01040004 CITY OF CUPERTINO
BUILDING DIVISION PERMIT. CONTRACTOR INFORMATION:
BUILDING A DDIt IiSS', - PERMIT NO. -
1127 KENTWOOD AVE. 01040004
OWNER'S NAME: APPLICATION SUP LATE
ERIN. M DANALD 04/02/2001
PHONE. SANITARY NO. CONTROL.NO.
p Y� ARCIII I'IiCf/IiNGINIaiR:
BUILDING 11ERMit INFO
z W- I tier 'LUMB MEC
z S yLICHNS171)CON'TRACI OR'S DECLARATION Job Descrip on
�c o I hereby alliin that l am licensed under provision.—I Cnapmr 9 to:.:...ening .
Fyn._ with Sanion 7(d(fof Division 3 of the Business and Pmfe�s.jio�ns Code.andmy license
11 d ..rens in Lic.M —t FINALfdION 403 SO. FT.
o are�A //G coranmtn.
3 f ARCI IjrfLC`S DIiCLARA"PION
CLLwrie,oi run ndmyplansshallhuseduspublicrecords JUN 18 2001
en 36 Licensed Profusionul
OWNER-BUILDS"k DECLARATION
=' I hereby alliin that I nm exempt lino.the Contmoor'v License Law for the
I_Ze Q hollowing reason.(Section 7031.5.Buninea,.and Professions Clull Any city or county BUILDING
zF= which"oi e,a Iv'nnit m construct,alter,improve.demolish,or repair any structure
iia= prior to its issuance.also rel,dri the applicant for such permit in file a.igned statement
mane is licenses)purwanitnmc IT—,.onudthe Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Seeliun`nm())of Division 3 of he Easiness and Prot2ssions Coact
min be is eacnp,memin,nn amt the nasis for die alleged aminplivir Any vibl.1n $45000
or secant 7031.5 by any appli ull for a amnio smnjcas meapplicant In a dvil penally
of ort nom marl Eve bnnared colla,6500). A PN Number Occupancy Type
171.31 trf my,
,no,coa my en.ployrr with wages s.neir ode co..,por-oc
win It,tire`wink.ti I the s....nim
re . .. rfn.od,d n,olf,red rnr cele ISrc.7044. Required Ins ectlmlS
Business and Prmnsions Cial Ilie conrachds Liecme Law does not apply to an q P
orr of propery,Who builds or improves Thereon,and who dies such work himself
mm.h hi,nwn and.yec.,poniard that such imprwenums are an intended or 101 — FOUNDATION
uttered her sale IL howler,the budding or improvement is sola within now year of
... Ictinn,thin uwnn-milder will have.he hunlmn of prt.er...cont hold not build ur 102 — PIERS -
mprovc n..pnrpm.c of sale.).
103 — UFER
Cl L as ironer of the pre,,my.70,14.esdmhely contracting ns Co
ccnsJ amo-anots m 104 — REBA R
construct the pn)ocj n (See
appl]Plan lboinowner
proand erty who builds Rdep Thr Conve%tmnmS
Llcewh Law d«,.nn apply man owner of ampuny who ice ord pursue to the
amt who emnmn,red such pr Jnnn with n rnmmcn,L.l ilrenara pt.ra.n.nt m me 105 — ANCHOR BOLTS
01 a.emorp,....eww. 106 — SEWER fl WATER
❑I am raempt under sw. .B R I'C for Thi.reawn
owner Dare 202 — UNDERFLOOR PLUMBING
WORKER'S COMPENSAI'ION DECLAR6fION 203 — 'UNDF_RFLOOR MECHANICAL
I hereby.allmn under pn.ary of Wqury tine of The following declarations: s —
.c04 UNDERFLOOR FRAME
® ° 1 have and x'ill maintain m certificate of Consent e.sell-insure for Worker's 205 — UNDERFLOOR INSULATION
Conlpenemion, is Inavided lin by Secnm 1700 of the Labor Code, for the
t,rrinm...mem
