02060077 CITY OF CUPERTINO
C BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
I BUILDING ADDRESS:' PERMIT NO.
20128 R DRIGUES AVE R & Z DEVELOPMENT 02060077
OWNER'S NAME: A PLICATION SUB DATE
/ CAMPO DE LOZANO L. P. 21771 STEVENS CRK BL #10 02/28/2002
I .,'HONE: - SANITARY NO. CONTROL NO.
(408) 252-1101
O O "ARCHITECr/ENGINEER:" BUILDING PERMIT INFO
BLDG ELECT PLUMB MICH
I— C J
Z 5 y=" LICENSED CONTRACTOR'S DECLARATION Job Description
O Z_ 1 hereby affirm that I am licensed under Provisions of Cbapmr 9lcommencing
Fm_;with Section1000)ofD 3of,he Business n lire
nu
pq� .i,mrmlto ameHer, TOWNHOUSE-LOT 3 #B
�o y.0 j�p„�"`�� c`'na � LIVING SPACE 1, 998 ' GARAGE 444 '
3 to HITECISD' SEE ORIG PERMIT 02020113 FOR FEES
I�y0 S � 1'u der and my plans shall be uses publ rd. C t A p
W7 r N
-p O Licensed Professional
°' ` OWNER-BUILDER DECLARATION
t� V 't hereby affirm that 1 am exempt from the Convector's License Law for the APR 1 7 2003
CZ following mason.(Section 703IS.Business and Professions Code:Any city or county
I F 0 which requires a permit m consumer,aper,improve,demolish,or mpair any structure,
3� _prior to us k5suavice,also rtywses Ne applicant!orsuchpumit to fileasiAned ssatenteru. .. .. _ . .
tlUst hgls lion;l pursbanl to the pmvsrom of the Contractors License Law(Chapmr9
! ,S9` pp FtG Flo r Area u_blelllatiM
(ommchcioQ wnh Section�701N1)of Divisian3of the pusings end Professions Code) _( . 1 i > 1 '1.� { {kr diddB�B�Y�I
r or thus he ix exempt meief inm and the husi.,forme allegeG csampuvmh Any violation so�}� It`if I, < ,
..of Section 703 IS by any applicem for a permit subjects the applicont too civil penalty-
:of dm more than love hundred dollars(5500). AAPNN N rub r . . . . Occupancy Type
3693'41 b60
"D 1,as owner of Ne pmpeny.of my employees with wages as their sole compensation,
wllPdo the work.-mad the'strucmrc is no,intended or altered-for sale'ISec:7t3L1;' - - ----
Business and Professions Cade:The Contractor's License Law does not apply to an 101 - FOUNDATPdWired Inspections,- it"
owner of p,a,,,y Who builds or improves thereon,and who does such work himself
or through his own employees Jed that such im '
.prom proiii solsarenot intended orPIERS-,.... -.____.__._._..__..._
oRved for sthin M1owevB the W ilding e I impmrcmini is sold within One year of —”— -- ---—' '
'sY a provean,NeownenWildcrwillharcthebuNenorpmvingthathediJnotbuildor 103 - UFER
imp f p ryou of sale 1
_.__ . _ ____ 1__1t).4_._7., REBAR
t o e P the P(Sol.7 um Basin ly c toff'Mill licensed- c m,o -"
' ono t thep Sect(Sec 9041 Bus nc and Proles.bras con'T The contractor, 105 - ANCHOR BOLTS
ants law does non appI to an ower of property who builds onmpro...memon _ _ 106___-_ SEWER & WATER - __ _
a raw csLtsefo�Wu h pro3 wW.a.cootmctort0 licensed pununnrm Ne
202 - ' UNDERFIOOR, PLUMBING
E. B � ` a'on 203 - UNDERFLOOR MECHANICAL
Owar IPENSATIOND.CLARATI 204 - UNDERFLOOR FRAME
I hem afErm ander pew!y fperjury our f he following decelarnion:r 2OS - UNDERFLOOR INSULATION
301 - ROUGH PLUMBING
{{ D 1 have and willrmuiuman''a'Cenifieate or'Consent to self-insure for Worker's
Compensationas provided for by Sect00 ion 37of the Labor Code: ter the 302 - TUB & OR SHOWER
p<rformanen of the wo,k for which his parmit is issued; 303 - ROUGH MECHANICAL
D l hde and will mainmin,Workers Companscam.Insurance.as tryuimd by Section 304 - ROUGH ELECTRICAL
• 37M of the Labor Code,for-the performance of the work far which this From,is 3 0 5 FRAME
issued.My Worket'i Compensation Insurance Cartier and Iblicy number ore: "
CS" -t:CERTIFICATION OF EXEMPTION FROM WORKERS -
.r -, CQNIPENSALTONINSURANCE ',+--:� _ 3.07 - INSULATI'ON
"Gbissciionneedno,becmmpleteJifthepcnnitisforonehundreddollam 308 ."-. SHEETROCK
SHih rine.) 309 - EXTERIOR LATH
'i' thin parr a rat rwhm t o�wrsi _ __ 310 INTERIOR:".LATH ..ai;,,,,
'shall nn n I ahf'ni ray a ° 311 - SCRATCH COAT `
Appl. .. .- _. ....-.
