01080123M.
x t
CITY OF CUPERTINO `
BUILDING DIVISION PERMIT CONTRACTOWINFORMATION:
BUILDING ADDRESS : PERMIT NO.
21063 CHRISTENSEN DR 01080123
OWNER'S NAME . APPLICATION SUB DATE
1. PEARLMAN DALE L AND DARA B 08/24/2001
PHONE : SANITARY NO. CONTROL NO.
O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
' 1-1 CI I_J LJ
i LICENSED CONTRACT'OR'S DECLARATION Job Description
Ihcreby0) of thision 3 oferm"under prosisirnsof m9(commenci REPLACE WINDOWS.
u
with Section ]000)of Division the Businessand Profess' n tl n nW lir se
is in full force and off#Lt - (ti/(
"tresis Clusa ` Lich #
U Ome 7_'S! Crntmnor
v ✓ ARCHITECT'S DECLAN O
1 understand my plans shall be use d as pir c re rds
CLicensed Professional
OWNER -BUILDER DECLARATION
11 1 hereby afOrm that 1 am exempt from the Contmctor's License Law for the
Q
following re son. (Section 7031.5, Business and Professions Code: Any city or roomy $7400
Q
which requiresa permit to construct. alter, improve. demolish, or repair any sttnemre
m -.pr t 't m acquires theappf am for s such Permit to File a signed statement. . - _ __ _ ...-... -. _ _ __..- _ _ ._._ --- .._.
_ th t hd E 1 n. d puk aM m the prov ;lo f th C mmemrs License Lsw (Ch pt r 9 Valuation
(commencing with Section7000) of Division 3 of the Busipess and Prgfessions Core) �.{-,`,h32�7YtjVT�yVva1{' A t rr}�1 }
or that he is exempt therefrom and the basis for the alleged etemption. Any violation - ' )
-of Section 703 E5 by any aPplirnnHor a permit subjects the applicant to a civil penalty'.
top nntmn2tnanrvehundred dollars (atom. 516APN L BUILDINtil :� Occupancy Type
111, res Owner of the property, or my employees with wages as their sole compensation,
will do thek, and thestructure 'is -not intended -or offered for sale -(Sec ]044;- --- - i t t -
tBn rad Pr fessmns Cod The Contmclor s Liceae Law does not apply to an Required Inspeetlons' '
me
nor of property, Who buddt or improves thereon. and who threat Bach work himself
offe ghF employees, em den thin. himprovements lere t't intended of, ,., - .. _.. .. ._. .... .. [_. ... .. _,
�rearpllef 'h ILahowever,ltheWildingp mmli Id 'thnone yar of - - - -- - --
compl t the rte builder will have the Wrden of proving that he did ..,build or
improve for puryose of sale.).
as owner of the property, am Business
dY contracting with licensed contract m y ,,� �� P t.,
consumer the project f5 ]044 B .ire . oiM rProfessionswho
Code 1 The improves
thereon, .,:
Laconic Law does not apply t Owner f p pony who hu las or seimproves thereon s _t
_and h co tracts for h p ) t with onwaorlq licensed pursuant -t the. ....... .__._... ......... .. _.... .. ...... 1
Contractor's License la ,
❑1 met dcrS "' a B&PCI there _rl ��--
O ner ' Date
WORKER'S COMPENSATION DECLARATION
I
hereby afromunderPscantly of pepury one i -11.f the Poll ng declo tions: V j
❑ 1 have'and will mmmam.a' Certificate of Cindcm 7o sdf-insure for Worker's
Crimps, ... ion,-mt provided for by Seetion-3]00' of the Labor Code, for the
_ piformance'of the work , for . which this permit is Issue q..
01h 'ind will ma t W k sCoipe at l urhn required by Setion
3]00 f the'Labor Cod f t perfoim nc of the work'Or which this per t is
its d M W k" C m ns t on 1 brunce tamer and P'1 "
My ., Pe _ yo y umbe a in,x .:..-
Cam r 'CERTIFICATION OF,.F_)(EMPTION FRO s I Y ti t
A'"' ¢. lb t' Y-' .. 4 1 h pp 1 _r'i 1 r I - I _.. 1.)�l,tt ..
M.WORKRRS tj. S is. y: v x t r a C_I 6c t C-+ N.
.,". .''. COMPENSA11 INSURANCE - ,.,.._..._. ..,,.. _.-..
t.. .. . ........ ...--_.... .._ _._. -�... . _.._.
' 41 (Thio tier on need rad be completed rf the permit is for one hundmd dollars °' } ; v `r ['.e ., , i. C, ti t ) a'
(g100)or less) r
NOTICE
1 1 nify thinirlzd
n sic f t -work fo h hub pe t slued Io y as4p t� oin b) t t S ... _ - ..
NOTICE A CANT If, Aller making h C n f caret Exemption, you should r.
b)m theta k C pe- t sprouts shall h deemed
Code yam must 1
�Forthwith comply with such provisions or this peon t shall be deemed revoked r
t... ._ _.... ... .. .,. ... .. ._ _... ......... ....._ _.. .... __
1 I
11 " rm thea STRUCTION LENDING AOENCY "" i . .
