01040042{^OUOIy_OI�
TUU
Nod
1
crry OF CUPERTINO
CONTRACTOR INFORMATION:
6WLDING DIVISION PERMIT
BUILDING AIIIIItIiSS:'
I'ERMI'1' N(1.
22404JONES
MASONRY
01040042
OWNIiR'S NAME:
APPLICATION SUB LATE
04/11/2001
BADERrcruy
'NONE:
41483777912
SANITARY NII. CON'IROI. NO.
AS C 111'1ECD1iNO I N1717 ',
-
BUILD/ NO ['BRM II' IN10
BLDG ELECT PLUMB MUCH
o Cl lu o
1.ICI!NSED CON9'RACTOR'S DECLARATION
Job Description
I Imlehy Nfirm thud I Dan litca"d under pnrvnion, of Chaffer 9 (ennm.cnCing
will, Section '1(XXO ut Division Sal"the llusin�„ and PN2v..... it Code, and my license
in lidl forte and effect
Iieen,ecla„ C�' uc.._L'Y_035�/
D
REPAIR OF CHIMNEY AT 6 BELOW ROOFLI I
Date _0H__7ZCL/ cnmmcmr,Tlr SMAS /Z--y—
ARCHI'1'LCCS DIICLARA 1 ) I
'
I uudaaanJ my plana shill he used u, public records
'
Licensed Professional
OWNER -BUILDER DFCLARATION
I hereby affirm that Into e,engn from the Calamitous License Law far the
following am" n. (Secdiol, 7031S, Basin.., and Prire,sinns Gx3e: An, city,,, I it,
whin, req. ires' a panda, a, c n,wed, he, Improve, demolieh, or repair any shutac e
prim el'n, inamnac, sins rryuiren the applicant lir such permh dome a signed,talemem
Sq. Ft. Floor Area -
Valuation
that he is licensed puovaal to the provision. of the Contractors License Law (Chapter 9
(commencing will, Section' 7000) of Division 3 of the Husinnsund Profession, Cale)
or the, he i, exempt mortar Land the hasi, tarthe alleged e,empdon. Any violation
of Section 9031.5 by any upplinmt lit a rental subjects the applicant u, a civil penalty
APN Number
Occupancy Type
of not more than live Imndred dollar, Is500).
O L a, owner of the pu,peny, mf np, a,tfliy,c, with wages a, f u,ir sole emnpenudm,.
Fi7_011 MAP 00
Required Inspections
will do the work, and the drucmrc i, not intended or nBefed an sale (Sec. Aw,
Pedes code: The Contractor's License Law dor, to
Hu, and , not apply an
Business Pmpcny Who oror improve, /hereon, :ltd who doc, such work Irmuell
w
or through his own anployces. provided that such unprovenlenk are not amended it,
101 — FOUNDATION
ofteaJ our sale. If, however the building or in,pmvemem is sold within are year of
onapleion. the owner -builder rill have the buNen of footing that he did nor build or
31.2 — CHIMNEY REBAR & STRAPS
improve for purpose of vale.).
514 — FINAL PUBLIC WORKS
171,mawn"or flue fy,an, exclusively ,,unnaaia, wilt Heen,ed lontcom,an
construct the prover (tics. 9I94. Bu,nil Profession, Code:) The Cnn,racho,
License Law tactual apply to un owner of pn,peny was build. ofd thereon,
Purse.
ts with rac,ods) IicenxJ pursuunt to the
and who commasuch fir eM1 pmjnn a,m
Co/License,License,law.
❑ I ,xcse n,pl unA¢I Ssn. . B Nr P C for this resin
l am
con
Owner Omc
WORKER DECLARXrION
�l
rmunder pCIIMPENSAd'IONyon ollowig
— / I heresy affirm nada pcwlry of perjurY ane of IM1c following Jcdamnoo:
'dl Tuve Imd will nwintnin a Cenifante of commut no ,ell -insure fir Wider',
� V
/
Comlenwdian, as provided fur by Section 37ql of the Lid, Cole• far the
per(nnnancc of the warA fm xhich this permit i, inwcJ.
El have and will maintain Workers Coml,en,a,lon In,umnce.us required by Section
3700 of the labor CnJr. fur the perlbnaunce of the work k a which Ihis per nil Is
sued/MY Wader'X Cntnlwn,efl n Insurance currier and amothe/r�ov
�Prolliiccyy
A, Pnfey Nn: Wtel-Dl.eDIL1Y_
, clu IFICATION OF EXEMPTION FROM WORKERS'
CONIP17NSKI'[ON INSURANCE "
(Has netfina need nal be cnn,pldcd if the parmit is for enc hundred iliums
(SI00)or lose.)
I certify thus in the pe ......sec of the work fir, which mi, remit is issued. I
,hall it employ any nawan in .Illy Iso aac s- as to beanie wbjecf to me Workers
Camfun,mum l.n.—I California Done
A,rund
NCH ICIi TO APPLICANT, If, after making Ihi, Cenili<me of liacmption, you should
becnne subject m the Worker's Compen,minn pmtixians of IM1e W Mr CNet you must
forthwith comply with such provisions m this permit shall he dern,N revoked.
CONS'I'RUCI'ION LENDING AGENCY
1 hereby anion flirt J,cre is n ana.auction lending agency for the pa'rfom,nnce
'
of the wink for which this permit ix issued (Sec. 30G.Civ. CJ
Under's Name
Lctulcr', Address
'
nfl, thatli. Illi. application ad fdc Tal h 1nation's
aree f ply with II city d e ry N J vital, I- claim,
eon etl g
tubuilding t dhereby n P t t ftti. 'tot eructation
i
the alone-mOttiomed propertyde r p m
'
rvcL ity; d kat to nil,: ttan Cly fC p,n' ay I
(W,)vbn,h nJ,nifY.
E
unA exhcn,., which nary in any way uccme a,uinxf ,ttid
hlllficx. IadgI11C111 e
,
ty in consequ• a ,c gntming of this permit.
--�-
PLICA rA! SAN ILL COMPLY WITHALLNON-POINT
Issuedby: /2i P_ 1�bV�rJA.c Ci `. Date
)URGE ' L ONSO_Lf / O,it
PAI
Re -roofs
o1 ppllaw� ,tractor �/—j Dwu
II '/.Aiva1= MATERIALS DISCLOSURE
will the Cppliaan, afumre hildin, iccupanl Nom or handle narwnm nenedal
Type of Roof
a, defined by the Cupenino Municipal Cade. Chapter 9.12, and the Health and Safety
,
Cale. Section '.
on 25532(u)C3 *6—
Yes
All roofs Shall be inspected prior to any roofing material being installed.
Will thearpfcard cma hudding octul,am use egd,ipnteata device, which
If a roof is installed without first obtaining an inspection. I agree to remove
emit hvardous sure .... unnotired, a, deft d by the Bay Area Air Quality Shang cn,end
District"
all new materials for inspection. Applicant understands and will Comply with
0Yes
all non -point Source regulations.
Ihove read the hunlNnnv Inulin lx Ingall cn...as malt,, Chapter 6.115 of the
Cunrmnin Health h Safey Code. Sections 25505, 25533 and 25534. I understand than
if the building does not currently have a anam. that it i, my resp.msibility to faulty 'he
ccupam yq qol entz whim nmst rte sat prior m issuance or a Cenifeme of
re
eOf '//
Q.W a" /_—
Signature of Applicant' Date
All roof coverings to be Class "B" or better
D m,r.r,tma agent
OFFICE