02010100 (4) CITY OF CUPERTINO
BUILDING DMSION PERMIT ~` - CONTRACTOR INEORMATIn
BUILDINGADDRESS. PERMIT N0.
822 STENDHAL LA BATHROOMS BY REMODELING SPEC 02010100
OWNER'S NAME: APPLICATION SUB DATE
�• BOYD THOMAS C AND JANE P 1422 SARATOGA AVE 01/24/2002
IONE: SANTTARY NO. CONTROL NO.
(408) 328-6700
°CZ ARCHITECTt`ENGINEER: BUILDING PERMIT INTO
O BLDG ELECT PLUMB MECH
�< IJ I_I L__J L_J
LICENSED CONTRACTOR'S DECLARATION
z 1herebyruff that I am licensed under provisions of Chapter 91s°men
meing ]Ob Description
° with Section 7000)of Division 3ofeeBusiness and Professions Code.and mylicense REPLACE BATH FIXTURES & TILE
y 2 7 is in full fora an W�L Lic.x E)
Ireer< Liccnse Class // FINAL
E®
h 0 a O Dmc S DECcmr L
l3 es.c lies ARCHITECTS DECLARATI
i y S 1 understand my Plans shall be used as puM1hc rtcrMs
i a s Licensed Prefessiooal MAR 2 12002
so m OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License law for the p
following reason.Section 7031.5.Business and Professions Code:Any city m county BUILDING $12442
F F p which requires ru permit to Construct,alter,improve,demolish,or repair any strucume
hath $ 'norm its issuance.elm rexdresthea liana for such permitmfik.signW statement - - ......
v3—
thath<u,li 8wah Section
e tion? 00)of dision the Convenors and Pr Law(ChapterCosts)
.1
t_,\3 fvF pp Alcvgr.f��,�; I �•r,i.r .. Valuation
(commenlin tht theranerm anj the
or the
eleged csaMPub.Any vi Code) TD4 ZtlZ1
of tut he is c&req themani an�toe basis for the alleged eiempf e.Any l violation
-of.1..]031.5 iv any applicant fora permit subjects the applicant as a evil penalry- ]�t.a..s5.��
mrtmt mar man Eve hundred sower fssm>. - 10 f3sPN 'Ia[917Y'IDAT I ON ' " Occupancy Type
❑1.as owner of the property,or my employees with wages as their sole compensation.
will do the work.and the structure is not intended or offered for sale(Sts:7614.
'Business said Profession Code:Ta,Conwcmr's License taw does not apply to an 103 - UFER Required Inspections- '
owner of property Who wild:or improves thereon,and who does such work himself 10 4 - REBAR
are throw his own employees.provided eat such improvements are not intended or
offered ar arts.ICbowevcc the Wilding or ini rovcmeni is sold within one ear of - -� _ .. ,._ __ . _.-_..._...,_.............._ _.... _ .__.. _.
completion,the owner-Wilder will naw heburd n of proving thin he did net build or 105 - ANCHOR BOLTS '•1'• -
ni mwforpurposeofalc.). 106 - SEWER & WATER
property .._ r I,wi_. .... _ 202' UNDERFLOORPLUMBING :
❑.I,as whey of the , xd.usiwl romnedn with tic-rosd con.._vacaan.to.. ' '- .. . . ..
comtsun the project(Sec.704,1,Business and Protections Code.)no convacmrs 203 - UNDERFLOOR MECHANICAL if
License Low does not apply man he,of property who builds or improv.Berton.
. ane who.commucts for.such projects with a convaamfs)licensed pursio nt to the .- .2 04UNDERFLOOR....FRAME-.-._.._._... .--.,___.- .__ ... ....
- C.rurmwra Licence Law.
❑l am exempt under See ,B APC roe Cis^„on 205 - UNDERFLOOR' 'I'NSULATION
Owner ' Das 301 - ROUGH PLUMBING
- WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
Ibereb, Mm under port of ,j.,on,dithcfollowing deaararom: 303 - ROUGH MECHANICAL
Ij a 1 have add will maintain a Canmcale, or Consent to self-insure for workers 304 - ROUGH ELECTRICAL
a y Compensation, as provided for by Session 3700 of the Labor Code. for the
perferrwhee of Ne work Lor whim Cis perissued. 3 0 5 mit Is — FRAME
have end will maintain Worker's CompensatloaiInsurarot.as require i by g«ton 306 — HOLDOWNS
tL of the Labor Cade.for the performance of the work Jar which this pcmua is 307 - INSULATION
issued.My WOAea Compensation Insurance carrier and Policy number rum:,
oSoSi] :_.. ':.,308 , S.HEETROCK ... _ ___. ...
iCERTIHTCATIONOFExEMPIONFROM�• - --3091 'EXTERI ORt LATH
N INSU
_COMPENSATIORANCE'•'
- LATH- .. -•. --- -' '_ -
t'(Thb¢onion '
needmt W completed if the permit is fur ore hundred dollars 311 SCRATCH COAT m 1.
