02050192CITY OF CUPERTINO
CONTRACTOR i2NIATYON•'
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
10804 B OOKW LL DR
MOCELIN CONSTRUCTION
02050192
OWNER'S NAME:
APPLICATION SUB DATE
1537 ORILLIA CT
05/31/2002
PHONE:
SANITARY NO. CONTROL NO.
(408) 732-6655
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
(-7 LJ L_ L_I
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed un r provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the 1321119, and Professions Code, and my license
is in folf ce an ecu r
ADD
582 S Q . FT .
License xs. c>7
Date Con etor
ENALARGE BEDROOM/NEW LIVING ROOM & ENTRY
HITECT'S LARATIO
I unde Land plans shall be used as public record.
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 703 1.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter. improve, demolish, or repair any structure,
prior to its issuance, also requires the applicant for such permit to file a signed statement
Sq. Ft.. F1aor.Area-
nation
that'he is licensed purstµnt to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code)
,
or that he is exempt therefrom and the basis for thea ilegdd exerriptioo. kny violation
of Section 703 L5 by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars ($500).
3 6
m Occupancy Type
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the stmcture is not intended or offered for sale (Sec. 7044,
—
Business and Professions Code: The Contractor's License Law does not apply to an
10 2
— PIERS equired Inspections
owner of property Who builds or improves thereon, and who does such work himself
or through his own employees. provided that such improvements are not intended or
10 3
— UFER
offered for sale. If, however, the building or improvement is sold within one year of
completion, the owner -builder will have the burden of proving that he did not build or
104
— REBAR
improve for purpose of sale.)
105
— ANCHOR BOLTS
Cl 1, as owner of the property, am exclusively contracting with licensed contractors to
10 6
— SEWER & WATER
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's
License Law does not apply to an owner of property who builds or improves thereon,
202
— UNDERFLOOR PLUMBING
and who contracts for such projects with a contractor(s) licensed pursuant to rhe
Law.
203
- UNDERFLOOR MECHANICAL
C. & C for this reason
nneLicense
%
204
- UNDERFLOOR FRAME
��t
MdEiv`seA til? R 9;
205
— UNDERFLOOR INSULATION
3O1
— ROUGH PLUMBING
I halty of perjury one of the following declarations:
3 02
— TUB & OR SHOWER
❑ I haveCertificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
303
— ROUGH MECHANICAL
performance of the work for which this permit is issued
304
- ROUGH ELECTRICAL
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3 0 5
— FRAME
3700 of the Labor Code, for the performance of the work for which this permit is
issued. My Worker's Compensation Insurance carrier and Policy number are:
306
— HOLDOWNS
Carrier:' Policy No.,
307
— INSULATION
ORKERS'
CERTIFICATIONCOMPENSATION
308
— SHEETROCK
INOSURAONCE
309
— EXTERIOR LATH
(This section need not be completed of the permit is for one hundred dollars
($100) or less.)
i
310
— INTERIOR LATH
I c if that in e t rfom `I''nce of the rl or whi this emus is issued, I
y P ` p
311
— SCRATCH COAT
shall not toy ai y p so, 7�ma nner c su ect to the Workers'
Com pens La:
— ROOF NAIL
501
— FINAL ELECTRICAL ENERGY
NVan`
( E TO A T: r aking this Certificate of Exemption, you should
e subjec to the k r s cation provisions of the Labor Code, you must
5 0 2
— F I NAL PLUMBING ENERGY
i forthwith co y with s ch rove or this permit shall be deemed revoked.
503
- FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
I hereby affirm that phare is a construction lending agency for the performance
5 0 4
- FINAL BUILDING ENERGY
of the work for which this permit is issued (Sec. 3097, Civ. CJ
(Sec.
505
F I NAL ELECTRICAL
Lender's Name
Lender's Address
506
—
GAS TEST
I certify that I have read this application and stale that the above information is
5 07
F I NAL PLUMBING
correct. 1 agree to comply with all city and county ordinances and .state laws relating
to building hereby representatives this to
508
_
FINAL MECHANICAL
construction, and authorize of city enter upon
the above-mentioned property for Inspection purposes
d 509
- FINAL GRADE
(We) agree to save, indemnify and keep harmless the City of Cupertino .rgains[
Iia 1i[ies. judgments. costs andxpenses which may in any way accrue aa,iinst said
'n
510
— i• 'r jxjAL/� G
Cit corse nen of the ran ng of this permit
-�o. Pc s _" �s� �� �. coa�t.� ��rrl �ft.�� ,_pu.'(
Issued`$ 4 tr
�I`1/h`7[-�(j'/��T,I�/
F ORKS Date
ate
Signal A p IvanJWding
Re -roofs
HA TERIALS DISCLOSURE
S 11 the lure buduccupant store or hmtdle hazardous material
Type of ROOF
as defined by the Cupertino 'Municipal Code, Chapter 9.12- and the Health and Safety
7 Code, Section 25532(a)P
Ye's
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
emit hazardous air contaminants as defined by the B:q Area Air Quality Management
District?
all new materials
for inspection. Applicant understands and will comply with
F.] Yes
I have read the hazardous materials requirements under Chapter 6.95 of the
( California Health & Safety Code, Sections 25505.25533 and 25534. I understand that
1 non -p int urce regulations,
if the bt' Ing does no currently ave a tenant, that it is my responsibility to notify the
occupa the requi me s ch mutt be met prior W issuance of a Certificate of
Occ, an �.
'gplicant
Dat
All roof coverings to be Class "B" or better
O r auth e etjr*-D�te!r
V OFFICE