01080079 (2) OF CUPERTINO
CI BUILDING DIVISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11002 SWEET OAK ST BATHROOMS BY HANS 01080079
OWNER'S NAME: APPLICATION SUB DATE
AI&BEEBE BARBARA E 4986 TIFTON WAY 08/16/2001
,HONE: SANITARY NO. CONTROL NO.
(408) 978-3053
O ow z ARCHITEC INGINEER; BUILDING PERMIT INFO
F O pOp BLDG ELECT PLUMB MECH
y 2 LICENSED CONTRACTOR'S DECLARATION
• 1hambyafro,that I am licensed under provision,of Chapter 9(eamnrcming Job Description
�mF¢i with Scnion7000)nf Division 3 of the Business and Professions Code,and my license FRAME IN NEW WINDOWS .
m I_ is in full force and fjfecy,
m a Liceme Class�SQI-- Lic.a
a v Dae i a.s, I Cnmmaor
CHITEC'S DECLA ION
"�g undcraand my plans shall be uncd as publm records
3 o O IJeeoaea Professional
OWNER-BUILDER DECLARATION
Ihereby alRm+that 1 am exempt loon the Contractor's cense Low for,he
indicating reason.(section 7031.5.Business and Pmfavocas Code:Any city m county
$1200
ce
ISP which requires a Print to construct, ler. p demolish, repairstructure
any.Sin
,prior to ax isounce.ales requires,he applicant fsuch parranit tofile a signed statement.
tbaTp]l ttnkd pumunt,o the provisions Tobe Co, lon's License Law,Chapter 9F( FJ rp, aI ,,, r Valuation
mma
(coe g with Section 7000; fD is 3ofsh a .me . .as PmfS. Cwt t;r.�3',�:} 1351057•
octal he ik axemp,memrmm and the Insi,for the alleged uempthim Any violation' 1
-of Sec,ion 703 k5 M any applirnm fora permit subjects sere applicant ate a civil penalty' y�l❑
of not.more than me hundred dollama5(xn. 516APNB'1NA t BUILDIN I.°P"" '" Occupancy Type
t ❑1.as owner ofshe nosors,or on,amPloyeas wish.,as uidmi,and.aompanwslon_, 1
will do the work,and the someone is not amended or oRcred for sale(Sec.70,14, ,i.y.yrB t,,`,t
Busiamailana Professions Care:The Contractor's License Law doax not apply to an Required Inspections'
owner of property who builds or improves thereon.and who does such wad him.alf
or Jvou h his own employees.Provided that such improvements is sol am not intended ori
omvplBeepindfor-sale.If,howevv, wibuilding ar improvement n sold within orc Year of - �: is✓s.Ser r•'"d '„
c
dprove far the owner-builder will have me burden of proving that rte did not boils or `
improve(or Pu,Pa,e of salt.).
O is as owner oL,he n.mn exclusively contracting with licenses conaawors,al
.: -. p(See r neon. soma , _ mi,v.�, tt
if �7i
N^ ani who.conuacts.for....h r ' P vlJ:p
Licens o the peseta IS TOf4 Business d Property
who
Cwt)The Contractor's
Limnx Low docs nm apply t r f p pent ho Wild,or tmpmvn thereon.
_ P 1 is ith.e summations)qs)hremw pursumt m shes .. ......_ _._ 11VAL 'L� -_.... _._ ...._.-
C mm<,ors License W C
Dl umexemp„nndei Se . "f s I " .B&PCforthnrtaaoa, ns,. II 1 t"ti
Dwsr ."as;�n' -SEP 1 0 2001
m'f _ WORKLR'S COMPENSATION DECLARATION -
�' 1 hereby affirm under penalty of perjury one of the following declarations:
D 1 have,am will man imain.'Cenifcim of C imErii"o sed awm fur Wo vies' BUILDING '
Compensation;us,provided for by-Section 379) of the Labor Code, for the
m
-- Perfoante ofahe work for which this Pemba is issued..a,
-� D I hal a d will loci o n W rk Camp m lowumne,as required by Scalon
3]110 of di Laboi Code for the Tianorromince of the work far which,ms permit is
si d MY W ke'a C l:c a Ire wan c d Policy number "ice
°MT e /g.ldt.dtiJ\'4:i1'ol'YN Z ,2f� _ .'.
