00090165 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: TERM lir NO.
OWN'ER'S NAME: APPLICATION SUB DAI'I7
7563 SQUIREWOOD WY " . 00090165
10NF.: SANITARY NO. CONTROL NO,
IM F DAVIS RICHARD J 09/26/2000
aJR7 ARCHITECT/ENGINEER: BUILDING PERMIT INFO
m BLDG ELECT PLUMB MECH
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Z 5 H Ln !.:CENSI:I1 CONTRACIOR'S DECLARATION Job Description
in e I barmy mrh r den 1.,it file-ed mere.provhmns orebapm,9(emmotmain,
1==^; w'nh Sec11On71XXl)of Uivi,ion3ofthc Business and Moks.ionsCNepand my license
2 m is a lull tlrcc and t.
z O x 6 I.iccn,e C� ` I.ie.N_6
KP c L' Dale_ C,unser
ARCHITECT'S DEC1.AR ION
t O 1undemandm 1 ill n dm blicwould, BATHROOM FIXTURES
_5 my spa
a Licensed l'rnfczsional OWNER BUILDER DECLARXI[ON
I hereby...i affims the 11. exempt from the Contractor An,c Law vx rhe V
C z< which ire rens a pery int pont. t.al.uss and Pmlaa.ian.Code:nnY city lir cooly
xe which its Ilmsapermit Iccomlrun.,lwlm,itnhnrve,h"loollli fieepairany.dpmure
3w run 1.heir lienunee.aluant toiresn,misionnm ler committee,License
Law(shapt em
— (that comms cingesd,Se,ti nolhipfDiomnnheCnmmemrwtianulnwlChumer9 Sq. Ft. Floor Area Valuation
or hat he is a wile Scarce 7000)of e basis
3,,l tins alleged
ex mpold ion,Any illsi Cartel
lir Scc he is 31.5 b Ihcrefrom and Ill,basis G,r the allege, emmplion.Any viulaion
oftia it..9(1315 , anydreddanl Ill,x500),(suljecl„hc uppbcnm n,u civil pcnulry
or ons,w,re tho„hve hundred 0,074...a511a1. APN Number Occupancy Type
❑L o,n»mer onhe p,Oy,or my employee,with wages as thelrsnle enmpee.admn. $8107
w'ih do the work,and the sumcm a is nor mended or oble'd for sale(Sec.7194.
Emiacm moil 11 iv,,i„es Core:The Contractor,License Law drw,no,apply In an Rcyuircd Inspections
r of properly who Mildx or improves mvreun.and who Joe,such work horwil 36227004. ¢10
urvthrough his owls mnployee,,provided that such improve,nc,ns are not intended or
offemd lir sale.if.however,the building or improvement i,add within line year lir
arm.pleline,leore ownernmuder w,If hit,,the hodco ofpnwin,hat heck nal build lir 101 — FOUNDATION
ouse for pp i of vie).
O 1.as owner of propeny,a exclusively contracting is id,licensed connector,to 1.02 — PIERS
L,name the project(see,7(wa.umhm..ami Pmre,sions Call:)Tic Coalm,mr:,
icense Law does not appy'loan owner of pmp,ny who builds or impmvc..thereon. 103 — UFE R
and who n,lout,mr.ant nruja,ta wile a santmcao.l,) b,amed porstuol Io me ]04 — RERAR
Contractor's Licansc Law.
C l um exempt under Sec. .11&PC hn mi.lesson 105 — ANCHOR BOLTS
0.net 106 — SEWER R LJATER
WORKER'S COMPENSATION DECLARATION
hcmby tdlirm under Mnnhy of perjury one of the fallowing,helumlem: 202 — UNDERFLOOR PLUMBING
❑ I have and win reontain L Cerlme,te of Comae m.elf-intlre for workers 203 — UNDERFLOOR MECHAN T CRI_
C...ii ,maann. as provider ba by Section 371X1 of be Labor code, our the 204 — UNDERFLOOR FRAME
,irlor❑I h:n,nce will moimm�the wonk r which this I,emlit is issued.
