00120074CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRISS:
PERMIT NO.
N
FRANCES J00120074'
OW NER'S NAM1}1!.
APPLICATION SUB DATE
12/12/2000
1 PHONE mush i I TSANITARY
r
NO. CONTROL NO.
ARCHITECT/IiNGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�I �J L. IJ
LICENSED CONT'RACTOR'S DECLARNI'[ON
I hereby ffir1
Job DBSCrIp[IGn
that
vm rosion. of
an licensed under Pencil Chapter 9 (commencing
with Sell 700) if Division 3 of the Biomass and Pmfcssionn Cade, and in, llcenne
tall force and eRecL
Lin
icense Class Lic. N
ADDITION
Date - c'nnlwnol.
LAR
DECLARATION
ARCHTI'Ithe
' 1 understand my plans \hall ha riw'd as
use ,TIONS
G `�
'
Licensed Professional
OWNER-BUILDER DECLARATION
1 heream by affair that I tnentre
hpt from the Concmr's LiccmLaw for the
't O p ,
1e
JUL
Inllowing reason. (Section 7031.5. Business and Prefespose, Cade, Any city orarianty
L L1002
which myoim, a permit ill comlman, alar', in.pnrvc, der lith, or refill, any nlmature
prior to its issuance, alt, rcyaire, the ttpplivaatt for nu. Ift permit Ill ti le a signed statement
Me
(nut he is licctucal phoornl,dre pmvl.ians of Enc Contractors License Law (Chapter y
S Ft. FlArea
q' Floor
Valuation
(commencing with Section 700) of Division 3 of the Business and Protessons Coln
or that he I, exempt thcefrom and the basis for the alleged csemption. Any violation
-137677 .
visceral 7031.5 by any afplicant fill a permit subjects the applicant to a civil penalty
of no, more man Fee hundred dollar. ($588).
APN Number
Occupancy Type
-Las owner at tat Profen, army employ, with lung,, as men sole compcnsefon.
^tu.
.
will do the work, and the structure Is not intended or alfercd forcall(See. 7044.
Required Inspections
!home, and I' t... into Ctbe:The Contmotortru . Ueen,a Law does rill apply Ott
lune r of property Will) builds or improves thereon, and woo docs such work himself
provided that such pnrvancros arenor pleadednscar or
,at through his own ent,loychowever,
alffirM for Buie. t
however. the nuilve or improvement is within one year of
101 —
FOUNDATION .
a t
the owner-builder will have the burden of proving Elia he did not build or
op that
im$pmol,
—
PIERS
for
pmva rat purpose of aa1e.1.
1,02
❑I. as n or he iroplere,a .elusively etnhtraeting wml licensed aontioctoanm
she 4,
103 —
UFER
proios4See. 70 Business and 11 b...en. C.nlc:l'Ihe Commctnr'"
1, 04 —
_
REBRR
,cnamel
l e Law doe mil aptly to all owner of property who blikk or improves thereon.
'who
and anomer, lot such projects with a untmctm(o licensed pur:nate to the
105 —
ANCHOR BOLTS
Contractor', License law.
B A P C far this faun
❑ la?�"
106 —
SEWER & WATER
Gw"atew•ol
202
UNDERFLOOR PLUMBING
DJSAI'ION DECLARATION
_
21213
UNDERFLOOR MECHANICAL
mare, aterat under penalty of p,Uiry one nr me rolawing dcel.........
�1❑ I have and win maintain a Certificate' of Consent In .ell :insure lar weaker.
204 —
UNDERFLOOR FRAME
Cbnpensadan, a, provided tar by section too of he [,all Code. for he
205 —
UNDERFLOOR INSULATION
perfornaace nt Elie work for wni<h ton fcnnit is issued.
