02050023 (2) OF
CI BUI DING m ERTONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
6069 SHADYGROVE DR VANNI BROTHERS CONSTRUCT ON99 y 02050023
Aft ja DSARUNDERS STEVEN E AND BETTY 433 TOPAZ ST AO SC/ 06/ 2002
f PBONE: (415) 369-2997 SANITARY NO. CONTROL NO.
(
Mal ARCHITEC(ENGINEER: BUILDING PERMIT INFO
wF O O BLDG ELECT PLUMB MECH
< lul U3 =1 L__I
�a
5 y z LI.that I CONTRACTOR'S DECLARATION lob Descri ttion
s=-o ction7ya rmthatlamlicenxdunderprovisionsofChepter9lcommencing INTERIOR REMODEL & SKYLIGHT
m t,w
with Section 91100)nl Dlvisinn 3nr the Businiss ane Professions Code.andmylitunme
m o-� is in full force and elfeet,
o6 License Class Lic.a
i O [)ate C°mmaor
wO In ARCHITECT DECLARATION
g1 understand my plans shall he used as public records
1x00
r 6 0 o Unlined Professional OCT _t 7 2002
y�a OWNEan c.emDER DECLARATION
1 hereby maso affirm thin 1 1. exempt from the Commuter'emions Ca License Law for the
t- a following mason, erionoto construct,
Business and Professions Code:Any city a county - $170000. -
I O which ts p mitt c Wier Iter,' demolish, p allyttuctureement RIJU T -
i 3= prim t ts's a also requires the pPlicant l h pumiu fl a signed statement
-
but be is licensed misanal to the pons ofthe C meam's License La (Chapter9 .- „341' r•@ . a) Valuation
(mm B withSect 7WO)ofDvisi ]oftn Business and Professions Code)
or that he is exempt therefrom and the basis for the alleged eka,mmi.Any violation
.f Section 4031.5 by any applicant for a pemdt subjecni the applicant o a civil penalty
of not more than five hundred d.l:an,(s500). 101APN TI�DAT I ON Occupancy Type
❑Las owner orthe prupcny,or my employees with wages as their sole compensation. 102 — PIERS
will do the work.and the grucum,is not intended or orrered for sale(Sec.v(w, 103 - UFER Required Inspections
"
Business and Professions Codi The Contractor's License Law does not apply m an 9 p
owner property who mild%or impr.vea thereon,ane who dos such work himself 104 - REBAR
or Ihmugn his own employees.provided that such vementemcn¢art not intended nr
comm ran sale.owner-builder rwev ,the baave t a,improvement nil sold within am rent or - _. .I 0 5 - ANCHOR BOLTS . . ... ....- . .. . . .-
improve far the scutofe).will have the harden of proving rim he did not build nr
improve for parpom.r sale.). 106 - SEWER & WATER
/�i,a:owner ai"the bnnpeny,y "efaaively c°ni,;cine with he-i�..,-d rnmmm°ran .. .. 202 UNDERFLOOR" PLUMBING__
dime, he p.Jj ct(see.2 nes,and Froreainns Cods:)Tire Contractors 203 UNDERFLOOR MECHANICAL
"
m
Liccnsc La docs not apply t an was nf,m,srIy who Wilds or improves there.,
antl who nra<u for sod pro'cis with convac this)IicenseJ.pursuam mthe.
-204 ._ ..UNDERFLOOR—FRAME
Conta
t mom
❑l all vnde Law .B&P C for this reasun 205 - UNDERFLOOR ' INSULATION
AM n / O�i 301 - ROUGH PLUMBING
wo MPIONbECLA TION 302 - TUB & OR SHOWER
net
mm'y a, ander penahyor'rerja,ynncnnner°0.wingeedaaJons. 303 - ROUGH MECHANICAL
❑ 1 have and will maintain a Certificate of Consent tb self-msare for workers 304 - ROUGH ELECTRICAL
V C.mpcowinn, as provided fin by Section 37M of the Labor Code, for the
pe —
rformance of the work for which this permit is issued.. 305 FRAME
C 1 have and will maintain Workers Co upenmdon Insurance,as required by Section 306 - HOLDOWNS
3700 of the Labor Code,for the performance of the work for which this pent is 307 - INSULATION
issued.My Worker'sC Compensation .y _ 308 S EET -- - -- -
. _ , , ROCK --
oro non nsurancc Carrier an Policy num r art:
to •
Car:ih: ' t I i I�n . Policy Nn.: .... .. _.. — H
+CERTIFICATION OF EXEMPTION FROM WORKERS' is <1" '309a -•:EXTER%I OR.IiaT-H':
"
COMPENSATION.INSURANCE' _ "- --- ---3.1.0 —r-'INTERIOR--LATH --- ---
'frnmaiF neem nm be c.m lercd ii me permit is r.r one mnarta collars 311 — SCRATCH COAT -
(slom.rie,,.l 313 - ROOF NAIL -
1ani y tr t in the perfor rnk��d the work nr whish this permit is issued,1
anaB not eml n pers. yrttfg�nas as me .t�mme w.rkert 501 - FINAL EliECTRI CAL' tENERGY r
c.mpniat 502 - FINAL..PLUMBING ENERGY.. ._
A,
become ` LCA �, amgtns ertifcme.rEaemptmn.roesnoam 503 - FINAL MECHANICAL ENERGY
z s hjemrothe W.i fir penmuon provisionsotitic LaMr Cale,you must
0 O r°mnwhma.mplywithmanprovision,o,mi,p itahmlb eamearev.kea 504 - FINAL BUILDING. ENERGY
..