205 — UNDERFLOOR INSULATION
370()or he LuMr Code.for the perfam,aece of he work for which this ferni 301 — ROUGH PLUMBING
issued.My�Workers Compensation Imumnce carrier and policy number Ire's
caaict .Qefe.J ois,Ne; OF, Clif0 _ -502 — TUB R OR SHOWER
claRnrlCnnoN OP ,x1:MPnoly rR<)a1 woRKERs 303 — ROUGH MECHANICAL
COMPENSA'T'ION INSURANCE
304 - ROUGH ELECTRICAL
fad,union n,cJ noI h cnmpleteJ it the Ihrmil k for enc hamar,)Jallan 305 — FRAME
[Miro)or Ia.$)
I atony dor he the pc,fenmmce of the work for which his Permit is issued.I 306 — HOLDOWNS
shall not employ any person in any manner w,a,to assume subject n,die Workers'
Cmnpenaonan l.tmaorcalie,rnia.nate 307 — INSULATION
Applicant
NOTICE'10 APPIJCAN'1:II',shone,king rid,Ccnmcamondaanpliam Ina should 308 — SHEETROCK
Ieeome,object rothe Worke..Carn,sawfinn provision.,of law,Code,you ma.' 09 — EXTERIOR LATH
O O ronhxim.....ley wills such Pn,vWin,n,this Permit shall he deemed revoked, v
''
4 CONS]eucooNLeNDINcAGENCY
310 — INTERIOR LATH
I herchy affirmlh:n them isaconstruction leading cam,Ir the permar acre 311 — SCRATCH COAT
of the work lir which this p,mo,is issued(Sec.3097.Co.C)
y p I,,adrr',Name 313 — ROOF NAIL
Z;) Z I<ad,,*,Addms.
U O 1canifythatIhavemad this applictionand walethalheabveiali,nnarionis 501 — FINAL ELECTRICAL ENERGY
y p. .nrroel.I o,r,e lo,ol... will an,ily and wooim
ly ord ,nce,amt a,am law,alone, 502 — FINAL .PLUMBING ENERGY
C [) mbuilding c miand barely andfiro presssatires ofthis ed,to courriflon
the an d"i,er,l peti p r 503 — FINAL MECHANICAL ENER"
G (Wc)agree to save.indemnify and keep h rdi the City of Collection agam,r
Z hidilitis,jag x,rwhich ans,inam.way' glimd.,id 504 — FINAL BUILDING ENERGY
C„) Z City inc nsecen¢offe granting of this p,
APPLICANT!A)ERSTANDSAND WILL COMPLYWITHALL/ 06 GAS TEST
ON�-POINT Its 505 — FINAL ELECTRICRbate
�SOLIRC�C��S$.���ATIONS. Q y' `
Si,n.ICrv•of Applma 110 onalor 7 Date Re-roofs
HAZARDOUS KING R1AUS DISCLOSURE 507 — FINAL PLUMBING
WiEdte apprcan or from heading occapanr.tore or handle na.:ndam.material Type of Roof
usJcfinsl by the Coleman,Municipal Code,Chapter 9.12.and the Health and safely 508 _ FINAL MECHANICAL_
Code,S,Oin 125532(x)9
0Ye, Olen All root's shall be-l-1 gyecTedFpr��i l -at{�I ,���material being installed.
Will the applicant or fawn buildi.,ne....in use,quipm,m or devire,which If a roof is instalfAi WitnU Ar.0%tai Sln�tlllthl, Rtion, l agree to remove
toil hac u.dnus air civic mntau.tell,sit by the Ill,Arc.Air Qua lily Management
i)istricn all new materials' df4nspecF(TiNAHpp1621f BLiTdersWfilRKS will comply with
0Ye, 0 N all non-point source regulations.
I love,read the hamrdom.materials aymmoneal,under Cu,e,,6,115 of the
C,Idomia Death R.safety Code.Sections 25503,25533 and 25534,1 un lersmnd that
if the building docs not currently have a mnnm,list it is it,rmponsibiny a,molly rhe
,cc up:mt of he regmimnmms which mol b,met prior It,iouance of a Cenificale of
Occupancy. .
Signature of Applicant Date
ow mtmthnrta.ca:rgenl o� All roof coverings to be Class`vB" or better
OFFICE