02050089 (2) CITYBUILDING DmstoNN� PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10280 SCENIC BLVD TERRY BROWN, GEN CONTRAC OR 02050089
OWNER'S NAME: APPLICATION SUB DATE
3UD ALFRED BRADLEY 14510 BIG GASIN WY 05/15/2002
HONE: SANITARY NO. CONTROL NO.
1p (408) 868-1640
W O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
E FF BLDG ELECT PLUMB MECH
Z<6 LJ Iia u u
ZH i LICENSED CONTRACTOR'S DECLARATION
g 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing C 1
F= with Section 7000).f Division Sof the Business and Pmfessions Code.and my hentoe <GA I 2 FT
is in full force end effe t
ne License Clms `c Lic.% �'1 2-60 Z s
O s O Data Conunctor l"" `
a t� ARCHITECT'S DECLAR
y 5 1 understand my plans shall be used as public research
p O Licensed Professional
B ca OWNER-BUILDER DECLARATION
u•7I hereby affirm that i am exempt from the Contractor's License Law for the
t;Z G following reason.(Seniors 7031.5,Business and Professions Code:Any city or county $30000
F C which requires a permit toconstruct.altar,impmve,demolish,or repair any structure.
3$_.prior to iU iswance,a O requ4es Ne applicant for such pcmtit to(ilea sigatd summeot. -
thSt pq if lianstl pu(sitpin tq 1�tt�tg pmasiom of the Contratols Littnse law(Chapw 9 i ,r Valuation
(cin—,,a ng with Sap.n]OUf))pf DivixionJof the Buaine5s and ppmmf ions Cade) �tsf t�si �• sRO. OF�g°!,,@iS;tl\nl.�a37I..' :
or that he b eumpi therefrom and the boars for the alle(ee esemptbl.Any violmion r
-of sac__"n:5 by a..appuaant for operant n.bjeets the appuaant m a aivu Penmty . Occupancy Type
Iof a.,more".a five hundred e.uars(SsoBl. 10 IAPN�6 AT ION ""'
❑1,as owner of the progeny,or my employees with wages as their sale compensation.
(Business o t cwork;and ssimb, ode:annure C noxi tor's Lf or se etaidLaw for sale f ppiy in n -- -- Re uired Ins ections',, t• ' '
rf and Profusions Code:The roves theme License law does not apply m an 103 - UFER q P
owner of hpropertyow Who builds or improves t thereon,orad who does such work intended
Orth through his n employees provided that such improvements hilus are in ne year or. 104 ..- REBAR_,.. _._.._ ...— ___._
'com--dr - eowne owner-builder
'he lhavegcir eburdeovememhcAahedidbee build
- ._-. _..105 — ANCHOR BOLTS - ` � . .
�ci
completion,the owner-builder w01 have the burden of proving that he did nm hu Id or
improve for purpose of sale.). 106 - SEWER & WATER _
-
❑1,as.vena of the property,con contracting contrsing with licensed commissions m 202 UNDERFli00R PLUMBING
.. : ..
- conswnt the pmjm ISa,1t14f,Business and Professions Coded The Contractor's p•
- andwhlnd.et.forsuW.cmanownshpmpenywhobuildese pursathereonar- , 2O3 — UNDERFLOOR MECHANICAL'--
141 am exams—"nde Scl 'scoMPEN ttA Ana�nmare nes. ----._...._204 = UNDERFli00R; FRAME-` -'— _. _
and who commcu.for such projms.with.a co.vanor(U licensed pursuant
as°n 205 - UNDERFLOOR 'INSULATION
301 - ROUGH PLUMBING
302 - TUB & OR SHOWER
I hereby aMm.Mar penalty of Perjury one of the following declensions: 303 - ROUGH MECHANICAL
cense
❑ 1 have and will maintain-o Certificatesof Consent to self-insure for Worker's 304 - ROUGH ELECTRICAL
C.mpesmion,-m pmvided-far by Section 3700 of the Labm Code, for the
- performanceof the work for which this permit is issued.. 305 - FRAME
0 have and will'maini.m..Woikers Compensation Insurance,as required by Scction 306 — HOLDOWNS
3700 of the labor Code,for the perfommnce of Utes work for which this Pestis is
hissed.MyW.rkera Compensation Insurance border and Policy number s2: ' 307 — INSULATION
canoWl t It'(!I a.1i,N.. Og; SHEF�ROCK::;S..
