00100030 (4) JT
Y OF CUPERTINO CONTRACTOR INFORMATION:
uaowc.mvtstoa PERMITNG ADDRESS: PERMIT NO202 39
'S NAME: APPLICATION SUB DATE
E & JANET COWAN 02 11 2002
SANITARY NO. CONTROL NO.
ECT/ENGINEF,R: BUILDING PERMIT INFO
g BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
S=0 1 hereby affirm that 1 am licensed under provision.of Chapmr 9(commencing Iob Desen tion
41- withSt...07000).1Division 3Ofthe BasinesrmdPrnm,doneCoceandmyfican"
Is In full force and cffcn. 8 ' HIGH FENCE . �IIV�41_E®
i m y
rc e a Liceme Class Lia.9
a Dam 5DECLARATION FEB 2 0 2002
G ARCHITECT'S DECLARATION
g I dersmnd my plans sM1arcN
ll be used as public cos
yaaa unLian>edProferrinnal BUILDING
OWNER-BUILDER DECLARATION
='or or I hemby a1Trm,bar 1 am exempt form the Convector's License Law for the
t z 0 followwhich og reason.(Sccmn]o31s.Business dna vet d rronr ease:Any city or county $1300
YFO which its voidne,also re cores the ol¢e,mprow,demolish.or repair anyswcmrt
um1 3? apron , ' also y pr ppl canf for thewch permit to Lice s signed Law
(Cha nem
that he licensed pda;ntmmep snnnecnntmnnrrLnenrel�w(enapmn9 ,Sq. F[:FloorArea - Valuation
(comm 8 ith S neon]000) f D' .ion 3 of the Business and Prefessmns Code) l)o; >t �C [ A r if','s
or that he is c)cmpt the from and the basis ror the alleged ascription.Any violation 3 7'S 3'0 02 1 .'0 0
of Section 7031.5 by any applicant for a pem;it subjects the applicant to a civil penahy-
'of do(more than five hundred d.11;...($500) APN Number ,. , Occupancy Type
01,as..net ohne rt or employees wim wa,,a,@elr sole coin 101 - FOUNDATION
trope Y Y corp Y g ea 70on.
will.a the work, ssi the swature is not intended oreofferedLav for sale apply 1.4.to - - — - - -
'ow,ner ss and Professions Cade:The Contractor's.and w Low tv such
not work
hi to en Required Inspections
owner ofpropertyhiso em bones or improves thereon.and who encs such wink intended
or 103 - UFER
on through air own bowe,cees.provided that jinn improvementsnitis sold within not i neve year of .__.--10 4 . - --REBAR
offered for sale.1[howd'cr,the building _ i is sold�within'one�cur of -'��"
or mden.1 an y
oprove for
will have the burden nr proving that he did not build or 105 - ANCHOR BOLTS
c '
improve for purpose of
_ . , _. . _ . _ __ _ _. _... __ 106 SEWER & WATER- .:. .
j,arowner nfthe P(Seeny,am B usinivelycommctssions licensed Controrsm ._ r .. - .
amt me Proj t lsee.]B .Bosinerr and rmresrronr coca:)The Cann horn 202 - UNDERFLOOR PLUMBING
Lleame Law does nm apply .an nwom ofptnpeny who bwles or impmvm mere,., 203 - UNDERFLOOR MECHANICAL
.. ) .-and who contracts for such projects with a cum ictons)licensed porsuxm tip the .- -. .. __.. ...— _. _._..__ - —.
mnemes License Law. 204 - UNDERFLOOR FRAME -- la umpt under Sec. B&PCfonhis reason 205 - UNDERFLOOR 'iNSULATION
� .1�I I�O;t,,,
` Ownr W RllONSMf'IONDECLARATION 301 — ROUGH PLUMBING
I hereby affirm under Penalty of penjur,one of following declarations: 302 - TUB & OR SHOWER
❑ 1 have and will maintain a Certificate of Cement to self-insure for Workers 303 - ROUGH MECHANICAL
comPcnratron, as provided for by Section 37M of ma Labor coca, for the 304 - ROUGH ELECTRICAL
performance nr me work ror wnien tin:permit is ismed.
