01030062 (2) CITY
OF G DIVIRTINN0
UIPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS! PERMI r NO.
21434 SHANNON CT AMERICAN BRANDS CO STRUCTION01030062
OWNER'S NAME: - API'LICAI'[ON Still DAPI;
BOUR DAVID P AND LAURA M TRUST 1. 145 HAWKS HILI_ R 03/12/2001.
I'IIONII, SANI'I'ARYNO. CONTROI.NO.
(406)265-6000
C N Z ARCIIITE(MENGINEER: BUILDING PLRM11 INFO
�u O COC IRI.U� 1:1.1= PLUMJI/ MIF
to 6 6 b�—f I_/J E L�
H 2 LICENSEDCONI-RAMOR'S DECLARATION Job Description
z _ l eerel,y ter Ihn,1 nn,In,:ued nmler Prnvi.i��ns„reh"me,o(ecru nein, .
ON O x'hSemion71XX1 f ion the Rnsiness:uN Ymle"in..Cile.:mJm111L
=x O PATIO COVER ENCLOSED.
K�¢ ¢en"e Cln.as Lic.p
0% Dnte Convacmr- -O _
C"I IF
I,,DECLAk/,TION
bromid my plans shall M u.vd us public reemd,
x « FINALE®
I O O LiccnseJ I'nRessiun:J
I9 0 (ANNEX-BUILDER UIiC1.ARA'I'ION ,
tv� I hemby alfinn thw 1 am exenp,t 1'mm the Cnmrac n'n License L"w for the
tza following mason.(Section 703 1.5,Ravine,and Padessinm Cod,Any city or county AUG O
€❑ which requires a permit to construct.alter.improve.demolish,or mpair any'.wemm ZOO'
a- ni to its issarner,also req"ire"theappinew fmsuch permiuo rte axigned stmerocnt
dm,tic i"licen.alpnmtmm tnmc pmvismnvof roe Co.,... ucen.el.nw(Chalnery Sq. Ft. Floor Area Valuation
wommencin,,kh Sen 7100of Division 3 ofthe business and Professions Calc)
or that he is exempt therefrom and the basis lin the alleged exemption.Any violation B $15500
of Section 7031.5 by any applicant or o pennit subjects the applicant m a civil Fcndoy
,It nmI ronre than Eve Immdral dollar($50(u. APN Number Occupancy Type
01.as owner of the property.or my empI,In,%with wages a.imia-le caapenwth,n. 3621212022. 00
will Jo the work,and the no m fie is not intended nn offered for sale ISec.70,1,1.
hoinuss and Profcaimns Cale:'rhe Coronation's License Law does not apply to an Required Inspections
sir lnolerly who hudds or anm.e,memon,and who does"urn work himself
net
his own employees.prodded that such imps, ,a intended or 101 — FOUNDATION
tiethrough
for sale.Jr.however,the budding or ImpmvemcmcI,.old are
one year of
imipleeon,me owner-builder will nave me burden or Forcing that he did not build or 102 — PIERS
t,tpors,,tpmmmueAside.). 1.03 — UFER
01.as owner of the propcny.am exclusively contracting with licensed conmacmh to 104 — REBAR
Laonmet the project(sae.7(114.business and Professions C dc:)'Me Contractor
ienee Lawda'sm,l apply ra:movsoaofompeay no haild—rtmpmves tit"`o"' 1.05 — ANCHOR BOLTS
and who contra,,,Inn such pr jeep with a umlraabalxt Incensed pnauam ut One
Contractors license law. 106 — SEWER 8. WATER
01 am eoralia ander sec. .B&P C for run mason
Owner Doe 202 — UNDERFLOOR PLUMBING
WORKER'S COMI1I7NSAI'ION DECLARAI9ON 203 — UNDERFLOOR MECHANICAL
I hereby affm,under penalty of pe jury rant of the following decimal a,: 204 — UNDERFLOOR FRAME
'} ° I have :nod will n dnanin a CenilicAm of Consent o sol1 l are fin Wmker'e
Compensadnn. as ponsided for by Section 3700 fir fire Laborru
Code. t the 205 —
UNDERFLOOR INSULATION
perfommnccof the.,k for which this permit i.issued. 301 — ROUGH PLUMBING