I h reby- Rrm thin thele a rotor a lend nB agency f Me perfo "rix c -, [„ . f ,
ofthe ark for which thispe sit a dd(Sec 3097 C CI _,° 1 .r
1 - Carders Nume'...:a .v, ..'.:, ..c ...._... %:,m w,.,. r.. _ _.. _ -. �.. .. ... ____�..... ..... .__._. _ .. .... ..
lender Add a, ``.. , .... .._.. -__... .. _.. _._ __....._
i
i 1 cendy that 1 have read his application and stain the, the ahave information is 1
cramoc 1, agree to comply with all city and coumy ordinances and sore laws relming
1 ro building conatruciion:ada hereby authoiiie'reprt'john0ex air his city io enter upon
the above-mentioned proPeny for inspection purposes..- ., _
Iwe) ee id save: indemnify and keCp harmless the city of Copeidrl. against '
liabilities.. d cots. coos Ana expenses which'. may,in any way im tie agaitat said
City n o s e. of the gmm g rm0
APPLIC {NDERSTANOS A fJ t' COMPLY VVITH1ALL NONIPOiNT Issued by: Dace
URC CATIONS. r)`%ti" d, t yp
ig t Appl wnUConbve4G - '.. Re -roofs
.; HAZARDOUS' MATERIALS DISCLOSURE
i Dam� t7-2-
der
�� r
Will the applicanlo fivebd bidding Occup ttmor hanalehazard'sm tenor :Type Of ROOF. .. ,/
_ _»r. .. _.. r_+.
std f edb Nc Cu ) - i: C,
- -
y ped o Mr c e1 CWe Ch t 4 13 na the H Ith and Saf ty
nae sem 25532(a) p t "' �` g If roof is installed without first obtaining ecerias be
❑Ya ❑No 'a. Yat 11 v 9 .. ¢' t )
s — P ray r in a gee toarem
District?W 11 the applica t n furore building occaptain se equipmentord which' '
emth d a conmm t as defined by th ByA 'AQaln M'� a t. gar P gC remove
_all new materials for inspection Applicant understands and will comply with
�r '°Y AA
+ +° ` ; all"non-point source regulations ,, ;
I h ve N hazvdous mamnels regmrements,unde Chapin 05 a, the
titch pit
t ...OFFICE.
a � a e m code Sections ss33 Ana ass34 l understand'h°' �
inn) ercnd h run t th t
Y yrc 534.1 t the
P y ..notify-
YWil
pm
he ret m em h h max pr or io'. xua e f a Cen feat of
Occu sic
I b, r
_
r
Signature of Applicant Date
_..
or th u g sit r .. Dat ,;;, . ,,
_ .
All roof coverings to be Class "B" or better
M.
x t
CITY OF CUPERTINO `
BUILDING DIVISION PERMIT CONTRACTOWINFORMATION:
BUILDING ADDRESS : PERMIT NO.
21063 CHRISTENSEN DR 01080123
OWNER'S NAME . APPLICATION SUB DATE
1. PEARLMAN DALE L AND DARA B 08/24/2001
PHONE : SANITARY NO. CONTROL NO.
O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
' 1-1 CI I_J LJ
i LICENSED CONTRACT'OR'S DECLARATION Job Description
Ihcreby0) of thision 3 oferm"under prosisirnsof m9(commenci REPLACE WINDOWS.
u
with Section ]000)of Division the Businessand Profess' n tl n nW lir se
is in full force and off#Lt - (ti/(
"tresis Clusa ` Lich #
U Ome 7_'S! Crntmnor
v ✓ ARCHITECT'S DECLAN O
1 understand my plans shall be use d as pir c re rds
CLicensed Professional
OWNER -BUILDER DECLARATION
11 1 hereby afOrm that 1 am exempt from the Contmctor's License Law for the
Q
following re son. (Section 7031.5, Business and Professions Code: Any city or roomy $7400
Q
which requiresa permit to construct. alter, improve. demolish, or repair any sttnemre
m -.pr t 't m acquires theappf am for s such Permit to File a signed statement. . - _ __ _ ...-... -. _ _ __..- _ _ ._._ --- .._.
_ th t hd E 1 n. d puk aM m the prov ;lo f th C mmemrs License Lsw (Ch pt r 9 Valuation
(commencing with Section7000) of Division 3 of the Busipess and Prgfessions Core) �.{-,`,h32�7YtjVT�yVva1{' A t rr}�1 }
or that he is exempt therefrom and the basis for the alleged etemption. Any violation - ' )
-of Section 703 E5 by any aPplirnnHor a permit subjects the applicant to a civil penalty'.
top nntmn2tnanrvehundred dollars (atom. 516APN L BUILDINtil :� Occupancy Type
111, res Owner of the property, or my employees with wages as their sole compensation,
will do thek, and thestructure 'is -not intended -or offered for sale -(Sec ]044;- --- - i t t -
tBn rad Pr fessmns Cod The Contmclor s Liceae Law does not apply to an Required Inspeetlons' '
me
nor of property, Who buddt or improves thereon. and who threat Bach work himself
offe ghF employees, em den thin. himprovements lere t't intended of, ,., - .. _.. .. ._. .... .. [_. ... .. _,
�rearpllef 'h ILahowever,ltheWildingp mmli Id 'thnone yar of - - - -- - --
compl t the rte builder will have the Wrden of proving that he did ..,build or
improve for puryose of sale.).
