03070043 CITY OF CUPERTINO �'
BUILDING DIVISION PERMITCOIiONTRACTINFORRMATION
BUILD301 2011-WIRUS Air
INGADDRESS: L AND D CONSTRUCTION 11104111,1903070043OWNERS NAME: 1555 YOSEMITE AVE. #1.7 PERMIT ISSUE DATE
E.
(415) 822-6383 SANITARY N0. CONTROL N0,
ARCHITECfyENGINEER: BUILDING PERMIT INFO
B�� ELO PLO O
jop LICENSED CONTRACTORS DECLARATION JobDescri tion
� F I hereby aM.Out 1 an liwucd under P iaiom of Con to 9(mrsom cin P
`� with Sectio ]IXIl6 u(Divixion3ob'rand Code,end myli<cnse is
in full force ffect.
:�: LLiiienseCl cap« REVISION--IN HOUSE USE ONLY
s^'" RCPFFECoDE ATION NO NEW PERMIT ISSUED, ORIG. #02120090
eI untly tend my p ons stall W used as public retards
ye,
PG Licensed s ml
OWNER_.BUI DER DECLARATION C
<E I herer chy e(Sect on 1 em exempt from the Contractor's Co License law for the, O
D o following requires
&.Permit
t 703 LL Business and Profusions Code:Any oily or county
S$ which itsissaae.also r cnmwct,e1Npimprove.demolish,are.sig anystructureV
_Z t plat to its issuance.pursuant
rt to the pr applicant for such pant's rile. Law statement
�$< that he or licensed PSemion 70Dc of Division 3 thek Businessand Prselsw(Cbapttt9 Sq. Ft. Floor Area U $O
(mmmcncintwith Section ad of Divisions aftxegedmymd Professions Any
Cade)tion of
Net he Is exempt therefrom and tie but for Ne alleged exemption.Any violaflOn of
Section 7D3 1.5 by any applicant for a Permit objects the applicant to a civil penally of 3GOVERI1&IvO0 'Occupancy Type
not..than I..hundred dollars($500).
❑I,uowner of the property,or my employes with wqu uNcinole compenufion,
will do On woek,and the structure is not intended oronered forsele(See 7044,Business Required Inspections
and Profeuons Code:The Conteutons
improves rs License law does set apply to an owner of 101 — FOUNDATIUN P
propenywho buildsaf themon,and who doessuch work himself orOmugh hit
own employee,provided that such improwmttm sat not Intended at offered forsale.If. 102 — PIERS
however,the building or improvement I,sold within one year of completion,the owner.
builder will have the burden of proving Nat he did not Wild or Improve for purpose of 103 - UFER
are')' 104 - REBAR
❑1.as Owner of the property,am exclusively canuacting with licensed contractors to
cotntmct the pmj.cl(Sec.7N,1,Business and Probationary Code:)The Contractor's L4 105 — ANCHOR BOLTS
came law data not apply to an Owner of propene,who Wilds or improves Norton.and 106 - SEWER & WATER
who contracts for such projeeu with a conuactor(s)licensed pension to the Compactor's
Limmalaw. 202 - UNDERFLOOR PLUMBING
❑l am exempt under Sm. B A P C for thio rtuon 203 - UNDERFLOOR MECHANICAL
Owner D
WORKER'S COMPENSATION DECLARATION
204 - UNDERFLOOR FRAME
Ihereby salon under penalty of perjury amofthe following decimations: 205 - UNDERFLOOR INSULATION
131'YOOof
ove and will maintain•Certificate of Co meat to selfdmum far Worker'Contain. 301 — ROUGH PLUMBING
,u provided for by Smile.57011 of the Labor Code,for the performance of dor 302 - TUB & OR SHOWER
for which this Permit is issued.
hove and will maintain Worker's Compensation Wurum,u required by Scotian 303 - ROUGH MECHANICAL
Nc laborCoda.for lx performance of the work forwhich Nis permit is Issued. 304 — ROUGH ELECTRICAL
orkers ComPen tin lnsunttce""larval PAl(ly numbcnn: 305 — FRAME
Policy No.: e
n CERTIF A .OFE% PION✓FROM 66& 306 - HOEDOWNS
COMPENSATION INSURANCE 307 - INSULATION
(This section=it ran tics mptnedifusepenothIsmronehundreddaBaealslm) 3 08 - SHEETROCK
unc,a)
I comfy that in the performance of the work for which this Permit Is Issued.)then not - 309 — EXTERIOR LATH
employ any Person in any manner mu to become subject to the Worxri COmpenseflan 310 - INTERIOR LATH
Laws
Lawsam
of California..DataApplic311 - SCRATCH COAT
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should 313 - ROOF NAIL
become subject to the Worker'a Compensation pmisiau of the labor Code,you mus
0z forthwith comply with such provisions or out Permit hall x deemed mwked. 501 — FINAL ELECTRICAL ENERGY
N
t—t CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
rM te-. I hereby affirm Nemthe to its construction lending agency for the perfarmu a of _
rG > the work far which this plsissued(Sm.s09],Co.C.) 503 FINAL MECHANICAL ENERGY
C. loadersNune 504 - FINAL BUILDING ENERGY
Z)Z anaer,Adeto,a 505 - FINAL ELECTRICAL
U Q I modify that I Mw read this application and sure that the she"Information is
Fconcet.I agree Io comply with ell city and county Ordinances and sues laws totaling to 506 - GAS TEST
pU Wilding construction.and hereby authenmaprefenutivesofthis city tocost upon the FIN PLUMB G
U exvo-mcntianed pmpeny rot inspection purposes.
d (We)at.t.ave,indemnity and keep harmless Ix City of Cupenino against O 8 F I L
N labilifies,judgmenu,costs and expenses which may in any way accrue against aid Ctry
U 7 in consequence of the granting of this Permit. 5
�7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POUFF Issued by:5 NG Date
SOURCE REGULATIONS.
Re-roofs
nature of p icVCo or tti °�� Det
HAZARDOUS MATE IALS DISCLOSURE CLOSURE Type of Roof
Will Ix applicant tar future building Occupant atom or Madre huardou m unriod
as dcrined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safely
Cade,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu [�'ft4u
Will the applicant or future Wilding occupant use equipment or de.iceihick If a roof is installed without first obtaining an inspection,I agree to remove
me"dons air commons""u defined by the Bay Arta Air Quality Management all new materials for inspection.
tynict? �/
❑Yes ad Nu
I have mal the husNOu maufials myuimmenu under Chapterh95 of Ix Calira,
aria Hcelth&S.fcty Cad.,Secuom 255)5.25533tad 25534.1 understand dlaifthc Wilding
Jots not cumemly haw a ramal,Nat it is my responsibility to noufy the WCUPmt Of the
m tmmcnuwhichmuaxmetpiorwissueetccofaCcrdgayl�of�Occu c Signature of Applicant Date
�� �"' � �
Owner or authorized ag�6. Date All roof coverings to be Class "B" Or better