00080125 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
11UILDING AUURISS', FERMrr NO.
10430 LOCKWOOD DR
OWNER'S NAME: AI'1'LICnI'ION SUIT Dr\1':
oi 25
PAM STEIGERWAI_D
fflONiq SANITARY NO U),'
(41 ED —�
OPO ARC HI'IECT/ENGINf ITR: BUILDING PERMIT INFO
wp Ea-DG ELECT PLUMB Nil CH
�U 1 _U 1--I l• LJ I_7 '
�Rd
LICENSED COM1TRACTOR'S UECLARA'IION .106 Description
O O 1 t 70 affirm Ilan ienn of the
under pinviniotc,,i Chep¢c 9(commencing P
v.I-•w with Sediorce and of Dhi,inn gut the l{uxiness unJ Pmfc,rionsGda and myllcennu
isinfull force mJelfect.
xo a Lide cla,.t Lie.li WATER HEATER
i, Dmc Comnmmr
a ti, ARCHt rECr'S DECLARATION
C u ON 1 undersand my phms shall be owd as public recta&
R5 C S j
a a I,iccnmd I'mfexinnal
O\VNER-nun ATTR 131: nrION
'x3'-R I brachy affirm Ihw 1 am v—,v than the Com acne:,License Law in Rte
l-ZS< Following reason,(Section 70313.Business nal ProfeWmis Code Any city or county
`�M❑ whkh rnptires n pemnit m clngmcl,alter,ingnove,demolish,or repair any viorture
a,3- pritrmit&issuancc ala,n'yuires the upphcam lnnuch pnnniuoficnsipncJ aatnncnt
aha he is licensed par&tant mlhe pravi&hon,ohne Contractor,License Law(Chmlr 9 Sq. Ft. Floor Area Valuation
(,on.mencing with Sector 41011)of Divioma 3 of the Fudncv,and Pmresmonx Code)
.r,bra he i,enempt ibcml..it,mode basis lot the alleged cacrl,ion,Any violation
of Section 7031 S by any applicant for a premi subject,the applicant to a civil penalty
of connmtrede ti,enmt]led JoRms(S5no1. APN Number Occupant
0 I,as owner of the progeny,or my employee,with wages as their sole compensation.
will do the work,and the an clurc it not intended or oucrcd lot sale(Sec.7044. 3422901 4. 00
Basins,and Pnfir,doa,Codr:The Commrmr',Lirrnse Low dans con upply 1,an Required Inspections
owner of property Who builds or improves Merton.and wdxi
no . such work himself
... iough his naipla,cc,.provtdrd that such bapr' mmoem&are mol Intmdee ar 502 — FINAL PLUMBING ENERGY
of(ceal Ibr,vain IL however,the building or aupnrvwnsit is slid within one Ycc,of
completion,the Owner-builder will have the burden ofpmving that he did not build or 506 — GAS TEST'
Ihnpnmc her Impost M andel. -
01.a awn r of the progeny.am exclusively contracting with licensed contractors It, 507 — FINAL PLUMBING
mxtrucl the prnjcet(Sec.7044.lhsinca&and Prmadnns Code)'[he Contrnaor'x
License Low does not p,l,In as owner of F,openy who build,or improves thranm.
and who contracts far such Projects with a contractors)licensed pursuant m the
ConuaaLicense oLaw.
0l am exempt order Sec. .Egli 1'C floe Ibis reason
Owner Date
WORKER'S COSfI'Dole PION DECLARATION /� /w-�n ,
I hereby affnu under penally of perjury one of the following Jcclutntlons: 0 `�✓K. O�
0 1 have and will maintain a Cenifcam of Consent to self-insure for Worker's
Cam stsellon, ;is ao,d,d far by Station 37N) of the Labor Gale, for the h
Performance of the work for which this pennil is ie,uell. I
37 have and will maintain
ar he 's Catnntiveof Ie,ummc,l whichmcimhis
Section / _— C-�'/ �'�•'✓/�/
JIIIe , the orkeC Cou for then insurance
lir the work far which this pcnnil ix �� L
Ixnual.My Wnrkcrs Conhpcneminn inwancc carica and Policy numhr nm:
Carica. PEMP't[[O
CERTIFICATION OF EKEMy No.: FROM WORKERS'
COMPENssrioN INSURANCE
I
Iltl§ion need all,be compacted If the Pmmil is for one hundred Collas `/^�
(SIIIB nr tun) V 2,
I arally that In the Fe,Romance A the walk aim which this permit 1,i,,ueq I t
,hull net employ any person in any,tanner w a,un hermne ahjec,w the Wbrka, j
Compcncaaion Laws of California.Date
Appltatt I
NOT ICH TO APPLICANT:IL alter snaking(his Ccnil ctur of 17xentption,you should
become ah vo to the 0brker's ComPenssnon prm'isions of the Luton Cute,you must
Q O Rmhwilit comply want such provision,or III purnth shall be deemed revoked. i
tiCONSTRUCTION LENDING AGENCY
> I hereby aft rnr that tare is a mmame.tien leading agoncy liar the pedorreave
of the work for which this Permit is issued(Sec.3097,Civ.C.) I ,
11C Iendah Name
5 Z Lrmu,',AJJte,o
U C 1 unify'that 1 have read this application and state that he above information is
4a F.t corell.1area,t ...l 'tl II ty and D 1' eco J t t l d:f g
�.V to Wilding construction.andhereby authentic mpac%scrtativcsof this city it) ter open
the aM l t J pn Pr Iy f pc m P rp
u
CL. (W g t ly l A 11 i II C y p n id —
✓
Z t j Jg s t d P &whichY y > r g id aid
City In consequence othe gaming of this
APPLICANT UNDERSTANDS
US ANU WILL COMPLY WITH ALLNON POINT
Date
SOURCE REGULATIONS. Issued by:
� '
Signature of ApplicamlContruemr Dam Re-roofs
IIALARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wil bog uecupaat solaria handle hwmdous mamrial Type of Roof
n,t6inN by Ibr Cupaii e,Municipal Colic.Chapter 9,12,unJ the Health and Sulmy
Colic,Scclion 255320)?