as owner of the property, am Business
dY contracting with licensed contract m y ,,� �� P t.,
consumer the project f5 ]044 B .ire . oiM rProfessionswho
Code 1 The improves
thereon, .,:
Laconic Law does not apply t Owner f p pony who hu las or seimproves thereon s _t
_and h co tracts for h p ) t with onwaorlq licensed pursuant -t the. ....... .__._... ......... .. _.... .. ...... 1
Contractor's License la ,
❑1 met dcrS "' a B&PCI there _rl ��--
O ner ' Date
WORKER'S COMPENSATION DECLARATION
I
hereby afromunderPscantly of pepury one i -11.f the Poll ng declo tions: V j
❑ 1 have'and will mmmam.a' Certificate of Cindcm 7o sdf-insure for Worker's
Crimps, ... ion,-mt provided for by Seetion-3]00' of the Labor Code, for the
_ piformance'of the work , for . which this permit is Issue q..
01h 'ind will ma t W k sCoipe at l urhn required by Setion
3]00 f the'Labor Cod f t perfoim nc of the work'Or which this per t is
its d M W k" C m ns t on 1 brunce tamer and P'1 "
My ., Pe _ yo y umbe a in,x .:..-
Cam r 'CERTIFICATION OF,.F_)(EMPTION FRO s I Y ti t
A'"' ¢. lb t' Y-' .. 4 1 h pp 1 _r'i 1 r I - I _.. 1.)�l,tt ..
M.WORKRRS tj. S is. y: v x t r a C_I 6c t C-+ N.
.,". .''. COMPENSA11 INSURANCE - ,.,.._..._. ..,,.. _.-..
t.. .. . ........ ...--_.... .._ _._. -�... . _.._.
' 41 (Thio tier on need rad be completed rf the permit is for one hundmd dollars °' } ; v `r ['.e ., , i. C, ti t ) a'
(g100)or less) r
NOTICE
1 1 nify thinirlzd
n sic f t -work fo h hub pe t slued Io y as4p t� oin b) t t S ... _ - ..
NOTICE A CANT If, Aller making h C n f caret Exemption, you should r.
b)m theta k C pe- t sprouts shall h deemed
Code yam must 1
�Forthwith comply with such provisions or this peon t shall be deemed revoked r
t... ._ _.... ... .. .,. ... .. ._ _... ......... ....._ _.. .... __
1 I
11 " rm thea STRUCTION LENDING AOENCY "" i . .
I h reby- Rrm thin thele a rotor a lend nB agency f Me perfo "rix c -, [„ . f ,
ofthe ark for which thispe sit a dd(Sec 3097 C CI _,° 1 .r
1 - Carders Nume'...:a .v, ..'.:, ..c ...._... %:,m w,.,. r.. _ _.. _ -. �.. .. ... ____�..... ..... .__._. _ .. .... ..
lender Add a, ``.. , .... .._.. -__... .. _.. _._ __....._
i
i 1 cendy that 1 have read his application and stain the, the ahave information is 1
cramoc 1, agree to comply with all city and coumy ordinances and sore laws relming
1 ro building conatruciion:ada hereby authoiiie'reprt'john0ex air his city io enter upon
the above-mentioned proPeny for inspection purposes..- ., _
Iwe) ee id save: indemnify and keCp harmless the city of Copeidrl. against '
liabilities.. d cots. coos Ana expenses which'. may,in any way im tie agaitat said
City n o s e. of the gmm g rm0
APPLIC {NDERSTANOS A fJ t' COMPLY VVITH1ALL NONIPOiNT Issued by: Dace
URC CATIONS. r)`%ti" d, t yp
ig t Appl wnUConbve4G - '.. Re -roofs
.; HAZARDOUS' MATERIALS DISCLOSURE
i Dam� t7-2-
der
�� r
Will the applicanlo fivebd bidding Occup ttmor hanalehazard'sm tenor :Type Of ROOF. .. ,/
_ _»r. .. _.. r_+.
std f edb Nc Cu ) - i: C,
- -
y ped o Mr c e1 CWe Ch t 4 13 na the H Ith and Saf ty
nae sem 25532(a) p t "' �` g If roof is installed without first obtaining ecerias be
❑Ya ❑No 'a. Yat 11 v 9 .. ¢' t )
s — P ray r in a gee toarem
District?W 11 the applica t n furore building occaptain se equipmentord which' '
emth d a conmm t as defined by th ByA 'AQaln M'� a t. gar P gC remove
_all new materials for inspection Applicant understands and will comply with
�r '°Y AA
+ +° ` ; all"non-point source regulations ,, ;
I h ve N hazvdous mamnels regmrements,unde Chapin 05 a, the
titch pit
t ...OFFICE.