- - " 305 - FRAME
- _ ❑1 have and willfmainmid Wtirher s Compensation Insuranst as rtglired by Section 3 06 - HOLDOWNS
3700 of the Labor Code,for me performance of the work for which this Permit is
issued.My Workers Compensation Insurance carrier and Policy number are: _. ..._307 INSULATION. .
Carr a ;'-.'l�tt' ' nc . .
CERTIFICATION OF EXEMPTION MOM WORKERS'-. �i%�'• dt3,O6 't 1�%SHEETRO`,CK:-� , Z; ••• ••
•" COMPENSATION INSURANCE_• '_'_ r., . .- _ 3.0.9 =-,..EXTERIOR LATH_.-„ -, ___.__
"jibi, cdmrn7,Od not be compined if the panni is for one hundred dollars 310-''- -INTERIOR LATH � ,
($'omor]aI”) 1 . 311 - SCRATCH COAT
1 cc ific matin the pedomty mor of the work for which this permit a issued,1 313 - ROOF NAIL,:, - -• '
Comnot employ any feral in any manner so ss m become subject m ibe Workers
compcmauonLawsotcauromia.Dam 501 - FINAL ELECTRICAL ENERGY
Applicant
'NUI
eomesuOnrPLICANIaACimi,emmaking this cemrcatftheLamptiode.youshould
as, . . .. 502 -... FINAli' PLUMBING ENERGY.. .... .._.._ :
Z beth.itbcoktmmth...htacbmpemationpeo ,, haofthelmmdrevokeoumust 503 - FINAL MECHANICAL ENERGY
Z O fonhwith comply with such provisions.,,his permit shall be dammed rooked.
"' CONSTRUCTION LENDING AGENCY - 504 - FINAL' BUILDING ENERGY:
a 'Iheeby affirin that them is acmistructinlending agency for the Performance 505 - FINAL ELECTRICAL ,
ofthea' kf Ichor Perini. ued(S -31yJ].Civ.C.1'p ...unaerrNaine .. _. ._ -. . .. _ ... ,,.. _ _ ..--- 506- - - GAS- TEST . ....- . . . . _ .
U'z0 Lenda,-.Address 507 - FINAL PLUMBING
I certify thin 1 have mad this application and sato that the above infom;atin.is 508 - F I14AL MECHANICAL
frrr(, mine I agme;n ttnnPly won all city and coumy ordinances and sora laws relating
tobuilJingconswciion:aodhereby authbnzempre,imitiivwofthis city to enter upon 509 - FINAL GRADE
the above-memioned pmpeny for inspection purposes.:
(We)agree or save,indemnify and keep harmlessthe City o(CLp=nino against 510 - FINAL PLANNING //
W liabilities.judgments,cost,and erp mart which may in any way accede against..aid 514f.,- 1 NA WORKS _ /
l U,.Z City in consequence of the grunting ofthii pmnit. !//JJ
'�"� AP ICA UNDERSTAND NtJ'''tt/yLL COMPLY WITH ALL'NON-P INT Issued b
S RCB E ULATIUN.•. z^ I d , DatLc5 ,__
IL
p man✓ccotranbr '. Re-roofs
- ' MAZARDOU$MATERIALS DISCLOSURE -
:,:.. w by he pnaante;Poore buaaidg captain store m handle boutons material ....Type Of.Roof -. .._._. .. .. . .... .
_ nae Chapter 9 12.and the Health and Safety
CodeSaecYon25521o) _oMncNIC _:n ` aets. 7 a4/ fi 'aa , >._g',.a l.il7.
�n
er
7 ' •'�j All roofs shall be mspectedpiior to an
material being installed... .
Will the applicant or m.ure building occupunl use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to'remove
MIL hazardous air contaminants defined by the Bay AmaAr Quality Management
miridt '/ al] new materials for inspection. Applicant understands and will comply with
oYet, No : all rion-point source regulations.'
"'t Lhave iead'the haxardoui'ma¢did,rtquirtments under'Chapter 6.95 of the
Califomin Hea11h&Safety Cade,Sections 25505:25533 and 25534.1 understand that
if, building does nil curmoly nave amnam.that it is my responsibility to notify the -' -- - — -- -
aceupyn the rcquireme be met prin 1.issuance.1 a Cenificme of
"` Signature of Applicant Date
!. °: when unptiaeaagent., pm All roof coverings to be Class "B" or better
-,
OFFICE- .
r. �