03030109 CITY OF CUPERTINO "'`'m�"I"'" '� ''�''>'' '` •" "�•r•" "'t`` F
BUILDING DIVISION PERMIT d. Oto � �� T' Qt
BUILDING ADDRESS: PERMIT NO.
6109
OW.,'ER'S NAME: PERMIT LS A
SANITARY N OL N0.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECTL� O PLUMB 'MBCH
app LICENSED CONTRACTOR'S DECLARATION Job Description
01 1 herchy eflhm that I em licensed under provisions archamer 9(commencing
with section 7(m).rDi0slon 3 club.Business and Pmfessuns Code,end my llcenmh
In full forte and.ffeet. BATHRM REMODEL/UPGRADE (E)
LIC.;16 License Class
Dau Contractor
ARCball W use DECLARATION JUL 2 P: 2003
I 1 understand my Fixes shall be used u public mrnrM
e Licensed Professional /�
s OWNER-BUILDER DECLARATION � Vl
1 hereby.loan that I am exempt from the CommunarBUILDING
s License Law for the �g XX
o o following mason.(Section 71131.5,Business and Professions Cade:Any city or county
which requires a permit on contract,muco.improve,demolish,or repair any Nuctum
�y prior u its Wuance,Ileo requires de applicant for Cash permit or file a signed statement
< that beim licensed pursuant m the imvitiou of the Communist's License LA.(Chapur 9 Sq.Ft.Floor Area ton
$ (commencing with Section 70001 of Division 3 of the Buunruand Prefesalons Code)or 1 6�
.. that he Is exempt t emfrom and the basis far the alleged ae.spliot Any violence or
nowt mom than eve any
y applicant
ppldo one a pen
h subjects the applicant to a civil Focally of 3$M&144c[0 0 Occupancy TI pe
❑1,An owner of the property,or my employees with wages As Inch sale rompeuatlon.
will do the work and the =lure to not intended or offered far uk(Sec.7061.Buatrcu 101 - FOUNDF4MIJ Inspections
and Pmfew lour Code:The Contactor,License Law does not apply m an owner of
property who builds orlmpmses thereon,andwhodaeseuchwark1droulforthrough his 102 — PIERS
own employees,provided that such impmwmenu Area notinueded orolumd foreau.If. 103 — UFER
however,the building or Improwment ts sold within one year m completion,the owner-
bundler will haw the burden of proving that he did not bund or improve for purpose or 104 — REBAR -
sao.)' 105 - ANCHOR BOLTS
41 u owner of the property.em exclusively contracting with licensed concomitant to
onmm�the pmject(Sec.701<,Business and Prelesslons Code:)The Contractor'L1- 106 — SEWER & 'WATER
cense law date not apply to an owner of property who bided or barrows thereon,and l02 — UNDERFLOOR PLUMBING
who contracts fm such projects with a CoanacwKs)licensed pommel to the Conrmetoel
License Law 203 - UNDERFLOOR MECHANICAL
Alam &I_PU:1:11::1ON
'Do thl run 204 - UNDERFLOOR FRAME
OECLARASONW 205 - UNDERFLOOR INSULATION
perjurytaroofthet�ingdlecluatlou 301 - ROUGH PLUMBING
ofcamentuaelr-Iaumrmworterscompen- 302 — TUB - & OR SHOWER
satlon,as provided for by Section 3700 of the labor Cade,fm the peRammsma of the 303 - ROUGH MECHANICAL
work for which this permit is lured.
❑I new and will maintain Workers Compensation luureace,as required by Sermon 304 — ROUGH ELECTRICAL
3700 of the tabor Code.for the performance of the work fm which this permit Is Weed. 305 — FRAME
My Worker,Compensation insurance center and Polity number ase: 306 — HOEDOWNS
Cartier. Policy No.:
CERTIFICATE OF EXEM lynON FROM WORKERS' 307. — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
or less.) his motion need not IN canplead tone Permit Is for me hundred dollar/slap) 309 — EXTERIOR LATH
Icenify that in'ihe performance of the work for which this permit is Wood.I shall not "' 310-----`'INTERIOR- 'LATH -
employanypenonlnasym sro anis nbee a subject the Worken'Compensation 311 — SCRATCH COAT
Laws of CaltfornilAIX
Applk til 313 ROOF NAIL
N(MC UC .ILenet mikingthis CeninceuofExamption.you should 501 - FINAL ELECTRICAL ENERGY
berom whJoft m t cher,Compensation previsions of Ne IaM+r CMC,you muss
�'Z forthwith Comply thauch provisions lir this persue mall Mdcemed rewked. 502 — FINAL PLUMBING ENERGY
zyCONSTRUCrION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hereby&Mmm that them u•construction lendingagency far the Performerccm 504 - FINAL BUILDING ENERGY
x> the work fee which this permit h issued(Sec.3097.Civ.Cd
JJ P; Lender's Nune 505 - FINAL ELECTRICAL
3. LendcrsAddw
D p 506 — GAS TEST
1 certify that 1 how reed this application and sou that see above Information is
h comet.I agree to comply with all city and county contains,and sues laws mining on 507 - FINAL PLUMBING
�fJ building convection,and hereby authodsa representatives of this City m enter upon the FIN MEC CAL
r W show-mentioned property for InsPeNon politics.
V) liab11Wesjjudgm agree to
indemnify
expenses when may In Cay Cay&cor erve against soldroo aCity 09 FI
U in consequence of the starting of this permR 5 NG
APPLICANT UNDE ANDS AND WILL COMPLY WITH ALL ON-POINT Issued by:5 Date
so
R A Ns.
3 a Re-roofs
Sigost f cenrContr¢lom a '
HAZARDOUS MATERIALS DISCLOSURE- Type Of ROOF
W applicant or future building occupanutarc or handle hazardous material
den by the Cupntllm Municipal Code,Chapter 9.13.sad the Health and Safety
Crude,Section 25532(e)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes ((Nu
Will the applicant or future building=upon,um equipment w Jcvimm which If a roof is installed without firs[obtaining an inspection,I agree to remove
O hazardous air rnmamuants as defined by the Bay Ama Air Quality Management all new materials for inspection.
Discoid?
❑Yn IIRNu
1 hers mead de h mardmu materials requirements underChapw 6.95 of the Califim.
nuhWlth&SatnyCede,Satires25505.25533 end 25531.1 understand dos irte building
Does not emmnlly ha a tenant,that it u my responsibility m nadir tie occupant of tie
tequ me bcmnprlormltsuanceofa(kmlifivaofOc Signature of Applicant `Date
r r odyetl spent • tau
All roof coverings to be Class"B"or better