02040133 (3) CITY OF CUPERTINO
BUILDING DIVISION PERMI* - -'
CONTRACTOR-,INFORMAT�T
BUILDING ADDRESS: PERMIT N0,
10703 PEBBLE PL PHILIP VAN POETSCH 02040133
OWNER'S NAME: APPLICATION SUB DATE
PHILIP VAN POETSCH 04/24/2002
HONE: SANITARY NO. CONTROL NO.
O O ARCHITECTIENGINEER: BUILDING PERMIT INFO
m m F BLDG ELECT PLUMB MECH
aK4 L-D CJ L---I
S
LICENSED CONTRACTOR'S DECLARATION 1 hertb tRion met I am licensed under provisions f Chapter 9 lcommencin Job Description I='�y p ��
iN_ y pr vPrefeW p g tl— N
im l� with Satfmnc Dad affect. on Jofthc Business and Professions Cade,and mylicenu KITCHEN REMODEL
is in full force end effect.
o n s License Class Contractor—
o a
Date SDEC A JUL 2 3 2002
�LL O S ARCHITECT ro DECLARATION
j—w 1 undemand my plans shall be used as public records
Or
LieenadProreaaianil BUILDING
R OULLDER DECLARATION
1 hereby affum maiast I 1-a. Business
from me ComwnC i License taw for the
reason
C?< following .(Section 703 13,Busins end Professions Codec:Any city s county $18000
E t�❑ which requires i permit m mms t m,alter,improve,demolish,or repair any structure
a3_ no Law
—^� prior to its usuame,ilmrequirex the applicant fm such permi
that to of Division Ne Ce Business
Licemetswons Coe) S ,F ,an'1ppl a Valuation
(commencing em Section om and
Division 3 of the Business end Professions Code) :.3'L 8 GS�'V 4 .. Y L r( s
of that he 7 eaempr therefrom ena the basis for the subjects
th.1 ex hetet .Any violationIty
-of Section]031.5 v any hundred!
dmf for a permit subject the applicenr m^civil penalty
of stat more than fir<nandrea aalars(ssof). 101A N�DATION Occupancy Type
°I,as owner of due properly,or my employees with wages as their sole compensation,
.111 do the work,and the aweme,is nm intended or offered for ale'(Sac.70W, -
Busitr,ss and Professions Cade:The Contractor's License Law does not apply m an 103 - UFER Required Inspections` '
owner of properly Who builds or improve thereon,and who does such work himalf
- is his own employas.provided dust such improvements arc not intended m 10 4 - REBAR
oBeredfor sale.If,however,the building or improvement is sold withu in one yeof
a completion,the owneobuilder will have me burden of proving that M did not build or 105 — ANCHOR BOLTS
p for purpose of We.). 106 - SEWER & WATER
Bias owner of the pmperry vat exclusively emmac6ng with lioenai convectors to 202 — UNDERFLOOR PLUMBING
construct the project(Sec.7004,Business and Pmfessions Cade:)The Contractor's
License law does not apply to an owner of property who builds or improves duemo 203 - UNDERFLOOR MECHANICAL
and who contacts for such projects with a comnnm(s)licensed pursuant m me
m
conuam"LicenseLaw. 204' -' UNDERFLOOR' FRAME'
Of d S . BhePCfor to,maaa 205 - UNDERFLOOR INSULATION
Owme ( OA 1PENSATIONDECLA /ION OZ 301 - , ROUGH PLUMBING
Thereby effiw under penalty of perjury nate or the followingdalmnione 302 -, TUB & OR SHOWER303 — ROUGH MECHANICAL
I have and will maintain a Certificate of Consent In ulLinsurt for Worker's 304 - ROUGH ELECTRICAL
Cempenration, as provided for by Section 3700 of the Labor Code, for the
pmformmea of the work for which this permit is issued. 305 — FRAME
°L have and will maintain Worker's CompensaYon Insurance,at;required by Sation 306 - HOLDOWNS
3700 of the labor Code,for the performance of the work for which this permit is
Issued.My Workers CompensNoninsurance earner and Policy number are: 307 — INSULATION
PolicyNo.:
cHRntTCAnoNOFEMIM171ONROM WORPORS" 309 =� �EXTERIOR 'LATH"
COMPENSATION INSURANCE''
(This union recd not be completed if the permit is for one hundmd dollen 31"0-- INTERIOR- LATH
(51007th less.) 311 - SCRATCH COAT
I omly that in the performsrea of the work for which this permit is issued,1 313 'ROOF NAIL
�sMll not employ soy person in any manna w ss to become subject to the Workers' 501 - FINAL ELECTRI CAL' ENERGY
Compennrien laws of California.Data
Applicrat 502 - FINAL PLUMBING ENERGY
NOTICE TO APPLICANT.H,after mekin�this Cenifima of Exempfion,you should
become subject o the Worker's Compensavan provisions of the labor Code,you must 503 - FINAL MECHANICAL ENERGY
00 forthwith comply with such provisions or Us permit shall bdamedteroloud. 504 FINAL BUILDING ENERGY',
'CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
0:'> ' I hereby sRiw that them u e construction larding agency for the perfmman m
W ti of the work for which this permit is issued(Sac.3097.Civ.CJ _ . - GAS TEST
a Q 'Lender's Name... .. .. .. 5 0 6 .. _
U
a'.
