02070198 "CITY OF;CUPERTINO
eumntNc DIVISIO vCONTRACTOR INFORMATION:
PERMIT -... -
;_
- BUILDING ADDRESSPERMIT NQ's"''
10082,.,SENATE WY ''` x 020701'98
OWNER'S NAME: .. .. - APPLICATION SUB DATE
SHIRLEY SPARKS 07/30/2002
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PHONE: SANITARY NO. CONTROL N0,
p.re zO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
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H pp BLDG ELECT PLUMB MECH
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y= LICENSED CONTRACTOR'S DECLARATION - )Ob DeSCIlphOn - - -
Oz'-�e 11, affirm lh«Iam lmen.m nna<r pppp igmng ar chapter 9(commenang INSTALL SKYLIGHTS (DINING RM)
F=try wish Semioos as)'of Division3ame BuslneypnJ Proressians Cale,and mylicenu
<y X is in Poll �effe�c�.� � ]J
«O<� License c1 -L]—E1-t t" Uc.a p,p ,p, tf
• con ��BMbW ttaE®
'�3 n• SCI ARCH'TECTS DE ATI
"-- g 1 undergmnd my plain sh II be usc0 as public..cords
SaoS -
LieemedPoe,ocoul BSEP 1'2 2002''
OWNER-BUILDER DECLARATION
�2, 1 hereby affirm that I am exempt from the Contractor's License Law for me
C?<
following reawn (canon 7031.5.15 Business andimprove.
P . m Cady My city or county -, O O
E F O which rtqu res a perm[t construct,slur,tmpm demolish,o repair any.fact ' S 1 1IN
C g!
°ui3�, " privet ussuaac lu re9 mg thepplicmt f hpewlt to Fit smmmem 60
math! sl acnsedp puam to the pm moons
or
C t t/,L V (Chaps 9 v OC,,pp,��ea VaIUBIlO❑
(uo mncmg with.5en ]IM,O)orO n, J hh B 'nc dPr"tea tons Cea)' t t,.' 13215'JVCJ,'7^. 17,17, x .
oothat he a e9 rc therefrom unJ the baso for the alleged cxemPlinn AnY violation -_. . .:.. ... ..... ... _ -... ...._... ........._ ... .... _.-_....-_ .. . -.
of 'coup]0315 by any a,,I cam for a permit nubjeok the applicmt m a civil pcnelty-
.r
layout man,man file hundred dollars a50B). - TOlAPNP� ATION. . cupancyType
❑I ow of propcnY or my employees with wages as mor vole compensation, - " t )' ' '•
'well do the winftmd'drc rWCm.I%oft-hommiM of'ofRned'fee Sale ISec'70fa -
IBuslness:and'Professionz Cods:The Convectors License Law does not apply in an - 103 - UFER Required Inspections •:L +'= -
owner of progeny Who build.buildv Or improves thereon and who does such work himself _ __104 _- _REBAR '
or through M1 n employees provided that h p em t. t intended or ....
-offered f l If he theWilding m p t s IJ `m ase year of. ...__ _ H ._ .._. .... .._..... . ___.. .. .
'complcrlon meow«rbalderwill have the wmenofproving that hedid not Wild or 105... ANCHOR BOLTS
improve for patpau of aide.). 106 - SEWER & WATER
psec. amexvirmasandPmnlne'wi de:)TheContmctato 02.. .UNDERFLOOR' PLUMBING ,ai';•rri
onxwcl the project(Sec.]044.Bminegs and Professions Code:)The Comrvaor's
Llcenm Lawoct,for splyman ownerth.emiyctimi licensed pursuit,
the 203 UNDERFLOOR MECHANICAL' '�'
.and who.con[rads Porsuch.pmjecu.wuh.a comrvnorts)licensed pursuant to the. . .. ......_.;204' -UNDERFLOOR -FRAME-------
I
RAME---- �-- --- — " '--
C mraaor s License Law.