IJI CCRTIPICATION;OF EXEMPTION FROMWORIOW', , ' L-C.g1 $ )309')� ?EXTER'IOR'•LATH'"
COMPENSATION INSURANCE" "'^
_ .. __._....__.... _ . _..._._.. .....-_ _.._._ .•.. 3 TO' . INTERIOR'-LATH.' _;.,._-.____.____ _---..._.._..___.._ . -.....-.
3 (Thin section need not be'cumpleted it the Permit is for one hundred dollars - '" .t,, t
(sloo).nesa.l 311 - SCRATCH COAT
Chat -:. . - _ ,_ .. . .. :___ _ :-._. : -_:.._3.1-3 ----ROOF 'NAIL
1 d nifY Nes in the performance f th k for wh h th pe t -is wed,l - -
`sn lr t mploy any Person an any ma ) t sco at� t t the w rkers 501 - FINAL ELECTRICAL ENERGYt
C n subject
p y with
ork r' a Date proms olns o the Labor Case, _
Applca t jpi-w—"—, 502-• - F-INAL--PLUMBING ENERGY, —
N(yfICETO PL Tlf��after mak gthiSC ndicvm of EXe pro you.hould � t
z barhmoncompl tWorker's
suchprovisions
rvoionsoruonpovsona Rha Lab rolmd. most 503 - FINAL MECHANICAL ENERGY
0 forthim comply such my s ons o thisyoked
5.04 _ __FINAL.BUILDING_ENER Y
•t' e ------------
'CONSTRUCTION AGENCY -- - I' r ' \'•at'
I hereby afli.n that there is v construction lending agency for Performance 5 0 5 - FINAL ELECTRICAL
of the work for which this permit is issued(Sec.3097.Civ.C.)
t
LendersNm . ... _. . ._. ... .._. -. ..-. .. _... ..._ _ 506 - GAS TEST ._.. . .. ...-.__. _... .......... ___. ..
D.Z LeadAddress - 507 — FINAL PLUMBING.;,
U O
I cenify that I have read this application and state that the ibove informiniont is 508 - FINAL MECHANICAL
correct.1 agree to comply with allcity and county,ordinances and state laws minting 509 - FINAL GRADE
D V 10 Wilding construction.and hereby authorize repmamodives of this city to enter upon
W the above-mentioned pmpeny for inspection purposes. 510 - FINAL PLANNING
'.y (We)agree to save,indemnify and keep harmicas th<City of Cupedono against 514 - FINAL PUB C WORKS
- to V] liabilities,judgments,costo-and expenses which may in nay way uccme against said
SU, Cit'inconsequcnce orthe granting.(this permit. rs
,P AST UNUETkSTANOS AND mLLCOMPLY WITH'ALL'NON.POfl I
U •Foul-Ar s. G Issued by: Date
gnat re.1A plicae omnsum at Re-roofs '
.HA2ARDOGS MATERIALS DISCLOSURE
_
Will the apple t future building oc upunt.tator handle m m xmm al Type of-Roof..
asrefund nSafety
yy the Cupertino�M Municipal d Chapter 9 12. d the Health d h T T i n a - s
ca.c.ys, 2ss32rl Its ttr 1.. 1. - y, a � ir .,,:, , Irt P .ah3.X 'O; etrr:
All roofs sfiall be_Inspected prior to_any,roofing material-being installed. _
Will the applicant or future building occupant use equipment or devices which If a roof is installed-without first obtaining an inspection, I agree•to remove
.anis hazvdons air cnnmmiwnumdefined by the Bay Arta it Quality Management
District' ..all new materials for inspection. Applicant understands and;will comply with
❑Yah .--
�. all tion-polar source regulations..,;
1 have read the fiamrdos'materials requirements muter Chapter 6.95 or the
Coldrod.Realm&Safety Code,Sections 25505,2553)and 25574.l understand that / /t Q
I the Wilding does moteurendy have a tenant.that it in my responsibility luno lytheX1, / -Z—
occupant of the requirements which must be met pour to issuance of e Cenificam of R' l
Signature of Applicant Dat
wbar or amh.daed agent All roof coverings to be Class'B" or better'
..._- .-. _ . _ ....- .. . . OFFICE -- -- -