01010030 OF
CI BUI DINGUDPERTON PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS, PERMIT NO.
10340 MORETTI DRIVE SUSAN TRELEAVEN 01010030
OWNER'S NAME: APPLICATION SUB DATE
SUSAN TRELEAVEN 01/08/2001
PHONE: SANITARY NO. CONTROL NO.
COO ARCHITECDENGINEER: BUILDING PERMIT INFO
p BLDG ELECT PLUMB MECH
Z W I"—
LICENSED CONTRACT'OR'S DECLARATION
.5 n? Job Descri tion
z:G 1 hereby aRrm thm I am licensed under provisions of Chapter 9lcomnuncing NEW HOME: �B�].�BAc I V ING AREA, 400 F
mtw with Sex,ion9000)of Division 3 of the Business and Professions Code.andm license �p
c m y is in full force and affect. B tl
z a License Class Lie,p
O a u Dam Cormictor
3 a.u.Ci ARCHITECT'S DECLARATION AUG 0 6 2002
j 25
g 1 understand my plans shall be used as public records
io o Licensed Fmreasion,l
OWNER-BUILDER DECLARATION
tI hereby affirm that 1 exempt from the GmnlrnsC a Liccnsc Law for the BUILDING
t?< following reason.(Section 7(131.1.5.Business and Professions Code:Any city or county $181529
I F o which acquimz a pemtit to con.atun,alter,improve,demolish,or tannin my structure
t�3$,pdor vita iswunce,elutrtyuircarbe applkmtfur such permit mfik,aigredwrcrrwm• --- -- ------ — - --- -
E. m5r h<is,littn$d pdrsoeni to the povislons of rbe Contnctora Licenu law(ChaMcr 9 Valuation
.._ ... _
(commerictng wiN Sation tOtlO)of Division3 of th,"ity vend Professions Codc) c`(3NTO)f9` ` �",ai?�'tXF11 h:
or th,i he
n=aemp[th7rcfrnm and[h=basis far th<slr ed eaampibn.Any violation
of
Section".",by,ny applicant for a permit'objects the,pplicam m o civil penalty
id not mom than five hundred dnuars(s500), 101ApN rl��AT I ON ''""'' Occupancy Type
❑1,as owner of the property,or my employees with wages as their role compensation.
:will do the work,and the structure is not intended or offeredfor sale(Sec.-]044,'
Bnzinesi and Professions Cade:The Contractor's LicenseLaw does not apply to an 103 - UFER Required Inspections d"
or through
r of property Who builds m improves rberam,and who docs such work himself 104 - REBAR
or through his own employees,provided that such improvements arc not intended or
;offcrcd'fnr sole.If,however the building improvement sold within one f -�����_'��"-- -�� � -"�� �� -�- I,�-� -�_���--
gorurden of pro r=errs 105 - ANCHOR BOLTS
impose for pormasethe eofbsula.)r will have me burden ter proving that he did not hood o, 106 - SEWER & WATER
�1�JII mownerof rheprofsmy em exclusively comracting-with licensed contractors to -- '202 ' — UNDERFLOOR PLUMBING- i b'•'f - -'�—
Xonstrmt the project(Sec.7044,Business and Professions CWe:)The Committee's
203 - UNDERFLOOR MECHANICAL"
-
License Law Jens not apply to an owner of property who builds m improves thereon,
:. ,
.and.who contractfor such projects with a contortions)ucemed.parsnam.m the .. - --'2'04--' UNDERFLOOR..-FRAME. ...... .. .. . . _. .. . _.. .._. _.._.
Contractor's License Law.. r.,t• „
`. ❑1amcex'em.ptawl See.' '' ,B&IsCfor this rcason 205 - UNDERFLOOR` INSULATION
ownai5' �g`f Daps m 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby affirm uMer pepany of perjwy 6ae nnha following d=elxratmw: 303 - ROUGH MECHANICAL
❑ 1 have and will maintain n cemecam of 6mant'w self-in,are far worker: 304 — ROUGH ELECTRICAL
Compensation,as provided for by Section 3700 of the Labor Code, for [be
performance of the work,for which this permit is issued. 305 - FRAME
- ❑I have'and will tneinmin Worker's Compensation Insurance,as required by Section 306 - HOLDOWNS
e 37W of he Gabmr code,for the perfnrmdrtm of the work for which this Permit is 3 0 7 - INSULATION
issued.My Workers Compensation Insurance carrier end Policy number arc: _
- tir..;y, . :v. Nw: 308`. t..SHEFTROCK -
N.. :CERTIFICATION OF EXEMPTION FROM.WORKERSS d-h� • - ..1.r=i3 .'d•
a COMPENSATION INSURANCE_ b _ _ 3.09 BXTERT0R�4liATH• —
310;—= I;N,TERI OR 'LATH'
fTnts'anon aced nutbevompleled ifice permit is for one hundred dollars311 - SCRATCH COAT
(81001 rk sJ D_, i.
