02030027 I
CITYILDI c DOF IVISION
+ CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS: PERMIT NO.
10285 MORETTI DR MICHAEL COLLINS 02030027
OWNER'S NAME: APPLICATION SUB DATE
'"tSCHAEL COLLINS 10285 MORETTI DR 03/07/2002
I MONS: SANITARY NO. CONTROL NO.
I `
q 0 z0 ARCHITECfrENGINEER: \ '- \ BUILDING PERMIT INFO
kCV pp \ BLDG ELECT PLUMB MECH1--D<Z 1 1 1CJ
y 2 LICENSED CONTRACTOR'S DECLARATION `� 1 F4.el
ZO Z-� 1 hercb ffum that 1 am licensed under pt 1 N s 5 1 �., / \ b Description
vat provl%ianaorCha erg panmenpi -� GARAGE 465 SQ. FT.
Fit with Sect ion 700 defDivision]oRheBusinessandProfessionsCode,vndm�licn 1` :'f FID) 74'4 "SF e
is force and eRcct. ✓ ` \\U
z < License Class Lia.
an O u Date Contractor +
:O ARCHITECT'SDECLARATION
S 1 understand my plans shall be used as Public rtlow,
e.a p 0 Licensed Professional
u�ca f" OWNER-BUILDER DECLARATION
=o 1 hereby affirm that 1 am nempt from the Complaint's L d� Law far Ne
t Z a following reason(Section 7031.5,Business and Professions Code Any city or county $85000
F G which requires a permit ro
co
alrao improve,demolish,or repair any swnurt.
3 m -Priorroiu issuance,also require tn"'Pliicantforsuchpewino fisc acigned statentem __ _
mora iss assupast..uan(to
He
provisions of rhe Cantrnctd License
Law(Chaptcr9 s, gt,���ss��qq ,per Valuation
(cdmm<ncingwithSmion.7000)of Division Sof the Business and Profgssioas Code) i,I*.e" '3+714V V'J �U V"ass��sl° try 10'
or tharhe,,sem ,therefrom-and the basis forth,ells ed,sem tion.An �' '' sMy "• 3 '
P g P Y violation
-of Section]031.5 by any applicant fora pewit sahjaso the p"bram m a civil penalty
ofa.,more rasa five hundred dollars"'fit,
101AEN k3l7ftATION Occupancy Type
❑1,as owner of the property,m my employees with wages as their sole compensation,
will do due work,and the slo cture's not intended or offered for sale(aec.-704,1, - - --- -
Business and Professions Code:'rhe Convector's License Law does not apply 1.an 103 - UFER Required Inspections' -
owner of property Who Wilds or improves thereon,and who does such work himself
or th h h' employees.provided N t h' provemems me not mended or 104 - REBAR
based -le If.however,-the llede p ne
moiissoldwthinoyearof -
completion,the owner-builderwll have the burden or proving that hadid not build or 105 - ANCHOR BOLTS � '
improve tar patpos,of sa)e). 106 - SEWER & WATER
..Q'az owner of tho" ^'._
6 woPc Y.am B.'rhavdrdPranmion,Cos:)Th Cmamanm 202- - UNDERFLOOR PLUMBING_.._...d:.:..i•.i .., .
namesme prosect notape Ito a.owners adProfession,who builds rodeo Theves Humana. 203 - UNDERFLOOR MECHANICAL'License law does not apply m an owner of properly who builds or improves Hereon, '`
.. :. and who contracts,for such projects_with.x conuacmr(s)licensed pursums.to the. _..I_..... .. .. . . .......