O Ye, [IN,, All roofs shall be inspected prior to any roofing material being installed.
.ill lbeapplicamorfmurcbut lJingcecup:mtu¢equipment nrdevices which If a roof is installed without lust obtaining an inspection. I agree to remove
mit b:rmduux air conlarrinam,uv defacid by he Bay Arca Air Qoalfly Mare gemcm
[)isIrio? all new materials-for inspection. Applicant understands and will comply with
0 Yet 0N all non-point source regulations.
I herr mudthe Wead i,macriul,equimill.11 under Cheptcr 695 of the
California Ilealth S,Safety Code.Sections 25505.25533 and 25534.1 understand that
if the building dues nal currently havealenunl, hall,ismy rcxpan,ibiliD m malty the
occupant at(lie requir mere.which"lust Ix met prior in ir,mnee of a Cenilicate of
occupancy. Signature of Applicant Date
..act
or aumumile agent uxtr All roof coverings to be Class t•B&& or better
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
11UILDING AUURISS', FERMrr NO.
10430 LOCKWOOD DR
OWNER'S NAME: AI'1'LICnI'ION SUIT Dr\1':
oi 25
PAM STEIGERWAI_D
fflONiq SANITARY NO U),'
(41 ED —�
OPO ARC HI'IECT/ENGINf ITR: BUILDING PERMIT INFO
wp Ea-DG ELECT PLUMB Nil CH
�U 1 _U 1--I l• LJ I_7 '
�Rd
LICENSED COM1TRACTOR'S UECLARA'IION .106 Description
O O 1 t 70 affirm Ilan ienn of the
under pinviniotc,,i Chep¢c 9(commencing P
v.I-•w with Sediorce and of Dhi,inn gut the l{uxiness unJ Pmfc,rionsGda and myllcennu
isinfull force mJelfect.
xo a Lide cla,.t Lie.li WATER HEATER
i, Dmc Comnmmr
a ti, ARCHt rECr'S DECLARATION
C u ON 1 undersand my phms shall be owd as public recta&
R5 C S j
a a I,iccnmd I'mfexinnal
O\VNER-nun ATTR 131: nrION
'x3'-R I brachy affirm Ihw 1 am v—,v than the Com acne:,License Law in Rte
l-ZS< Following reason,(Section 70313.Business nal ProfeWmis Code Any city or county
`�M❑ whkh rnptires n pemnit m clngmcl,alter,ingnove,demolish,or repair any viorture
a,3- pritrmit&issuancc ala,n'yuires the upphcam lnnuch pnnniuoficnsipncJ aatnncnt
aha he is licensed par&tant mlhe pravi&hon,ohne Contractor,License Law(Chmlr 9 Sq. Ft. Floor Area Valuation
(,on.mencing with Sector 41011)of Divioma 3 of the Fudncv,and Pmresmonx Code)
.r,bra he i,enempt ibcml..it,mode basis lot the alleged cacrl,ion,Any violation
of Section 7031 S by any applicant for a premi subject,the applicant to a civil penalty