y - 'CONSTRUCTION LENDING AGENCY 505 — FINAL ELECTRICAL
a'71 hereby affirm that theme is arum union lending agency for the performance _ GAS TEST
t
Lenders Ad dress hthis permd is issued lsce.3139p,Civ.C.) 506
of the work for which _
'a o d"'"°'"`'"" 507 - FINAL PLUMBING
U 0 508 - FINAL MECHANICAL
1 certify that 1 nave read this application and.tete thin the above inti is
0 E^^ correct.1 acro to comply with all cart and county ordinances and state laws
s setts relating 509 - FINAL GRADE
O v to rfic,cgc.a.savedp,.,ndhenebyaathnrirempmsedmevesortni,drtmem"nPo^ 510 - FINAL PLANNING
,T thepbove-memi.ned propenY for inspection purposes.
prAt�m
agmetosaaindcmnlyand keep huml.the City ofCa,mintagainst 514 - FINAL PUB C WORKS
rajgmmns, s fund expenses which may,in any way accme against said
C.> Zquence t e garrho this permit Q /V/
,REG R fANOSA WILL COMPLYWfn1ALLNONPOINT lssned by: Dale
S.
1 at
A nmacmr . Dare Re-roofs
",HAZARDOUS MATERIALS DISCLOSURE
• Will the applicant or,furore Wilding occupant time or hostile haurdous material . Type of Roof ..-
defnee by the Cuperi M "P°IrCnde,Chaprtr 9 12,and the Heahh and Safety
Code,Sectio;255326)
❑v, �rN All roofs shallbeinspected poo;to"any roofing material being installed,
Will the applicant or future Wilting occupant use equipment or devices whichIf a roof is installed without first obtaining an inspection, I'agree to remove
emit harandiumiur cont ants a,reform!by the Bay Area All Quality Marmicurrunt
District .. all new materials for inspection. Applicant understands and will.comply with
Dyes "° ' all-non-point source regulations. - -- -
'C� 1 have read the hmsrdous materials mqum m m,,mdcr�Chapter li 95 of the -
Calif. Health&Safety ode.Sections 25505.25533 and 25534 1 understand that
it the ding docs not c oily have a tenant,that it is my respor,du t,family the '
Deese f tAe regm a rs which m at IN,met prior to issuance his Certificate of
Signature of Applicant Date
dam. . nt Date All roof coverings to be Class"B"or better
,.OFFICE - --..
CITY OF CUPERTINO ' '
BUILDING DIVISION PERMU& CONTRACTOR INFORMA' N:
BUILDING ADDRESS: 1W PERMIT NO.
6069 SHADYGROVE DR VANNI BROTHERS CONSTRUCT ON 02050023
OWNER'S NAME: APPLIC9TIONg EDAM
SAUNDERS STEVEN E AND BETTY 433 TOPAZ ST 05/ 062002
/ HONE: (415) 369-2997 SANITARY NO. CONTROL NO.
f
G p
6 ARCHITEC'UENGINEER: BUILDING PERMIT INFO
kC FF BLDG ELECT PLUMB MECH
L_.I
LICENSED CONTRACTOR'S DECLARATION
i S y- I hereby aR that I am licensed under provisions of Chapter 9(cammcncing Job Description
E2 with Section?goo)of Division 3either Business and Professions Cattle.and mylicense INTERIOR REMODEL & SKYLIGHT
iyy< i,infull 1r,i deflect FINALE®
z z a License Class Li<.p
'O n U Dale Convector
LO ARCHITECT'S DECLARATION
:Mtot 1 understand my plans shall be used es public records OCT 1 7 2002
Y
I d oO Licensed Professional
n OWNER-BUILDER DECLARATION
I hereby affirm that 11. exempt from the Contractor Co License Lew for he' BUILDING
C?< following rtes".. erfmion]O3L5.Business dna Professions Code:Any city structure
$170000
$C O which requites a pernit m construct,abet,impmve,demolish,or repair any swnum
e3m
posse to its issuance,also requires the applicant for such permit to Me"grand susement
Net but is licensed!pursuant to the provisions of the Coneaofs License Law(Chapter 93329 ,[".1..,.r.�>iga. Valuation
(commencing with Section 7M)of Division 3 of the Business and Profusions Code) � ' ! j, Y `YIy.V VCY a
or that he is exempt therefrom eqqd the basis for the alleged exemption.Any violation
of Section 7031.5 by any.pplicmd for a permit subjects the applicant to a civil penalty
ofnofman,than five hundred dollars(s50o). 101APN IQIDATION Occupancy Type
D 1,as owner of the pari ,ser my employees with wages as their sale compensation. ER
win do the work,and the swaum is not intended or offeree for sale(See.7044. 10 3 — UFER
Business and Professions Cade:The Convaau;a License law does not apply 10 an
Required Inspections
owner of property Who builds or improves thereon,and who does such work himself 104 - REBAR
or through his own employees,provided that such improvements are not intended or
offerrd for sale.If.however,the building or improvement is sold within one year of 105 - ANCHOR BOLTS .
