02110128 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 7CONTRACTOR INFORMATION: .,
a+
But ILDINGADDRrss: JEFFREY JOHNSON PERMIT NO.
10550 CRESTON DR 02110128
NF.
SANITARY NO. CONTROL NO.
III(RCHITEICTIE-ISGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�00 LICENSED CONTRACTOR'S DECLARATION
0 P I herchy aRnn Nal 1 um lacenacl under provisions of Chapter 9(commencing Job Description
with Section 7100)of Division Sof Me Business and Professions Oulcund my license is
to imfull force aadeffect. NEW SFWDL-LIVING SPACE 4 , 13
zogz LicenseClas Lic.O
Dam Cnnuaztor �IGARAGE 596 SQ FT WALE®
pyo
G� ARCIUTECI'S DECLARATION
o W 1 malcrsand my plans shall be used as public records
0"
.LLoG Liccn¢JPmfssional 2 3 2003
3 OWNER BUILDER DECLARATION
I hereby affirm that I am exempt fru.the Convacmea License law for IW
04 construct.
reason.(Sccunn7of L5.Business and Professions Code:Any city or county �'�'��
a K
S2 which requires a permit to nmsct.ulcer,improve,demolish,or repair any structure
'o—xN
poor o its issuance.also requires the applicant for such permit o file a signed statement
qCq�0 that he is licensed pursuant o the provisions of Me Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
y+ $ (commencing with Section 710(B of Division 3 of the Business and Profusions Code)or
3r'.. Net he is exempt therefrom end tbo basis far the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit Subjects the applicant to a civil penalty of APN Number 4i 40MAWcy Type
not mom than five hundred dollars(1500).
❑1,as owner of Ne property.or my employees with wages as their sale compensation, 3261:2062 . 00
will do the work,and thestrvcture is not intended oroRered for We(Sec.7W.Buainess
and Professions Code:The Co.aaora License Law does not apply m an owner of Required Inspections
property who builds orimpmves thereon.and who doessuch work himself or through hia
own employees,provided that such improvements are not intended or offered for ale.If, 101 — FOUNDATION
however,the building or improvement is sold within one year of completion,the owner. lO2 — PIERS
builder will have 0e burden of growing that he did not Wild or improve for purpose of
We) 103 - UFER
KILowner of the propel.am exclusively convecting with licensed convacton lis 104 - REBAR
l the project(Sec.71b4,Business and Professioe Code:)The Corcractor s Ll
cense law does not apply to in owner of property who Wilds or improve Menem.and. 105 - ANCHOR BOLTS
who co.ncts for such projects with a cimeractor(o licensed pursuant m the Contractors
License law. 106 - SEWER & WATER
❑lam exemp Oder Sec. .B&PC for thisrcazon 202 - UNDERFLOOR PLUMBING
2/lL j�j 203 - UNDERFLOOR MECHANICAL
WORT( 'S COMPENSATIONDECL ry 204 — UNDERFLOOR FRAME
I by at ndcrPenalty ofperjoryone ofthefollowing declarations: 205 — UNDERFLOOR INSULATION
I have and will
to
u Certificate of Consent self-insure for Worker'sCompen-
on,as provided for by Section 3700 of Ne Labor Code,for me performance of the 301 - ROUGH PLUMBING
rk for which this permit is issued. 302 — TUB & OR SHOWER
❑1 bars and will maintain Workers Compensation Insurance,a required by Section 303 - ROUGH MECHANICAL
37101 of the labor Code,for de performance of the work for which this permit is handed.
My Workers Compemation Insurance cnricr and Policy number arc: 304 — ROUGH ELECTRICAL
Carder. Policy No.: 305 — FRAME
CERTIFICATECOMPENSATION NR
ION INS RriON AORKCRs' 306 — HOLDOWNS
(Thissection need notWcompleced ifine permitisforonc hundrcddollars(5100) 307 - INSULATION
orlC5t) 308 - SHEETROCK
I cenify Nat in the perform pee nr the won far which this pg IDiLb issued,I shall not 3 0 9 - EXTERIOR LATH
Iowa of C
employ any penton infant as nap HRQnc warkerY cammat
leion 310 - INTERIOR LATH
APPIi nm
NOTI O APP A :11,a ng this Cenificate of Exemption.you should 311 - SCRATCH COAT
boco aan;ega a Worker o enation provisions of the labor Code,you must 313 - ROOF NAIL
Oz furthwithcom with such provisions or this Permit shall W deemed mwked.
CONSTRUCTION LENDING AGENCY
501 - FINAL ELECTRICAL ENERGY
L 3 I hereby affirm kforwhichthiNenncrciaacdswct3097ndingagencyhulheprlormanccof 502 - FINAL PLUMBING ENERGY
x
the work ddreasnmisp .aisisaed(see.3a97,ci..c.)Under's Name 503 - FINAL MECHANICAL ENERGY �y
ZD Z anaeraAaaress 504 - FINAL BUILDING ENERGY
U O 1 cenify that I have read this application and scale that the above information is 505 - FINAL ELECTRICAL
V. F correct I agree to comply with all city and county undmances and state lawa relating to
O U buildingconswction,andherebyauthnrixrcpresentativesOfthiscitytoenterulonme 5 GAS TEST
W above-mentioned property for inspection purposes. O7 FIN
IAQ—
(We)agree to save,indemnify end keep harmlea the City of Copenano against
,„r y linhilities,judgments,costs antl expenses which may in any wa aae.cagninstedd Cary 5 CAL
U 7 in vonscyucncc of me grunting of mis permit. 1 /
G7 APPLICANT UNDERSTANDS AND WILL PLY WITH ALL NON-P{JIN7 sued by50 Date I/
SOURCE REG TIO 5. l 7
Re-roofs 514 - NAL PUBLIC WORKS
s' nawre or .anbconvac am
HAZAR US MATERIALS DISCLOSURE Type of 1349(91`2 - ROOF PLYWOOD NAIL
the applicant ser for..Wilding occupant amrc ser handle havallous.acerial
as defined by the Cupenino Municipal Cade.Chapter 9.12,and the Health and safety 603 — ROOF BATTENS
ode.Section255RP)7 All roofs"It be-irvl ]a&B pff(W 4d1RP REhj Snaterial being installed.
❑Yes /JV
Will theapplicant n, (inure building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
I haeandous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
riot
❑Ycs
[haw read the har Nous matrrialsmyuirements und_crCWpterfi95oftheCalimr-
canUcalth&Safety Curie.Secumes 25015.25533 and uMeratvMthatifde Wilding
Yea not curtently hew n tenant Nat it is my mihility notify tW rc�a�me
rcyvircmenuw
C DateAll roof coverings to be Class "B"or better