03060185 CITY OF CUPERI'INOrKKr_ k, �
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION .
BUILDING ADDRESS: ALL PRO MAINTENANCE PERMIT"'03060185
OWNER'S NAME: 10070 CRAFT DR. #1 PERMITLSSUEDATE
iE. (408) 718-1630 SANITARY NO.. CONTROL NO.
ARCHITECTMNGINEER: BUILDING PERMIT INFO
BLDG 0 Its PLUMB MF.CH 0 0 0
300 LICENSED CONTRACTOR'S DECLARATION
I Wmby affirm that l am licensed under provisions of Chapter 9(commencing Job Description
withll tutored
effect.Division7of the Bulinusand Prulcuinu Cade,and mylicense is
I.full force and effect.
a«na claw see.« REVISION--IN HOUSE USE ONLY
Data Contractor NO NEW PERMIT ISSUED/ORIG. 401100139/03040059
` ARCHnE=DECLARATION
t I understand my plans Mall W used a public records
J$
s C Licensed Professional x`
n1us Oat I am exempt
to DECLARATION 0s
E a 1 Wmhymotor.
affirm Nat 1 1. ucmpt from Nc Contns Co :An,c taw for the S
EOO following mann.(Section]1171.5, t,alter, and improve,
lou Code:Anycity or county \J
3$ which requires a permit m construct,alcor,improve,b Permit t or e a signed
ig e d structure
prior mits censed a.elumquims the applicant rot swhpctor'toccuseLnedmtemcm
( othat(commelicenudpSectiouotheprovivioesnalikeBwnessnicanulaw(Chapter Coxie)9 Sq.Ft. Floor Area anon $0
y,x❑ 'hot he 1.exemall pth Section d and of Division3 nrtW aged x and m.Any
3 Nal he Is exempt say applicant
li and the beau for be alleged eumant to Any l Irma isle of
Semon 70.3five
any berthed
dolla rot•pennluubjccts to applicant to a civil penalty of 3 2e1Y3`0aA*Qr0 0 Occupancy Type
not mon Nm fw hundred dollen($500).
❑1,u owner of the propuly,or my employees with west u their sale compensation,
will do the work.and Ne awetum is not intended or offered fonau(Sec.7044,Buireas Required Inspections
and Profession.Code:The Conuecmr's License Lew does not apply m an owner of 101 - FOUNDA egON p
property who Wild.car improve them m.mf whadu,..h work himself uthrough his
own employees,provided Net such improvements art not intended in offered for sale.If. 102 — PIERS
however.the building or improvement is sold within oro yea of completion,Ne owner.
builder will have the burden of proving that he did wt Wild or improve for purpose of 103 — UFER
❑L ase
owner of tip property, exclusively eonuactines with licensed m 104 - REBAR
eed c
common the project(Sec.
Business and Rofeaiaw Code:)7fie Convumfa Li- 105 — ANCHOR BOLTS.
cense Law duo not apply in an owner of property who Wilda or improves thcmun,and, 106 — SEWER & WATER
who contracts for such projects with a convacmr(s)licensed pursuant to the Convector's
License Lew. 202 - UNDERFLOOR PLUMBING
❑I am exempt under 5 ,B&PC for this moon 203 - UNDERFLOOR MECHANICAL
204 - UNDERFLOOR FRAME
O mer /�/ /'�ate� f .
O COMPENSATION DECATION
I hereby affirm under penalty of perjury am of the following declarations: 205 — UNDERFLOOR INSULATION
have and will maintain a Certificate of Comm to self-lune for Worker's Compen- 301 — ROUGH PLUMBING
satlnn,as provided for by Section 3700 of the Labor Code,for the performance of tW 302 — TUB & OR SHOWER
work for which Nis permit is issued.
❑1 Nva and will maintain Wortrfs Compensation Insu me,as required by Station 303 - ROUGH MECHANICAL
3700 of the Labor Code.for the performance of due weak for which this Permit is issued. 304 — ROUGH ELECTRICAL
My Workcri Compensation Insurance carrier and Policy number am: 305 — FRAME
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' 306 — HOLDOWNS
COMPENSATION INSURANCE 307 - INSULATION
(Thu section wed not W completed if the ismll is for ow hundred dollen(5100) 308 — SHEETROCK _
to less.) 309 - EXTERIOR LATH
e unify that I.the in any manne of th woh for which this permit is ivud,I shill not
employ any poison in any manner snsambccome subject o tW workcn'CompeesNon 310 — INTERIOR LATH
Laws of California.Date
Applicant 311 - SCRATCH COAT
NOTICE TO APPLICANT.
� APP e If, this Certificate of Exemption,you should
313 — ROOF NAIL
become a the WehM1 Compensation yrovidmv of NLabor Code,you moa
xforthwith comply with asehprnvisinmorthis permiuhallW deemed
revoked. 501 — FINAL ELECTRICAL ENERGY
?O CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY
Fw ry+ Ihemhy&amthat Nen is a conaruction lending agency,for the performance u(
Ca>
to work fur which this permit is Wood(Sec.3097.Civ.CJ 5 0 3 _ FINAL MECHANICAL ENERGY
W Lender's Name 504 - FINAL BUILDING ENERGY
DZ Landar'.Addna 505 - FINAL ELECTRICAL
U O 1 certify that,I have mad this application and sum lest the shove information is 506 — GAS TEST
P toren.I agme to comply with al city and county ordinances and state laws misting m
U building construction,and hereby auNmiu representatives of Nis city to enter upon the FIN PLUMB G
w ahovcmentiuned Property for laputme Purposes.
py (we)agree to save,indemnify and keep harmless the City of Cupertino against 0 8 F I L
to liabilides,jullnums.c.am and capev�which may in say way accom geiesl aid City 5
t„)7 in consequence of the granting or this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 PLUME Date
SOU REGU A I Ns e� '�- L PUBLIC WORKS
Re-roofs
Sigm,ur ppli ommcmr Oak
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building ucuput Store or handle husolm s material
s claimed by the Cupertino Municipal Code.chapter 9.11,and the Health and Safety
Code.Section 13331(e)?
❑Yu We All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Immdom air contaminants as dcftwd by due Bay Asea Air Quality Management all new materials for inspection.
District? ��yy
❑Yea Lydru
I have coed the hvanLm's materials mVuiremmnu under Chapter 6.95 afthe Glifor-
niaHulth&Sefcty Codc,Se<doa 25505.15533 w2553a.1 undcnmid Nm if da Wilding
does not currently haw a reason,Nat it is my responsibility m notify Inc cuPsal the
me whit sl W met Poor m issuance or a Certificate of Ocaupan Signature of Applicant Date
Owner or aulluancItagent in All roof coverings to be Class "B"or better