01080121CITY OF
PERONNO
DPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
1598 POPPY WY
HALA SHOUKRY
01080121
OWNER'S NAME:
APPLICATION SUB DATE
HALA SHOUKRY
08/24/2001
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LI L7 I__J CI
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby a(6roshat 1 am licensed under Prat isio u or Ch if er 9 feommv,cing
with seenm7M)ofLitman 3ofheBmira,mdPr°a..ion,Code ,and mylicense
KITCHEN & 2 BATYRMS REMODEL.
is in force and effect.
urease Clercs Lir. a
pC O N A � ®
`Ul
Date Contractor
0— 9 LL�
ARCHITECT'S DECLARATION
1 undencwnd any plans shall he Lined as public records
_
J L
SEPZOQQ
Licensed Pmfcssitard
OWNER -BUILDER DECLARATION
I horm, affirm that I am exempt Iron, the Contractor', License low for the
following reason. (Section 7031.5, Business and Pmfcssions Cwt Any city or county
BUILDING
improve. eemolish.
$70000
which requires a permit to coot.. altar, or report any swrat m
-print t to q thepplcut! uch perannm fl inedstmement.
thin he I - JI : imth profthe C t tis Licenseft.mmi
Sisid.00000 Division i f B ' Professions CoJc)
CC? "•: *-3'�� fb fir: f,�;t'v � ', 5. b;; 4 i�
• Valuation
(emor tic ng with of the ss M add)
or that he is exempt themf.. and the basis for the alleged eiempuon. Any violation
L
of Section 7031.5'by any applicant for a permit subjects the applicant m a civil peoalty'
•of not moremunfivehundred dollars (5.5(X))
10PPL' DATION
t , Occupancy Type
° I. az owner of the ProrenY• or my employees with wages as their sole com%asatian.
�
will do the work. and the structure is not intended or offered for sale (Sec. 7041,
Busines, and Pmrensi°as Code: The Coatrat°r's Liccow Low does at apply to as
103
— UFER Required Inspectionsh.'
—act of property, Who builds or imprm'es therm t. and who does such work himself
10 4
- REBAR
_ or throw his own employees. provided the. such improvements ve not intended a
'nrzema
_ -
rroar ifhowthe sitlacingortmProvertmnrissold withinyear of
'illi
105
— ANCHOR BOLTS
complt a nenbdld a the buNennf,mvntg that he did at Wild or
mpro pmawof 11
106
— SEWER SEWER & WATER
.azo ner of the pmpcny. .elusively contracting with licensed °tmetors to
2p2'
- UNDERFLOOR 'PLUMBING'
emrstruct the project (Sm. 7044, Business and Prnrem,ons Coec:) The Contractor's
License Law does not apply m an owner of property who Wilds or improve dreaeun.
2 0 3
— UNDERFLOOR MECHANICAL - ' '
and who contracts ror.sunh_projects with a contme,tons) bemosi po mat to the
204 '
_' UNDERFLOOR -FRAME
Cant.curr's Liana low. roto.
❑lam exemp Lige. rsau. '' .B& PC for this reason
205
- UNDERFLOOR'' INSULATION
owner CUMPbNb
301
— ROUGH PLUMBING
- I[ONU
WORK R' COMPENSATION DECLARATION
302
- TUB & OR SHOWER
uereby affirm under n<rn,lty of i+rri,'n;'ince qr me rmmwmg ercmmtians:
303
- ROUGH MECHANICAL
° 1 have acid will n;,airimin a Cerificite'of Concent to selfuntim for win«;
304
- ROUGH ELECTRICAL
Compensation, as Provided for by Section 37W of the Labor Cade, for the
perom,ance of the work for which his permit. is issued, U.
3 0 5
- FRAME
° I have and will maintain Wodcr's Compensation Imumme, as required by Section
3 0 6
- HOLDOWNS
37M of the Labor Code, for the performance or the work' for which this permit is
',
3 0 7
— INSULATION
,.tnaed My W k r a Co % I 1 mace c d Policy number ore„ „
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a' I l.. .. •:
308 i.-;.SHEETROCK
e
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Camera s't P°IicyN
( CERTIFICATION OF EXEMPTION PROM,WORKERSA
i•7• .,
t -' ' '3 0 9'
'EXTERIOR;LATH •
„
COMPENSATION .;T"
._...;-..,._., roto •• roto roto "".! roto.
