03020044 CITY OF CUPERTINO
BUILDING DIVISION PERMIT i',CONTRACTOR INFORMATION:'`
BUILDING ADDRESS: SYL—MAR CONSTRUCTION PERMIT NO.
20803 ALVES DR 03020044
WNER'
(408) 293-7969 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MFAH
0 0 0 0
�00 LICENSED CONTRACTOR'S DECLARATION Job Description
s m 1 hereby affirm that 1 am licensed under p cions of ChaPmr 9(commencing p
U
with Sc9Vk ]�NO of DivisionSof NC Busine, d rfc inns CrWc,endm licrnx is
G „ worn umd� nB �6a�d0 ROOF SCREEN (NORTH &. WEST) FINA-4LE®
Z O D Z License CyN5 Lir.N
OZ—O p Conti
iy ARCHr1ECTSD ATION MAR 0 6 2003
eS g w ndersund my plans shall he uxJ u public records
d OAU
to Lkcnxd Pndessinnal
y�y OWNERn BUILDER m CLARATION BUILDING
a a a j I hereby mason.sect that 1 1. aurin (tom Nc CnntamnAd,c Law for the
i 600 followinguireaPermian]onstr Business and Professions Code:Any city of county
X which requires a permit re nmswcs,alter,improve,demolish,or repair any structure
F"f„^
poor it) Exudative,
nsedpursuarequires the provisions
of the such Contractors
Lice age
Lawdnatemcnt
C
that heisliccnxJpSeauan7(k(gpmvisionsofNcCnusinesSLicenselaonsCodur9 Sq. Ft.Floor Area $13V81t�ation
(mmmcncing with therefrom
and of Division 3 of al Business and on,Any
vi Code)of
y�— that he is exempt therefrom and the basis for Nc alleged caemplion.Any violation of
Section]071.5 by any applicant for a permit subjects the applicant o a civil penalty of Occupancy Type
not more than Eve hundred dollars($500).
0 I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the atactu.isnot intended or offered for sale(Sec.7044.Business
and Professions Code:The Contactors License law does not apply to an owner of10 2 — PI ERS equlred Inspections
property who builds or improves thereon,and who doessuch work himself orthrough his
owoemployees,provided that such improvements are not intended oroRered forale.If, 103 — UFER
however.the building or improvement is sold within one year of completion,the owner- lO4 — REBAR
builder will have be burden of proving that he did not Wild or improve for purpose of
ale.). 105 — ANCHOR BOLTS
O L as owner of the property,am exclusively contracting with licensed contractors to 106 — SEWER & WATER
consumer the project(Sec.7W,Business and Professions Code:)The Contractors Li-
.ase law does but apply toad owner of moparty who Wild,or improve.Nereo ,and. 202 — UNDERFLOOR PLUMBING
who contacts for such projects with a contractor(s)licensed pursuant o the Contractors
License Law. 203 — UNDERFLOOR MECHANICAL
O l am exempt under Sec. ,B&P C for this reason 204 — UNDERFLOOR FRAME
wncr Date 205 — UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 — ROUGH PLUMBING
I hereby aRrm under penally of perjury one of the following declaration: 302 — TUB & OR SHOWER
O l have and will maintain aCcniOcate of Consenuoself-inaure for WorkeM1Compcn- 3O3 — ROUGH MECHANICAL
cation,as provided for by Section 37M of the Labor Code,for the performance of the
work for which this permit is issued. 304 — ROUGH ELECTRICAL
0 1 have and will emblem Worker's Compensation Insurance.u required by Section 305 — FRAME
57OOof the Labor Code,for he performance of which this permit is issued.
My wor`keIrs Com^penation tdsurence carrieN�y,.��^id poli nerare: 306 — HOLDOWNS
Cantu, Policy tr: /�—� 307 — INSULATION
CER FICATE OF
COMPENSATION lINSURANCE ON FROM RKER 308 — SHEETROCK
(This union need not he compawd iflhe petmh is for tine hundred dollars(SI0r) 309 — EXTERIOR LATH
or leas') 310 — INTERIOR LATH
I mnify that in the perfotmance of the work fur which this permit is issued,I and]not 311 — SCRATCH COAT
employ any prison in any manner so 0 to become subject o the Workers'Compensalion
Laws of California.Date 313 — ROOF NAIL
Applicant
NOTICE TO APPLICANT:If,after making this Cendicate of Exemption.you should 501 — FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation provisions of the labor Code,you must 502 — FINAL PLUMBING ENERGY
Z forthwith comply with such provisions or this permit shall be deemed marked.
y O CONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY
E IherehyaOirmdoor ft.iaacoruwnry
innlendingagenlinNeperformetwcof 504 — FINAL BUILDING ENERGY
> the work far which this permit isi..ad(Set.ID9],Ci,C.) 505 — FINAL ELECTRICAL
IL)Q union's Name
5 z Under'sAddress 506 — GAS TEST
U 0 1 cenify that 1 have read this application and sure that the above information is 507 — FINAL PLUMBING
D. Pconics,l agree m comply with all city and county ordinances andsare laws relating to
building cnnswction,and hereby motion.repascnarivesof Nis city cat enter upon Nc 5 FINAL MECHANICAL
Wabove-mentioned property for inspection purposes. 09 FIN & GRADE 11
lC—'r (We)agree in save,indemnify and keep harmless the City of Cu,xvdm against
r,y h liabilities,judgment,,cos pcnacs which may in any way occme again said City 5 N Grel
U Z inmnseyueor ,,f mgr tin tcrmif ;/72APPLICANT U DE T ND W COMPLY WITI{ LL N -P01 Issued by5 1 WORKS
SOU CE RE L S.
/ Re-roofs
stu a AppIhnUdContranoe Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
ill Ne applicant or future building occupant store or handle haaardous material
as def ed by the Cupertino Municipal Code.Chapter 9.12,and the Health add Safety
- awe.Section255J2(a)? All roofs shall be inspected prior to any roofing material being installed.
O Yes )<No
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
chair hmardous air contaminants as dcrined by the Bay Area Air Quality Management all new materials for inspection.
District/
O yesOo
I have read the haawous materials requirements under Coulomb 95 of the Califor-
niaHcwN&Sufmy CoNu,Sce0ons25505, Sand 255W.1 undcrstund Nmif Ne building
does nm currently ho n f t it is bus samihiliry or notify the sccutam of Nc
requimmemawhich n or to arecofaceni0 a Iy-entreaty. Signature of Applicant Date
f -1
owner auNo 'cd agent m All roof coverings to be Class "B" or better