_
301 —
ROUGH PLUMBING
❑(have he Coain N'nbe Le Compen.atif the wnnccl hick his permit Section
?91X1 of the labor Ctde, Ina hoe perfnnnansx of the Ink far which this permit is
302 —
TLB & OR SHOWER '
issued. My Worker's Ctnnpencution Insurance currier and Policy number arc:
303 —
ROUGH MECHANICAL
Cartier: palicyNo,
CERTIFICATION OrEXENIMION FROM WORKERS'
304 —
ROUGH ELECTRICAL
COMPENSATION INSURANCE.
- 305 —
FRAME
(This section need not be completed if the permit is for one hundred dollar
(M(M])er lesa.l
306 —
HOLDOWNS
1 cendy teat in me peAommaoe of the weak rill which ads perms is issued. 1
307 —
INSULATION
sn.Jl riot emptily any person in any morns, so as to beumm sohicet It the Workers
Compcasatlan Laws of California. Date
.
308 —
SHEETROCK
Appllcam
NOTICETO APPLICANT. If after mating this Carl onimmption, you should
309 —
EXTERIOR LATH '
Compensation provisions oflhe edearned Code, you nae
forthwith comompe pto ly 'with such
p y wi is Co nna omian perms shall be Jeabor revoked.
310 —
INTERIOR LATH
CONSTRUCTION LENDING AGENCY
311 —
SCRATCH.COAT
I Ill mean that there i.aeou.traetmh lending agency for the t„•rrarman.e
313 —
ROOF NAIL
it he Ind. Ill, which holler it is i,,mN (See. 3097, Civ. C.)
Le�aer Name
501 —
FINAL ELECTRICAL ENERGY
I certify that l hale read has application and state that the above information is
502 —
FINAL PLUMBING ENERGY
correct.I agate m comply wart all city and county ordinances and vats law.matting
503 —
FINAL MECHANICAL ENERGY
In Wilding c... motion. and hereby authnrirc lepre,ch atives of this city m enter upon
bLOb(We)agreedpropnyrlard, ndoripar""`.`
504 —
FINAL BUILDING ENERGY
It I.. the City al against
( g I,ays dm Tmor,
w'T
it ,Ip t.cnt 1 f lastrin y my way bma said
h 505 —
FINAL ELECTRICAL
City
City in tonne lust a of the flaunting ill' hi.. trial
APPLICANT CIE TA DS WILL LLN N-pi
SOURCE RE '_
Issued by: 506 —
GAS TEST
t�_
ate .�
_
Signature of It canVConmem, Dam -
Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
—
FINAL MECHANICAL
Will Ill plical furore building ovcnpant maro, handle hvanlous maetiul
,508
'Type Of Roof
tri
as defined by me Cupertino M1 u pm C.ntic, Charter 9.12. and me Health and smtty
crude.
509 —
FINAL G RADE
soaimh 25532myr
�No
DVco
w,u me appheam 9r rmure huileagtx¢apam a,r cyaiptnem par Jecir<, which
All roofs shall be i te7c p ��rly P NNING.
r at�r. installed.
Ifaroof is installeeP �lhout �ecYi'bflgree
mit hazardous air mntamita hsaz defined by the Bay Area Air Vualiry'Matngemcm
ts�hfi�lsini�i' to remove
'nintri"'
O Yes �;�a
all new materials for inspection.
n
nn
Applicant understands and will comply with
all non-point source regulations.
under Ch:yver h95 of the
I have rend the ry,
rcyvir5533
dur Stncty, Code Sections
Care. Serious h
3, enA nanf that
'
it the buil ingIficoff
in amount.
building Jtws not cunemly lime:uenunL that it is my rcptnhnihility m nosily the
that it %,oras ly to
occupant
ecupam f the reyuiremvnu wp ch must b met friar m Issoxnac of Cenitica¢ of
(kcupan n /' I ,
(p,0,)
Signature of Applicant
All roof
Date
coverings to be Class "Bo' or better
owner r u im reed agent - Date
__/ OFFICE : , '
J