03030113 CITY OF CUPERTINO m ^y"�
BUILDING DIVISION pF-eR1�T Yat..�4\ILsC����lL1P�. 1l � llPl
s9 x ' Y�'� {✓4 cot a#'�. -.ria: :](&'.
BUILDING ADDRESS: PERMIT NO,
WESTHILL CONSTRUCTION CO
owrlEseAPERMIT Ise
5354 RUCKER DR
ff.;R99 G91-44-AS (408) 395-4361 sANrDkar @9401.1 NO.
ARCHITEC(ENOINEER: BUILDING PERMIT INFO
O I Q O PLUMB
MECH
I�
+iD'z LICENSED CONTRACTOR'S DECLARATION Ib Description
1 hemby ar ion that I em licencehb
Returned under provon OCSCTI of Chapter 9(commencing p
with Section] l 1,f Dh,i hm3.fdm Budmx3 d fculnne Cadc.mdm lieenuia
^ in full forte an10 J
�� uecnseCnv ue.« -- - - �
BATHRM REMODEL
Dam =cmnukcmr 1�DC ONALEED
1l understand my plate thallf M uried u c records
Licensed ProfeuboW JUL 2 2 2003
g that I"BUILDER DECLARATION
4 a 2 I hmosee .(Seco on I am exempt from the Contractor's o License law co the
o which following muoaeemit t Yos5,Busii¢uand
ve,demolish.
Code;Any cbyacoumy BUILDING$ which its ha a p.also re cnnarracL alter.Improve,de ermit t or repair any structure ID
ji^ prim mbubnuatogalw requires the daishouamfnr wen Rance, m.Lonedtutemcnt
g < (commelimnedpunuanmthepmvuionnfortheBushrunandParlaw(Chalner9 Sq.Ft. Floor Area V, on
a
(commencingwithSection 70M)and aDivisionbotl of meagel exemption.
MynneCrvJe)uf - $22 VUV
.. that io u exempt anmlran and site bash for the aluged eacmant to Any vlNation of
Section than tee airy red doll for a permit subjects the applicant t civil penalty of �p
naturae thin raw mmndma dollars(s500). - 3.G'011 YO 19�cf00 Occupancy Type
❑1,u owner of the property,or my employcu with wages u their sem compensation.
will du the work.and theswctum Is not nmMed a offered for W.(5ee.](wa,Business 101 - FOUND QI'�d Inspections
and Profession Code:The Contr ctofa Lbcnrum e Law does mot apply an motor of
propotywho buihdsorlmproves thereon,endwhodoeaaochwork himself orduough his 102 - PIERS
own employees,provided that such Improvements arty not intended or offered for sale.If, -
however,the Wilding aImprovement hwldwithin amyear ofcompletion.da,mmer. 103 — UFER -
Wilder will have the burden of proving that he dial not build a Improve for purpose of 104 — REBAR
MIs.).
0 1,as owner of the properly am exclusively contracting with licensed contractors to 105 — ANCHOR BOLTS
construct the project(Sec.rote,Business and Professions code:)That Conhacm s U. 106 — SEWER & WATER
man Law does not apply 0 an mwner of property who builds or improve,tenon.and,
who contracts for such projects with a contrector(s)u«issed pursuant to the Carmichael 202 - UNDERFLOOR PLUMBING
1-kenty Lawexempt 203 - UNDERFLOOR MECHANICAL
❑1 am uempt un@r Sec. .B k P C for Wa rtuan
owner Date 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 — UNDERFLOOR INSULATION '
1 hereby aflhm undo pcnity of perjury,orc of the following dulanhionr. 301 - ROUGH PLUMBING -
Ihave andwdlmainalnaCenlBcamofConanuoseU-insure forwnrkeesCompeo- 302" TUB & OR SHOWER
wrkforwhihtope„"ysmit�ssuee3]mofteaLabor Code,mrthe pemm.rnmfine 303 - ROUGH MECHANICAL
❑I have and will maintain Water's Compensation Imunna,u required by Section 304 - ROUGH ELECTRICAL
37M of the LainarCode.for use,performance ofthe work for which this permit is Wood. 305 — FRAME
My Workers Cnmpen anon Inp�nz n cr and P 'ry numhr am:
m e„r rii k PmhiyN , 306 - HOLDOWNS
J\f ceanPlcATEOPexEMPno oMwoRKERs 307 — INSULATION
COMPENSATION 161CURANCE 308 - SHEETROCK
or less.)(This section need net hecompleted if the fourth is for one hundred dollars($10s) 309 — EXTERIOR LATH
1 ceNfy that In the performance of the work for which this permit Is broad,Fdull not 310 INTERIOR LATH '
employ any person In any manner esu in become subject to the Worked'Compensation 311 — SCRATCH COAT
Laws of California Dam
Applicant 313 - ROOF NAIL
NOTICE To APPLICANT:If,After making this Cemlficate of Exemption,you should
blame suhjwt onsite Worker's Compensation provision of the Lana Crude,you most 501 - FINAL ELECTRICAL ENERGY
OQ forthwith comply with such provision or this permit shallNdeemed mooted. 502 FINAL PLUMBING ENERGY
y
CONS MUC ION LENDING AOENCY 503 FINAL MECHANICAL ENERGY
lr 1hemhyalnrm Net there Is construction lending agency fur the performance of
C� the work for which this permit hbanned(Sec.3B9k,Civ.C.) 504 - FINAL BUILDING ENERGY
W LaLender's Namc 505 FINAL ELECTRICAL
z hander's Addteu —
U OF I certify Nam I have mad this applintionwid state thus dic above Infea nlon is 506
GAS TEST
IL U correct.l agree to comply with all city anal county ordinames and onto laws relating to 50,7 , - FINAL PLUMBING
0 WildingeonarWhemby orlon natives of mhiscity to enter upon the0 FIN MEC ICAL
shove-mentio 'on 1.(Weter harmleu the City of Cupertino against 09 F I
y RabilW dx I mrybnmywayacedegaistWdChy
U ancon acnetAPPL ANfCOMPLY WIT ALL NON-PO NT• I5Sued by: SDate
U REpgKS
3 21 LP Re-roofs
( q Signa pplianVConuachor ate '
HAZARDOUS MATERIALS DISCLOSURE ' Type of Roof
Will site appliant cefactum building uccupantsm e a handle hazardous material
n defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section 25532(x)1 All roofs shall be inspected prior to any roofing material being installed.
Yu �o
Wil)the Applicant or forum b ilding occupant esu eyulpment or devices which If a roof is installed without first obtaining an inspection,I agree to remove .
hna' alrcontaminxnu dcfinOM1ysite AmaAlrQuality Mangcmcm all new materials for inspection.
A=nul
No
have
aNn ma Tel ui uunderChapnr6.95ofncCelifnn 25534.1undersmnd thus lith Wilding
t u ponibithy n nntify de ocetqu mf dien or aCcNfne QJu . 03 Signature of Applicant Date
Owner ........
su W"c'agent Dan All roof coverings to be Class "B”or better