03010134 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR FOR, 10
BUILDING ADDRESS: PERMIT NO.
R.J. PEREZ CONST INC 03010134
M PERMITL4UE DA1E
10485 BYRNE AVE 05/23/2003
MONE SANITARY NO. CONTROL NO.
(408) 252-2797
ARCHITEC rENGINEER: _ BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
00 LICENSED CONTRACTOR'S DECLARATION
1IWmhy affirm that I am licensed under pmviaioms of Chapter 9(commencing
with SJob Description
Section Division 3 of NC Business and Profcasions Code,and my license is ll�
in full to= Il�����
-o wEEEy rce and effect.
yi
License Cl. tae.. NEW SINGLE FAMILY DWELLING
Do.-Ciministo,ARCHrtECTS DECLARATION 4979 SQ. FT. LIVING SPACE MAY 1-' 2004
C I understand my plans shall he used as public reenrds
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Licensed Pmfessinnel BUILDING aos OWNER-BUILDER DECLARATION B�JJ LDIN/�
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i1 WrohaRu am Lee..rm NI exempt from the Contractors ee..Law for the MI
_
no following reason.(Section 7031.5.Business and Professions Cads:Any city or county
$E which requires a Permit to eom mc,,alter,improve,demolish,or repair any stmmure
to prior Bs i0 issuame,alar,requires the applies.,for such permit to Glc a signed stammem
-�a Nal he is licensed pthomanuo the provisions of the Contnctori License Low(Chapter 9 Sq.Ft.Floor Area Valuation
EO (commencing with Section 7000)of Division J of the Business and Professions Crude)or
E R- that he is eaempt ihimfrom it tW bass for the alleged eaempuon.Any violation Of
Section 7D31.5 by any applicant for a permit subjecta the applicant to a civil penally of APN Number ccupancy Type
not more than five hundred dollars 4500).
❑L as owner of the propcny,m my employees with wages as their sole compensal on, 35711005 . 00
will do the work and the struco m is not inteMW or oRcmd for sath(gee.I(WI.Buuoem
and Professions COEc:The Contracmrt Licame law don not apply In an owner of Required Inspections
pmMny who builds in improves thermn,and whodoes such work himselfm through his 101 - FOUNDATION
own employe.,provided that such improvements are not intended or offered formic,If,
however,the building or improvement fa sold within one year of completion.the owner- 102 - PIERS
builder will have Or WNen of proving that he did not Wild or improv=for Purpose of 103 - UFER
sale.).
❑I.as owner of the property,am exclusively contracting with licensed conoactort to 104 - REBAR [�
contract the pmjtct(Soc.1041,Business and Professions Code:)no Contractors LL 105 — ANCHOR BOLTS
c rase law ues not apply an m owner of property who Wilds or improvws daemon,and
who c0 ca prujmis who a conuacmr(s)licensed pursuant to the Contractors 106 SEWER & WATER
L` 202 UNDERFLOOR PLUMBING
I cacmpt y dv Scc. ,DB k P L'for i o
� V` 203 - UNDERFLOOR MECHANICAL
coo x $COMPENSATION DECLA ON 204 — UNDERFLOOR FRAME
t mbyafwttundnpelwtyofpnjuryumuflhefmlowingd.lmdonic 205 — UNDERFLOOR INSULATION
❑I hoe and will maintain a CeniGate ofcortsent to self-insure fm Workers Compcn- 301 - ROUGH PLUMBING
nation,as provided for by Section 3700 of One labor Code,for the performance of the 302 - TUB & OR SHOWER
work for which this permit is issued.
❑1 have and will maintain Workers Compenmtion Inwranm,as required by Section 3 03 - ROUGH MECHANICAL
37M ofthn labor Code.fm the pcitnrnameof be work for which this permit is issum. 304 — ROUGH ELECTRICAL
My Workers Compensation Insurance carrier and Policy number art:
Comm Policy No.: 305 - FRAME
CERTIFICATE OF EXEMPTION FROM WORKERS' 306 - HOLDOWNS
COMPENSATION INSURANCE 307 - INSULATION
or less.)moo semien reed notal completed ifft permit is for one hundmal dell.(SIM) 308 - SHEETROCK
1 certify Nat' dac perf cosec of dac work for which Nis permit is issucd.1 shell net 309 - EXTERIOR LATH
employanypeattymannermolo Wcomesubjecl to the women'Compensation ,310 — INTERIOR LATH
laws of Califomna Da¢
Applicant 311 - SCRATCH COAT
NOTI E APPLICANT:IL after making this Certificate of Eacmption,you ahold 313 - ROOF NAIL
become jcn to the Workers Compcnmtioa provisions of me labor Code,you mus
Jo mods comply with such provisions ormispcnnitahauWdamedmvnkd. 501 - FINAL ELECTRICAL ENERGY
z
CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
[:. .N. I hemby affirm that there is a construction lending agency for the performance of 503 - FINAL MECHANICAL ENERGY
CG the work for which this permit is issued(Sec.309'!.Civ,CJ
sn lender's Namc 504 - FINAL BUILDING ENERGY
Lenders Address
V o 505 - FINAL ELECTRICAL
I ttmfy Nat 1 have read this application and ata¢Nat the obese infomntiun is
correct,I agree to comply with all city and county on inuntts and sole laws relating to 506 - GAS TEST
building concoction,and hereby authorize rcpmsentatocs of this city to inter upon the
V above-mentioned property for inspection purposes. IN PLUMBI G
�v A,)
G
We)agree to rove,indemnify and keep harmless the City of Cupertino agaiml IN L
fq liabiliu..judgmcnu.ems0 and expenses which may in any way ePinsI said City 50%
U rY, APon(ggmd U c RSTAN of s = f
APPIIIRAiCANT UN RSTAND AN WILL COMPLY WITH AL 0 -POINT Issued bYNG Date
SOP seem u o S. i
Re-roofs 514 - AL PUBLIC WORKS
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sigmsuroeantyc Dote OOF PLYWOOD NAIL
HAZARDOUS MATERIALS DISCLOSURE Type of
Wilthoapplicent or future building Occupant or handle hanNous material 3 - ROOF BATTENS
as defined by the Cupertino Municipal Coda Chapter 9.12,and the Health and Safety 60 ROOF IN-PROGRESS
�
ode,Section 255324)?? / All roofs shal be inspected prior to any rooting material being installed.
Y. [�Nu
Will the apphcanl or future building occupant use equipment or min mo which If a roof is installed without first obtaining an inspection,I agree to remove
cmll hamrdous air cominnimane as defined by the Bay Ama Air Quality Management all new materials for inspection.
Diavin7
❑Y. aNt>'
I have read the hvsrdmsmaterias tequimmemts under Chapter6.95 of the Califor.
nieH Code. .255115,2SSJJ am125534.1 undersmnE dauifdw Wilding
Jt of cuemml ave e e t Net it is my responsihill m notlfy the rceupanl of Ne
unmet ohm nme r,racerti ¢mraeupyiZ Signature of Applicant Date
caner r,mdamdrea.g t �V<j Date All roof coverings to be Class"B"or better