02040019 (2)CITY OF CUPERTINO
BUILDING DrvtstON PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
7683 SHADOWHILL LA
MEACHAM ROBERT L AND JOANNE
02040019
OWNER'S NAME:
APPLICATION SUB DATE
MEACHAM ROBERT L AND JOANNE
04/03/2002
HONE:
SANITARY N0, CONTROL NO.
00
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
N i
LICENSED CONTRACTOR'S DECLARATION
lob Description
Ituua
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3ofthe Business and ProfessionsCWe,and mylicense
BATHROOM REMODEL.
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is in fan force and affect.
License Class Lic, g ,f
_
-_ s � P
y19 `'�'`s,A sue s_
\
- J I L��
Di
Dam Contractor
ARCHITECT'S DECLARATION
1 understand my plops shall bo used as public records
i O ce
z
Is
Licensed Professionol
io�y
OWNER RDECLARATION
so
exempt
I hereby aRum that 1 am exempt from she Canvactor's License Low for t
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O
following mason. (Section 7031.5, Business and Professions Cade: Any city or coup
which requires a permit to construes, alter, improve, demolish, or repair any structure
$1500
13 m
. Poor'. its issuance. also requiresshe applicant for such permit o file a signed statement
_ ___—
(` �y (g.....gt� p{��r {��
i x; (�3' D U:S• � JjU tax �t 1?,•rTfl-,
• VaIUBIIOn
(hoi mincing with
M Section71)( par,)of Division dre Ce Bulipls Little Lasions Acr9Code)
the
(commencing wmpt basis o
of thatheIs exempt dhe cfimn and t e t alleged iampodan. Any vi lection
Any violation
um end n basis for the alleged carman
of Section 7031.5 by any applicant (m a permit subjects the applicant m o civil penalty
any a to l
of no, pare than live hundedd.11m(s5o0).
10111PqP5ftDATION
- "' Occupancy Type
❑ I. as owner of Ne properly, m my <mployces with wages as their sale compensedan,
-tum ad mrwml, -and the svucture'is'notinlended or offered for sale (Sec: 7044,"
r Busineai anProfessions rofessions Cade: The Contractor's License Law does not apply m an
Required Inspections "
103 - UFER -'
0 tuner of property Who Wilds or improves thereon, and who does such work himself
his
104 - REBAR
or through own employees. provided that such improvements arc not intended or
offered for sale:B:howeba,ilio Il that he not Weld of
'completion,
1C)5 - ANCHOR BOLTS-
have theburdenof proving did
Ne owner-builder will have the When of proving (hes he did not Wild or
improve fm purpose of sale.)'
106 - SEWER & WATER
_
— - - - -- --... -
(]pxaerthepftnepropcny.amcusineselycamrfessinsCodensWcomrucmtero
- --
202' - UNDERFLOOR-PLUMBING-"-
_
covuun she project (Sm. 7044. Business and Professions Cole:) The Contractor's
udwh
203 - UNDERFLOOR MECHANICAL"i
= -
-
.and-who. ronmcm.forauch projecrs. wiN a uommcmr(s).hcenxd pursuant m.the.
cordoesnmapplymmawmwofacontrtuboWBaertedpursuatnhi.the
coatracmrs ucepse law;,
__._ - .._ 2.04- ..__. UNDERFLOOR` FRAME"
❑I sm excmps under Sec a&P c for this reason205
- UNDERFLOOR''INSULATION
owner " "''Date'
301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
302 - TUB & OR SHOWER
I nerebr afino under penalty officipoydae,gnhe following declarations:
303 - ROUGH MECHANICAL
�Compcmation.
❑ 1 have and will maintain a Cenifiea;e at Consent to self-insure for Worker's
304 - ROUGH ELECTRICAL
as provided for by Sttsion 3700 of the Labor Code, for the
_ -
per(amian¢'of Ne work tar which Nis permit is issued.
305 _ FRAME
'
❑Inaveandwilimamminwargaacampc�utibninaamnre,.:reymreabystttion
306 - HOLDOWNS
=
3700 of the Labor Code, for the performance of the work -for which this permit is
i� w. Mr waders camp nude i uarunen tar ere A Paneynamb r ore
307 - INSULATION
t
cml 1,;. _„7f:+.�Pol¢yNo ,.'
