03080116CITY OF CUPEt2TIN0
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INFORMATION
BUILDING DIVISION PERMIT
CreONTRACTOR
Bm10wc ADDRESS:
MANSCH MICHAEL P AND JOANN
ERIT 3'03080116
'R'S NAME:
PERMIT ISSUE DATE
ryE:
1Job
SANITARY N0. CONTROL NO,
ARC HITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
E
0 0 0
LICENSED CONTRACTOR'S DECLARATION
9
Descri IIOD
P
I hereby affirm that 1 am limned under previsions of Chapter (commencing
with Saline 700LB of Division 3 of thc Business and Professions Code, and my license is
in full force and effect.
License Clam. Lica
NEW ENTRY
PORCH & WINDOWS UPGRADE
Dae Cuntmeon,
ARCHITECT'S DECLARATION
I he
a
164
understand my plans shall used as public records
�1' 7 L
)004
Licensed Professional,
OWNER-BUILDER
mDECLARATION
"firm Not I ore exempt from the Contractor's License Law for the
1 herebyreason.
1onstr Business and Professions Code: Any city or county
ire rcassa
which requires a permit alcor, improve, demolish, repair any minimum
which Permit
"uhreuue,
fi
prior m its issuance, also reqs as the applicant for such permit m f Ie a signed Chapter l
(Wmme cingwispursuant to
Sq. FL Floor Area Valuation
ortheBuaemnndPToff,onsCodt[r9
ion7"the )pmwamMnf
(commencing with Section ](Hold of Division 3 of the Business and Professions Code? ser
Net he is esempl therefrom and the basis far the alleged exemption. Any violation or
3 2 6 0 3 0 2 5
APN Number
Occupancy Type
P Y YP
Section 7031.5 by any applkant for a Permit subjects the applicant o a civil Penalty of
not more than five hundred delta. ($501.
❑ 1, u owner of the property, or my employee; with,wages a their role compensatlon,
101
�T nn
— DA �'eTgQ
will do did work, and she awewe is not intended oruRered for sale (sec. 7014, Business
and Professions Code: The Conlmctori License Law does not apply to an owner of
property who builds arimprovu thereon. and who doeuuch workhimselfonurroOhis
102
^r•• d Inspections
- PIERS
own employees, provided thmsuch impravemenISAM natimmnded oroRered formic. if.
103
— UFER
however, Lie building or improvement issold within one year afcomPlction. the owner.
builder will have the burden of proving Nat he did not build or improve for paRou of
104
- REBAR
sal`'/'
105
- ANCHOR BOLTS
❑ I, as owner of the pro,lsec. 704 am exclusively contracting with licensed contactors to
construct the Project (Sec. Business and Professions Cede:) The Li
10 6
- SEWER & WATER
<cnu not o an es thereon,
apply loan who Wildspursuant
themon,or's
202
— UNDERFLOOR PLUMBING
cowdocs aofproperty
r such with
ho c0mracts for such protects with a eontaclor(p licensed pursuant to the Contractor's Y—Law.
203
- UNDERFLOOR MECHANICAL
Iam estop, ser c. . k1&PP CCfM,hi. red.
204
- UNDERFLOOR FRAME
R's MPENSATIONDECLARTIONN
205
- UNDERFLOOR INSULATION
I hereby aim aoedr By of perjury one of the following den,sumo::
3 01
- ROUGH PLUMBING
haveand will mainainaCcrtiM.m of ConsenOo self-inmm for Worker's Cumpen.
101
302
— TUB & OR SHOWER
, se provided fm by Section 37M of be Labor Codc, for the performance or the
303
- ROUGH MECHANICAL
for whim this Permit is issued.
304
- ROUGH ELECTRICAL
ave and will maintain Worker's Compensation Insurance, ss required by Section
3] 0) of the labor Code, for the performance of Lie work for which this perm it is issued,
305
— FRAME
My Worker's Compensation Insurance carrier and Policy number an:
3 06
— HOLDOWNS
Cartier. Policy Ni
CERTIFICATE OF EK EM PION FROM WORKERS'
307
— INSULATION
COMPENSATION INSURANCE
308
- SHEETROCK
This auction need Out W completed if the ,in it is for one hundred dollars ($ l00)
309
— EXTERIOR LATH
or Iess.7
3 10
— INTERIOR LATH
1 certify that In the perromanec f I c sore for which Nis permh is issued, 1 shall not
employ any pc r 'emor, rep ohc cmbjecuo Beworte ' Compensation
Lew,afc.Ernmi
311
— SCRATCH COAT
re
Applic m
313
501
- ROOF NAIL
- FINAL ELECTRICAL ENERGY
NOTI APPLICA :1 - ngthisCenificaaofExemption,youshoultl
Wcom hien to @d Woh i ompc ¢Lion provisions of the laWr Cndc. you muss
ren it camPlywithmmPnnvismea rthi,,cMnitsh.RxdcLmedawkLd.
502
- FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY
503
- FINAL MECHANICAL ENERGY
I hereby affirm Nal there is a construction lending agency lot he Performance of
504
- FINAL BUILDING ENERGY
me work for whim mire Permit issued (sec. 30Y7, Civ. C.1
Lender's Name
505
506
- GAS TEST
— FINAL ELECTRICAL rl/.
Ln°"sA°01e
1 ttnee Nat I haw read this application and sure then the above information is
507
- FINAL PLUMBING
bonding 1 agree no comply with all city and county ordinances and role laws relating m
Of
banding conswnion, and herchy.athedm rcprnematiwsuf this city menmr Upon me
MECHAN CAL
above-mentioned prepcdy for inspection purposes.
(We) agree no aave, indemnify and keep harmless the City of Cupertino against
FINliabilities,
judgments. costs and estimates which may in any way sec. against said Cityin
%FIN
NGAPPLICANT
consequence of the granting of this Permit.
UNDERSTANDS AND WILL COMPLY WITH ALL NON P01
Issued bT
WORKS Date
5 URCE REGUL 1 S, s 14 T^�
(aj'kr5
Re-roofs
Signature or APIPEONY noon Date
H A MATERIALS DISCLOSURE
Type of Roof
Will furore building Occupantstoreor handle
ytheC,emser
Hearduusd Safety tlefiSetl by the Cupertino Municipal Code, Chapter 9.12, and the Health and Sefmy
. Oycyzss3z(a)+
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed
without first obtaining an inspection, I agree to remove
Will the applicant or tea Idiogoccupant use equipment or devices which
itha'rardom air contaminantsas it,by the Bay Area Air Quality Management
all new materials
for inspection.
itn't,
❑Yes
/qy�^!��
Ihaw rtaJ the has¢ turd $materials reyuimmcn¢undcr Chapter fi.95 of Nc Califon
nia H"lI ksafe1yCode,sem6..25315,25533and25534.1andb.udthuifthe Wilding
does not currently ha a mnank 041 it is my respomibiliry m notify the Oceupantlf the
to iamcn.wh m n met prArtoissuanceo(aCcrdfcamorOccupecre yarJ
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner
or sumo ed agent Datate