03020078 CITY OF CUPERTINO + •�t y rg z:, 3Y .;
BUILDING DIVISION PERMIT �CONTRACTORINFORMATION �-
BUILDING ADDRESS: DAN .& PAM STEIGERWALD PERMUTING.
ifA 1 E)e!EWE)eB BR APPLICATI
. SANITARY CONTROLNO.
GHITELT/ENGINEER: BUILDING PERMM INFO
BLDG ELECT PLUMB MECH
LOO LICENSED CONTRACnderp DECLARATION Job Description
1 hereby ef0rle that 1 am 3.f be
under provisions of,Code, 9(commencing p
n� with Salion]gp)of Dividon3of the BasineasaM Prufcrsinm Code,and my license is
in full Porro and effort.
5'jS License Class Lk.g KITCHEN REMODEL
t;, Dete CUNnnar
B ARCHM-CrS DECLARATION
1 understand my plana shall M used as public records
3 Licensed Professional
p OWNER-BUILDER DECLARATION
8 Q O 1 hereby affirm that I ole exempt from the Cnnlns Co License Law for Ibo
i p o following requires
(Saito 7 hallo Business and w,de Professions Cade:Any city stcounty
$ which requires a permit re cnnatrvm,alter improve,demolish,at repair ed them rat
FZS^ priormiu issueae,alar myuire[rhe applicant for such permit to Elcaeigned summed.
££ that he is licensed pursuant In the provisio is License Law(Chapter 9 Sq. Ft, Floor Area 12�tion
C $ (commencing with Section]WO)or DiviF
a sand Irl-ii
eryhm� c)tL vl/v
3—
that he is attempt therefrom and the btged rep g�i.A l-iila --
Section 7031.5 by any applicant for apethea ideal to a Nvil penal y Jill Sat er - Occupancy e
not more Nen five handled dollen(S500OOP Y EYP❑1,as owna of the property,or my crewagais their vole compensation,
will do the teen,end ire[W"urt is noocrtdforWe(Sec.70N,Ba[inevand Pm(asions Code:The Contnmo's 0 tai apply m en ownerofL;BAR
UNDAK'ejft d IDSpeCt100S
properlywhoWildanrimprovesNemona4l�n wohlgMcedf orNmuyh hG I 10ERS
own employees,provided Nat such Impressment art not intended or offered forale.4f.
however,fie building or improvement Is sold within one year of completion,fie owned ER
build"will have On Ono en of proving Nal he did not Wild a improve fa purpose of 1 O 4 —
❑La awmr pT Nyproperty,em exclusively commuting with licensed contractors to 105 — ANCHOR BOLTS
construct they ,"1 Sec.70dA,Buai end Professions CWe:)'Me Comncter'a Lb lO6 — SEWER & WATER
arae law door Out6rely to as r of propel who Wilds or improves thereon,and,
wh u tot cera chpmjteGwi eco mHs)Iicensedpursvmttothe Contractor's 202 — UNDERFLOOR PLUMBING
nder5 Bd:PC forism on
203 — UNDERFLOOR MECHANICAL
lam ea' ,
data 02 204 - UNDERFLOOR FRAME
t
WO Fits OMENS ONDECLAR 205 - UNDERFLOOR INSULATION
I embyaf ntoundsrpenalty a Perjury am of the following declarations: 301 — ROUGH PLUMBING
I neve and will maintain a CertiOcaw of Comer,to xIf-wore to,Werner.Comped. 302 — TUB be OR SHOWER
n,n provided for by Section 3700 of Ilse Labor Code,for the performance of Ne
tforwhichthisPermitisaded. 303 - ROUGH MECHANICAL
❑1 have and will maintain Waters Compensation Insurance,as required by Section 304 — ROUGH ELECTRICAL
3700 offt Labor Code,for the Performance of she wort ler which leis permit is issued. 305 — FRAME
My Worker's Compensation Insannee carrier told Policy number art:
Carrier: Policy No: 306 - HOLDOWNS
CERTIFICA OF EXEMPTION FROM WORKERS' 307 — INSULATION
C MPENSATION INSURANCE
308 - SHEETROCK
Or1..rl7tuxc/nnnced. thecorep.mci(Ihe s florch ndmddonua($IW) 309 - EXTERIOR LATH
1 calory that in Ne a =once t he or ler Of rah a issued,) hll nm 310 - INTERIOR LATH ---
ad ---
employtn vo n toner W,mka.Compenxtion 311 - SCRATCH COAT
Laws of Cel ,a
NIM
p t ' 313 _ ROOF NAIL
NOT TOIAP ANT:IL w renin, t Exemption—,you should
.JO NIM la tltotheWoderbCompensation provis sa(th Iah.,Cook,you musl 501 FINAL ELECTRICAL ENERGY
me each prnrisinm or this fermi met ecmcd revoked. 502 FINAL PLUMBING ENERGY
�N CONSTRUC`HONLENDING AGENCY 503 - FINAL MECHANICAL ENERGY
H I hemhyefnrm Net there is coM11oleion lendingageney for the performance of
oG > thew
.Z LenddrkforwhichOffNorrilisissued(See,3W7,Civ.C.) 504 - FINAL BUILDING ENERGY
sop LeNeedc
ndar'sddm 505 - FINAL ELECTRICAL
= er'r'sAddrcu
U O I cenify Net 1 have reed this applicadon and stew Net the above information is 506 - GAS TEST
IL Fcorrectl agree to comply with all city and county ominances and cute laws relating to 507 - FINAL PLUMBING
pU Wilding tion,and hereby[uNorin rtpeammantes of this city to enter upon the FIWNWG' L
til above. enlis cdpwKrtyfor inspcc' hgPtxs.
