02030062CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,,
- - - -
CONTRACTOR INFORMATION;
t
BUILDING ADDRESS:
PERMIT NO.
21063 CHRISTENSEN DR
02030062
OWNER'S NAME:
DALE AND DARLA PERLMAN
APPLICATION SUB DATE
03/14/2002
SANITARY NO. CONTROL NO.
ONE:
ARCHITECT/ENGINEER:
BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
LJ J L,
LICENSED CONTRACTOR
1 hereby underSDECLA RATION
chin 1 am licensed undo provisions of Chap¢r 9 (commencing
Job Descnpti n
0Rof
wish Section ]000 _Division3 arch, Basincs nd Profession, Cde. and my license
full Cars react q 9 7 77
Licepx Class ` Lis.
C. ,a
RE -TILE
SHOWER ����®
_
♦ ����,,__
DEC
ARCHITECT'SS DEC RATIONunderstand
1 understand my
2 1'2002
plans shall used as publicrecordsJUN
records�a
i Licensed Narcissi ... I
OWNER -BUILDER DECLARATION
1 hereby alb chat 1 s Limns Law che
exempt from he Cosi...
BUILDING
1. C ma
Code Any =try st county
' following reason. (Session IDnso Business sod we. de io demolish.
i whish requires permit conswe, improve, demolish, or repair any vructme
$5800
aalter.pplicant
n re
j .pdonoiuissmncaalmreguiresothe the provisions mforsuch Contractors Licenfile ase Law (Chapter
License Lowmu,
(omm�
(-noat mesiicenxd pursues tothepmDiskicof the he Business
3 ofthe Business Prolusions
i1a with Sectionom
QQo- t
C� Q.��y
��i�r.-
- -
Valuation
nap code)
Code)
or Nat he exempt and Ne basis for the
anof 1 basis Any violaion
i' i8 i CJ 4
U V :' s
oris
of Secdoe smy applicant subjects; the
by arty applicant Con permit subjuu the applicam m a civil penalty
, than
croperty,mmhundred yemploy).
10I�PN
jI DATION Occupancy Type
,Irhan
01. as ymmyemplot wages used for lecompcnsntion.
PTRPq
it•uowner"lchand the intended
' it] do the work!'end the stmcturt is not in¢ndetl or o(fcred for salt (Sec. ]014,
_
Business'and Professions Cade: The Contvnm's License Law does not apply to an
103 -
UFER Required Inspections
—net of properly Who builds or improves thereon, end who does such work himself
or through hia own employees. presided that such improvements arc not intended or
':
104 -
REBAR
offered ror'sate: If. however• the building or irnt,m cmcm is sold within one Ycar of
completion, the owner -builder will have the burden of proving that he did not build or
105 -
ANCHOR BOLTS _.
improve forparyoae"r=ata.).
106 -
SEWER & WATER
❑I; es owner crime proprdy.amaa=ma;veiy contracting wish licensed con w
'7054,
202
UNDERFLOOR PLUMBING
construct the project (Sot Business and Professions Code:) The contra='st's
License raw does not apply to an owner or pmpery who wilds or improves merean•
203 -
UNDERFLOOR MECHANICAL
and who count for.such projects with a contrucmr(s) licensed pursuant m the
Contra=mrsLicenseLaw.
204' -'
UNDERFLOOR FRAME -
0 1 am exempt aodersa. - ,B &Pe mania reason
205 -
UNDERFLOOR INSULATION
° " r D"e
' WORKER'S COMPENSATION DECLARATION
301 -
ROUGH PLUMBING
I hembyaRrm under penalty of p a do onner"lmwingded.ationa:
302 -
TUB & OR SHOWER
303 -
ROUGH MECHANICAL
1 hive and will mairnein is Certificate or Carom, ro self -imine for worker,
Campcnsation, u provided for by Section 3]00 of the labor Code, for the
3 04 —
ROUGH ELECTRICAL
poor. Cc of the work lm which this permits is issued.
305 -
FRAME
O I have sad will mvnuin Wmkets Compommion lnsurvnce, as required by Section
3 06 -
HOLDOWNS
37W of the Labor Code, for the Performance of the work for which this permit is
'smell
i My Worker's Cisn'..don Imtimme c er end Pott=y num bo are:
�%e?7%CG'LOyl�ear=r'793�/%-�Z
307 —
308;`
INSULATION
SHEETROCK.
