02010100 (3) euanwc]DIVISION PERMIT CONTRACTORq it INFORMATION:
BUILDING ADDRESS: PERMIT NO.
822 STENDHAL LA BATHROOMS BY REMODELING SPEC 02010100
OWNER'S NAME: APPLICATION SUB DATE
BOYD THOMAS C AND JANE P 1422 SARATOGA AVE 01/24/2002
G�PHONE: (408) 328-6700 SANITARY NO. CONTROL NO.
ARe 'TECIIENO1NEER: BUILDING PERMIT INTO
w BLDG ELECT PLUMB MECH
u
y<n IJ U L _J L_J
I zi LICENSED CONTRACT'OR'S DECLARATION Job Description
h 1 hereby affirm that I am licensed under provisions of CTapter 9(commemin p
,_Cs withS<aion10001ofDivisionloflhcBusinessandProfessionsCodeandmylicense REPLACE BATH FIXTURES & TILE
in full force an c
o w< no
Clnas_ jYi L Lie.. 0 3
LL g De Cr� 0nAH DENAR
ATIo I understand my Dims shall be used
as public rtcoNs
T
.i O C Littered Professimnvl
exempt R m the CoATION
1 hereby.Rens that T 1. exempt from the fersns Cox License law for the
?a following rea(Smile 7031.5.Business and improve.
de o demolish,
or Any city«county $12442
aro
8 x G which requires o permit to construe,alter,improve,demolish,or rtmig my swnute
aa.3$ prionostlianedr,assort to the theapplicantfor such Cartrarmit es Licensle a e
Law(aurtmcna
Jia HeiiIicrnsed PSex6ontoW fDivisiof me Conuacivrs Liccnssfew(Chapter9
or°mmedeingwimsKaon,oa rDiviasisoofm.Buailldomand ion,Anyvicodm 3�JFti3lIP4t:�3�"%',) +'I Valuation
or mat E.is.aemyt m y ppli on$for basis for the alleged eiFinant to Any l violation '
of Section 10]1 i by any vpplicma for a permit subjects me applicant io a civilPenaltyj�tara"a}a,a�
'of net more than five hundred dollar,(SSW). 10�'PN-L"C-9b DATION '` Occupancy Type
°1,as owner of the poepeny,or my employees with wages as their sole compensation,
will do the work,and the structure is not'intended'or offered for sale(Sec:7th .
Business and Professions Cm.:The Commeora License raw docs nat apply to an 103 - UFER Required Inspections'
owner of property Who builds or improves thereon,and who docs such wok himself
Lir thenupW his own employees,pr°vmed that such improvements are not intended or 10 4 - REBAR
-f offered(or sale.If,Howe-""the W bite - .r t is sold within one yew of " ' ANCHOR -- -- -._ ._.._ ......_._.._ ..... _
goy rdenofpro r 105 — BOLTS
completion,me awne"W cider will have tW W Ncn of proving Wt he did nes build«
improve f«purPuaeof sale.). 106 — SEWER & WATER
oi;tai"rofm."leery ad exciusi-"ly eontmaSngwith Hansen contractors m - 202 - UNDERFLOOR PLUM) ��E®�
consuurt he ojec,(sec.7044.Busineses Oeon
a and Professions Cade:)The Contractor` 2 03 — UNDERFLOOR MECHANICAL
License Law docs not apply m are ow.,of property who Wilds or improvers ur .
aad.who convects for.such proj.es with a eomaemga)licensed puramm.ao the - 2 04 UNDERFLOORFRAME-
Conp,"mraLicenselew, A% 2 1-2002
°lam.aempt unair se"; B&Pefar his
i�an 205 — UNDERFLOOR' 'I•NSULA
wmm . Date 301 — ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER BUILDING
Ihereby arimaunder penalty ofperjury one ofthe following derlarati°na: 303 - ROUGH MECHANICAL
' ° L ha-e and w B mamum a Certificate of eonscm to if-insure for Workers 3 04 — ROUGH ELECTRICAL
.00305
ctim'staum., ss provided for by section 37W of me Labor Code. for the
performance of the work for which this permit is issued. 3 0 5 - FRAME
have and will maintain Worker',Comen
pvtion Insurance,u required by Section 3 06 - HOLDOWN.S
W of the Labor Cod.,for the perfornvnce of me w.&J.r which lois parmt is 3 0 7 - INSULATION
issued.My Wokces Compensation hemmer cancer and Policy,number are: 'I/
Cade"- iCERTIFlCATIONOFE%EMPTIONFROMWORKERSSOT7 _-.- . _.3.QB ; r: SHEETROCK':. .. . ....._..,. ...'- ' ` ..