Il (We) gra to save,ind l y and kap harmless Bw City of Cupenino against 0 9 F+I
ry h tubi lies,J dgmenls,� dexpe ¢ sy in any way attmc againstaald City
U Z A c LI NTOUNNER�A n WILL COMPLY WITH ALL ON-P INT Issued b 5Date
S EREGU AT N •� y'SORKS'
igna rtofAppiica'Lc n Dew Re-roofs
HAZARDOUS ]ALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hawduus material
as defined by the Cupenito Municipal CWe,Chapter 9.12,and dw Health and Safety
e.secllon zss3zca)7 ,/ All roofs shall be inspected prior to any roofing material being installed.
[3y. [ No
Will the applicant or future building occupant use equipment ordcvims which If a roof is installed without first obtaining an inspection,I agree to remove
ulbarardnua air...taminenta as defined by the Bay Arte Air Quality Management all new materials for inspection.
9evc adAlhNo Slee ' amquiremcntaand rChepwr695oftheGliforyair N& clyd $1523377ead23530.1understandNatifde Wilding
does Ica mlyhute y respomiN it m holly the Occupant of theyui ofwhic spoor to iss Curd¢ ofOccupea .
Signature of Applicant Date
0 cr orauthonrcd agent Daw All roof coverings to be Class "B"or better
CITY OF CUPERTINO + •�t y rg z:, 3Y .;
BUILDING DIVISION PERMIT �CONTRACTORINFORMATION �-
BUILDING ADDRESS: DAN .& PAM STEIGERWALD PERMUTING.
ifA 1 E)e!EWE)eB BR APPLICATI
. SANITARY CONTROLNO.
GHITELT/ENGINEER: BUILDING PERMM INFO
BLDG ELECT PLUMB MECH
LOO LICENSED CONTRACnderp DECLARATION Job Description
1 hereby ef0rle that 1 am 3.f be
under provisions of,Code, 9(commencing p
n� with Salion]gp)of Dividon3of the BasineasaM Prufcrsinm Code,and my license is
in full Porro and effort.
5'jS License Class Lk.g KITCHEN REMODEL
t;, Dete CUNnnar
B ARCHM-CrS DECLARATION
1 understand my plana shall M used as public records
3 Licensed Professional
p OWNER-BUILDER DECLARATION
8 Q O 1 hereby affirm that I ole exempt from the Cnnlns Co License Law for Ibo
i p o following requires
(Saito 7 hallo Business and w,de Professions Cade:Any city stcounty
$ which requires a permit re cnnatrvm,alter improve,demolish,at repair ed them rat
FZS^ priormiu issueae,alar myuire[rhe applicant for such permit to Elcaeigned summed.
££ that he is licensed pursuant In the provisio is License Law(Chapter 9 Sq. Ft, Floor Area 12�tion
C $ (commencing with Section]WO)or DiviF
a sand Irl-ii
eryhm� c)tL vl/v
3—
that he is attempt therefrom and the btged rep g�i.A l-iila --
Section 7031.5 by any applicant for apethea ideal to a Nvil penal y Jill Sat er - Occupancy e
not more Nen five handled dollen(S500OOP Y EYP❑1,as owna of the property,or my crewagais their vole compensation,
will do the teen,end ire[W"urt is noocrtdforWe(Sec.70N,Ba[inevand Pm(asions Code:The Contnmo's 0 tai apply m en ownerofL;BAR
UNDAK'ejft d IDSpeCt100S
properlywhoWildanrimprovesNemona4l�n wohlgMcedf orNmuyh hG I 10ERS
own employees,provided Nat such Impressment art not intended or offered forale.4f.
