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CITY OF CUPERTINO
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RINA�O AT1Y
BUILDING DIVISION PERMIT
t/VONTRACTC
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BUILDING ADDRESS:
CCK CONSTRUCTION CO
PER""03080173
R'S NAME:
860 THORNHILL DR
PERMIT ISSUE DATE
PHONE:
(650)992-9168
SANITARY 0. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that 1 am licensed under po, a rets of Chapter 9 (commencing
P
with Section 7") .1 Division 3 of the Business and Professinu Code, end my license is
in Liana Class Come ad effect, Lie,#
REVISION --IN
HOUSE USE ONLY
Date. contractor
NO NEW PERMIT
ISSUED #03030025
ARCHITECTS DECLARATION
1 understand my plans shall W used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby wGrm Nat 1 em exempt from the Convectors License Lew for the
\
following reason, (Section 7101.5. Business and Professions Code: Any city or county
which tequtres a permit t" construct, eller, impose, demolish. or repair any comm.
prior m its issuance, also requires the applicant fur such Permit m rile a signed+ulement
that be is licensed pursuant to the povisiau of the Contractors LieerLse Law (Chapter 9
Sq. Ft.
Floor Area
Valuat4107
(commencing with Section 7000) or Division 3 of the 8usincas and Professions Cole) or
Nat he is exempt themfram and the buH for the alleged exemption. Any violation of
' ' 3 O O
Occupancy T e..
Penc y yP
Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of
"—
not mom than five hundred dollen (5500).
0515 CY
V'Y'Y' •ei
- - —
❑ I, as owner of the property, or my employees with wages as their sole compensation,
ns Required Inspections
q P
will do Ne work and theswcture is not intended or offered farsel.(Sec. 7044, Business
Professions Code: The Con License Irw does
mal nctures oat apply to an owner of
property who build+ur improves Oemon, and who dres+mh work himselforthmugh his
101 .-
FOUNDATION
..employ., provided that such improvements arc not imemictimmifmal fmsalc.11.
102
— PIERS
however, the building m tmprovement is veld withinm eyearof completion. On owner -
builder. will have the burden of proving Nat M did not build or Improve for purpose of
103
— UFER
u1e.).
104
— REBAR
u no, of property, uvelyand contracting with licenThe sed i.
nttrutan
t , Business s Li-
camtmct shoes
105'
— ANCHOR BOLTS.
came, not appl(Smy
In a nowneandry, whoWil"ori proms Osman.
whowd
106
— SEWER & WATER
suchplymm ith.ofpmpeny portmpro the Contra.ors
who cYnMcn fonuch pojecU with a conuanort+) IittMcd pursuant to the CantncmM1
,
Late"selaw.
WIa lundcr . B k P C fm this reason
202
— UNDERFLOOR PLUMBING
je
203
— UNDERFLOOR MECHANICAL
ate 4&
OR 'S COMPENSATION DECLARADTION
204
— UNDERFLOOR FRAME
Ihereby aRtrmttnderpetwtyofpedOy, mas of the faltoa,mgdeclarations:
205
— UNDERFLOOR INSULATION
❑
301
— ROUGH PLUMBING -'
cation, at provided far by Section 3700 of the Labor Code, for the Performance of the
302
— TUB & OR SHOWER
wart for which this permit is issued.
1 have and will maintain Worker's Compemadon Insurance, at mquimd by Section
303
— ROUGH MECHANICAL
3700 of the labor Cods, for the peRaroantt of the work for which this permit is named.
304
— ROUGH ELECTRICAL
My Worker's Compensation Insurance cartico and Policy number am:
305
— FRAME
Cartier, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
306
— HOLDOWNS
COMPENSATION INSURANCE
307
— INSULATION
fm one hundred dollars
antro ntro need not be completed if On permit 0 n(5
308
— SHEETROCK
or Ices.)
1 sonify that in the perrormance of the work for which this permit Is issued, I shall not
309
— EXTERIOR LATH
employ any portion in any manoer an as to become subject to theworkeri Compensation
310
— INTERIOR LATH
Laws of California. Data
Applicant
311
313
— SCRATCH COAT
— ROOF NAIL
NOTICE TO APPLICAT: IL after making this CeniOcale of Exemption, you+hould
bmame auhjact to the Workers Compensation provisions of the Lahnr Code, you must
forthwith comply with such prnvt+inmmthis pmositshall beeeemerevoked.
501
— FINAL ELECTRICAL ENERGY
CONSTRUCTION LENDING AGENCY
502
— FINAL PLUMBING ENERGY
I hereby affvmthat there he construction lending agency for the perfurmamcuf
dm work for which Nu permit is issued (Sec. 3097, Civ. CJ
503
— FINAL MECHANICAL ENERGY
Lender's Name
504
505
— FINAL BUILDING ENERGY
— FINAL ELECTRICAL
I<ndcr+cenify
1 ttnee timid have read this city
correct. and application and rule that the above im misting to
to comply with illdtyand county oNimn¢+and +um lawtrupin
506
///l��
— GAS TEST
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conte the
entadves of Nis city to enter upon Nc
buildingcontraction,pro and herebyin,
FIN PLUMB G
shave(We) gm popery fm impenian keep ha.
u.nin iscuse
(We) agree m save, indcmmfy and keep hsrmlcss the City of Cupertino against
O $
FI L
IiebiliBu.judgmenu,emu end apemen which may in any weyeceme egeittu said City
in
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consequence of the growing of this permit.
APPLICANT UNDERSTAND WILL COMPLY WITH ALL NON -POINT
Issued by -5
l Date
NG
SO GULAT
Re -roofs 514
Type of Roof
NAL PUBLIC WORKS
is O—to'Appricaft7CMIxecon. ease
HAZARDOUS MATERIALS DISCLOSURE
Wlll the applicant or future building occupant store or handle haiardous material
defined by the Cupertino Municipal Cade. Chapter 9.13. and the Health and Safety
Secti.ea 25532(.)?[3 Yoe 1514.
❑
All roofs shall be
inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building acculsom use equipment ordevice+which
emit hamd"us air contaminants u defined by the Bay Area Air Quality Managcmcat
all new materials
for inspection.
District?
❑tics C/INu
1 hive mad the Wurinus materials requimmenu under Chapter 6.95 ofthe Califor.
.is Health& Safety Code. SectOns 25505.25533 and 25531. I understand Out if the Wilding
col hot currently hue a tenam, th my responsibility m notify the occupant of the
esat r aa,nmoracrniBeateoroc y.
SignatureofApplicant
Date
All roof coverings to be Class "B" or better
caner unutharacd agent ,le