03090087 CITY OF CUPERTINO :a�s+ ,„gg ,+Rx 'sw :: =
RUILDINC DIVISION PERMIT CONTRACTOR INFORMATION
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BUILDINGADDRESS: J M J CONSTRUCTION PERMITN003090087
.R'S NAME: 480 BAYVIEW DR PERMIT ISSUE DATE
NE: SANITARY NO. CONTROL NO.
(408) 621-7844
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
30 LICENSED CONT'RACTOR'S DECLARATION
I Manby affirm Be,1 Am licensed under provisions of Chapter 9(commencing Job Description
i with Section 7MAnnf Division 3olthe Business and Profession,Code,and my license is
°?u in full fade And effect.
;mz 'mAnAr Lie.« REVISION--IN HOUSE USE ONLY
Dam Contractor NO NEW PERMIT ISSUED/ORIG. #k02120041
ARCHITECTS DECLARATION
f Iunderstand myplans shall heused aspublic records REDUCE SIDE SET BACK TO 9 ' -6
)n,U
SQA Licensed Professional
HS OWNER-BUILDER DECLARATION
F 1 hereby Affirm that I am eacmpl from the Contractors License Law for the
00 following moon,fSectiun 7031.5,Business and Pofession,Cole:Any city or county
m which requires a permit to construct.alma improve,demolish,or repair any structure prior m its issuance.also mquirts Lou applicant for such Permit to flc a signed nammem
¢ <
that hcislicensed pursuanun the prnviAinnaofthe ConlmcmriLicense aw(Chapmr9 Sq. Fl. Floor Area Valuation
i (commencing wi th Section 7000)of Division 3 of the Business and Profesdom CAN)Of
$
that he Is exempt therefrom and the basis for the alleged exemption.Any violation of $34
Section 703 1.5 by any applicant for a permit subjects the applicant to A civil penally Of APN Number Occupancy Type
not more Wil Mc hundred dollars 4500). --
Ol,as owner of the property,or my employees with wages u their sole compenmlon, 3692 1024 . OO
will do the work and the awnure is not intended or offered for sale(Sec.1044,Business
and Profession&Cada:The Convector's License Law does not apply to an Owner of Required Inspections
property who build,at improves Narcan,and who dom such work himulfar though his
own employees,provided that such improvements are not intended An offered for ale.It. 101 — FOUNDATION
however,the building or improvement is sold within one year of completion,the owner.
builder will haw Be burden of proving Nn he did not build or improv for purpose of 102 — PIERS
i[e')' 103 - UFER
0 1,as owner of the property,am exclusively contracting with licensed common to 10 4 — REBAR
Camtraal the project(Sec.7044,Business and Professions CWc:)Tim Contractor's Lt
come law Lima not apply to An owner of property who builds or improves Nemon.and 105 - ANCHOR BOLTS
who contacts for such pmjecss with a contractor(s)licensed pursuant to am Contractors
License Law. 106 - SEWER & WATER
01am marinunderSee .BkPCfar this reasuA 202 - 'UNDERFLOOR PLUMBING
,4 Data_ 203 - UNDERFLOOR MECHANICAL
WORKER'S COMPENSATION DECLARATION
I hareby affirm under penalty of perjury Om of the following declarations: 204 — UNDERFLOOR FRAME
�. Iend will moinuin A Ccnificole of Co..,.sel6lmure for Wmkpereer'a Com205 — UNDERFLOOR INSULATION
Mw
salion,As provided far by Section 37M of the labor Code.far Ne per(mmace Of the 3 01 - ROUGH PLUMBING
workfor which this permit is issued. 302 — TUB & OR SHOWER
0 I have and will maintain Workers Compensation Imursnce,ss mquired by Section
37n&orthe Labor Code,for ran performance ofthe work for which this Permit isaimed. 303 - ROUGH MECHANICAL
My Workers Compensation Insurance carrier and Policy number am: 304 — ROUGH ELECTRICAL
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORK ERS' 305 — FRAME-'
COMPENSATION INSURANCE 306 - HOLDOWNS
(Thusection=ad not M completed if be Nanat is far one hundred dollars(Slip) 307 - INSULATION -
or Ask)
I Unity Nat in the per(armoncc of the work for which this Permit is immed,l shall not 308 - SHEETROCK
employ any person in any manner an As At hecome subject to the Workers Compensation 309 — EXTERIOR LATH
laws of California.Dem
Applicant 310 - INTERIOR LATH
NOTICETO APPLICANT:IL after making this Cenificam of Exemption,you should 311 - SCRATCH COAT
become subject to the Worker's Compensation provisions of the labor Code,you must
�Z forthwith comply wiihsuch pvadMansA,thOPermit,hall hedeemedrewked. 313 - ROOF NAIL
�C, CONSTRUCTION LENDING AGENCY 501 - FINAL ELECTRICAL ENERGY
I hereby affirm that Vert is a construction lending gency for be performance of 502 - FINAL PLUMBING ENERGY
xiz the wurkfar which this Permit aissued(Secs3097,Ca.C.)
A nit,h 503 - FINAL MECHANICAL ENERGY
U
31
jz naeraNamc Address 504 - FINAL BUILDING ENERGY
;gyp IcenifyLast lhaw readdo.Application And sumBar she aboveinforromm.is 505 - FINAL ELECTRICAL
building I agree to comply with all city end county ra inance,and sake laws relating to /
j building cane La
gand herchyaity and
rcprtanmlinanesthis city to sakela enter upon to GAS EST
W shave mcntiamd PoPcny fro indemnify
an keep ha
(We)agree m ssw,indemm(y and keep harmless the City of Cupcnino against O 7 F I /1
~ {z0./( Ilablllllµjuagmcnts,easts and expense,which may In any way see=against aid City 5 AL
J^ APPL CA nceof the gaming of UNDERSTANOSthis AND WILL COMPLY WITH ALL NON-POINT Issued b Date
SOURCE G NS. y' S
Re-roofs Sf14 INAL PUBLIC WORKS
4 SIrlWum0 H ARDOUS MATERIALS DISCLOSURE am Type of Roo
J Wllllbeap !cantorfuture building Occupant smrc or handle haardous macrial
as defined by the Cupenina Municipal Code.Chapter 9.11.and the Health and Safety
,Seclian 15532(¢)1 All roofs shall be inspected prior to any roofing material being installed.
(DoreO
Will the applicant or future building occupant use equipmentm devices which If a roof is installed without first obtaining an inspection,I agree to remove
it havaidnus Air conn inane ss defined by the Bay Ana Air Quality Management all new materials for inspection.
er1
0 Yrs u
I haw mad the hu>aN mmamriahmyuimmenu under ChaPmrh95 of the Califon
ili.w.lN'Safcty Cade,Sections25505,25533.d1 S34.1un&.dthmifNc Wilding
does net cumenit,hmse a meant,Idem itis my msNuaLONY m mmdy the aacupant of the
nquiremcn which usthemet priorto issuance o 'Be IGeeoP.n . Signature of Applicant Date
ownA, arimdagdat Da All roof coverings to be Class"B"or better