tors License law. 2 04 - UNDERFLOOR--FRAME -
cc
- �iameaem njr�Iso.' B&PC lot his remain 205 - UNDERFLOOR"INSULATION
r'/tfCG �,a ZG 7i 301 - ROUGH PLUMBING
WORKER'aCOMP qTP DECLARATION 302 - TUB & OR SHOWER
Ihereby affirm andarpenaltyof,erimyone of'he following declaration,: 303 - ROUGH MECHANICAL
t, O 1 have and will maintain a C,rtifcare of Consent to sel6inxure for Worker's 3 04 — ROUGH ELECTRICAL
Compensation, as.provided for by Section 3700 of the Labor Code, for the
pe305 — FRAME
rformance of Ne work for which this pcmdt is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section 306 - HOLDOWNS
37M of the Labor Code.for the performance of the work for which this pewit is 307 — INSULATION
issued.My Worker's Compensation Insurance carrier and Policy number are:
,30,8.. _. SHEETROCK
Comer -'t•l'" ,�._. "Pot cY No
•CERTIFICATION OF EXEMPTION FROM,WORKERS" r+`t h3O9• •F' ''EX-TBRIC)R� LATH •
COMPENSATION INSURANCE ` " •
11.0 .__..._INTERIOR-LATH'-........... ...............- - _.._.._..-----
;SI�;iTh'tus section need not Wcompleted irthe pewit is for one hundrW dollar 311 - SCRATCH COAT
- 313 - ROOF-NAIL
ttrofY)hm in the perfowance n the w rk for bleb this permit is issued,i -
',Wall snot emplo/iy pen ainany r - me subject a the Workers 501 - FINAL ELECTRICAL "ENERGY "
Com(tensa' of C�tfor
-APP( an - - _ 502 - FINAL.- PLUMBING ENERGY_..... _.._ __... ..
NOT PLICAm':If,Lifter making t u C tificnm of Csentption,yon should
Z
Wcon subs rtatheWoder'sCompensatumprovisionsoftheLaWrCode,yoummt 503 - FINAL MECHANICAL ENERGY
zO fnnhwiN en ply with such pmvisions nr this pewit shall be deemed revoked.
�htreb atrrm atnre .. 504 -FINAL. BUILDING ENERGY
� � CONSTRUCTION LENDINCACENcY 505 - FINAL ELECTRICAL '
y 'a consu'uction lending egcnry for the perfowana ,t,
Q of the work for which this pewitisissued(Sec.3097.Civ.C.1_ GAS TEST
w rdersAame .._..__, _,. ,.. _ - `"507 - FINAL PLUMBING_ _ ._ .. ...
G 1 certify that 1 hmind d this application and slam that the ahoce information,.s 508 - FINAL MECHANICAL
w-F correct.1 agree to comply with all,city and county ordinances and state 13W%relating 509 - FINAL GRADE
.0 V to building eonnroctical and hercbyanthoriee representatives of Hais city to emarupon
j. W the above mentioned property for,inspection purposes 510 - FINAL PLANNING
4, (Wc)agree in save indemnify and keep hal the City or Cupertino against
h liabilities,judgments.costs and espentts which may in va,way scent,against said 514 - FINAL UB C WORKS
V Z Cityin consryu ce of the graining afflik pewit
SOPLICAII the UL amort wrcrWild PLY\vITH ALLY N.POL Issued by: r Date
E
app
"° pct - �/ -Data Re-roofs '
HAZARDOUS MATERIALS DISCLOSURE.
g occupant aore or handl Lasa Nous mitcmal. - T f Roof .
as d I r M by the Cupar Municipal Code,Chapter 9.13 and theHeath and Safety Type oo
Cod Scto 255321x1 't' i t -
oY 11 q ; •.Iq , . .t.
4 All ioofss6a11 be.inspected prior.to any.roofing,material,being installed.
wu n exp costa t t rc b Id g oy P Bay AZw Pm Quality
ana a mat If a roof is installed without first obtaining an inspection, I agree to remove
mit ham osair contaminants as defined by th Bay.Am rtQual ty Managemem g p g
dist ct all new mate ials for inspection. Applicant understands and will comply with
°1c all non-poi _source regulations: -
I have read the harardous materials requirements under Chapter 695 of the
Coif naliehh Safety Code Sectuns 2550525573anJ 2353a lundemandthm
fihetxldingd snotcumntlyhaveatenantlhattusmyresponsthrluytonotifythe
ace
,ad
at
of"
f ih req it eon wh¢h�mus poor to ixmance al a Ce fevte of V V
CL Z G/Z_ gn re of Applicant
Date
Own In xuthm.mdngent Dam Alitll roof coverings to be Class "B" or better
.. ., OFFICE . . _ _ .... .. ...