03030011 CITY OF CUPERTINO
BUILDING DIVISION PERMIT G49NTT' CTOR lIN1 b A' IQ•; ; •
BUILDING ADDRESS: RSC CONSTRUCTION COMPANY PERMIT No.
r sNAME: 45973 WARM SPRINGS
IIKPeRMITI�O
IN XU
PHONE: (510) 353-0588 - - SANITARYN OL NO.
ARCHITECT/ENGINEER: BURDINO PERMIT INFO .
BLDG ELECT PLUMB MECH
amp LICENSED CONTRACTOR'S DECLARATION Job Description
l8 1 hereby affirm Nu 1 Me licensed under provisions ons of ChAl 9(commencing with
with Section 7000)ofDIAIon 3.f du Bud=l and Profadmu Code.and my liccns Is
me, In mu forte and Ancor REVISION--IN HOUSE USE ONLY'
?04 Llanm Cam Lic.g
Fet
Date Contractor ARCHIIECrSDECLARATION NO NEW PERMIT, ORIG. #02080116 �D`\
I q I understand my plans shall be used As public records '
\�
.� Lieen+eProfesdoml
OW ID
\
NERBUIBR DECLARATION
I hereby.(Se o n I am exempt from tun CantractCo :A License law for the
p O which requires;
(Section 7031.7,Budu=and Profeailons Code:Any city of aunty
$ixi which requires a Pump to ahea the alar.Impmw,de ch Permit
t m e a sig ed euucmm
�Sr P hAislmnmdp,dsurequiresd30appll=tf CaptmtoALI file Valuation
22 < dlnhcisllanaapuuuammNepmvinoiuoTlhcConuanor'sUttnselawlCTaPm9 Sq.Ft.Floor Area
$ (commencing with Section TOD0)of Divinon 3 ofd=Business and Pr.feuhnna Code)a
Is he exempt themm fmand the basis for the alleged eacmom My vlolWpdun of
Swim 7031.5byAny applicant for a permit aubjeN the Applicant An a chin Perully of APN Number Occupancy Type
NI more than Ow hundred tints.($500)•
❑I.u manor of the property.mmy employ=with wages As 113011 sole compensation, 35712038 . 00
willdo thew tk.and Neawctuens.,intended or.ncmd fwasle(Sm.7044.Business Required Inspections
and Profession,Code:no Convacur'a Liam Law d=not apply in an owner of p}
property who builds mlmprows hhemenandwho daamh work hlmultorthmugh his 101 — FOUNDATION
own employ=.provided that such improvements as not Intended or offered for sale.IL 102 — PIERS,
however,the building or Improvement is cold within one year of completion,the owner•
builder will have tie burden of proving that he did ata build or Improve for purpose of 103 — UFER
sate')' 104 - REBAR
❑1,as owner of the property,am escludvely,contracting with Iicemed coommen to
construct the preject(Sec.7044,Business and Profesdom Code:)The Omtraeter'+LL 105 — ANCHOR BOLTS .
cense law d=not apply to an net of property who bunds or improve,the.On,and, 10 6 — SEWER & WATER
who convects for such projects with a eonuaclors)licensed pursuant Or the Contractor's .
License E.W. 202 - UNDERFLOORS PLUMBING
exempt undo .B 9 P C fa Nle reason -
0 203 - UNDERFLOOR MECHANICAL
°i" 204 -' UNDERFLOOR FRAME
WO trust CO SArt
ON DEC A770N -
IhembyaO11munder penalty ofpeduryOneofthe following dal,ranans: 205` - UNDERFLOOR INSULATION
❑I haw and will madman a certificate Arcanum to al6lnsure for WmkeraCompen- 301 — ROUGH PLUMBING
anti..•as provided for by Section 3700 of the labor Code,for the performance.f the 302 - TUB & OR SHOWER
wort for which this permit is issued. -
❑I new and will maintain Workers Computation Insurance•as mquimd by Section 303 — ROUGH MECHANICAL
3700 oro.labor Code.In,the performance Of the work for which this permit is Issued. 304 — ROUGHELECTRICAL ,
My Woricrs Compensation Insurance artier and Policy number Are: 305 — FRAME
Carder. - Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' 306 — HOLDOWNS
COMPENSATION INSURANCE 307 — INSULATION
(Thissectlunneednol M completed if the Permit is for we hundred d.11.($1011) - 308 — SHEETROCK
nr I=)
1 certify Nn rfmmame of Ne work for amici this p rm1141asad.I shall ata
309 — EXTERIOR LATH
employ any . c 'anymanOcrmasmbea 6 I ken'Compensation 310 ' INTERIOR LATH
Laws of U In.Dau 311 - SCRATCH COAT
'
APplicw
N CETOAPnthe If,attar -ktithshNncaOfofFaemrOon,youNould 313 - ROOF NAIL
ehsubject
comp ro the W ch pop compensation permit
sha+o(du labra Cade,you muss -
,JZ . Mwith.omply with earn Pmddnos or that Permlunatl be aecmee mwYca. 501 — FINAL ELECTRICAL ENERGY
Z� CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
'I hereby grim that deco s a c.mtmcdon lending agency fm Ne perfmma=of 503 - FINAL MECHANICAL E Y
D4> thdwork for oesN-wmmtMapermulawwd(sa.3a7.cia.c.) 504 - FINAL BUILDING EN G
IT7 0 Lenders Name
a z Ia.eeraAadreas 505 - FINAL ELECTRICAL
UO IcomfythatIhavereadthisAppliationandsumthatthe-W-InformWats 506 - GAS TEST
Is,— emrecl.I agme to amply with ill city arta county ordinances and sues laws relating to
O building construction,and hereby aathod.rePresenwlms of this city te cnw upon de &&ING
.bow-mentiorcA pmpcny for inspection purposes.(We)agree to taw,Indemnify ad keep bums.1130 City of Cupnhw against 0 8 FIAlabilides,judgments.costa and expenses which may in any way Accre against said City 5conaequcnee of da treating of ths permit.APP (CANT UNDERSTANDS AND WILL COMPLY ITH ALL NON.POINT Issued by:5 Date
s CEREGULA S. 4 NAL PUBLIC WORKS
tgnuurc of ApplianuContr-clor
Date Re-roofs 6E2 - OOF PLYWOOD NAIL
HAZARDOUS MATERIALS DISCLOSURE Type Of Rtao 3. - ROOF .BATTENS
Will 1130 applicant m future building Occupant nom orhandlc hazardous material b
nod by the Cupertino Municipal Code,Chapter 9.12.and the Ha1N and Safety 604 - R001, ZN-PROGI.E S S
Seeder,25532(a)? All roofs shall be inspecte prior to any roo mg material being installed.
Oyu u
Will the applicant or Tut rc building Occupant use equipment or devlcea which If a roof i5 Installed without first obtaining an inspection,I agree to remove
Will the applicant a,IT. .
I'D2
erardou+air conumiraNs m dcMW by 1130 Bay Am,Air Qunity Management all new materials for inspection.
@ -❑Yes
Ihawmad theheardnuam udtllmqulmmenuunderCh-pw6.93oftheCalifor-
lN&SawyCm ,Sceduns25S115.25533ud25534,1mi sw,dNUlfthc Wildingmtcurrently haw amoan.Naths myresponsibility uma ytheatupmtofthe
emxwhic metph.,tuluuanaofnCeroucawA c �� Signature of Applicant Date
r cert amnndvea,em Dam All roof coverings to be Class"B"or better