ll oO CERTIFICATION'OF EXEMPTION AOM O K RSI
•ri lir r - u COMPENSATION INSUBANCE'r _ ..,t ..�...-__.. ..__ _. ... .__..__. . L.....,
`a f l It ITN i section neva not M1e'cbinple ed if the Permit is for one hundred dollars
51001 or kss.)
1 n fy That in the perfotkna ce of the oak f avhi h dais pe i iso 'd:Iii
shall not empl'j mya ,any mane as ate becuma wblact to the Workers f
Comps fon Laws of Cafit .Dais "' t
. . Applicant u.., .,. . ..,
"NOTICE'TOAPPLICANT IC-titer maki'6 ah.Genf arc afE Pa You should " '•' I"' '
bete hJecii itieWrkce-C parent pm nsol'th 1bo Cod.:yah -a ,
Q O Noon sh_ii Pi such Provision,or this Permit hall be deamad
.pj'.is„i ofs thc,l Mr D
which
_ revalued.
F y'J•"i CONSTRUCTION LENDING AGENCY
> a �aprtoied6 a, h fa sepM rmo.
arynce
hihaed(5c 31pCCs
,.
o
'a.Q
Under
-
.Q z -Isndcr's IAdtlrc r ;+ .• .; ht 1n.
U , 1 Gratify baa 1 haw read shi applicai tea and same than the above info trom,. n is
cnrreii.i an onplY ith.11 it,an s um obtain a,and state Is.,Mining
.�.(� no Wi oaioma hemb auto xc h'p ser tivc,of city u,enter.,a
}:W aIle. emir cd ro yfo,i a . ..
.F.p, '( lig io ave! dcmni s�' ke aha City 4CupeninWriptin,
Z) liabilia adg 1, st. and a -h any way acerae eg.lnst said
' U."1. Ci'y'm be mi if `t '
^' (,FELL t.D R T 'r L, ON 'LY 'ITHA .0 DINT/' Issued b Date
SOUR' 'I S SOI y'
Nat Apphcan C t cite. " lip a t, Re-roofs
HAZARDOUS MATERIALS DISCL URE _ - - / .G - H 3/_-
o,, sh ,plc t fun.nlmld,ngacc pan a one handlelociardlousnatisial Type of Roof
,as tlefnes,h C pen o Mu <ipd Cw Chapt 9 13. d m H alsh nal 5 f,y r s a s t y , t ,t,1
.Cade.Sa n�3532lld t a r •ts l 6f
All roofs.shall be inspected prior to any-roofing material being.installed___
.__. .
I.Will the applicant or future building oaa win useequipment ordeviceswhich If a roof is installedwithout first obtaining an inspection;I-agree to:remove
roil b arcot fatlehh dHysh B AraA Q ItyM nagemm
F 1, - all new materials for inspection.. Applicant understands and will comply with
s"Hoyt °Y f pf: tti 411
No , ;5 (.: all-non-point source regulations.:{.I. ! , '•i:Si7• ' .
.i I ha •cit naamd n atm9 amara,minfici Chapter 6.95 of aha_
,Calif" H hN Sa ellv-1 Bain Soy 533 and 25534.1 undersmodthau
'if di Jing boa vrrcn0- bah i is my responsibility to notify the' - s.
'I&fe oNaw '
one. or to rice of, fic.maf
i
°00e Signature of Applicant Date
, Dam All roof coverings to be Class "B"or better "'I
d tvil.
OFFICE