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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
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BUILDIJ`1QA�DD00RESS.
PERMITNO.
N BLANEY AVE
SC BUILDERS
INC
03040045
owhgElq.TIFIC GAS AND ELECTRIC CO
AC.
491 E EVELYN AVENUE
ISSUE DATE
PERMIT04/08/2003
(408)328-0688
SANITARY NO. CONTROL NO.
ARCHITECOENGINEER:
BUILDING PERMIT INFO
PLO MECH
BO
0
LICENSED CONTRACTOR'S DECLARATION
lob Description
I hereby aEirm deet 1 am licensed under provisions of Chapter 9 (menumdng
with Scene. 7007 of D Polson 3 of the 0 ustrrax and Profndmu Cede. and my license u
in full foam and.ffm
License Class LIC.0
TI --13936
SQ.FT.
Dem_
IM7pnRATION
'
1 understand my plane ahIIIrecord.
JUL 0 7 2003
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby effion dust I em exempt from the Contract's License Law for the
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following mason (Seedon 70315 P, Bu rues end ficss un Code: Any city or county
which requires a permit he consumer, alar. Impmw. demolish. re mpstr any structure
PAW in its lung=, also mquba the applicant forsuch permit m file • alined Mal mat
that he is licensed purmand to the pmvislom of the Contract's liana Law (Chapter 9
Sq. Ft. Floor Area
ion
(Commencing with Section 700M of Division 3 of NW e Business and Professions Code)
$4,��la
that he is exempt damfrom and the basis for to alleged exemption. Any vloladon of
A9'
8Tr F!
�I e
•7 P
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty orOccupancy
net more than fin hundred dolun ($300).
0 0
❑ 1, a Cann of prepeay, W my employees with wages as the4wle Compensation,
101
— FOUNDAM44 3d Inspections
wllldo tits work, and the s=hire u ammmnded oro0ered forule (Sec. 7044,Bustnas
and Pmfeaemm Coda: The Conuectoes Liceve Law does not apply a an owner of
pmpenywW Wildaorimprowa thereon and whodaaguch workMmxelrorthmugbhis
102
— PIERS
ownemployees. pmvidcd that such improvements are not Intended oroOerml foraale if,
however, to buildingorimprowmcmuaCld within one yeudamplelon. the owner.
103
— LIFER
W Inver will ban the burden of proving that he did not build W Tmpmn for purpose of
104
- REBAR
Lia.).
I. u owner of the property, am ueludnly eontrafing wide licensed eonuanors to
105
- ANCHOR BOLTS
act the project (See. 7044, Business and Professions Cade:) The Conmacter's U.
106
— SEWER & WATER
ane law does not apply In an owner of property who Wilds Cr improves, liemon. and,
who acufor such prokca with a comncwrts) licensed pstrumn m use, C"ntnetpr'e
202
— UNDERFLOOR PLUMBING
Li"n
I e r .BAP IW this
203
- UNDERFLOOR MECHANICAL
-6.0)
MW
2 04
- UNDERFLOOR FRAME
Ow
205
- UNDERFLOOR INSULATION
•S MPENSATIONDECV. ON
hereby affion under penally of perjury one or the following declaa0ora:
301
- ROUGH PLUMBING
P1
nu wondwilloomWn a Currin.f Comenuoulf.imumforwmkefa Compen.
302
— TUB & OR SHOWER
,un, provided for by Section 3700 of the labor Code, for to performance of the
work for which this permit is Issued.
303
- ROUGH MECHANICAL
❑ 1 Mw and will maintain Workee, Compensation insurance, u required by Section
304
- ROUGH ELECTRICAL
3700 of the tabor Code, for to performance of the work for which this permit is laved.
305
— FRAME
My WorYds Compensation Imuana abler and Policy number sue:
Carder. Policy No.;
306
- HOLDOWNS
CERTIFICATE OF EXEM MON FROM WORKERS'
307
- INSULATION
COMPENSATION INSURANCE
308
- SHEETROCK
(Thu sectionneed notbcemplead Rise permit lsforom hundmddollaa(SI01)
nr less.
309
- EXTERIOR LATH
1 unify that In the Wormance of the work fed which thl. permit is tasted. )shall not
.. 310
— INTERIOR LATH
employs.) gglty come mbjecnq teworken'Compewuon
311
— SCRATCH COAT
Laws of Ca�Tid�nr
Appo�.�1 g
313
- ROOF NAIL
NOflye�Os A . alter making this Cenifinte of Exemption, you should
beeo see jeelm the Worker compensation provisions of the labor Code, you must
501
'
— FINAL ELECTRICAL ENERGY
forthwith comply with such Nwisom W this permit shall be dames revoked.
502
— FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY
503
- FINAL MECHANICAL ENERGY
I hereby affum that Nem Is a commetinn lending agency for the performena of
the work for which this permit uissued (Sm.3097.Civ. Q
504
- FINAL BUILDING ENERGY
Lender's Na nta
505
506
- FINAL ELECTRICAL -
- GAS TEST
Lender'sAddmu
1 certify that 1 ban mad Isla application and role Nat tic AWW Information It
Correct I agree to comply with all city and county ordinances ed sate laws c W ng to
5 7
- FINAL PLUMBING
building CWutruction, and hereby a dada mpreanudws of thH city ro Cour upon the
.hove.mmnonee roeimnify ankeeppurposes.
0
- FIN MEC ICAL
to an
(We) ague to an, indemnify and kap harmless the City o(CupeninC agsWt
0 9
F I
liabilities, judgments. costs and expenses which may in any way sa7oe against said City
in uencc Cf dire swung of this permit.
N
AP NT E ANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by:
Date
SOU R -I^ O
Re -roofs
Type of Roof
gnuure of AppO HAZARDOUS MATERIALS DISCLOSURE au
Will she applicant urfutum Wilding occupant am orbandle Invention, materiel
as dented by the Cuperth Municipal Code, Chapter 9.13, and the Health and Safety
Code, Section 255324)7
All roofs shall be
inspected prior to any roofing material being installed.
❑Yu No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the Applicant or fumm Wilding occupant on equipment W devices which
.vardnu. air connu u defined by the Bay Ams Air Ouslidy Management
"A's
all new materials for inspection.
len
❑Yes 6No
have reed We haradnumauriab myulmmenu under Chapurb.95ofthe CJlfnr•
riall I Safety Codo,Satom25505,35533und25534.lunwe dlbmif Np Wilding
don no(u mly w. anent NatIt b my msponslhlliiy w notify the occupmt d the
mgmm nt,ltlt iiaormwomaefaeeNneat ranpan9yp—��
wed
Sign ature of Applicant
Date
All roof coverings to be Class "B" or better
0 ormmodrd.ge Dau