01070042 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
10840 SANTA TERESA DR TOMLINSON CONSTRUCTION C MPANY01070042
OWNER' NAME APPLIC TION.UB DA TE
MCK�INNEY SYLVIA A 5667 SNELL AVE 07 �11f2001
PHONE: (408) 281-7326 SANITARY NO. CONTROL NO.
n.Z ARCHffECDENGINEER: BUILDING PERMIT INFO
w— D ELELT PLUMB MECH
H I.ICENSEDCONIHACI'OR'S DECLARATION
1 hereby affirm Na 1 am licensed under provisions of Chapter 9(commencing b Desc P1100
Fsof with Scnion]WOIofDiviaionJofmcBumnes'anJProfessionsCode,andmylivense NEWFRWAILA9@7JPERS .
Qyf is in fu 'rte and elle[
3or Cl...• / uc.x o, 34 3 �oo�
t` Can' JUN 14
ARC red
F— 1 yuA rctand my", c,vs<d o s
2jy p�
'E5. Littnud Prufe. e�ial— BUILDING
OWNER-BUILDER DECLARATION
n ereby affirm not,1 am escmpt from the Contractor's License Law for Ne 1
r z following mason Section 7031.5,Business and Professions Code:Any city or county $7000
f x❑ which requires a perinit to cons met.alter,improve,demolish,or«poor any swcmre
c. ...Out -
woor re uh mus tram v . rm c na t roe . IChapte 9 35°511�OFllgoreTa , y r ! Valuation
fcanm g npi i ]ala) fO l fin ll s r[dP f .Cal) J,1_),-, ,. .,l :t „�.
or mm hes 1.5 b therefrom and or bass for the alleged esbmpuoa.Any violation
of Seniors,man
by soy applicant for a permit subja¢the applicant m a civil Penalty
urour n,nro man five hundred dollar,LssWl. 101ARNYATION Occupancy Type
❑I.as mone,anne propert,or my employees with wages a.their.sale campe...i... 102 PIERS
will do the work.and the so etem isnot intended'or offered for sale(Sec.-7044, 103 UFER Required Inspections
Burins,and Profusions Cala:The ComocmLicense Law LicenLaw dom -es not apply un q p
rofpropeny Who Wilds or improves thereon.and who does such work himself 104 - REBAR
or through his own employees.provided that such improvements are not intended or
Mfe-d F4 sale,If,h we a he building or h4overrim,I, old uddo.are yeataf 105 - ANCHOR BOLTS ..a .". . ,
iompl t n,the ovener-bu'IJ r will have the b den of p oving Nat he J A not W ild or
mpro.em,par,dscaf.ma). 106 — SEWER & WATER
— —....... . . .... . . —.. - 202 — UNDERFLOOR..PLUMBING _ ..
❑1,as owner of the property,am exclusively contracting with licensed rontractom to ..
construct the pmjat(Sec.]aU.Business and Professions Cedc:)The Contractor's 2 03 — UNDERFLOOR MECHANICAL'
License Law docs not apply n,air..o,,of po,peny who builds or improves thereon,
and who contracts for such prnjaP.wim a conwcwr(sl-rcen.ed.pur:aant to the -. .- 204 ---- UNDERFLOOR--FRAME. _. .._ ._. ... _
Contmescmpt etor's License Law,
El arrundc,Sc,, 1 .B&PC for this.... 2'05 — UNDERFLOOR ' INSULATION
Owner Dare 301 — ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
I hereby affirm under penalty of Perjury ude or me foil raving decmmdons: 303 - ROUGH MECHANICAL
❑ 1 have and will mamdin.Certificme of cirnSem to'elf-inti,air Worker's 3 04 - ROUGH ELECTRICAL
Compensation, a, provided for by Section 37W of the labor Cade, for he
_ performance of the wort,for which this permit is issued.. 3 05 — FRAME
❑1 have and will maintain Worker a Compensation mmrance.a,required ny Section '306 - HOLDOWNS
37W air tlm L Wr Cade,for he perta,mana air the wark'mr which his peord,is 307 - INSULATION
1'socd.Aly Worker's eon,pen'aann Inspancfcarrier and Policy number arc:
30.8 - 'SHEETROCK
Carer CERTIFICATION OF EXEMPTION FROM.WORKERS�,: —fit . -� 309. •-`: EXTERIOR, -LATH'
_ COMPENSATIONINSURANCE,•,•.', r .—..__.—.— .._. - ......
