02030218 OF
CI BUILDING DIVISSIONN� PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22742 MAJESTIC OAK WY MICHAEL BODO & ERNA WENTIS 02030218
NER'S NAME: APPLICATION SUB DATE
IICHAEL BODO & ERNA WENUS 03/29/2002
P ONE: SANIARYNO. CONTROL NO.
s_
qQ ZOARCHITEC'UENGINEER: BUILDING PERMIT INTO
kC ELECT PLUMB MECH
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L7
LICENSED CONTRACTOR'S DECLARATION
iZy_ Ihcubyaffvmthat lamlicensedunder provisions ofChapter 9(commencing ria JobDeslription
i`=E° with fatioracmdafDivision Jof the Businessand professions Code.and mylicense DEC Zlgu / A� l
is in Sell farce and effect.
o PSS License Class Lic.0 1
5
Data Contmcmr
I li i)(n ARCHITECT'S DECLARATION
y I understand my plans shall be used as public records
i
3 p Licensed Professional
% OWNER-BUILDER DECLARATION
w 1 hereby.(Seth that 11. exempt from the Convenor's License law co the
C?< following reason(Semon 7031.5.Business and improve,
de professions Code:Any city or county
FF O which requires a Parodi to construct,aver,improve,demolish,w repair any stroctune
_priwmit iuuance.e4orrquiru die applicant for sudspamino filaadgned auten¢nt, --- -- -OOO-- - -- -- ----
thatjleiihliafeWputsuMndthepiosd.pm ofdreConvectorsLicrnutaw(CTuga9 ,- ,+ t SValuation
(conimenamil with Seplical7i")of Division 3 of the Buimaxss and pqrtp�fixei...Code) lQ�� E\3i?;'"t �Y �'?M=�V:i..4I:1t
or Nat be ie exempt theiefAnn and the basis for Ne alleged ekempXn.Any violation
inno u applicant Sp)t subjects the pphcam to a civil Penaltymmallnfven lod.1.( , 1Wy
NHIS0DATION OCCU aney Tap
e
°
1,as owner of the property,or my employees with wages n their sole compensation, 102 — PIERS
-will do the work,-4nd'the structure is not intended or offered for'sale'(Sec.7044."
hies,and'Professions Cada:Tit,Cammctor's License law does not apply to an 103 - UFER Required Inspections"-
net of property Who builds or improves chances,and who does such work himself — REBAR
through
his own empl y p 'dad met such Improv-solani are not intended or
oRemil(or isle 1(however,the building or Int vemem is sold within one' of ""—" ' -1-04- _
enmplevon the ownenbmlder will have the When of proving that he did net build or 105 - ANCHOR BOLTS
impraveforparpose°fsale.), 106 - SEWER & WATER
aenwaecennepropeny,am«cweivelyaontmanng withBaen.eaaontraemram 202_-._ UNDERFLOOR PLUMBING x1.1': ,:
conswet the project(Sec.7044,Business and Professions Code:)The Conlramm's 203 — UNDERFLOOR MECHAN'I CAL'
License Law does not apply to an owner of property who builds or improves thereon,
who co tract for, p )eats wuh.e ontrecums).licensed.putsuavt.ta.Ole. ___ -_._....._. ...........
,mall
tmcto ae La . ..._.._.. -204- ' UNDERFLOOR-.FRAME'---
��ua Sc B&PCfonhisreaon
$'• 205 - UNDERFLOOR °INSULATION
wncr ' Data ��� 301 - ROUGH PLUMBING
OWNER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby aRml under pppwy of perjury,one of the following d«leruionso
303 - ROUGH MECHANICAL
° 1 heve'Ad will'tottintain a Certificate of Coount to self-imme for Worker'. 304 - ROUGH ELECTRICAL
Compensation, as provided for by Section 37W of the labor Code, for the
pado.o.of ane work for which this pemut is issued. 305 - FRAME
❑1 have and will maintain Worker's Compensation insurance,u nxiti e l by Seition 306 - HOLDOWNS
37W of the labor Code,for the O form .of the work'(or which this pemdt is 307 - INSULATION
issued My Wo k rot Compensation Insurance cartier and P.is numb arc 1.
