00080170 CITY OFCUPFN
RUNO
NPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20956 HOMESTEAD RD 00080170
OWNER'S NAME: APPLICATION SUB DATE
OLIVIA JANE 08/23/2000
PHONE SANITARY NO. CONTROL NO.
❑oeZ ARCHITECUENGINEL•R: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Z i7 y 3 LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby afOnn that I um of the
under provisions of..Code,(commencing
with Section 71 and of Division t of the Business and Professions Code,and my license
c Y 2� is in full force and elicct. —
_��a Date stn ue« ADDITION_
°s�3 d y Date Contractor
mm I" ARCHITECT*S DECLARATION
0 S 1 undersand my plans shall be used as public mentis
}
LO O Licensed Pndiseiun:J
60
OWNER dIl chip,fruit,
DECLARATION
t3 1 herthy a(See slim 1 nn exempt from the C ssions Co License Law for the
fallowing re,sa,n.(Seefio17031,5,Business and Pn,fdemolis Code:Any city or county
Illicitel Icr It f uc , ,p demolish, e.sign any structure
pn r t d.os a u I d pp t t h pen f r Iles geed Chtemam
d
that n Tee svlpmuon neon i.; n nn c t m c La (Chapter Sq. Ft. or e Valuation
or m e exempt,h 5 t 70gB I'D v int t me leged x d i f tans Code)
of that io o31.5 btany applicant
li and the bus.t for the alleged exemption.Any siltation
�•; O
of Section 71111.5 by any applicam fpr a permit subjects the applicant o a civil penalty
�pfnitt/mpytnny me handred dollars(s5a). APN mber� Occupancy Type
'HT,usowner nf0e pmpeny,u my employees with wages as their sole compensation, r
Ah.-
will do the work,and the structure is not intended or ntem l for sale(Sec.OWq, l - I '
Business d P 1 s:' Code:She Cnmmcmr's License Use does no,apply,o an ql nccl.1 � tion .,
ow r t f xid,srty Whobu Id. mpnrves thereon,and whod h k himself % 1k(
pthrough sa n how,yes: provided that such improvements are , tended or 101 — •FOJ` T +.
or red f I Jr.however.the Wilding a trach impr v -is within one year of !g/•jam[//\s�
completion,the covarcar,builder will have the himl n of playing that he did not build or 102 - P I E
improve for propose nitric.).
01.as ownempe
rof the pny,v xceuaively emanatedemanated., ns
meing wam liceed ac
contrfomm
1�� .. UFER
construct the pones(See.nun,Business and professions Cale:)The commcmr's 1.04 - RF_RAR; _
License Law nes not apply to an owner of property who builds or improves thereon,
and who contracts for such pnjects with a commcmr(sl licensed pursuant to the 105 — ANCHOR. BOLTS. .
cpIamex� pt��nrSee. B&PCformismason 105 — SEWER d WATER
net p Dine . 202_.— UNDERFLOOR-PLUMBING, _
w1�'MPENSAnaNDECLARATION 2203 — UNDERFLOOR MECHANICAL---
I hereby affirin under penalty of perpary one of the following claclarrations:
204 — UNDERFLOOR FRAME
❑ 1 lowland will annalun v Cerif¢me of Consent ,,self-insure for Wmker'e 2 —
Cninpenso it , its provided for by Section 3700 o1 rhe Labor code, for the 205 UNDERFLOOR INSULATION
perfor mancenot the walk for which this rail i.,issued. 301- .— ROUGH,—PLUMBING,
1:11 lave and w0i m;dm,in Worker's Cmn,savitdon bro mime as requ and by Stallion 302 - TUB $ OR SHOWER
3700 of the Luhnr C du,for the perfnrmanm of the work for which this Permit is -
issued.MyWorker's Compensation Insurance carrier and Policy number are:' 303 — ROUGH MECHANICAL
carder: Policyfiu, 304 — ROUGH ELECTRICAL
CERI'IFICAl]ON OP EXEMPTION FROM WORKERS*
COMPENSATION INSURANCE 1 305 - FRAME.
(This section need not be completed if the permit is for one hundred dollars 306 — HOLDOWNS
($BID)orless.) 307 — INSULATION
amity that in the performance of the work far which this pons,is issued,1
shall not employ any firs...in any manner so as to became sabjee m he Warkar 308 - SHEET ROCK
Compensation Laws of California.Dam
Applicata 309 — EXTERIOR LATH
aft
ould
NOTICE TjecttoheW APPLICANT IL Compensation
this Cenificme m Exemption."We Code.
you
310 — INTERIOR LATH
becomeh comprothe such
sr Ci,icm, ,.his peranitoha ofinevoted Cade,you must
Z O forthwith comply with such provisions.,.his permit shall be deemed revoked. 311. — SCRATCH COAT
lZ) CONSTRUCTION LENDING AGENCY
I hereby apms that them is a construction lending agency for the perfmmance 313 — ROOF NAIL
w _ Dfill,weak for which this Permit isissued(See 3097,Ch.C.) 501 — FINAL ELECTRICAL ENERGY
0. Q Lender's Name
U C leader'.Address 502 — FINAL PLUMBING ENERGY
I cetifyllat l have mad lld,appheadsrsve
on a ad ems,the alwfnfarmaronis 503 — FINAL MECHANICAL ENERGY
fns [.. comet.I agree m comply with all city and county ordinances end state laws mining
Ou mbaldingcondowlita,andhebyuamprimmpresenmryesplmisfityment alto, 504 — FINAL BUILDING ENERGY
,y the above-menliened properly lot Inspeeion purposes
F a (Welagrtelosnveixantiadeexpenses
pensswhihmayinan way
air SOS — FINAL ELECTRICAL. j -A Q/
r+. Al liabilities,j)agreenm,cods and expenses whim armless
in any way name iso at su10
V City incmmcgnencenfla,prinatin,ofthisPearat' 506 — GAS TEST
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU 1EGUI.A3' y'
Slgnamme ppheantlComr m Daae Re-roofs 508 — FINAL MECHANICAL
HAZAR OUS MATF:RIAI.S DISCLOSURE
Will the applicant is,I mlwlbou,eeupmttstore orhandle haaWnysmaterial Type of Roof 509 — FINAL GRADE
us defined by the Cupertino Municipal Cade,Chapter 9.12,vnd the Health and Safely
Cale Section 25532(¢)7 510 — FINAL PLANNING
C Yes 0 N All roofs shall 6�Ii4spute �R'1�'Ito o�i�g r�lsbeing installed.
wlR the applicant at tanto nudamg occupant use equipment or devices which If a roof is ins[a((led without trs[oob[ammg an mspec
to[
1 agree to remove
emit has mbas it cnnmmin ids at defined by rhe Buy Area Air Quality Management
. nisa;er7 all new materials for inspection. Applicant understands and will comply with
❑Yea 0 N all non-point source regulations.
1 harc read the tornNnus materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 255115.25533 and 25531.I understand that
if me(wilding nes not currently have a tenant.that it is my msponsibility an notify the
occupant of the requirements which most be met prior m issuance of a Cenificme of
Occupunsy./�
VQ.Y`y_ Signature of Applicant Date
Owne,vr an horrred agent C1 0 Date All roof coverings to be Class`B" or better
OFFICE