00100161 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRILSSI PERMIT NO.
7998 WOODLARK WY 001.001.61
OWNFR'S NAME, APPLICATION SUB DAFE
BRADLEY CYNTHIA M 10/24/2000
PHONE, SANTT I'ARY NO. COMFROL NO.
O C Z ARCDRIiC1 IENGINFER: - BUILDING PERMIT INFO
sur m O BLDG ELECT PLUMB MITCH
Ga� u u o Ci
,9 z LICENSED C.ONI'RACFOR'S DECLARATION
z 1 h,rebv:mirm Ill.,Icor hill, en.mdcr prolmonsof Chatterer(I...unicorn, Job Description
Fv_w with Seclion7i)(Nuof uimdon 3ofine loinexsnnd Net...on,Code.Tied to,license
�eewl isin
C force Jeffc`u HLA y, ` REPRIR CHIMNEY STRAP AND REBAR AT ROOF
,up Uam��f1CnnlruOor_LL
ARCH]'I'ECr'S DECIARATION
I undemmmJ mY Plans shall be used to public Acted,
u6xi hirenscJ Rnfcaiawl
%o a that I a.BUILDER DECLARATION
ry z v: 1 hereby all levo that 11. .business
Iran the Cessions Co :Anne law for the ^�
Z followwhich'ingreason.(S«tioncont5,Rusiter. and ve.derions Calc:Any city or county vO
S s C which require.a permit to a.nswa,cher,improve.Demolish,or repair any swnum
a3- prim to its issuance.also requires the applicant for such Wrmnn
iGlc a signed statement
that he i,licensed pumammtheProsaioneofthe eontraeornLicense,Law(Chapteq Sy. Ft. Floor Area � Valuation 1500
mo�n ietcing with Section 70cf)of Division J of the Buni.reas and Professions CMd
or that he is exempt therefrom and the basis for the alleged cxmnplion.Any vinlmion
of Sm osrr 7031.5 by any applicant for a permit subjects the applicant to u civil penalty
ofno, nno.Ill..fit ehundred dollarsf550(M APN Number Occupancy Type
01.as rw net of property.or my eniployees with x-ages as their sell,compensation, 36204H034. 00
will do the work and the bra lure la not Intended art offorel for sobs(See.71W,
Business and Professions Code:The Contractor's License sew doe,not apply R.an Required Inspections
owner of property Who bolds or reproves thereon,and who does such work.himself 101 — FOUNDATION
or through his.ren enploy.ms,provided that.such inipr venmmx art not intended or
offered for sale.Ir,h+meve,the building or mWn°vemenl is sold within Inc rear of 312 — CHIMNEY REBAR S STRAPS
completion.the owner-builder will have the humen of proving that he did not build or _
intprTfor pa'pf,eafedc.) 514 — FINAL PUBLIC WORKS
01,Ticoaf the no pent',am exclusively eomrmting wish licensed cornmeal,m
h
nnael the project(Sea'.71114,Business and Professions C dcD The Commctor's
License law does not apply m an oo ner of property who builds or improves themn.
and who mmmcn Tor such projects with a commcmHs)licensed pursuant to the
Comes, r,License Law. ,
0 l am csempf under See .11&1'C fix this reason ,
Owner Doe
WORKER'S COMPENSATION DECLARA'nON
•_ 1 hereby affirm under pcnuhY of perjury one of the following dedmatlnns:
❑ I have and will n.2mlxln n,Cadlicme of Consent u.velf-iomre for Worker's
Con,wroalion, as provided for by Section 37W of the labor Calc, for the
perfnrmne,c of the work fill which this pemtit is issued.
0I have and will illusion n Worker's Cmmpcnention Insurance,as required by Section -
370()of the labor Coln,for the performance o1'the work for which this pooh is
isaed.My W�c� n aawemce c:rriv;,,It l policy nun loer or:
Currier:S � Politylso:14w ir" M 1
CHR9_LICATION OF E%IINTIN[ON FROM WORKERS'
COMPHNSATION INSURANCE -
I He,reel.....teed on be entnplated if Ileo permit is for Inc hundred dollars
S I bit nr less)
I cct ity.hut in.he odonn:n.m of the work lar which thus Penno is is%ua 1.1
'hull not employ any person in Tiny.uunner so its its bcnmte subject to the Workers'
Conamn,ute Eases of Cahill ill Dwe
Appliaam
NO[CE TO APPLICANT':II;do,. 11,11,H.,this Cndfcum of isen.ptiun,you nhnuld
Z hecumcsuhjn',to l he Wndmi Cn.nl"oulit pre
e . ,of hUlster so.Cndu,yl m
u . e.
Q O R.nhwl.l..c..nply wlm Inch pro oun..or.hi,inrnit'rdl fedeuaed m...ked.
z
F r✓ (:DNS I RUC ono LENDINGaten AGENCY '
a > 1 Lcmhy nlhinn that there iss csued(S Ian 3097:nµagoney or the Iwrfnr.nunee
W ol'the send fix whi0h thin Penni,is imncJ(Sec.3097,Civ.C.)
n. Lender's Name
� z
z Lender's AJdrens
V C) I comfy.hau utnwc rad this upp wanne and'tate fell.he ubove i eorncloon is -
W E'
correct.1 ague IT cmnply with all city and county mdinanees and state laws relating
V ,,building nrometion.and hcrchy full orirc repreve'ltmivcsol.Itis city to enter upon
the above mmohioned property for inspection purryo—
F. y (We)agree it)save.indctnnily and keep harmless the Cry of CuPerienaguins
rA liabilities,judgment..cuss and expenws whteh nmy in Tiny x'a,retire ll ire.said
V Z. City inn seyucna of the gem.ing of this pl'CO
S rrI .NEO,LDERSTAN[)S`=—ND WILL COMPLY WII'HALL N�OR;OIti� IgtinCd by: Date
__- I6
S�gnauhrc m'nppbm9ARD Dale Re-roofs
HAZAZAIIDOUls,S MATERIALS DISCLOSURE
Sandi
Will y t e Cutirlo,Muni:pal o e,Culu 9,12,and
the
hmzrdnm material Type Of ROOF
Code.Sed by the Cupeninn Municipal Calc.Chapter Y.12,and the 11e:Jlh and Salify
Code.Section 255R1:t1° - -
0Y"' <°i All roofs shall be inspected prior to any roofing material being installed.
Will the applicanrtn Whom buildingaeupaut use rctoomm or device.which If a roof is installed without first obtaining an inspection, I agree to remove
emit hmarlous air contaminants as defined by the Bay Area Air Vu:dily Management
Di,tden all new materials for inspection. Applicant understands and will comply with
O Yes all non-point source regulations.
I have mad the harurdn s materials oruirementa under Chapter It of the
California Health&Safety Code,Sections 255115,23533 and 255)4.I understand that
if the ildi •docs nor currently have o minor. hot it k my ne"nnihility b,notify the
he requirements which must be neat prior m issuance of a Certificate of
O .
Signature of Applicant Date
JUr Tit or.eed agent Date All roof coverings to be Class "B"or better
OFFICE