Lenders Address 507 - FINAL PLUMBING
0 I certify that 1 have read this application end star,that the above information is 508 - FINAL MECHANICAL
w.F comet.l agree to comply with all city tab county orn inunces and state laws refining 509 - FINAL GRADE
Q V to Wilding consuumion,and hereby authorize responses.ponsennrives of this city m en¢r upon
meati°(We)arce to propertymrtmpatiaeapharmless 510 - FINAL PLANNING
LL (We)egm,msave.mad.,and kaph may
me City of Cuperiaiagainst —
FCrr LI)z Cliabilities,1ycjudgments,costa and upenus which they io any way accrue egeinn aid 514 FINALAP I C- WORKS
V y City in consequence of the granyy0'nnna mf is u. '
APPLIC}�yj� $7ANDf� d MPLY WITH ALL
sotflec .T'l�up/.rg Y d� Issued by: Date Z O 7,
Si...part ofAp iconUC.Mmeo ¢ Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will ate applicant or(urate Wildh,g ocespmr store or handle hazardous mnenil Type of Roof
as defined by One Cupertino Municipal C ,Chapter 9.12,and the Heald and Safety
CadwSation'2553I(p? .. . .
°Ye All roofs shall,be,inspected pr or to any.roofing,material being installed.
Will the applicant orfutun building occupant use equipment or devices which If a roof is installed without first obtainingan inspection,I agree'to remove
mit hasNous air contaminants as defnfp,by the Bay Area Air Quality Management P
Asvim7C{Q/ all new materials for inspection. Applicant understands and will comply with
Ely,, ^ all non-point source regulations.
1 have seed the hezudous mnariels requirements under Chapter 6.95 of the
California Health Ae Safety Code.Sections 25505,25533 end 25530,1 understand that
'ifthe building aasnot"mem0y eat nC merit is my responsibility so notify me
Or�p�aty rc menu w n r r to issuance of..Certifier,of
' Signature of Applicant Date
Ownerorevrhortzed agent Dam All roof coverings to be Class "B" or better
.. :. . .. - OFFICE
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APPROVED �� �;• R
IN ACCORDANCE WITH THE CITY I ' �Y
CUPERTINO DES AND RDINANCr APR 2 4 2002
)ATE d� IT 333
•V
se _
set of p`ar s _rid specifications MUST
be kept on the job at a l times and it is un
lawful to make &ny c',-,ges or alterations --------------------- -------------- --------
on same w:th�u, w hten permission from F1A(T gppS27 36"
r�„ �f r��nortinn i B
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Lhe stamp E
SHALL NP�e
Ito permit or to be n S SS 4BUTT W274 W30308
pproval nHnT of aag�rnvisi
any Ci. cram iroi.
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All dimensions 8 size desi nations This is an o j desi n and must 3230CF84 Scale:na)dmum
:Date
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/02 Dwg no.
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are subject to verification on HOME DE POT not be relea opied unless pHIL VAN POETSCH
ire and adjustment to fit job applicable f een paid or job 10703 PEBBLE PL Desi
gner
conditions. order placed. CUPERTINO CA ANTON A
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PR 2 4 2002
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ote:This drawing is an artLstic THE 3230CFB4 Dwg no.
• tpear etien or the general HOME DEPOT PHIL VANF*SCH
ppearance of the Ooor pWn.It is
not meant to be an exact rendition. PHI=*
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All dimensions 8 size designations THE rs is an original design and must 3230CFB4 Scale:mabmu Dwg no.
• given are subject la verification on HOME DEPOT released or copied unless PHIL VAN POETSCH es�9ner
job site and adjustment to fit job licable fee has been paid or job 10703 PEBBLE S ANTONIA
conditions. - order placed. 10703
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job site and adjustment to fit job ficable fee has been paid or job ' ANTONIA
conditions. order placed. 10703 PEBBLE PL -`
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• All dimensions&size designations 7HE is is an original design and must 3230CFB4 Scale:maArnum Dn no.
given are subject to verification on HOME DEPOTbereleasedorcopledunless PHIL VAN POETSCH
esigner
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conditions. order placed. CUPERTINO CA I WaIUC Line# 4LL`
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F3231POCFB4All dimensions&size designations TME his is an original design and must Scale:maximum Dw9 no.
given are subject to verification on HOME DEPOT - ��released or copiedunless VAN POETSCH esigner
jab sde and adjustment to fR job licable fee has been paid or job - 3 PEBBLE PL ANTONIA
conditions. order placed. ERTINO CA Wait/ Line#