. . r 3fi0- ---INTERIOR-LATH'---:,- .-,_..,..-:.;- -..... . _._....,.. .
-(This sermon need hat be cmnpjeied if the Permit is to one hundred dollars 311 +—` SCRATCH COAT +r-
aual al 313 — • ROOF NAI-L
lworythatiod, ��Ihft nicb th pc l 'issued1'hall ta ,plynn ,,me` bj t, one Workch 501 — FINAL ELECTRICAL''`ENERGY
Couc ' ° an'u,ih Permit _502 — FINAL PLUMBING ENERGY
Applicant - -
NonccloaPl n B 1, k em c ,r tcnrEx d nyaysnaul° 503 - FINAL MECHANICAL ENERGY
C) O forth th ply ith such provisions coed mvowd. ' 504_ - FINAL. BUILDING. ENERGY
nee me. hlec the W r4 t C pe t p of he LaborCoJ you most
z CONS rRU=ON LENDING AGENCY " 505 - FINAL ELECTRICAL
I hereby affirm mm there is b construction lending agency for the perfommac
a > 506 - GAS TEST
,.., of the work for which this perms is i.emed(Set.BfN].Cie.C:1 -
y 0 Len&,',Namc 507 FINAL PLUMBING _ . .. __.- .. ..
r7Z Lender's Address -
i certify mve at 1 haread,hi,appli,,u a and+tate that he above mfom
raron 1, 508 — FINAL MECHANICAL
V. � �,ma.1 agree to comply with ail city and county odnran«,add store moa tameng. 509 - FINAL GRADE
O V mWilding conswnion;and hereby onhmimrepresentrowsofthis city toenter upon 510 - FINAL PLANNING
R] the xbovun,comned propnty fpr Inaµv oo purpos
Os'q agmcm saw.indeinnily and keep harmless the City of Cupertino against 514 — FINAL PUBLIC W
V1 omod...es,judgnmms,mus xM n¢r which may in. why acerae against said
V G Chy In con+c uenanof'he un dml _
^ \PPLICA' UNOH ND. LL O Y_W 'QN-POINT Issued by: - Date
'OUR EGUL O'
eofApprt ant, Date
Re-roofs
- . :' i�n sLS MATERIALS DISCLOSURE
Re-roott.s
Will pfinowbaddmgavpam'ama,nanmenarma,mmda Type.ofRoof
as defined
Cuum Municipal Code.Chapter 9.12.and he Healthand Safetv ._. -.. _. - - ,•—i
- -..
Secuon_55320)".. ( s'1 r '. 1...; - r ,• ! -r,. ,
❑Ye. - : ON.a• !,''' All roofs shall be inspected prior to any.roofing-material.being installed..,.- .-.
Ri use ..
Will the eP' nu or future Wilding occupant uequipment or devices which'I If a roof is installedwithout first obtaining ad'inspeeti6ti',4'agret:'•to'remove
emit Wxardous mrcnnmminan v as defined by the Buy Area Air Quality Management
Dismn". all new materials for inspection.. Applicant understands and will comply with _
❑ye,have
oma• all non-point sourcy lotions.
1 have rcadme e,,Cot us rations 2 505. 5533 a,neos under Chapter eodi of the L//
cahe Imla Heelm&Safety CWe:Seaiona 25505.155]7 yre, 3J yu,miif,the
it me buildipg does not cu nant.that ills my res n +ability tonficav the
ccupen of the rc mots svhichn he «of a Cmificatc of
O u cy.
Signature pplicant Date
whet ur assent ,gen, - -Dire All roof coverings to be Class "B" or better
:..
- q
OFFICE ,