(Stw)m laa.) •
,1 certify that in the perforimntt of the work p,which this pemd;l
ut is issue
shell net employ any person m. manner so s}d,ycpope subject to the Worker' 501 - FINAL ELECTRICAL'tNERGY
Compcnsmian laws of Col It _ /L7 502 - FINAL PLUMBING- ENERGY
Applicant. ��:ee..�L _ .. - .. _
NOTICE TO APPLICANT:IL ether making this Certificate of Exemption,you should 503 - FINAL MECHANICAL ENERGY
become subject to the Worker's Compensation provisions of the Labor Cade,you must
O mnnwiecompq'withsuchprovisiomorhisPermitshallbedeemedrevo_ ked. 504 - . FINAL BUILDING. ENERGY
Fz— 7) CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL ,
.� I hereby affirm that there is a eomwction lending agency for the perfor mnce
permit 3W7.Civ.C,I 506 GAS TEST
0 Lenders Name .. . —
.. .... ..
Z Last nnagrcs: 507 - FINAL PLUMBING
UO Icenifythat Ihave madthis application and state that ecabove informations 508 - FINAL MECHANICAL
WE.. cannot.l agree to comply with all city and county ordinances and state laws relating 509 - FINAL GRADE
O t.) m Wilding construction,and hereby northern representatives of this city to enter opera
>a v] due aboe.mentlonedproperty for inspection parposes. 510 - FINAL PLANNING
.Fn M. (We)agree to save,Indemnify and keep harmless the City of Cupertino against —
lice arabins.judgments,costs and expenses whim may in my way accrue against said 514 FINAL PUB I C WORKS
ony,consequence ofthe nom
in8 ofthIlive A.
APPLICANT UAEq�grgJDS'AND WILL COMPLY WITH ALL N u.Po Nr Issued b r` Date
SOURCE REG S. ��.�j� y
Signnmrt�ApplicanVCommctor ' ' "Date Re-roofs /
HAZARDOUS MATERIALS DISCLOSURE
will the.ppucart or future bulldingaccupant smrc or baame haiardbus matcud Type.of Roof. .. . .__... -__. -
es tleffmd by the Cupertino Mun'hpal Cade.Chapter 9.12.and me Health and Safety
Cade.Sauon 255321 in, ,i .-.. ..�.LJ. '.c h `' ,
CY "�"° ._..All roofs shall be inspected.prior to any roofing material being installed....
W-11 rise or wrote building occrp.nt use equipment or devices which If a roof is installed without first obtaining an inspection;'I•a'gree to remove
:mit hazardous air etmvear. mOefincd bYec Bay Ana Air Quality Management
)imicR all new materials for inspection. Applicant understands and will comply with
(r� J °r°'. "° '. .. all non-point source regulations. -
'"_� ' I have'mi d the haiudous mareriali m phstrcmi under Chapter 6.91 of the -
CalreitiaHealthd:Safety Chad.Sections 25505.25533 and 25534.1 undersuadthaa
if the Wilding does ria cuvemly have a tenant that it is my responsibility to notify the T
Ocnt
cupaof the rcr which must bc'met poor m issuance of a Ceihircem of
Occupancy.
Signature of Applicant Date
Gwnerrr na prized agent t Date All roof coverings to be Class "B" or better
.. ....» _
OFFICE 1 E . . .. . .. ..
3,47tW-,0N. S 13y
Zrwo0FLIi✓G Sore G/b11A)i
•
ropy. ,
APPROVED
IN ACCORDANCE ITH THE.CITY t
CUPERTINO GODF AND ORC`NANC :S
GATE d
l
SIGNED O
This set of pans aria: rpc6icetions MUST
be kept on the 'ob at c'! times ind it is un
lawful to make any c ,_r•,;;; or alteration'
on semp. WJ111 ci p: .'tr h pe n.ssio,n from
the uup,., City c,'„Cupe tino.
The .tamps U .h : , n f,,..specifica
SHALL h01 be tan:, ;:. mit u L b, ai
• approval of the v .1 ., :ny provi on
of arysM Dldm&,,x or '.;aic I, w
Q
[JAN 2.4 2002
i
•
o
L JAN 2,4AU02
• BY