^bNiiou a tgthscrir 1,ofEseopto r .ihoala _. 313_._-.._ROOF_.'NAI-L-_._-" --- - -..__,,.. ..,.., 1. I___.._ __ .._
fwc n vat t c B p rax of the Lb Critic,you a,,
501 - FINAL ELECTRICAL ENERGY
O O fdOba faith comp y will,. h p o sio s or th s permit shall be deemed revoked.
_. _... 502 - FINAL PLUMBI-NG'--ENERGY -
"1 eChatNSereis.1oN artimslic-AcegCr 503 - FINAL MECHANICAL, ENERGY'
- 1 hereby hick that there g s coued(S I d'ng regency forthe parfnrmantt
a� .� ofthework fo hichthis p mtsusuedlSec3B9zo.c) . ...504_._-._,FINAL....BUILDING,_ENERGY .. _. _ .
.Q "LendrsAddr .. .. _-_ _..._. _. - ..
;Dz Lena hale.., ' - 505 - FINAL ELECTR•ICA'Lt+,
'1 ecnify that I have mal this application and state than the above information is 506 - GAS TEST
correct,I ngme to comply with all city and county ordinances and state laws relating
to building conawction;undherebyaothoriieap.,antmi,,softhis city to enter upon 507 - FINAL PLUMBING
the etenra,rdprye.i form,fic,lim 508 - FINAL MECHANICAL
.•},+fib
(We):iyrce m sive,i emnlfga A keep harmless nhi City of Ciike n.6goino
'V1 lir Iii ,jud a is ream nd expei es which may in any way accnm agoimt said 5 0 9 - F NA G
ons •of mgrunting thin permit. "�
g u Fox: � ND al,c
COMPLY ver H y Issued 0 r N r' Date
ss tun o mHAZARDOmmaU A'I'ERSIALS DISCLOSURE Re-roogs 02 - ROOF PLYWOOD NAIL
_ 'M -', � '
I,I irpInficurt orfut re bolding occupantst re orhandleh lousmwenal Type Of6l?)oiaf _. ROOF--BATTENS--•-- •-
JeOnWbyth C pend M n ICM Chapter 912and the Health and Safety •`�" _"`" - ..m_,�•--"-"- `-'
C ad SDeY zss3zO u ` { i.= P. T 1604 'tROQF4;IN'=PROGRESS
.. All roofs.shall,be.mSpected prior to.any.roofing material being.installed.
W II th ppr.' t f b ld ng p t use equip hent o device,which _••If a roof Is ifisialled without Irst ob inmg an inspection;I agree to remove
•mit he d -i conmm ms a eEred by theBay Area r Quality Mu agem m
Distric' all new aterials or inspe Ion. plicant understands and will comply with
av a . - • N . - - - 7tet s c regu tions: f. -_ - -
1 h.i a cal the bazar no mammals gmrtinems rend Chapter 695 of the
Cal f - Health&Safety Cad Sections 5505 25533 and 255341 id tn'mJ that / y,Ts
Jsh ilJt gd current] have a i ant that tt' yresW-s b'I tyI notifytHe s/f,., C/�////
Oc a
f in quit mems hath m be me,poor.to sus a of n n team of
Sig atur li a D e
a Data All roof coverings to be Class "B" or better
FFIC