0sface 11illmtdon:dnWorker xCt"nteneh0onlnaammee.asre9tonedbySenion 302 — TUB d OR SHOWER
37tH)of the Labor C(dx f �',o mmme of oho work Inn which thin pennit is
tested.hly N' Minn lnwane carrier. JY ben,
303 — ROUGH MECHANICAL
cooter rnhtyNo.:� / �t4 304 — ROUGH ELECTRICAL
.IiRI'IIICArION OF EXEMI'I'ION FROM WORKERS'
COMPENSATION INSURANCE 305 — FRAME
('red.mmlnineed trot In completed if the permit i.for one hundred dons. 306 — H01_DOWNS
(sbXBmrle"",I 307 — INSULATION
1 entry ohm in the peroarance of oho work I'nr which this penult is issued,I
..hall ant employ any perp er m any manner w as m beemroe subject to me worker) 308 — SHEETROCK
Genpensmion L:,ws of caErO`"i'''Do'Ap, 309 — EXTERIOR LATH
NOI ICD,(
NOTrrettOAI.1'LeW..I` ',sloa ompenstion this Crnim.ol hewmp Crodc.ushnald 31.0 — INTERIOR LATH
become wbjmp m the Workers Compensation his p annit shall
name In un Cede,you mull
O rottbox dh comply stub web Forni<h,ns or nth peand"ban ext aeemea necked.
31. 1 — SCRATCH COAT
F' .tea CONS'I'RUO'IION LENDINGAGCNCV 313 — ROOF NAIL
1 hemhy alfinn that there is a construction lending agency Orrin,perlommncc
oRhe work for whichhis permit is issued(See 3037.Civ.C.) 501 — FINAL ELECTRICAL ENERGY
Q Lender's Nano
p z I,cmler',Addwy,' 502 — FINAL PLUMBING ENERGY
L O leanly deal Ifairs,wad ad,application and wmcmm be aIvwofor.anafirm is 503 — FINAL MECHANICAL ENERGY
correct.I agree to comply with all city and county ordinances and state laws miming
O r, Iona❑dim,cawm,oor,Rall,.r.byamhotiwmine.erionsvofhis 0,Orcourruion 504 — FINAL BUILDING ENERGY
} ry] lite above-omnauncd property lin inspection purposes.
- y (We)agmeIn save.indemnify and Ice,harmless the CioyofCupertino agna 505 — FINAL ELECTRICAL
Vl liubilia ,judgmenu,c...r,dad expenses which may in say war weroe against aid
U Z
City mtnmequNOIIRSflue gnatti,gnlWI pencil 506 — GAS TEST 3_ /
AIIIII-SCAN,11
RCGULA'11ONSN1 f1U WII. CO `.Y yX'I'I'@ALL NON-POINT Issued by: NA6 — N Dale
sign,mrenrAFphtanveotnntmor Date Re-roofs 508 — FINAL MECHANICAL
HAZARDOUS h1A113RIA S DISCLOSURE
well 1w."Iicamorfmme l,altim, eeucent"loneor handle Invamoa"numeral Type ot'Roof 509 — FINAL GRADE
as Jetined by the Cupertino Municipal Cod,Chapter 9.12.and be llc,lth and Safety
Cede.Setaun25532007 510 — FINAL PLANNING
El yes 0N All roofs shall benlrgfcfcd ffitOwenm'r idL. 6taW6e� ng installed.
Will me applicant...more building ee<an pmno, aipmemmdemce"whi,h If a roof is installed without first obtaining an inspection,''jI—agree to remove
•mit Ins...dom,air communicant,as defined by the Bay Amu Air Quality III ansgmnem
Diatom all new materials for inspection. Applicant understands and will comply with
El yes °u" all non-point source regulations.
1 have read the ha mous nmmrial.,mquimmem.,under Chapter 6,95 of the
California Ileahh&Safety Cale,Section,25505,25533 and 25534.1 undeaat"nd that
If the h"IIJin,dons not currently have amount,that it is my responsibility m notify the
''count of in.mynimoan,"which......I be net prior to in um,c of o Cenifimve of
Omit
3_ra-0I Signature of Applicant Date
— �
owns of umhnri.cdgcm Dam All roof coverings to be Class "B" or better
a
OFFICE