"_,_tT;'},MTHICATION
'. r
: ', •I.
OF EXEMPTION FROM WORKERS':
.•_.- -_-, _�.,.... :.' COMPENSATION INSURANCE ' • ""
•.
•' 3 0 9 -
". .. .. t'''•".
EXTERIOR " LATH'
t •::• �piva socrom mmill not be completed if the permit is roe no hundred dollars
310 '-
INTERIORLATH ._. _.
(s Minsk..)
311 -
SCRATCH COAT
coma 1 centurythat in the n in any ma of the war to chid, this pettish a iasned, 1
Part employ any Person in any manner so as ro become subject to the Workers'
-' 313 —
ROOF � NAIL
'
Compensation taws Celiromia. Dem'
501 -
FINAL ELECTRICAL ENERGY
.1
A0rICET "
502 -
FINAL -PLUMBING ENERGY - - -
thin CeruOcax of Emispuon. you should
rboco..TOAPPLICWorknes
Compensation
x=emraobje,twrhewmker:compacta,man provisimrs cane tabor Code, you mast
rdanwitn mmpty wire amn prowsmna ar rots permit an.n he dames rewkea.
503 -
FINAL MECHANICAL ENERGY
.•i.
504 -.
F I NAL .BUILDING. ENERGY,,
CONSTRUCTION constitutionLENDINGAGENCV.
i hereby affirm that then is aconstitution lending agency rot die performance
SOS -
- ... . -
FINAL ELECTRICAL
of che wink Cor whish chit permit is issued (sec. 3119], Civ. C.)
-Le6dv's Name:.:._ aa-:Lmoders'Addic:
... 506 -
GAS TEST '
... v.a .:,.; ,,.
507 -
FINAL PLUMBING.
lccnifychatlhavereadthisepplicnionandalaechmtheabo��informationis
508 -
]
FINAL MECHANICAL
boriiea I agree to comply with all city and county ordinances and sum laws Totaling
m Wilding Oirmrucdon, and henebyeudmrim repmsdnudses of this city to enter upo
509 -
FINAL GRADE
the.asom-memiapwpropertyfe,mapasionpntosam.
(Wd) Agree ro inim indemnify and keep hamdesi the City 6f ca 'giro against
510 -
FINAL PLANNING
liabilitiu, judgmenu, coin eod upcnsu which my in any way accrue against said
City in eonscqunce or Ne grmitGg of Nu,.,.'-' "' ' .1 '
514 -
F I NA PU I C WORKS
APPLICANT UNDER $ TAN DS WILLfOMPLY WITH'ALL:14, P PINT
T
S ITRCE REG W,A ONS. " " j v" '!�/
I
Issued by:
Date /
argmtute,o(.'pp(licar� onrncmr, •. / '/Y g/sx
- ' RDOUS MAT&Aiz DISCLOSURE
Re -roofs
" WII the applicant orf cure Wilding occ pant store or handle bawdous material
sty;doh od by ch Cupertin M n c pal Code, Chapter 9 12 and W Health
Type.of Roof
and safety
Code.s.t o 25532(x)'! - - -
-
All roofs shall be:
inspected: prior to any roofing
's
Wll che eppl cant6amrc bulang oecupa t sere spm t devses which •
r harallo s suco umtnanu defined by Ne B y A ea Air Quality Management
_ If a roof is installed
material being installed.
wth
iout fust obtaining an inspection, I agree [o remove
PF.r`°"" ❑Ysl ,Ory
. ; , ..
all new materials
for inspection. Applicant understands and will comply with
t.o_ t _
Cham
all non -point source regulations.
read the ppaeardous materials rtquiamau motor Chapter 6.95 of the
Calilomia Health AS2y Code. Sodom 25503, 25533
"
and 25534. 1 uodetsund that
'OifNpant Ongdoesnmr000.whavee¢nam,tc potis mytosp"nsibilitym mailythe
cupsot"f die requimmcnu which must br�md prior to Asnunpce Cnifimte a(
-
'=�/
Signature of Applicant_
Date _
All roof coverings to be Class "B" or better
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