improve for purpouofle.)
completion, esaf �will have the burden of proving that he did not build m 106 — SEWER & WATER
L as owner of the propeny,sou elusively contracting with licensed convactosm 202 — UNDERFLOOR PLUMBING
-
fouct the project(Sec? s and Professions Cade:)The Continuum'. 2 03 — UNDERFLOOR MECHANICAL
License
U e«snot.Poly t an ter of pruprry who buaas or improves thereon,
of who acts to
sur pof un with conuanor(s)licensed pursuant m the -2 04 - UNDERFLOOR FRAME
C.❑leer dc c. ,B&PCferrous reason 205 - UNDERFLOOR INSULATION
/GMaA�OZ 301 — ROUGH PLUMBING
WO MP! ONGECLA nON 302 - TUB & OR SHOWER
«rIhereby.rcrmunderPenaltyar6er)uryoneofthefollowingdeclnations: 303 - ROUGH MECHANICAL
❑ I have and will maintain a Cerream of Consent to self-insure for workers 3 04 — ROUGH ELECTRICAL
Compenitom". as provided for by Section 37W of the Labor Code, for the
performance of he work for which his permit is issued. 305 — FRAME
❑1 have and will maintain Worker.Compensation Insurance,as«qulred by Section 306 — HOLDOWNS
3700 of the Iabm Code,for he perrorman«of the work for which this permit is 307 — INSULATION
issued.My Worker's Compensation Insurance framer and Policy number arc:
—30No: .8 - SHHEETROCK
Carrier: • .CERTIFICATION OF EXEMPTION FROM WORKER$',' 30'9 = 1EATERIOR •LATH
COMPENSATION INSURANCE ' '
_ . ..3fi0 - - INTERIOR--LATH-- --
That . . _... .. --.._.
s see n need not be from laed ii the permit is ror o.e hundred dollars 311 — SCRATCH COAT '
c"'M m less.)
i ani y h in me Parra !n
,epr me work
Jowhim this Prm,h is issues,I ' 313 - ROOF NAIL -
shannoteml n erso rlthners as,4fbe orae cno the workrrs' 501 — FINAL ELECTRICAL ENERGY
Com�p,nj1 c fro a(e 502 — FINAL PLUMBING ENERGY
NOT'�t LCA . . to . ingt ra emfieaeofEaempaan.You
shodE 503 - FINAL MECHANICAL ENERGY
hicume, bject m the wor
er pemmion as to
Orme Laborcade,y«muss 504 — FINAL BUILDING ENERGY.
O Q forthwith comply with such provisions or this permit shall be deemed revoked.
H (Z) CONSTRUCTION LENDING AGENCY 505 — FINAL ELECTRICAL
ai > 1 hereby affirm that them is a construction lending agency for the performance 506 — GAS TEST
of he work for which this permit is issued(Sec.3097,Civ.C.)
y $ L.aers"am`' 507 — FINAL PLUMBING n
UO Leode's'Aaartss 1 certify that I have mad this eppliatian ane nae that the about information is 508 - FINAL MECHANICAL
m E„ umrcr,.I agree to aomplr with.n ei[r.ma raanryrain.«rs and.tae laws relating 509 — FINAL GRADE
O v toBuildi"gconstruction,and hereby authorimrepresenutivesofaascity toenter upon 510 - FINAL PLANNING
Wthe above-mentioned property for inspection purposes.
00 We)agreetosavermiemnifyand keep harmless life City ofCupertino against 514 — FINAL PUB IC WORKS
r V2 liahif s,judgments, s and expenses which may in any way accrue against said
U Z Cin ! c sequence I agranting tris permit - 6Va J
SP NT R ANDSA WILL COMPLY WITHAIIN NPOLY1' Issued by: Date
rete orA .fore —Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant shirt or handle hazardous material Type of Roof
as defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Code,Section 253321.)?
over XiNo All roofs shall be inspected priorto any roofing material being installed. -
Will the applicant or mmrc building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
Disvio? all new materials for inspection. Applicant understands and will comply with
(� 0 yes "CNo all non-point source regulations.
'vPr I have had the hazardous materials requirements under*Chapter 6.95 of the
Calif. Health&=�d
05,25533 end 25534.1 understand that
ifthc !ding daea .that itis my responsibility to notify the
ofeu f the r< met prior m issuance of a Cenifcae ofD" a Signature of Applicant Date
r.uthoDate All roof coverings to be Class"B"or better
OFFICE