02060080 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR'INFORMATION:
BUILDING ADDRESS: PERMIT NO.
' I-0338 LOZANO LN R & Z DEVELOPMENT 02060080
OWNER'S NAME: : APPLICATION SUB DATE
rCAMPO DE LOZANO L. P. 21771 STEVENS CRK BL #102/28/2002
1 PHONE: SANITARY NO. CONTROL NO.
(408) 252-1101
MO ZO 9ARCHDECTIENGINEER: BUILDING PERMIT INFO
<U q BLDG ELECT PLUMB MECH
o S'y LICENSED CONTRACTOR'S DECLARATION
y G 1 hereby affirm that 1 am licensed under pine'io sof CINIdcccyyy91w clean Job Description
p_�u,t wanse`tn,n]000 ian3anneapamesn at ns fir . TOWNHOUSE-LOT 5 #C
m n mu a ala //
go�u; Li`en " s u`:x LIVING SPACE 2 , 0121 GARAGE. 4441
°� a Date - Cot eta
FLLoa ARCHITECT'SDECIJIIcreyQ SEE ORIG PERMIT 02020114 FOR FEES
anderswn my plane anal)be used as PINALED
t+�+ p O Licensed Professional
OWNER-BUILDER DECLARATION
m nerawI hereby M.mat I am exempt from the Cssion, o License Law for the JAN 2 9 2004
G following reason.(Section)m ma Business and Professions Code:Any city or worry
Whichreg re apermo .t t p improve.demolish, ep ystru0nre.
�opnorfo is issuance,Wsor qu sth applicant for,ruch,amail 1.file asg Wstatement. � _ .....
th,he islranTd putsBtl thel ,ilosat the C t to License L (Chapter9 �1 (� S Ft. Floor A{eg lnation
(c mens h8 With S t ]000) f Dre J f the B it s,and protea ns Code) d��.'11 A An_.�}1�, d r,};v. 3.'i} t b i{�'.-!' '�': ' ' raNY■
or that be Is exempt therefrm l and the buss for the all gea exemptiam Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
:of not mare man file hundred dollars(s500). Appe�rr NN mbe fl'-:- Occupancy Type
369MNm0S
❑1,d owner of property,or iy employees inno,In wain wages a ed far a compensation,
i
Will tlo'th o k anJ the '. not mtenJed or offeretl-forad<(Sec.]044; --
�Busno.ead'Professions Ccda:'Iha Contractor s License Law docs not apply to an 101 - FOUNDATI�)Nuired Inspections - '-
..a,cAlmolErt,Who builds p diftnerm and Who does such walk himself
or through h own a pl Y provided th i Inch improvements rent intended .. .PIERS '
1.0 2---
. _off rdl7o-S le'IEh thebuilding or p --'P ('s lti within oneyour ot- .".._._ ._.. ._...._.__._ L..... .._.... ..__-- ._.-........
'completion theownerbuilderwillhavetheburdenofprovingthathedidnotbuldor 103 - UFER
im f p rpose fel ).
104 . 7-_REBAR
ler fthe popBY dos alandnt erg mr rte<dcantmetaram 105 - ANCHOR BOLTS _rl
t' t theproject(Sec.]1144 euein ss and Pmfessino,Cale)The Commcmr's
p
'Lc a Law does not ppl to, vnet of property who builds or improves thereon,
. -..and. coin ,tors rhpoj 'ts-wth comracmds),Icensed.pursuantto.Ne 106 - SEWER & WATER
, c We < aL 202 - UNDERFLOOR PLUMB _. .. ..__..-. _.
ty ,�a^ 203 - UNDERFLOORo' tItHANICAL
G oMPENSATIONDE LAR 1 // 204 - UNDERFLOOR FRAME
' bya�rm d p nahy,orp , ryanr.arm<mlwwin,aeWarabons: 205 - UNDERFLOOR INSULATION
ai ❑ 1 nate'and will mainmm'a'CertuEmm of Consent I.self-riame far worker's 301 - ROUGH PLUMBING
Compensation, as;provided for by Section 37W of the Labor Code,for me 302 - TUB 6e OR SHOWER
p<rtormana
ear me ware far Which mis par itis coiad.. 303 - ROUGH MECHANICAL
❑Ihave maintain Workers Cmnptonlnsumnce srequired'bySection 304 - ROUGH ELECTRICAL,
3](10 of the Labor Care,for the,performance ofthe work for which this Permit is
issued.My Worker'Compensation Insurance dine and Pat y he e 3 Cj _
.. ....Pal Policy . .. -..R WNS . -. ,,,...., „ ..: ,..:_.,.._..........
