01100110 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22394 RIVERSIDE DR 01100110
ON SUR DAM
B��'gSp6 STEPHEN W AND SUSAN W 1P0r19/2001
HONE: SANITARY NO, CONTROL NO,
n mm Q ARCHITEC iENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Sym
z LICENSED CONnRdunderSDF.CnsofCON JobDescriLtion
iZ-O Second 7")
)of ivishat am of
licensed under provisions Proruofns apter Code.and
mmencmg NEW ELECT PANEL LIGHT 6c
ml- wish Sation]Oqp of Division]of the Business and Professions Code.antl my license r
A6j< is in full home and effect. U (.r qo FIXTURES .
?as U License CI s Lic.X
1 3 N Dae Cuounmuor
CHITECr'S DECLAR N
t=O g rand my plans shall be used as public cards FINAL.-
OWNER-BUILDER
! L E
iv$i•� u
1 i p O Li u rofessienal $ 2002
o� OWNEnd eawnDER DECLARATION LAMA
I-= 1 hereby affirm thus 1 nm,Batons from the Contractor's License y o mite
C?< following reason.ISectian 703 L5,Business and Professions Code:Any city or county
Exp which requires a permit to consuu".alter,improve,demolish,or mpair any swcwrc
63� .pnormiu a'.-
suashay easheapplkant forauch permiuo Rkasigmtl
that he
liccn¢d puiauam iOT 1he provisions of the Commoors License Law( r, ,f$q,- t,FloorA[�a, Tf,rte, Valuation
(commencing withsenion]OOfq°l'Divid n3ofthe Bufinesaptd Proles.+iu e _,[_)!T :,4. �PM1 1..44 hJ LZ�s MATION
or than M1e n eaempt ahemfr swi she basis for the alleged eabhptibo.My viohtion
of Sermon 7fif l by arty applicant fora permit subjecu the applirnm so a evil penely
fn°t...than fiiveWarlord dallars(Wnn). APN Number ,. Occupancy Type
01,asow.wrifthc property.mo,wdpI.yc.with wages astson sole campenution. 103 - UFER
will do the'work:'aad the xwcture is not intended or offered for sola(Sen.7614, 304 - ROUGH EL[; gTTIIIIii
'Buiineas add'Professions Cade:The C°ntmemis License Law does not apply to an WXi4 Ctlons '
owner of property Who builds or Improves thereon.and who does such work himself 505 - FINAL ELECTRICAL
or through his own employees.provided that such improvements arc not intended or
.offired for mile.Ir,however,the building or improvement is said within one year of
completion,the ownerbuilder will have the burden of proving that he did not build or
improve for purpose of sale.).
r, ❑I:as owner,of the prone.,,am evduswdy contracting with licensed contractors to - - -- - - - - - - _ i..r t -
_ cl c°rmwct the project(Sec.7044,Business and Professions Cade:)The Contractor's ,_,t, [, p . •,t
License taw does not apply to an owner of property who builds or improves thereon,
and.who comment for such projectswith a contmetons)licensed purwamdo the
_ Commoner License law. .-
❑IwnexemptouderSec. _ .B&P C for this reason �.;h (.' `N•nf
Owner" Dam "
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty o(perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to self insum for Worker's
Compcnsaion, as provided for by Section 37W of the Labor Code, for the
- ' perforanance of the work for which this Permit is issued.
111 have and will maintain Worker's Compeusation'Insurance,as required by Section
3700 of the labor Code,for the perfomwnce of the work for which this permit,is
iasued.My We&e. On ion Insurance carrier and Poli,numbe,am:
i ,.. ,...... avaay.Cion,an,. "1 1:'.. 3J .t,. 'f Poi rNo: ` r u r-t'3 6 .� br
s ICER1'1FlCATION IiSATION IWNRANC WORKERS]
..y � .. ._._.
COMP[NSATION INSURANCE
" (Tarsscetto0 octal not he completed if the permit is for one hundred dollars ' • '
IS 100)or lesO
certify shat in the dorrnantt of the work for which this permit is i....d:l (�f n r .
sail oat employ anyyy,�JXccc s�PM1�m any manner s°as m become suhjat m the Workers' - ' '
C° bernsatinrJiJ�s pf piAsfosrua.py _ -
Applicant 7C / -L'iGGgi•L'e�?-�— _ i! _. _ . _. .. ._ .. .. _ _
•NOTICE LIC NT:IL nfmr making this Ccnifcete of Exemption,you should "
Q 0 bceoine subjc to she Worker's Campcnsnuon provisions of the Labor C«le,you must
forthwith<omplY with such provisions or Nis pemnt shell be Jcemed revoked.
rzi, 1""fr "" CONSTRUCfIONLENDINGAGENCY -
E"" I hereby olfirm that there is oconsuuction lending agency for the perfomrance t
�' � o[rhe work foa which this posers is issued(Sen 309].Civ.C) ,..
Wy Q -Lender's Name"
7qZ Landes Addm,,
C.71 certify that 1 have ret this application and sum that the above information is
W F., cbncn:I agree to comply with all city and county ordinances and in...laws retiring
D.V to building conswction:and hamby aahodxe representatives of this city In enter upon
the above-mcmiotmd p.,.y for inspection purposes.,. . .
y I We)Agree to save,indemnify and keep hamleu the City of Cupertino against
r�i V1 liabilities,judgmcnjt costs end ax,ma,s which may in any way meme against sold
V City in conseyu kef Of the granting of this permit.
SO pu�cgNr�"'EEFRRRSfANDSAt:DWW.COMPLYWfIHALLNONPORiT Issued by: Date
Si at ofApPlirmu1C t cmc.. :''-• ". ': Dane Re-roofs
HATARhOUS MATERIALS DISCLOSURE
I.Will'the applicant beforme rodding°ceupaat nom or handle hiaardous matenm Type of Roof ___. ... _/ .D..L F•--r_�„L .
as def ed by the CuKinno,lvfiubacipal Code Chane 9,12.and the Health and Safety r'l'1 e'' -t 1 l del `a 4 t'i!'31:
Code,Secs of 25532(rd n'.:, r ..+L
'OY09 _ ,!_,O"° •. ''z; t- _All roofs shall be.inspected.priorto.any,roofing material.being.installed. _.._._
`. Will the epprerm far..building occupant sex egnipmem or devices which If a roof is installed without first obtaining an inspecti6ri, I'agree'to remove
emit h'eurdous air contaminants as defined by the Bay Arca Air Quality Management
Districts all new materials for inspection. Applicant understands and will comply with
ovga oNn all non-point source regulations:
".\I have read the hdiardous materials requimmenul under Chapter 695 of the
California Health&Safety Code.Section 25505,25533 and 8534:I understand that
Eiltling does no Andy M1ave a mnant,Nat it is my msponsibility to notify the . .
pant of there ems which must be met prior m ismatim of a Certificate of
w x Signature of Applicant _ - Date
own or au@orimdagent Data All roof coverings to be Class"B" or better I�
OFFICE ,. f
t