of connmtrede ti,enmt]led JoRms(S5no1. APN Number Occupant
0 I,as owner of the progeny,or my employee,with wages as their sole compensation.
will do the work,and the an clurc it not intended or oucrcd lot sale(Sec.7044. 3422901 4. 00
Basins,and Pnfir,doa,Codr:The Commrmr',Lirrnse Low dans con upply 1,an Required Inspections
owner of property Who builds or improves Merton.and wdxi
no . such work himself
... iough his naipla,cc,.provtdrd that such bapr' mmoem&are mol Intmdee ar 502 — FINAL PLUMBING ENERGY
of(ceal Ibr,vain IL however,the building or aupnrvwnsit is slid within one Ycc,of
completion,the Owner-builder will have the burden ofpmving that he did not build or 506 — GAS TEST'
Ihnpnmc her Impost M andel. -
01.a awn r of the progeny.am exclusively contracting with licensed contractors It, 507 — FINAL PLUMBING
mxtrucl the prnjcet(Sec.7044.lhsinca&and Prmadnns Code)'[he Contrnaor'x
License Low does not p,l,In as owner of F,openy who build,or improves thranm.
and who contracts far such Projects with a contractors)licensed pursuant m the
ConuaaLicense oLaw.
0l am exempt order Sec. .Egli 1'C floe Ibis reason
Owner Date
WORKER'S COSfI'Dole PION DECLARATION /� /w-�n ,
I hereby affnu under penally of perjury one of the following Jcclutntlons: 0 `�✓K. O�
0 1 have and will maintain a Cenifcam of Consent to self-insure for Worker's
Cam stsellon, ;is ao,d,d far by Station 37N) of the Labor Gale, for the h
Performance of the work for which this pennil is ie,uell. I
37 have and will maintain
ar he 's Catnntiveof Ie,ummc,l whichmcimhis
Section / _— C-�'/ �'�•'✓/�/
JIIIe , the orkeC Cou for then insurance
lir the work far which this pcnnil ix �� L
Ixnual.My Wnrkcrs Conhpcneminn inwancc carica and Policy numhr nm:
Carica. PEMP't[[O
CERTIFICATION OF EKEMy No.: FROM WORKERS'
COMPENssrioN INSURANCE
I
Iltl§ion need all,be compacted If the Pmmil is for one hundred Collas `/^�
(SIIIB nr tun) V 2,
I arally that In the Fe,Romance A the walk aim which this permit 1,i,,ueq I t
,hull net employ any person in any,tanner w a,un hermne ahjec,w the Wbrka, j
Compcncaaion Laws of California.Date
Appltatt I
NOT ICH TO APPLICANT:IL alter snaking(his Ccnil ctur of 17xentption,you should
become ah vo to the 0brker's ComPenssnon prm'isions of the Luton Cute,you must
Q O Rmhwilit comply want such provision,or III purnth shall be deemed revoked. i
tiCONSTRUCTION LENDING AGENCY
> I hereby aft rnr that tare is a mmame.tien leading agoncy liar the pedorreave
of the work for which this Permit is issued(Sec.3097,Civ.C.) I ,
11C Iendah Name
5 Z Lrmu,',AJJte,o
U C 1 unify'that 1 have read this application and state that he above information is
4a F.t corell.1area,t ...l 'tl II ty and D 1' eco J t t l d:f g
�.V to Wilding construction.andhereby authentic mpac%scrtativcsof this city it) ter open
the aM l t J pn Pr Iy f pc m P rp
u
CL. (W g t ly l A 11 i II C y p n id —
✓
Z t j Jg s t d P &whichY y > r g id aid
City In consequence othe gaming of this
APPLICANT UNDERSTANDS
US ANU WILL COMPLY WITH ALLNON POINT
Date
SOURCE REGULATIONS. Issued by:
� '
Signature of ApplicamlContruemr Dam Re-roofs
IIALARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wil bog uecupaat solaria handle hwmdous mamrial Type of Roof
n,t6inN by Ibr Cupaii e,Municipal Colic.Chapter 9,12,unJ the Health and Sulmy
Colic,Scclion 255320)?
O Ye, [IN,, All roofs shall be inspected prior to any roofing material being installed.
.ill lbeapplicamorfmurcbut lJingcecup:mtu¢equipment nrdevices which If a roof is installed without lust obtaining an inspection. I agree to remove
mit b:rmduux air conlarrinam,uv defacid by he Bay Arca Air Qoalfly Mare gemcm
[)isIrio? all new materials-for inspection. Applicant understands and will comply with
0 Yet 0N all non-point source regulations.
I herr mudthe Wead i,macriul,equimill.11 under Cheptcr 695 of the
California Ilealth S,Safety Code.Sections 25505.25533 and 25534.1 understand that
if the building dues nal currently havealenunl, hall,ismy rcxpan,ibiliD m malty the
occupant at(lie requir mere.which"lust Ix met prior in ir,mnee of a Cenilicate of
occupancy. Signature of Applicant Date
..act
or aumumile agent uxtr All roof coverings to be Class t•B&& or better