- _-- 3-08--
'" -CERTIFICATION OF P-KEMPnON FROM WORKB
'''. : ii.i i•n :. ri"
3'09'-'EXTERIOR'LATH
COMPENSATION INSURANCE. �,'_!'F
:
---3T0;,--7INTERIOR- -LATH'- ...__;.__,
`Ii100) rrn r,rarleawjnionneed not be completed if the permit is for care hundred dollars
- 0 1) :1, ' I .f,
311 - SCRATCH COAT
1 mfy Net' Ne pefferma ce o(N f r nice N¢ perm s t slued I
b""'oNpwau
:. 313 - ROOF ' NAIti :.. - .• . _. .
compoemploy
.eco`
501 - FINAL ELECTRICAL`''ENERGY
-502 ---F-INAL PLUMBING- ENERGY-.
Z
this CeniQcme of Labor Exemption, you ,youshould
'NOTICE TO APPLhe Wort If. after Compenssingation
become subject m she Compensation provisions of the lamed Code, you must
mail
503 - FINAL MECHANICAL 'ENERGY
Q
such ps
forthwith comply with such provisions or this pem,n shall be deemed revoked.
504. -. FINAL.. BUILDING.. ENERGY_.
ION LE
CONSemisoe0NLENDINGAGENCY .
-g.
505 - FINAL ELECTRICAL
Ih by effirmNtNe o lending M'
y forte rf rmence
.
j:..
o mkfc0 whichNapermu enauW(S e.�o9r c' c) _ ', ._
"
506 - GAS TEST L
' C
_. ...
Lender', Limiter nupreaa.
;..:..,
507 FINAL PLUMBING_
__ .. .. ... — .._.el,516,
„y.1certifyNal
1 have read ad.a application and stem Nal the above information is
508 FINAL MECk)ANI CAL'
Fscorrect
p
I agree to comply with all city and countyordinances and state laws relating
to building cons0uciion:andherebyiuttiorimrapresentativesofNiscitytoenterupon510
509 - FINAL GRADE
Neaboe-mentioned property for inspection purposes,,Gr'
- FINAL PLANNING
(We)igrec tosdve dmmfy and keep hamdue the Cuy of Cupertino agamstrn liabilities judgments, costs and expenses hicn may in any ay accNe against said
514 - FINA PU IC WORKSCity
n c a• nonce ofte Bmnung of Nis perm t
APPLIC VI Ek$' USA ANb WILL COMPLY WITH ALL NO INT"'
t
s uR� g ,L
Issued by: Date
f)to Rc.
e-rOOfs
-gnamr`hiAPp"
-
,t�HAZARDOUS'MATERIALSDI$CLOSURE.
""AL. Wlltui epplcantmfuturebuilding oeupentstore orhandleheiardui mldenel
•Type. of Roof..
' -
ea darned by sh Cupertino Mu c p ICod Chapter 9 11, and 3h Health and Safety
coda S
Section 25$ z553a1.i 1
s ; t 1 ( _ ss `,, s, `
` ..
All roofs shall be ecte
.- . � nip d pilot to any_roof ng-material being installed.
,.
,Will lheapplicantorfuwre building occupant uscaquipmc In, devices which
'emit commorad.
_
If a roof is installedwithout first obtaining an inspection, I' agree' to remove
herardWs air as carried by the Bay Area Air Otority Management
District
all new materials for inspection. Applicant understands and will comply with,. .
P
all non-point source regulations:,,
I ltd ad'the 6a;eFdous oulted'als requirements under Chapler'fi.95 of she
'
Calddmia Health & Safety Cade, Sections 15505, 35533 end 25530. 1 understand that
Hit
If thebo ldm do s not cummly hoe ten tNtttsm res nstbdt mnotif t
Y
u2cLpa o hi
'
r' u toe= ounce of..CerofceYe
h muv be ten 'm.hu m issofup
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1sia 10
Signature of Applicant Date
All roof coverings to be Class "B" or better
tuner re sh riz deant o
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t
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OFFICE