02110107 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTORAINFORMATION:
BDIrP&(1QDRhiUNAR CT GREG WENDSCHLAG PERMIT NO 2 110 10 7
a31�@4EWEND S CHLAG APPLICATII)IIJI dTIO 2 0 0 2
ONE: SANITARY NO. CONTROL NO,
ARCHITECTRINGINEF.R: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
pp LICENSED CONTRACTOR'S DECLARATION
til I hemby off roe thio I am licensed under provisions of Chapter 9(commencingescrlptlon
.'In"Clint 700)n(Division Sof Me Business and Professions Codo,and my license is .2^BATH $ uPG
nn in full force and affect. s
O Z J Z License Class Lie.a RED, ,F—FpGave ConsmcI.,FF7lARCHITECT'SDECLARATION rr� N I understand my plans shall he used as public wordsrLicensed Putassional OWNER-BUILDER DECLARATIONu 0 1 hereby alOrm on 11. exempt from the Cssions is License Law Inr Ibe 444999 000
�u—p 0 following mason.(Section 7(1715,Business and w,de Professions Code:Any tiny or county
and$ which requires n parrnil w construct,alter,improve,demolish,or repair any structure
rzY+ prior to its issuance.also requires the applicant for such permitto file a signed statement
S < that he is licensed pursuant wthe provisions of the Conuacuo'sUccnscLaw(Chapter 9 3WBDF0(2AA&G Valuation
a+ZF$ (commencing with Section INS))of Division 3 ofthe Business and Professions Code)it
that beis exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant fora permit subjects the applicant o a civil penalty of i JAPm N Occupancy Type
a.I more than five hundred dollars(5500). 102 — PIERS
-
0 1,m owner of the property,or my employees with wages as their Sale compenmtion,
will do the work.and lhelumnure Isn.Iintended or offered for sale(Sm.71144,Business 113Required Inspections
and Professions Code:The Conuactor's License law does not apply m e an owner of 104 - REBAR q p
property who builds or improves thercon,and who does such work himself or through his
own employees,provided that such improvements arc not intended or offend for me.fr. 105 — ANCHOR BOLTS
however,the building or improvement is sold within one year of completion,the owner- lO6 — SEWER & WATER
builder will have the human of proving that be did not build or improve for purpose of
tele.). 202 - UNDERFLOOR PLUMBING
❑ h as owner of the property,am exclusively communing with licensed convectors to 203 - UNDERFLOOR MECHANICAL
Conswct the project(Sec.7044,Business and Professions Causi The Conua.mes Li-
cense Law does not apply 10 on owner of property who builds or improves thereon,and.
204 - UNDERFLOOR FRAME
who contracts Law. for such projects wwacomnnorts7Bensed parsuam to the Convecmrs205 — UNDERFLOOR INSULATION
lemexcmpt under ,B&P C for Misrcason 301 - ROUGH PLUMBING
are 302 - TUB & OR SHOWER
WORKER'SCOM Ns IDN DECLARA 303 — ROUGH MECHANICAL
(hereby e0itm onderpendly rjary one of the following declarminna: 304 - ROUGH ELECTRICAL
I have and will maintain a Certificate of Common to self insure for Wurker'sCompcn-
'ation,mprovided for by Section 3710 of the Lahr Code,for the performance of she 3 0 5 - FRAME
wart for which this permit is issued. 306 — HOLDOWNS
❑ 1 have and will maintain Worker's Compensation Insurance,as required by Section 3 0 7 - INSULATION
J7BB of Ne labor Code,for the perfurmene of the work fur which Nis permit i•issued.
My Worker''s Compensation Insurance carrier and Policy number are: 308 — SHEETROCK
carrier: Policy No.: 309 - EXTERIOR LATH
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 310 - INTERIOR LATH
musscuim mtil of becompleud ifthe permit is for one hundred dollars 311 - SCRATCH COAT
orum) 313 - ROOF NAIL
1 certify that in the perform nm of the work far which Nis permit is issued.)shall not 501 - FINAL ELECTRICAL ENERGY
employ any person in a nor, to cmesuhjaun the Wnrkers'Cnmpenstion
Lawsfaufom• rx u- �9^4�5$— 502 - FINAL PLUMBING ENERGY
NAppiN A LICANT:If,a( eking this ComficateofExemption,Youshould 503 - FINAL MECHANICAL ENERGY
, act so the workenC ovation provisions of the Lahr Cook,you must 504 - FINAL BUILDING ENERGY
Z forth with comply with such provisions or permit shall Ise deemed revoked.
O 505 - FINAL ELECTRICAL
CONSTRUCTION LENDING AGENCY
[-. IherebyalTvmNatthereisaconswctionlendingagencytertheperformanceof 506 - GAS TEST
C ti the work for which this Permit is issued(Sec.7097,Civ,C.7 507 - FINAL PLUMBING
{kt Q Lender's Name
]z lander;Address 508 - FINAL MECHANICAL
U p I certify that I have read this application and sure Nat the above information is 509 - FINAL GRADE
come,.I agree to comply with all city and county ordinances and show laws relming lis
OU building conmrecmion,and hereby authorice Mprcacmmivice of this city ser enter upon the 5 FINAL PLANNING
>, W above-mentioned property for inspection purposes, 14 — FIN LIC.' W RKS
(We)agree to save,indemnify and keep hmmless the City of Cupartum against
,Fs V) liabilities,judgments,costs and expenses which may in any way accrue against mid City
U in consequence of the gnming of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON DINT Issued by: Date /rt�
SOU REGU AT ONS,
ro Re-roofs
Sir/of ApplicamOUo vac x Data
HA US MATERIALS DISCLOSURE Type of Roof
Will theapplica Ior uture huilding`xcupant store or handle hvamous material
AS defined by the CuKr ino Municipal Code.Chapter 9.12,and the Health and Safety
C,Scction25532007 All roofs shall be inspected prior to any roofing material being installed.❑YeqNo
Will the xppl!van,or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ld�.
s haaamous air contaminants m dcOncd by the Bay Arca Air Quality Management all new materials for inspection.
is n7
❑Yes At Nn
1 have read the hammnusmawrialsmquiremems under Chapur6.95ofthe Califor-
Hcalth&Smcsy C(mc,Sm,dom25N)5,25533md255J4.Iundcrsundthatif Ne building
not currently hese a unm4 Nal it is my responsibility mo madly the ecupml of Ne-
iremenu maim Ibe IpriarmimumceafaComnciworskmpan Signature of Applicant Date
d
n amhnrizcd agentm All roof coverings to be Class"B" or better