however,fie building or improvement Is sold within one year of completion,fie owned ER
build"will have On Ono en of proving Nal he did not Wild a improve fa purpose of 1 O 4 —
❑La awmr pT Nyproperty,em exclusively commuting with licensed contractors to 105 — ANCHOR BOLTS
construct they ,"1 Sec.70dA,Buai end Professions CWe:)'Me Comncter'a Lb lO6 — SEWER & WATER
arae law door Out6rely to as r of propel who Wilds or improves thereon,and,
wh u tot cera chpmjteGwi eco mHs)Iicensedpursvmttothe Contractor's 202 — UNDERFLOOR PLUMBING
nder5 Bd:PC forism on
203 — UNDERFLOOR MECHANICAL
lam ea' ,
data 02 204 - UNDERFLOOR FRAME
t
WO Fits OMENS ONDECLAR 205 - UNDERFLOOR INSULATION
I embyaf ntoundsrpenalty a Perjury am of the following declarations: 301 — ROUGH PLUMBING
I neve and will maintain a CertiOcaw of Comer,to xIf-wore to,Werner.Comped. 302 — TUB be OR SHOWER
n,n provided for by Section 3700 of Ilse Labor Code,for the performance of Ne
tforwhichthisPermitisaded. 303 - ROUGH MECHANICAL
❑1 have and will maintain Waters Compensation Insurance,as required by Section 304 — ROUGH ELECTRICAL
3700 offt Labor Code,for the Performance of she wort ler which leis permit is issued. 305 — FRAME
My Worker's Compensation Insannee carrier told Policy number art:
Carrier: Policy No: 306 - HOLDOWNS
CERTIFICA OF EXEMPTION FROM WORKERS' 307 — INSULATION
C MPENSATION INSURANCE
308 - SHEETROCK
Or1..rl7tuxc/nnnced. thecorep.mci(Ihe s florch ndmddonua($IW) 309 - EXTERIOR LATH
1 calory that in Ne a =once t he or ler Of rah a issued,) hll nm 310 - INTERIOR LATH ---
ad ---
employtn vo n toner W,mka.Compenxtion 311 - SCRATCH COAT
Laws of Cel ,a
NIM
p t ' 313 _ ROOF NAIL
NOT TOIAP ANT:IL w renin, t Exemption—,you should
.JO NIM la tltotheWoderbCompensation provis sa(th Iah.,Cook,you musl 501 FINAL ELECTRICAL ENERGY
me each prnrisinm or this fermi met ecmcd revoked. 502 FINAL PLUMBING ENERGY
�N CONSTRUC`HONLENDING AGENCY 503 - FINAL MECHANICAL ENERGY
H I hemhyefnrm Net there is coM11oleion lendingageney for the performance of
oG > thew
.Z LenddrkforwhichOffNorrilisissued(See,3W7,Civ.C.) 504 - FINAL BUILDING ENERGY
sop LeNeedc
ndar'sddm 505 - FINAL ELECTRICAL
= er'r'sAddrcu
U O I cenify Net 1 have reed this applicadon and stew Net the above information is 506 - GAS TEST
IL Fcorrectl agree to comply with all city and county ominances and cute laws relating to 507 - FINAL PLUMBING
pU Wilding tion,and hereby[uNorin rtpeammantes of this city to enter upon the FIWNWG' L
til above. enlis cdpwKrtyfor inspcc' hgPtxs.
Il (We) gra to save,ind l y and kap harmless Bw City of Cupenino against 0 9 F+I
ry h tubi lies,J dgmenls,� dexpe ¢ sy in any way attmc againstaald City
U Z A c LI NTOUNNER�A n WILL COMPLY WITH ALL ON-P INT Issued b 5Date
S EREGU AT N •� y'SORKS'
igna rtofAppiica'Lc n Dew Re-roofs
HAZARDOUS ]ALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hawduus material
as defined by the Cupenito Municipal CWe,Chapter 9.12,and dw Health and Safety
e.secllon zss3zca)7 ,/ All roofs shall be inspected prior to any roofing material being installed.
[3y. [ No
Will the applicant or future building occupant use equipment ordcvims which If a roof is installed without first obtaining an inspection,I agree to remove
ulbarardnua air...taminenta as defined by the Bay Arte Air Quality Management all new materials for inspection.
9evc adAlhNo Slee ' amquiremcntaand rChepwr695oftheGliforyair N& clyd $1523377ead23530.1understandNatifde Wilding
does Ica mlyhute y respomiN it m holly the Occupant of theyui ofwhic spoor to iss Curd¢ ofOccupea .
Signature of Applicant Date
0 cr orauthonrcd agent Daw All roof coverings to be Class "B"or better