I certify that in[tie perfomtance of the work for wwhich his permit issued,) -' 31-3 ----ROOF 'NAI-LE
A I,L"
Snell not employ any Person in any mann= so as to become anbj et to m5 Worker 501 - FINAL EliE , TR I CAL' ENERGY
AoPpmplianeuonLawaprcararisDate 502. FINAL-..PLUMBING ENERGY. .. _ .
NOTICE TO APPLICANT:If,afmrm,kingthiq C'm'cate.,Exemption yon should SO3 - FINAL MECHANICAL ENERGY `
berome subject m Ne Workeh Compcnse[ion provisions of the Labor Coda,you must
O mrthwntienmplywithanenproviainnserrrainpermhRhaRxattmedre�ok, __ 504 - FINAL BUILDING ENERGY)
r,- - '1inb"'CONSTRUCTION LENDING AGENCY, `. - 505 - FINAL ELECTRICAL
1 herehyK' i that there .a construction lending age cy fo the performance
W.�., bfth= nrkm',hahth ,onfl,is,issued(s 305) Co C. 506 - _GAS TEST
Wid
o' er.AAddress +�. .- .-' - - � - 507 - FINAL PLUMBING
z
U , I eentry rho 1 have reed this application and ata¢[hat the above information ss 508 -FINAL MECHANICAL
W cF 46ncct.I agree to comply with all city and county,ordinances and sure laws relating 509 - FINAL GRAD E
O.0 a building vonswdion,and hercbitimhorim'mprcsemadveanrtniscity towine,open 510 - FINAL. PLANNING
>;D7 the move-mentioned property far inspection purposes., .,
` L (We)agrtc m save,indemnify and kttp harmless the City of Cupertino againn
Lrj V] liablties judgments, ser and epenes hch ynany ay _ gains)send 514 - FINAL PUB C WORKS
U 7U. C ne any n= fthe grat goftht p< r - " 602 OF NAIL
U WILL COMPLY WITH ALL'PONPOR+T" Issued� Date /��-2 LpJ
APPLICANT UNDERSTANDS AND ,
-_ _ SO EGULATIr�NST�_
SigmtummAppliewillcom�meeno .,.,� .Dam Re-roo�0 - ROOF IN-PROGRESS
„ -i; 9 �HA]ARDOUS'MATERIALS BISCLOSURE t;' ' '"' 1
•" WiII hie appl'cmt or hwe buldidg 6c Pant store or handle harmd.mneml Type of Roof.
as d f red by theCatan no Meant Code Charter 9 12 vin the Health and Safety _ - - t• 1
Code Sau 25532(a) I] G. t r^ r, '[6[ a (Yhv 1-y>_yj n j 4 {- IY; •.•-i4 is
❑Y« . .. 1 , N „ e- c . ., 1 „All roofs.shall.be.inspected-poor to-any roofing-material being installed.
Will the spplicnm or future handling occupant use equipment or devices which If a roof is in$ialled without first obtaining an inspection;I'agree'to remove
emit briewil is aircontaminants as defined by the Bay'Arm Air Quality Management
DtaWeta all new materials for-inspection.,-Applicant understands and will comply with
R ,p �Yt �.;. ., °,. all non-point source regulations:,_
sfC� tl
hawe read the hazardous matedid, q emen[s.wide,61apter'69 of the
California Health&Safety Code,Sections 25505,25533 and 25534:1 understand that
ifthe building does not cwmn0y have a mount.that it is my responsibility w notify the'
occupant of the iegoircments x4ridh'must be me[prior m[sumer,of a Cenifiiane of
°""p/f[�[ay' ' rri2 Signature of Applicant Date
Owner or euthnrizcd engem,' Dine„ s All roof coverings to be Class "B" or better
OFFICE