01010114 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT 'CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10355 MENHART LANE REYNA GOODINGO 01010114
OWNER'S NAME' APPLICATION SUB DATE
REYNA GOODINGf 01/26/2001
HONE: SANITARY NO. CONTROL NO.
p O ARCHI=rENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Z L_1 IL-J _.
LICENSED CONTRACTOR'S DECLARATION
Z H 1 hemb affirm that I am licensed under Job Description
Y provisions of Chapter and my lice se
Fmt_w withsemm��IloolnrDivi:mn3nrmeBnsiness,ndPmressmncnde.anemyRcensc ADDITION NEW BATHS, BEDROOM, KITCHEN & RO
ie Y y is in full force and dyed.
x ce-u License class Lic.a GARAGE
Data L'onViClnr
F LL O fn ARCHRECT'g DECLARATION
8 I understrnd my plans shall b<used as public mcoNs FINIALED
Y
a'f pC Licensed Professional JAN
i R
OWNER-BUILDER DECLARATION 2 3. 2003
1 herehr affirm mm 1 um pt from,he Connacmr's License Low for the
z a following muss (Section"Illi LS.Business and Professions Code:Any city or county
5
I which reclaims y permit I t alter.improve,demolish.or mpor
a , t
c- - s al q th ',mthat he Ise with Si Lt mO) •sw Its t rnr L u ons Cor $q. ht.rFlcopArea r., , r - �aluation--
or that as ca-g with t the "r.an The h 3 f the Business and Profess,vi Cotler) i-'t 1 + ,
or he is cxempf th<rcfmm and the basis for the allege)<xemptioh.Any violation
-of
of ran dmma,rcr,om3aTns five handprepaudollars rIassrweml.asabJens meapplitanttnacmilpeoemr umber Occupancy Type
°L as owner of the progeny,or., their with wages u their sole rnmpensation.
will do the work,and the structure,is not intended or offered for sale(See.'/BSJ, Required Inspections
Business"rid Processions Code The Contractor's License Law does not apply to an 102 - PIERS 9 P eet1o05
'
owns
r or property Who builds toimproves dram a,and who does such work himself
or through his awn employers.pmvieed that such improvemems arc nm intended or 103 - UFER ......... .. .. _-, _
-;br&dd for Bale:IL-lovon,cl,the building m burden
of pow is sold train one year ur "' --' - '-� �' '-'
'complaion the owner hu Ids will have m<bumen of qov, g the h did not build m 10 4 - REBAR i�� 's' '
imprnvcfnrpury , ofsale.). 105 - ANCHOR BOLTS _
strunwner sane pmpe.7N4,e ruaresely=nmmetn,gwhhhansThenmahomim 106 - SEWER '&WATER ...-..- .
instruct the does
project IS<c,vrlen Business mN Profession Codor The Centrations
License wh Law does nnor such
then c".w th a property who banes improves roves thereon, 202 - UNDERFLOOR PLUMBING .
and who contracts for such protects.with a eontrxtoffsl licensed Pursuam to me .-_.- .__.
Colmre aLieensalSw.. . „ 203 - UNDERFLOOR-MECHANICAL
❑Iemesem,underSec: ,B&PCforthisrcason 204 - UNDERFLOOR' FRAME
Ownerj g Date 6e off ` ' 205 - UNDERFLOOR INSULATION
O WORK: 'S CO ENSATIO DECLARATION 3O1 - ROUGH PLUMBING
enghy nr
I hereby notion under pperjury mic of the loeowing decmmn
do : 302 - TUB & OR SHOWER
° I nso:'nna tam mvimma'a Cenifiede of Comw-at to serf-insure for Wo,kers 303 - ROUGH MECHANICAL
Comrmancemtas provided for bySretion 3280 of the Lab°r Cede. for m< 304 - ROUGH ELECTRICAL
performance of the work fur which this pcnnit is issue)
,
°I hale and"wilrmdritan Workers Compensation Insmarce,as required by Section 305 - FRAME
37Mtar me Labor Code,for the i,erfomaince of the work fear which this permit is 3 0 6 - HOEDOWNS
slued.My Wohcls Compensation Insurance carrier and Policy number am:
Ca r PnucyNn. 307., INSULATION ; - '
: CERTIFICATION.OF EXEMPTION FROM WORKERS'i; = 3O8 ' 'SHEETROCK' " ' •I
(This lesion need nm be comb etNNf rc�NCF. .,'T' __ _, -„ ---`
CO .. . -EXTERIOR--LATH
the
_._ 309; EXTERIOR' liATH'"—
ISHpl or lese)_ it hfar one n°nercd d°°", 310 - INTERIOR LATH
313 _ SCRATCH COAT -
Ices fy,that
h tin tleMro eshhe kfo hich this
pertnnn usucJl -�••^
shall late ploy any'ami
c.o any man err do o m bees ne mbj wt w the Workers' <II I.'
