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03020023 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 10025 BYRNE AV 01020023 OWNER'S NAME: APPLICATION SUB DATE IOWHICKER RICHARD E AND NORTHRUP 02/06Z2003 NE: SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH �CO LICENSED CONTRACTOR'S DECLARATION Job Description C u I Mmby affirm Nat 1 am licensed under provisions of Chapter 9(commencing P with Seclimilo Bof Division 3nf the Business end Profcuinnsemk.anJ mylicevc is �� mrwlmre-9iffe r� 3g 9y6 y REPAIR FIRE DAMAGE zop3 LicenuClatt Con SIDING/GYP BOARD�WIRING�FRUE ?y� D -o comrgeLARC /�� m ARCHITECTS..panic m rON 1 understand my plans shall M uuJ as public mads �lC 3a Licensed Professional a'p OWNER-BUILDER DECLARATION APR 1 0 2003 zZ I hereby affirm Nal I am exempt from the Contractor's Licen¢Law for the i p O following reason.(Section 7031 5,Business and Professions Code:Any city or county x$ which requires a Permit to construct,alter,improve,demolish,or repair any structure 10 prior to its issuance,also mquires the applicant for such permit to file a signed statement BLUING < that W ishwereard pursuant to Me provisions of the Common a License Lew(Chapter 9 Sq. Ft. Floor Area 9 (commencing with Section 7")of Division]of the Business and Professions Curio)or $19000 y Nat he is exempt therefrom and the basis for Ne alleged exemption.Any violation of Sation7031.5 by any applicant for a Permit subjects Ne applicant to a civil Penalty of APN Number Occupancy not more than five hundred dollars($500). 35711023 . 00 P y Ty� ❑I,vowner of the pmpeny,or my employees with wegesu their sole compensation, will do the work,and the structure is not intended or offered for sale(Set,7044,Business g�D�� and Professions Cade:The Commons Liam Law does not apply to an owner of 101 - FOUNDA"j` d Inspections property who builds or improves thereon,and who doesauch work himself orthrough his own employae,provided that such improvcmenu on,not intended merited for sale.V. 102 — PIERS 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 Mild or improve for purpose of 103 - UFER i1t) 104 - REBAR 0 h as owner of the progeny,am exclusively contracting wife licensed contractors to 105 — ANCHOR BOLTS convect the project(Sec.7094,Business and Profrstions CQkq The,Concractor's Lt unac Law does not apply in an owner of property who Wilds or improves therenn,and. 106 - SEWER & WATER who contracts for such projects with,commai Bernard Dorsum to the Contractors cme Law. 202 - UNDERFLOOR PLUMBING a lam el oder Sec. ,B&PCfmt,BmkRm 203 - UNDERFLOOR MECHANICAL I�wo KE ROMPENSATION DECLARATION�_6 'O,� 204 - UNDERFLOOR FRAME l hereby affntn under Penalty of perjury one of fee following dalartiions 205 — UNDERFLOOR INSULATION ❑Ihavn and will mainminecenifcete of Conxnun calf-insure for Worker'sCnmpen- 301 — ROUGH PLUMBING sation,as provided for by Section 37M of the Labor Code,for the performance of the 3 02 - TUB & OR SHOWER work for which this permit is Wind. 303 - ROUGH MECHANICAL ❑1 have and will maintain Worker's Compensation Insmsnce,as required by section 3 04 - ROUGH ELECTRICAL 3700 of the labor Code,for fee performance of the work for which this permit is issued. My Weaker.compensation lma.cariere numMram: 305 - FRAME G 306 - HOLDOWNS CERTIFIC OMPE SATION OISROM WORKERS' COMPENSATION INSURANCE 307 - INSULATION Mixsectionnad not M completed K IM Kornil isformte hundred dollar(SIfkB 308 - SHEETROCK erless.) 309 - EXTERIOR LATH 1 certify that in the performance of the work for which this Permit is issued,I Nall not 310 - INTERIOR LATH employ any wnln any manner so ssuLscc�imc syQlecuolhe Werkors'CnmPensallnn Lewxof Caf ro ate ll o J 311 - SCRATCH COAT Ap t LJ N To ICAW.I,e ler ing this Canificalc of Exemption,you should 313 - ROOF NAIL Become subject to the Worker's Compensation provisions of the Labor Code,you must 00 forthwith comply with such provisonsorthis Permit shall Mdurnedrevoked. 501 — FINAL ELECTRICAL ENERGY CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY .N. Ihereby atTomMen Me.isaconstruction lending agency fonhePenfuromhowof 503 - FINAL MECHANICAL ENERGY Ge the work for which this permit is issued(Sec.3097.Civ.CJ W 504 - FINAL BUILDING ENERGY � 0 1<ndef's Add. z nder'sAddress 505 - FINAL ELECTRICAL u p 1 unify that I have mad this application and sum that the above information is 506 - GAS TEST Lks (~ correct.1 agree to comply with all city and county ordinances and sum laws"cutins m O V building construction.and hereby amhorire mpresenmuvea of this city m enter upon the FINAL PLUMBI G Ik( shove-mentioned Property fur inspection Purposes. O 8 FIN L 4 (We)agree to save.indemnify and keep harmless the City of Cupertino against yz liabilities.judgments,toss and expactes which may in any way same against said City CJ A in his U w+ APPL conCANT`UNDERSTAof the NDSof IANDrinfil. 4,71 WILL COMPLY WITH ALL NON-POINT Issued by:5 NG Date SOURCE REGULATIONS. _ 9- Re-roofs D1 1i St aA icentlCommmnr Dam HAZARDOUS MATERIALS DISCLOSURE Typo Of ROOF Will the applicant nr future building occupant sine or handle hvamous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the licallh and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.❑Yea ;W_ 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 haamom air amlaminans ss by Ne Bay Ams Air Quality Management all new materials for inspection. Districl7 ❑Yes No 1 have mail the ha>rdous materials requimments under Chapter 6.95oftheCalilin- niaHealth&Safsty Code,Secdons 25N15,25537 and 25574. unQuand thnifthe building does not currently have a tenant,that it is my mspmn sibilityotify the occupant of the 7 ZiilawhichmanMmetpriortoiomanceofacenife of eupaney. Signature of Applicant Date Own rm atuhori ed agent Date All roof coverings to be Class "B" or better