ca 306._r HOLDO d ;
s CERTIFICATION OF EXEMPTION FROM WORKERS =-i.. l s ' sit
COMPENSATION INS URANCF. 307 INSULATION f
ora (tnuoh <a"at the completed recall iarra hundred aan ._ ._.
308, - SHEETROCK ....- :r r c. ..
fsmo>or le ) t _ _ _ 309 - EXTERIOR LATH i
;^' t mai t prr �,� ftl iva renins pq LATH .i �.. ..'..
n n yin n ` so . w°kcre 310`- INTERIOR, ,9t t
Cr t<, '�� ` 311 - SCRATCH COAT
Compels n f ai` r i
App' tmr , 1 a 3.13.__= _ROOF-"NAI-L.. _
Non ak ng�tr ttifcete at E empt y ,h Itl n l .. .c
CZ ' x„ -pen W6 plater,aim Labor cad y ma must 501 - FINAL ELECTRICAL ENERGY
'o h permit allb d d ked
p . 502 __ F-INAL -PLUMBING ENERGY
.4 :" CONSTRUCTION LENDING AGENCY _ -
' rf hillthemreloWonleadingagwyfar the pomrmar&e 503 - FINAL MECHANICAL .ENERGY-
ntenm p t . s.p<ars` 3o9] ci ct 504.._-. _FINAL. BUILDING._ENERGY.- _
Leader's rvdtne. ._ _.:C,, - " _ .
�.z ' Lea Aaarcee creadihisapplication, and.iamthmOtedoveinfu 505 - FINAL ELECTRICAL','.
v'�O fa 'cnlylhatlninf
ormation 9 506 - GAS TEST
tT+-Fy arrest 1 llm comply th all city.a d my ordinancesd state laws r 1m ng
O;p nob Id ' n.vutlan th' by th rm rpre "tauve fm'se city to emanpot 507 - FINAL PLUMBING
` z�P, F �y P`t` 'prro508 - FINAL MECHANICAL
(we))) frond rh y in an a r e p diftorial agmna E-
509 - F NAL
b t mens t d .pence h h m l 'n eny y cine ugai t rind
f..l Cit un att ntng:fth Inn ��
Ar !T L '4{R S- COVIPLYWI` 4 JI
R[ � Issued$ .0 N I G Date
6YzdS('/` HAZARDOUS MATERIALS DISCLOS Rc rh n`. R� roo�s02 ROOF PLYWOOD NAIL
no aeF bGu C p n M a1C d Chapter 912` ndm H 1� Pe o�lc3f_ ROOF BATTENS -.. ,...
A
W ppb&nt or
f t re holding o p t t ha dl haz 'in t •p _ .
p dS f,,
cnaes t zsFiw '- 604""T,;ROOF:,IN ;PROsi
GRESS -
All roofs s}all be inspected pnor to.any roofing,material being Installed.
Will the applicant or fu re h Ailing occupant useequipmentordc me:;which If a roof Is installed without first obtaining an inspection; Fa ree.to remove
en t h d air cat t as eFlred by theBay A_e Quality M ag t g P g
all_new materials for"I ectto Apphcant understands and will comply,with
g Y - — - -'_ ....
nmr,tb` all -poll o cere ulaho . .
S
ft. local,
k baldIdatl me hazCod S f---r---0 25533_ d 2553� nderst tithe
q p and that
if b .not tl e to t at t s -
f ere ire e X P n 1 ry tc °t R the
ct pnor co s/x nfn Ceni Rolf
g a 'e f p Icant e
t
f�.
rte,ora thn m Dote -
All roof coverings to be Class "B"or better
OFFICE .-_ - . .. . . _ . . -, _. .._ ._..... .._