enfinwktorwldchtld.pnil
rkissued 301. — 'ROUGH PLUMBING
0 have and will.r imain sVbrker's Conferred i lmmnamr.as required by Section 302 TUB R OR SHOWER
37Tg1 of the Lahti Code,for the performance of the work Int which this permit is
sed My Wmket.ComprroMo ilmwrancecarrierandPolicynumberam: 303 ROUGH MECHANICAL
qNN yNt' �'. 304 — ROUGH ELECTRICAL
CUR IIlC FION 017 ES. ;M 1'1'ION FROM WORKERS'
COMPENSATION INSURANCE 305 — FRAME
(Thi. redo.im,dmiIbeem.nnli,edit heamm,1,h..mwhambed doun, 306 — HOI_DOWNS
6100)err Icr.l
I certify but in the perfomae of Inc work for wh ..e
which his permit is 307 INSULATION
rnc
.roan not employ any person in any manner xo as n become subject to the Worker: 308 — SHEET ROCK
C.... co,artin Lmxs m California,Dam
Appheam 309 — EXTERIOR LATH
NOn,17 TO APPLICANT:II,mor nuking.his Crnifiaw err fsonpdnn, no mould
memne sub ,,,he Worker,Cnnpc.ammi lrneidon,or the labor Calr.you nue 310 — INTERIOR LATH
O Q forthwsu
ith comply with ch pnok m.
m w or his peit shelf «
t l he dmod revoked.
311 — SCRATCH COAT
C'ONSTRUCI'IONLENDINGAGCNCY
a > 1 henebm
y amo thin hem ro
11 a rnrnain i lemrng..geney for die permrriance - 31.3 — ROOF IdA I L
of he work for whirl,his permit is issued(Sec.3(y)7.Ci'.Cd
y c Lnaer'sName 501 — FINAL ELECTRICAL ENERGY
D 7 I.craef'sAddresv 502 — FINAL PLUMBING ENERGY
U O 1lerhfy,l.alllaveread il,Iauppnr:.m.nmmin,a,uflat'he ahonminfmoiaineis
Ii 50, — FINAL pANICAL ENERGY
F tomn m
tomer.I agree. comely with all city and county ordinances and nom laws minting 503
O U tibuildingconstruction.anlherebyaumnill — FINAL UILDING ENERGY
the til,mc-narnitioned peepsny I fret') P rp .
'�.. 1 eCy fC pen uigansl
m r:.nu, I Ih r d 1 b .:...any against said 50 FIN ELECTRICAL
U T City •d theS tarring f this ..
APPIIC INDERSTANDS�'1 COMPLY WI'fit ALL NON OI' Issued by: 1 G _ST Date / D/
O ATIONS y'
S reof.App,ranrcanwtr ��to Re-roofs 508 — FINAL MECHANICAL_
IIA%Alt Ut ATEItIALS DISCLOS PRE
Will me apahranrmf rluoIbog,,,r,, u.orcor handle her—hu.,material TYPe of Roof 509 — FINAL GRADE
m defined by the Cola mo,Municipal Code.Chapter 9.12,and the Health and Safety
Code.Seelion 2553-lar 510 — FINAL PI_ N I NG.
0Ye.s 0 N All roofs s all be p cted .tJkll1o� tr❑Many 11�nk7r a g installed.
Wlli he nppliran,err lour buddin.....nlndl use n ni,wmo,dreier,winch If a roof is installeU thout IIr1l UUtain II iWeCl1U11, 1 Lgree to remove ,
nmol I.aaardous air rorto...marl.as defined by the Say Arta Air Quality Management
Dishcr. all new materials for inspection. Applicant understands and will comply with
°''O9 C)No all non-point source regulations.
I hove lead the hazenioms materials re9one,owns turret Chapter 6 9 err the
Cnlilnrnill Health ".fay Calc.Sections^_55115.2 _714.l undc,,gantlma,
if the building ncurcnTly lwveatenant. ,nry mspmsibili,ymnolify the
Incupam o uiremcnT%which in .1 prior to issuance ofIm
roc o f
cape Signature of Applicant Date
con�ammtidam agent -- / All roof coverings to be Class "B" or better
OFFICE