_
- 310. -'1;
i
-
-'"INTERIOR -LATH--'• \)'-,;U Tti',:;�}
p10N
''' frac permit i'foram hutMrcd dollars
iThiixcti"Wited obeemn le
311
_ •,L :,. 1'"'
— SCRATCH COAT '
isiBBl m .)
..
'
-313
•.• •
- ROOF NAIli 'a-
1 n (Y Ila, ane pgrf rat l the tk f M1 CM1 ih p2 l'
shall Lit o"fy any,pe n'nanymarine-mastribecame b)anotheWurkrn'
501
-
- FINAL EDECTRICAE'`'ENERGY
Compsn cmd Lawa pfeprramia. Date -
-APPlicant .... -,yn roto...... roto roto.
502
.
- FINAL PLUMBING -ENERGY -- -
NOTICETOAPPLICANT.If.aftcrmuklnS this Crnifcam of Gxcnnpti°n, you sNmlJ
's
503
- FINAL MECHANICAL'ENERGY
become subject m the Wo'rkdi Co.pensvuon Prnvi of the Lafior Cale, you must
Tann~ithcomply withor ravisionsarmisp ma Shaun a mere.akm.
504..-
FINAL BUILDING .'ENERGY _.
•' 'CONSTRUCTION LENDING AGENCY' "' -"
505
— FINAL ELECTRICAL -
','' I hme6y aRmi that there is dmnswnim lending agency foo the lierfolinamm-
6rthewwkfor which th;r perms, idi,xugq(Sm. 30w7. Civ. C.)
506
— GAS TEST
'Lender's Name- '-'. "' ' " . ...
Lmdcr•andpk,'•.'.' ,•
507
roto .. .__
— FINAL PLUMBING ..
'I sate information
5 0 8
— FINAL MECHAN I CAli
.1 Certify thathave read this application and that the above is
Earrmt: l agree to comply with all city and county ordinances and state laws refine,
509
— FINAL GRADE
to Wilding construction, and hereby amhaiiie iereeenmtives of this city to enter upon
the above.mentionadproppny for inspection purpinc,
510
- FINAL PLANNING
(Wt,) it. or save, indemnify' and keep Wood. the Ciry' of Cupertino against
514
- FINAL PUBLIC WORKS
liabilities, judgments. cost, and expenses,which may in any way acme against said
City in um,equcam of the griming of this permit.
APPLICANT UNDERSTANDS' AND WILL COMPLY WITH ALL NON -POINT
Issued by:
Dale
Re -roofs
ViAsy t a ., D m
P.no'
. . HAGARDOUg MATERIALS DISCLOSURE
: ; h
'.' Wil the applicant fat bu10 B Pato handl hta duaz mater,]
Type of Roof---
aw definedbythe C.111noMunicipal Cale Ch%e 9.12 andh Health and Safety
- `(•
ro to. a'�t
t ) i i %-I dJtu `
l •." ,` :. •. t
Code. Section 25532(riy? f sry 's !,.';+F/,roto
All roofs shalLbe.inspected,poor
[o.any, roofing material being installed.
.,cyc,,
Will the pplicant future Wilding occpant use equipment devices, rich
If a roof is installed
without first obtaining an inspectiori; Pagme'.to remove
man hurardms air contaminants as defined by he Bay Area A r Quulip Management
.iron : roto
all new materials.
for inspection,_ Applicant_ understands and will comply with
., ,
°Ya` ' °No
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,Chapter
-
all non- oint source re ulations r`, •,
P g J
1:
1 have hodthe haiardnus' materials requircmenti'under 6.95 of the
roto,
Calirmam Hwlth'toSafety Code.'Sections 25505.25533 and 25534. 1 understand that
tithe building does ma currently have a tenant, that it is myresponsibility m notify the
�'utpant of rhe requiternerai which most he met prior to issuance of a Certificate of
Pa ' , �• '' � `n � "' • •
Signature of Applicant Date
roto. roto roto
' "
All roof coverings to be Class "B'• or better
�,
Ow cif° drained agent' 'h;' - Dam
into.. roto roto i roto roto... lOFFICE
roto roto