.Lys r . .,.. _...
caner• +'f�j t.'tPolicYNo t30.8d; , SHEETROCK,_..
nCExrl— mennONOFEXEMPnoNFnofwaRReRsd % Ya'3'09I— EXIEItIORla1LF1TH
r. COMPENSAnONINSURANCE
(THlsxciati need not be coolleted ifhundred
` 311 SCRATCH COAT P
p y y n r so as
to for c dolls
n Jhe performance of the work(r wh .- '313 -"'ROOF" NIS I L " l . ..
P
)or less)
cmlry thea i' ich thts'permli a issue leml on"pe con Yntenne - become subgecl to the Work rt' 501 — FINAL ETRE CTR ICALENERGY
Appl ci evi.in.'
,°Lewe of Cahfomla.Da
m,. 502- ----FINAL .PLUMBING ENERGY-..---. ..-..-.-.-.
Com nsat o
NOTICE TO APPLICANT Ilefmr mak�� �amax,
Ezcmption.you should 503 - FINAL MECHANICALENSRGY
bdcome eubjeci m the Worker.CompeniIafior Code,you'niust
O moth.bbcomply wish ..Is mvisms,odeemed reveked. _.- _ 50.4....-_ .FINAL .BUILDING ENERGY_
_..
CONSTRUCTION LENDING AGENCY
L•• 1 hereby affnn that thema construction lending agency for the pedomlantt 505 FINAL ELECTRICAL
nrthe wk re hichhis pemftisissued(Se 3o97,Civ.C) 506 — GAS TEST
lander Addneu- 507 - FINAL PLUMBING
U=0 y"i.,
,tl sanity that I have need thus application and sum that the above information is 508 FINAL MECHANICAL'
ortae 1 epee to comply with all city and county ordinances arW state laws relating 509 - FINAL GRADE
O'U to building construction,and hereby maboiiss'agesentauves of this city to enter upon
W
the aW on.9edpropemr pecdonp pp 510 - FINAL PLANNING
_y
((WF):gree to tiF indemnify and keep h lesss the City of Cupertmo igeima
CA liabilwe ud,arm cost expenses which may'n any way accrue aganet said 514 - F INA PU IC WORKS
U Cit m sequenb fibs ung of this perm. ' ""
'ADPL UNU- STA, SgIVe WRL COMPLYGRrH Ai,L N INT I'r r
ed Ns Issued by: Date
i nemre ofApplica VContrector ". ? """"
she , r Re-roofsIf
"' Ye pp ad Che ter 4 12 and the H�th and 5 chmes nal '�'Pe of Roof. --
URE
Code SWO he ejJl woto for re buadi g t\ r+ qui y f k
RIALS DISCLOSURE"
occupant store dr handle
p p
a;define th Cu mato Mum�lC ' - p .-
' WilltCp Ic alw Nre building
3 lk' 1� p k FA
I ° ' All roofs shall be ms acted nor to an roofin material beingnista
n aapa t e ipm nt or devices which If a roof Is mstalled without first obtainingan ms echos;I agree to remove
nth uxdous all contaminants adefined byth Bay Arca Air Qualfly Management
Dlemn^ _ all new materials for inspection. Applicant understands_and will comply with
( � °Y" $"": all non-point'sohice regulations,.
`✓,-/' ' I habe read the:hinudoue materials regmremeht'hnder Chapter 6.95'of the
6hromu Ninth&Safety Coda Sections 35505,25533 and 25534.1 understand that
i(�d� l Winnam the it ie my rnpon.ibiliy eco notifythe be met poor to issu sec of a Cenificam bf
Signature of Applicant Date
r wmr or authors
d oared age m 2 All roof coverings to be Class "B" or better
OFFICE