I < asp nde,SB&rernrmi. aan 205 - UNDERFLOOR'II'rNSUliATION
el ' ' - .7 ' d'Oz- 301 - ROUGH PLUMBING
'WOR( SCOM ENSATION DECLARATION 302 - TUB & OR SHOWER
aher<ny,rrrm rd< nnany raj ry ash rml gd l runs:' 303 - ROUGH MECHANICAL
o I have ane'wlil m "c nificr f Co ent'10 B for Worker'. 3 04' ROUGH ELECTRICAL
x Compensation as prondea as
for by Section 3700 of.the Lebon Cddc. for me ,
pcifomlmce'or me w«�inn which mig permit ig iazaed; 305 - FRAME
❑1 have and will mal ry Workers Concrourcartiorthrourance.asmerited by Salon 306 - HOLDOWNS
3700 of the Lmm Cade f thepbkprm c< f thewink fo h ch this pemus Is I _
.:ad MyWorkersCompensation'h care 'a Policy umber ale 307" (INSULATION
carve
i''t i r. i1 .-, r -, ar 30'$ SHEETROCK:,.. :.,, \ h s ,•,
CERTIFlCATION OF EXEMPTION FROM WORKPRS' 5 i_�' 3 0 9 " EXTERIOR LATH
'� COMPENSATION INSURANCE } V'
31017--t;INTERI0R_' LATH
Cfh coon need not hcompleted ifine permit is Fo one hundred dollars
dyed.d 311 SCRATCH COAT
31,3''-.-_:,,ROOF'• NAIL
1 nfyth[in thepc'fo ce of II workf whih this stens d,l t "^ ^,t, _
fall not plymyP yiJp�y} "" subject N Workers 501 '- FINAL ELECTRICAL"ENERGY
Co pe wt, w_, rc1_ V Iat/glL�_ _ _...502___.FINAL-.PLUMB ING-ENERGY
.Appi --
;NOTI P r5"1-a gt - cnr<a� nrEx pilo Ypagnald 503 FINAL MECHANICAL` ENERCY
bee 1 n m tha Worker s C mpenz t p x of th<Labor Cad,you mus[
OHO form tI c oo,Iyw ithi so chymv.nnsnrhis pe ['hintbeaemee I evliked, 504,_ . FINAL BUILDING,ENERGY
E
-Vi 1 1 '." "'CONSTRUCTION LENDING AGENCY I'" 505 - FINAL ELECTRICAL
1 work
wRw that inert ifs construction lending agaw5'for the perfowantt
� 7
Limber's Adan., _ 506 - GAS TEST
tea= z507 FINAL PLUMBING
of the ork for which thispemmt t sued(Sec 7097 Ci,.C)
Q lid Nmc '-
V O
508 - FINAL MECHANICAL L
Icertify that acJtht t state that the bo fain nig
correct.1agree[ocoinply with city
and tyordinances
and.t t srelating 509 - FINAL GRADE
tobuilding cu.t alo anbyhum rpsemeuesofthis citymcn¢rupon
me above me t o M pmpenyforinspectionp proposes. 510 - FINAL PLANNING
L-46 I(We) dv Idi inspection
S ,
and keep h 1.s the City of Cupertino-against
CA liabilities.1 dg ms,costs and expenses which ay in any ay hccme againstsaid 514 - FINAL .UB C WORKS
J City in coneq cce f,he Bmnfng of thil nort r
APP( VUERSTIVIJS AN L MPIY WITH ALC V�VO V7"'
. cart or lmmVGomm " ' sued by Dar'
50th U:RL<,L:ERT IS
non .
P .HAZARDOUS MATERIALS DISCLOSURE 5 D��" ', Re-roofs
.. b Y a a p P t
Wit applicmI or fu bolding cups,.tort«handl haurd smaunal ...Type Of Roof_ .-- _. —...-. �. ,.,.-t>• ..- . ..,...".. .
'az def ed p th Cu n no M ase al Ch t 9 12.¢d th H ,Xlth nd Safety l- s I};�,-: s'r 1 1 t' i
Code Sor on 2SSa2le) ,I ) 4' ,� 9 k '�' t .
aye f AlI roofs1Shall bemspected,prior to any roofing material being installed
-
1, W 11 h ppin t' rat building p t ro p t a g h h. If'a roof Is msialled without first obtaining an inspection;lugree to remove
<mt Neva c1 tt t sdcfool byre ByArmAir Quality Management I 't
D m t [. all new materials for inspection Applicant understands and will comply with
❑Y r Il. - .____. _ ._
all'"' nt'source re '
1 h' d m h za thenal gdrt t under Ch Ater 695 of the
C 1 P H Ire&Safety C J Sections 25505 25537 d 25514 d de sand that.
dth building des not cummlY ha es a, tM1 t I my esW blty t,n«tfy the -
exc pmt of the rtqu ams xK ust t prior ro i a c qf.a CenOcF 1. ificam of '
° Signature of pp scant v Date
� re � All roof coverings to be Class" B or'better
�a M1 etl g tit , arc
..OFFICE. ... .. .. . . .-' . -. .. ._ . _. . . . .. . .