CompenmuonLawsofCnlitemiu.Daie. '
ROOF NAIL
s 11nnt ` 501 FINAL ELECTRICAL--ENERGY- - - -----_._.
O C, PTO APPLICANT II alter mvk g" Cmifcam of Ex pt you shooltl
0 z ronall" Lab" Ic..damas, 503 - FINAL_-MECHHANICALNENERGY_.
•here° c bled to the Wnh I C pensuu npro502 FINAL
Q ronh ,h c mply will cM1 p ¢ s o A "nor
shall b Jec sed kee.
y 1''^^ CONSTRUCTION LENDING AGENCY
C > Ih by dRrm lh uhcomwnion lending agency for the le.Hermm,ce 504 - FINAL BUILDING ENERGY;`; ,
or mewnrk lar winch lata Permit ia.isxam flee.3091,civ.c.l _ -
505_ - -FINAL ELECTRICAL _
= z c de Nam506 - GAS TEST
<ere s spa
UO tictfytnutilwumanm6arrfiatsnanestate mwmeabove nfer„mmois 507 - FINAL PLUMBING
E;+ throen.lagrcemevmply,wiMpll,Ntym,dcoumynNinancesand xeateiawxctarrng 508 - FINAL MECHANICAL
to able ngcon.t t dhrby'uthoz p mtiv<. fth city me upon
y m theabo<m t edproPenrmr rep pryose . 509 - FINAL GRADE
OW
JWc)agree,ox J 'fy and keep harm) dthcCty ,f 6penmovgmnss
liabilities,ludg is d e penes which yin am r see a not said 510 - FINAL PLANNING
U Z City c yueaceor the,Fntne ofm p nt "
"s APPLICAN7fIfjDHRSTANDSrkYDWILL COMPLY WITH ALL NON-POIN'T 5514 - NA P C WORKS ��Z7--O�
so' ERE'cur�noN t'• Issued 6y: Date
gntd<nrArphtanticnm GOR.i. .D Re-roofs
HAZARDOUS MATERIALS DISCLOSURE '
Will the applica 1 or future haffinjoccupant store or handle haia d s maternal _ - ,_ ... -._.... ... ..
Roof
aldefined by me C tpertpn Municipal csN<Chapter 9.12,and m<H Irl ,d safety YPe of Ko _
Cade 5 etwn 255321
°Y " ' I _ All roofs shall he mspected_pnor.to.any roofing material.being installed
W 11 the pplicam rfumeb lei gate gala ux eyv pee t ere ice, lath If a roof is installed without first obtainingan ins eetion, I agree to'remove
< ,n d °mm am arnebym BayArcaA Q ltyvanagmcm P S
�Dwriwt all new materials for inspection. Applicant understands and will comply with .
❑ver:tNnall non-point source regulations:
'I have need the hemNoui- aerials requ¢mems under Chapmr 6.95 of the
Cabrc
fomia Health&Safety Code.Sections 3585,15533 and 25534.1 understand the
"Ir the building don no,rmrcntlyhavehimount,mm it is mY msronsibilirymnotify the
r p t f th equir n m hi,h must he n et prior to is ^ c F a Cenilicme of
/a,/� Signature of Applicant Date
Lc ppP. y
2Z c.�6i -tl, ed Ogen D e All roof coverings to be Class `B"or better ,
e. :.
' OFFICE -