
offered for sale.IL however,the building or improvement i.uold within one year of 102 — PIERS
eo picann,ran nwnerhuilder will have the burden III moving that Le Old not build or
a,prova rot parpn,e or.nr..). 103 — UFER
❑1,asowner of the pmpeny,am exclusively contracting with licensed contmcmrs I" 104 — REBA R
Linstruct the project(Secs 70 W.Best cs.and Professlom C,dc:)'nnc Contractor.
lame Low d«.not apply to an ownerofpropety who builds or improves thereon. 105 — ANCHOR BOLTS
and who contracts for such projects with a commmnr(.) licensed pursaam I)the
Cemmchn,l.i"e,,,n l,aw. 1.06 — SEWER & WATER
❑Tan,exemptI let See. .I)in P C lour his rea,nn 202 — UNDERFLOOR PLUMBING
°u°" WORKER'SCOMI'LNSn'r10NUnCLARATION 203 — UNDERFLOOR MECHANICAL
Iherchyaufim,umlcrpenalty III p"rjary(One m'(he Flowmgdechtmoons; 204 — UNDERFLOOR FRAME
❑ I have and w;B maintain a Cmiicme of Can...I m .cif-imor, rot Worker', 205 — UNDERFLOOR INSULATION
Compensation, a, provided for by Section 3700 of the Labor Codc. fee he 301 — ROUGH PLUMBING
,rdonntncc of the work for which this permit is issued
❑Ihave Umawdlnmmn:mnWorker.Coameladnnmom„ace,it,remand by Semon 302 — TUB & OR SHOWER
370 of the I.ahm Codefor he ptrionnalOc or the souk far which this"count is 303 — ROUGH MECHANICAL
issued. )Worker',Comlxn,pIeon Insumnce carr(iera1nd. policy numNr arc:
carrier �_�K�poficIeNo.!�W� ZL 304 — ROUGH ELECTRICAL
CE I MCAn222NNN OP l xEMI"N NFROM WORKEW 305 — FRAME
1. COMPENSATIONINSURANCF,
rlDi,-Oimnecdaorhecompieedifthepermitioforonehundreddollars 306 — HOLDOWNS
S1a,)otlin—) 307 — INSULATION
I a I fr that i me rfermana of for whir thin d i,issued,1 308 — SHEET ROCK
,hull nu aapiny p a is any na r vu u.be-Wn h' q uiAhc Wnrkud'
cou,pen.ar rpt — V 309 — EXTERIOR LATH
N61Ia°t g p 'boom 31.0 — INTERIOR LATH
Nfrl'ICE'rOA PLI AN'f:IL aOcrnmAin this Ccmiric:ne of F.xcm lion.you.nu
became subject to It Workers Compensaion Dprovisions of the Labor Code.you must
0 0 fonnwimcomplywithsuchpro,kiomorthisNot.hall WSeemed evakM. 311 — SCRATCH COAT
Z — CONSI'RUC I'I ON LENDING AG Ii NCV 313 — ,ROOF NASI_
C 7i herby about(hut there i,u conswction lending agency hit he pefformance
of wnrk —
for 30o)7,Ch.C.) 501 FINAL ELECTRICAL ENERGY
L2lander'.Name
5 .z Lender.Address 502 — FINAL PLUMBING ENERGY
U O 1anaytn”tIhame"ad th'appricatinnand,nocmameabove infmmaiionis 503 — FINAL MECHANICAL ENERGY
1�1. F cmTaLngco trcnm.andheauebyanderumymdma"ee,aad.mtynomnelarng 504 — FINAL BUILDING ENERGY CE :a Wilding construction.and hercM1y:mthnrue representatives oOhi,city menmr up,m
the aMnx-memiomed pro,.,foo impellum purpose 505 — FINAL ELECTRICAL
ti d (Wel agree it,sms,indenmify'n Ikeep humlcn,the Cityof Cupcnine against
m Iia ilm iodgme ,.co,(.and „south may in any way aarnc against`"° 506 — GAS TEST
V z City IID"I a, cot(I c grin gnat '.amdt.
APPI.IC DERS'rA S .L COMPLYWITHAL.NO/fI-P�O\INT Issued by: S0L 7 — FTNAPI IIMRING Date
So 1 TIO . /QV —
Signal c, Applicanucnntractm poor RC-roofs 508
HAZARDOUS MATFRInIS DISCLOSURE 509 — FINAL GRADE
Will m""",beam or future wdding,xenpum a' orandla b"aardmo nnmcdal `Type of Roof
m droned by the Cupertino Mumc, al Code.Chaplet 9.12,arra ate Health aad Safety 510 — FINAL PLANNING
Code.Station 25532,19 j o
r�N All roofs shall 5elilrspcetdcljNbtltD f3ij7Rln&6� IVdQthth(6 ting installed.
Will ave aPPllrmt nr action, iBaingnano"annne eryipn'Omo,devlccs which If a roof is installed without first obtaining an inspection, I agree to remove
nth hneurdons ulr"onwm
in n 1,Gnat by the Buy Area Nr O,ulh,Manage.wnt
Di.td"torr. .Nn all new materials for Inspection. Applicant understands and will comply with
all non-point source regulations.
I have readthe m, ,us saw I,tenon coma,under Chapter 6,95 of the
Culili,uia Iicalth&5 ety Cele Satinn,25jf1."5533 and 25534.1 unde mad that
,I the huilding dost t cumnoiy have a tan'm,th: 't i,my regxm.ibilty m Dobry the
:!,,,,all't c t mancm,which ,,a neo 91 o 'dill mol'
" a Signature of Applicant Date
b ass
\` OwneToerota"t odaedagent ate All roof coverings to be Class "B" or better
OFFICE