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02060149CITY OF CUPERTINO BUILUINC DIVISION PERMIT CONTRACTORINFORMATIO , emq)p1900napq BLANEY BLD 6028 FERMI rNg2060149 AQ/PFIC GAS AND ELECTRIC CO APPLICAT®l5sri`2AT'i2002 IIONE: SANI'T'ARY NO, CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 j LICENSED CONTRACTOR'S DECLARATION - IWhiny affirm tatIamlicensed under provisions ofChapter 9(commencing TENANT' �[0 77 A��p�,�g IMPROVE1vl�RTSYrlt'An Fp1LL'ty7rihJ�® with Section 7g)(p of Division 3 of Inc Business and Profesaiulns Cook, and my license is L in full tome and effect. STRUCTURAL UPGRADE c Llaeae Class Lic.N Dan Contractor MAR 10 2003 or ARCHITIiCTS DECLARATION i 1 understand my plans shall he used as Public records BUILDING Licensed Professional S OWNER -BUILDER DECLARATION E 1 hereby zlfirm that 1 am exempt from the Comr,mou's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct. alter, improve, demolish, or repair any sWcture $221165 prior [it int issuance, also requires the applicant forsuch Permian file a signed statement T Nat he islicensed Pursuant tothe provisionsofthe Contractor's LicenceWw(Chapter9 Sq. Ft. Floor Area Valuation with Section IlMgB of Division3 oflhc Busirmseand Professions Code) or s 31603045.00 tat -Nat he is exempt therefrom and the basis for the alleged exemption. Any violation til Section 7031.5 by any applicant for a Permit subjects Or applicant to a civil Penalty of than five hundred dollars 450O APN Number Occupancy ane p y Type not more ' 101 — FOUNDATION ❑ Lo withwagcsasthei(role �om. pestrac,or the work, andis intendeddJ Inn sale(See,to an, Business Busti is will do Inc work, and the structure is not s Lice s fir Law and CWT: The convectors License Izw tines apply to an owner 1:62 103 - PiERS UFERormRequired Inspections JZ' ,t,.hons and wh9 ams such woe himClfar through his or is pmpem who builds of improvesat ch Improvements for buipmvior 104 — ^% REBAR / however. one imrovemintisod wfsanene year of comoropletion, or improvement issoldwithinoneyear or completion, throw, owner. owner - meave 105 — ANCHOR BOLTS builder the builder will have the burden of proving that he did not Wild or improve for OurPose of of T) 106 - SEWER & WATER Og u owner of the property, am exclusively contracting with licensed connectors to 202 — UNDERFLOOR PLUMBING no the project(Sec. to an Bnsimssand nose Law dors no, apply m an owner of property who builds or improves theicon, and rtyProfessions Wilds or:)Theves Contractor's fid 203 — I�P� UNDERFLOOR MECHANICAL v who connacu for such projects with a comracton(s) licensed pursuant the Contractor's License law. 204 - UNDERFLOOR FRAME ❑ lamest tunacr c. ,B&PCfor this rcazon 205 — UNDERFLOOR INSULATION e 19�L0— 301 — ROUGH PLUMBING o Ice 's c NSATI CLARATue 302 — TUB & OR SHOWER hereby aRrm under Penalty of Iw jury one of the following declarations: 303 — ROUGH MECHANICAL ❑Inarcandwudforbynecion37renftheLabrComard to Cdinforthesum for Wonkersceofthemport. cation. az provided for try Section 3]11() of the Izlwr Code, vv me performancc of the 304 — ROUGH ELECTRICAL work for which this permit is issued. 305 — FRAME 1 have and will maintain Worker's Compensation Insurance, az required by section 3 0 6 — HOLDOWNS 37(X1 of the LaNx Code, fill the performance of me work for which this pc.it is issued. My Wooers Compensation Insurance carrier and Policy number am: 307 - INSULATION carni Policy No: 308 — SHEETROCK CERTIFICATE CION FROM OMPENSATION COMPE SATION INSURANCE 309 - EXTERIOR LATH (Goisseclion need not bccnmpleted itmcrermrtisfironchundrcddollars($100) 310 - INTERIOR LATH lea`) 311 - SCRATCH COAT 1 ccnify met in the pe ,Tran tf the work for which this permit is isvue4l shall nou 313 — ROOF NAIL employanyP ym m bcnme sublectaothc kcrs'Co pensation Lawsnfcaf `- °a_1:nt.Ya` v/nr�ai Ap li ill I 1 / 4'1 A/JLL aprJO� 501 — FINAL ELECTRICAL ENERGY Np E'I APPLZC4NT. If aftlir damorigghts Certificate of Exemption. you should 502 — FINAL PLUMBING ENERGY nemme eufl l to the Woeer:s Compensation provisions of the Labor Code, you most ' forthwith comply with such provisions or his Permit shall be deemed mseked. 503 - FINAL MECHANICAL ENERGY — FINAL BUILDING ENERGY CONSTRUCTION LENDING AGENCY I thereby amnm Our, there is a conmuction lending agency 0v the pfroromee of 505 — FINAL ELECTRICAL the work (if which this Fermi t is issued (Sec. 3(N7, Civ. C.) 506 GAS lender's Name — TEST Leder's Address 507 — FINAL PLUMBING Cd I certify mal I have read this application and state In., the aMove information is 508 — FINAL MECHANICAL correct, l agree to comply wit all city and county ordinances and state laws relating to building 5 construction, and hereby authorise representatives of this city m enter upon the aMwr lin inspectiones.ho FINAL GRADE (We) are to saw romvc, indemnifyandkeepharmless the City of Cupcninu against mnify an keep 10 FINWPLANNI(Wc3ned liabilities, judgments, costs and expenecs which may in any way accmc against said City m consequence of the Granting of this Femur. 5 F NRKS APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Dale SOUR A Re -roofs sGyGIU lo, 31 L tine of Ap c urict II m� HAZARDOUS MATERIALS DISCLOSURE. Type of Roof Will the applicam or future building occupant store or handle hazardous material defined by the Cupertino) Municipal Code, Chapter 9.12, and the Ucaltn and Safety le. Section 2ss3zfan ❑Yes A No All roofs shall be inspected prior to any roofing material being installed. 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 mit bvaNaus air concomitants as defined by the Bay Area Air Quality Management Dlwfiell all new materials for inspection. ❑Ye., I have read the hazardous materials requirements under Chapter 6.95 of me Califor- nialleaWdrSafety Code. Sections 25505.25533 and 25534.1 undersand then it the building does on currently have a tenanh that it is my responsibility to coli fy the occupant of Be regnhc ntswMT nmst m promwomometoaccrtmoduf a p Signature of Applicant Date n it, stir mi,ea cgs tt Date All roof coverings to be Class "B" or better