x'309' '_''EXTERIOR' LATH
COMPENSAnoNINSURANCE':_. :..: ._ . .. ...._ .. . ..3 TO' INTERIOR- LATH..... . .._.---.. . . ... _.... ._ ..._._.... _ .
1'(rhis section need not be completext if the perm t is f«one hundred dollars 311 — SCRATCH COAT -
(510()or less.)
1 candy inns m the perforinnnc.of m.wok hkh ms p"nsJt'u issueE;I 3 1'3' — ROOF -NAIL
shill nes<mploy at i person m, manner so subject to me Woken 5 01 - FINAL ELECTRI CAL ENERGY
Compensation Laws of'
f Calim o¢ '
Appluant. ..t ' -: / ' . .. 502 — FINAL PLUMBING ENERGY . ..
NOTICE TO APPLICA, Ifeller making thisCmibcam of Eacmption.you should 503 — FINAL MECHANICAL ENERGY
become subject to me Worker's Compensation provisions of the Labor Code,you muss
zrunnwitn<umply'wins such erre-isinns Lir lois p m h shoo x ecemed reroked. .504 — . FINAL BUILDING. ENERGY
E' .moi CONSTRUCTION LENDING'AGENCY 505 - FINAL ELECTRICAL -
> I hereby at that then is a construction lending agency for the perfbrmantt
6r me work for whichdo,pem0isissued(See3091,Civ.C.) 506 - GAS TEST
Q Lender's Name .. .• .. . . .. ... .
D Z Lmder'.Addrexe 507 - FINAL PLUMBING
U O Iceeifythatlhavertadthisapplicationandstalethattheaboveinformationis 508 — FINAL MECHANICAL
tam-F. correct.I agree to comply with all city and county ordinances and state laws telling 509 - FINAL GRADE
C) V to building convection.and hereby aum°rise represintatives of lois city to enter upon
W the above-mmtionedproperty for inspection purposes. 510 — FINAL PLANNING
tiG. (We)agree to save,indemnify and keep harmless the City of Copenin°egat.mo
to liabilities,judgments,costs and expenses which may in any way active against said 514 - FINAL PUB I C WORKS
U y City is consequence of th renting dfmispemut.
SOURICE REGU DE S.•DS AND WILL CO)IPLY N'ITH A�NQN.PO N-r Issued by: Date
Sigmtor Ap,hcmVConiracmr 'Care/lL Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or fvmte Wilding recupent store or handle hisiarilm,menial Type.of Roof ... . -.. - . . __..
M defined by Ne Cupertino Mun' spat Code.Chapter 9.12.and me Health end Safety
Code,Section 25$R(alt i :r,:•,; r
°Y"` " _All roofs shall be inspected.prior to any roofing materia]being installed.
Will the applicant or future building"ccupantme equipment or devices which If a roof is installed without first obtaining an inspection;'Pagree to remove
emit humi.mi air mimsor in" "fined by the Bay Are-Air Quality Management
N
Distract^ all new materials for inspection. Applicant understands and will comply with
❑r.s n all non-point source regulations.
1 have read the huriardous materials regb remmti under Chapter 6,9i of the
California Health&Safety Cad Scions 25505 M533 and 255141 undersmnd that
fth Wlding due,, fly h have t that it is my responsibility to notify the
occupant of ah rt which must bi, a,prior m Issuame of is Certificate of
Signature of Applicant Date
pwmr or aumorizcd agent-'
Data All roof coverings t0 be Class "B" or better
.. .. . . -. ., .. .. OFFICE