01120005 cIBUILDING OF O
UPERTNO
PERMIT CONTRACTOR INFORMATION:
8181481 ADDRESS PERMIT
CT DONALD DUNN PERMTNo. 01120005
obbW �3 DUNN 10481 MANZANITA CT Al2c/03/ 2001
PHONE: SANITARY NO. CONTROL NO.
O_O ARCHITECr/ENGINEER: BUILDING PERMIT INFO
s BLDG ELECT PLUMB MF.CH
V<n
,8 v= LICENSED CONTRACTOR'S DECLARATION Job Description
z:C I hereby aRrm rW
shat It.Ilcansed uen provisions of Chaptar 9lcosmnencing NEW POND.
!—s with Sealon7000)of Division 3 of the Buunees and Not...im.CudG.andmylacen.se
em I j is in full(mae end effete,
S z%a License Class Lac,a
O a U Dae Contmcun
3 u. ARCHITECT'S DECLARATION
LL O 1 mmarnand my plain shall he used as public records
ip O Licensed Prom,,iurml
of�2
OWNER-BUILDER DECLARATION
a'+ I hereby arfir mar loin exempt bum the Cnnlmemr's License Law for the
fallowing mason.(Semon 7031.5.Business and Professions Cade:Any city orcoumy $800
I C I h P Y Irvin e wti cM1 9ie. pe tc t l h p JeaWm prom t I. eq thefo such signed. t mem
chat lito islcnaedl atluth P s r(ha Cimtma',Liceryse La (Cnpm,i) , .3 Valuation
(coin nanGpb swim Section 90Wlot Division lortbe Bashes.find Profes\ons CWe) ; Jt'... _
or mai he is exdmpt thciefio'm'and the nasi.Ota rhe alleged exemption Any violation
of section 9031.5 by any applicant lot a permit subjects the applicant to a civil penalty Aiai5mw�,,k5Ga� .
f co,/9W a Ihu i five hundred dollars rnn0). 10 6AP'N 1J@INCH? & WATER Occupancy Type
Cy,'ee ownKn the property,in my emplhycea with wage,i.their wale crmpensamn. 202 - UNDERFLOOR PL MBING
win ne be work,and ns awn are as not mounded J e noticed for am(sec:noun 301 - ROUGH PI '�.T sections
'
Business and Professions Cole:The Convector's License Law does nor(applySce. to an g [>
owner of pmpcny Who builds or imprnves therton,and who does such work himself 302 - TUB & OR MOWER
err through his own employees provided that such improvements arc not intended or
offered for sale.If.however.the building ' ' year or 502' ='" FINAL`PLUMBING"ENERGY-
g or Improvement as the within one
mmNetioa,thenmerisfunderwdltimemehardenerrprovingInasheaidnotbunderr 506 - GAS TEST
improve for puryou of sale J.
o i.as awre,nil he propeny,a exclusively contracting I»ith licensed comactor.m - 507 - FINAL-'PLUMBING .. - --" ---
onwm
s ,he pmiKr(Sec.7) .Business and Profesons Cade:)The Comacmr's r _
License Law does not apply to an owner of property who builds or improves thereon,
tied who contracts for such projects with a contractions)licensed pursuant to the
Convaemrs License Low.
clam uemptu .B&PCfar this
mason FINALE®
Own JG m
KER' COMPENSATIONDECLARATION DEC ((�1 �sg
cr l hereby aRml under Penalty of perjury Om of the following declarations. EC V 6 2001
❑ 1 have and will moinaan a Cmlbcam of Consent to self-insure for Workers
Compensation, as provided for by section 37W of the Labor Code, for the BUILDING
pertw
armance of the work Tor which this pe.if is issued.
e 1 have and will maintain Worker's Compensation Insurance,as resumed by Section
37W of the Labor Cade,for the ley fomtan&of me work for which this Permit is
issued.My Workers Compensaion lnsummgcarraer and Policy number ate
Carrier i.., s '.Ii•..rl, 1.*'Policy No.: .� \ t
CERTIFICATION OF EXEMPTION FROM WORKERS' i. ` - - ') !
.,
COMPENSATI ON INSURANCE'
fmis'senour nccd not be completed i1 the permit is for one hundred dollars '
C$100)to less.) _
I certify that the Perk lar Flie rkt which pe
is issued,I -. �,.• - ..
sball'nm employ any Person^ any numoner.ser as to beco tie subject to the Workers
C.P
NOTICE TO APPLICANT'If.of a Dme
penial . -
Applicant .. ... _ . . __.. ... .. ..._ ._ .. ... _ _. _
lar making this Certificate o h Labor un,you should "
� Obccomczabjen m int Worker's Compensation perunitnhall heLaborCade,you mint
forthwith comply with such Provisions err this permit shall be deemed mvokW.
HCONSTRUCTION LENDING AGENCY
1 hereby otrrm thin,hem ko,onformilinny lending typeric,.mirthaperforrimance
�.i oflhe work'for islikh,hi,pe 1isxuN(SK 1091,Civ.C)_.w.i
Q Lender's Name
]_Z larder's Address _ .1"\t ' 1
U C I certify ohm 1 have rrnd this application and state that the above information is
W E. 'comet.I agree to comply with all city and countyordinances ertd state laws offering
Q.C.) to building comminution.and hereby iumodu reuesentrares of this city to enter upon
�] the above-mentioned property for inspection puspous.
(We)agree to save,indemnify and kecp harmless the Cir,of Cupertino ogtime
Z) himilitias,judgments,cons and eapenus which may in anyway gm eragaimr amid
U Z City in consequence of the gnnling of thai pe I,.
^ APPLICA, D tDSAND WILL COMPLY WITH ALLNON-POINT Issued by: Date
so URC E/
re.1 nppncanticontacmr . . - Date Re-roofs �—�— 12- - 3
,rrJ
HAZARDOUS MATERIALS DISCLOSURE '
W 11 doe typplicant my future ba Id lig orcup Tit store or handle hiiies trs mmerizl .Type of Roof
as difined by the C.Pudirmys Municipal Code Chapter 9.12,and me Health fund Surety t I
Cod Section ❑N 25532(a _ t z.'1 >t r Iq'- r:' ..t
_ All roofs shall be inspected prior to any roofing.matenal being Installed. _
Wiffi the applicant or future building occupant use equipment or deficits which If a roof is installed without first obtaining an inspection,'I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Manapart
Dinrall? . ❑Na' all new materials for inspection. Applicant understands and will comply with
0 Yes .. all non-point source regulations.
C� 1 I have read he htrurdoui'maarialz requirements under Chapter 6.95 of the
Califomia Health&Safety Code;Sections 75505.25533 and 25534.1 understand that
if the.mmIding doe,not ca,emly have.anon..ohm it is my responsibility m nutify the
occupant require is w mus!be mei issuance
prior to of u Cenificate of
Gc?ap y' ,• - _ • • Signature of Applicant Date
er uamnriam agent, ;t. • ' Date All roof coverings to be Class "B" or better
scr . . _ I OFFICE