02070032 CITY OF CUPEWFINO - �- =
BUILDING DIVISION PERMIT 0.CONTRRACTOR INFORMATION:
BUIIvTalAYIESCRESTON DR. NICE & RIGHT CONSTRUCTION- 17FVr:N®2070032
Is MAS LIM 166 EUCALYPTUS DR APPLICArnIP?VEnTY2002
HONE: (415) 239-2696 SANITARY NO.// CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLIP ELECT PLUMB MECII
a�irp� LICENSED CONTRACTOR'S DECLARATION
C m E, I hcrchy:dfirm most 1 am licensed order prnvislnm'of Chapter 9(mmmenclag ob Description
t,« With Section 7aanofobi.sion3olthe BusineasaeJPmessionsCode.and
mybeen.a ADD 1719 SQ. FTi.
nlull
ense force s crreet OO p F1s ..A�
7p _
in
cense Class !J hic.M 71 r 96 f AY
oz-o Dale_(_wjk(J I Z Contractor A2/Gb •M
A0.Cill TE:CPS DECLARATION
' m U —1crtand ttTyns Shan Mused ns pahhc mcmds FEB
Lcl1 8 2004
6i W y Licensed Professional
F f—' OWNER BUILDER DECLARATION
<Y 1 hereby allirm that I am exempt line me C.ntramors Liacnac Luw lir,the
al
o 0 fouowing mast n.oc,don RI I3,Bananas and rror odors Code nmy city or vaunt, BUILDING $220000
;e m which requires a Permit In construct,alter,improve,demolish,or repair any structure
tO poor too,isnance.also imports the applicant l.rsmch Permit o The usigredslatcmcrl
�S�S<
that he is licensed puauanllo be pro visions of the Compactor's License Law(Chapter 9 3S?6Bt]f0(0)6A0ID Valuation
WI-0 (commencing with Section 7000)of Division 3 of the Best mess and Professions CialJnr
i 3- that he is exempt domfmm and the Travis for the alleged exemption.Any violation of
Section 7031.5 byanyapplicamfurapermiuubjecls Nc applicant o a civil Penally of i UAPNN Occupancy Type
not mom than nKhundred donata(SSW). 102 – PIERS p Y YP
0 I.m owner of the property,or my employees with wages as their sole compensation,
will do the work,and the stromme is not intended or offered for sale(Sce.7811,Business —
and Professions Cure:The Contractor's License Law doe.,not apply to an owner of 104 – REBAR Required Inspections
property who builds or improves thereon,and who does such work himself.,through his
own employees.provided that such improvements are not intended or offered for sale.If, 105 - ANCHOR BOLTS
however,the building or improvement is sold within one year of completion.the owner.
builder will have the burden of proving that he rid not hem of improve for purpose of 106 - SEWER & WATER
s"e) 202 - UNDERFLOOR PLUMBING
f7 1.as owner of the propi am exclusively contracting with licensed contractors to 203 - UNDERFLOOR MECHANICAL
construct the project(Sec.]acid,Business and Professions Code:)The Contractor's Li.
cencete Law does not apply to an owner of progeny who milds or improves thereon.and. 204 – UNDERFLOOR FRAME
who contacts for such projects with a contracnr(s)licensed pursuant it)the Contractor's
Liver.Law. 205 - UNDERFLOOR INSULATION
❑I am exempt under Sec. .B&PC for reason 301 - ROUGH PLUMBING
mer Date 302 - TUB & OR SHOWER
WORKER'S COMPENSATION DECLARATION
Ihereby afntmunder Penalty ofperryoneofinefollowingdeclarations: 303 – ROUGH MECHANICAL
ia
304 – ROUGH ELECTRICAL
01haw and will maintain a ce,tire of consent to self-inure for worker a compen-
eat
anion.a,provided for by Section amu of the Labor Code.for me Performance,of the 3 0 5 – FRAME
work for which mice rtes is issned. 3 0 6 – HOLDOWNS
1 have and will maintain Worker's Compensation Insurau,,ss required by Section 3 0 7 - INSULATION
3'101 of me Labor Code,for me Performance of the work for which this permit is issued.
My work,,sco pcnr tion ln' ancc carr'cr and Policy number re. 308 - SHEETROCK
cy-W,:_�P.Ii,ywo.:2Z - 2 309 - EXTERIOR LATH
CERTIPIC TEPP ISATIONIONPROMWORKERS
COMPIiNSAT1ONIN5URANCE 310 - INTERIOR LATH
obisseaionneM not Incompic¢difffin mini,forinchadoddelfura SIIMp 311 - SCRATCH COAT
ir1Csa) 313 - ROOF NAIL
1 certify that in the performance of the work for which this permit is issued,I shall not 5 O l - FINAL ELECTRICAL ENERGY.
employ any pcoam in any manner so as m m ke
become subject the Worrs'Comp endinn
Laws of California Dat c 502 – FINAL PLUMBING ENERGY
Applicant
NOTICE TO APPLICAN'llIf.after making this Certificate of Ea,mplion,you should 503 – FINAL MECHANICAL ENERGY
hecomc sobject,the Worker's Compensation Provisions of the Lahnr Code.you muss 504 – FINAL BUILDING ENERGY
O Z forthwith comply with such prnvisiona or this Permit shall M deemed revoked.
Z CONSTRUCTIONLENDING AGIiNCY 505 - FINAL ELECTRICAL
P - IhemhyafTitmmahere isa construction lending.,acyIn, heperformance of 506 – GAS TEST
CZIhework torwhmhthis Permit isicsned(Sec,31N7,Cie.Q
Le507 – FINAL PLUMBING
Lt1 Q mer'a Namc
j z Lcnde(iAddress 508 – FINAL MECHANICAL
(J O l cemfy mal I have rem this appliemion and spite that the above no mruron is 5 09 - FINAL GRADE
U. P cored.1 agree to comply with all city and county ordinances and state laws relating hr
C) U building construction.and hcrehyawhOHIZrepresentatives ofthis city to enter upon the 5FINAL PLANNING
above.mentioned property for inspcedon purposes.
>' S (We)agree to save,Iademaily and keep hmmless the City of Cupcnino against 14 FIN C W RKS
F-' N liabilities.judgments.costs and expenses which may in any wayaccme againasaid City
V Z in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WI III ALL NON-POINT Issued by: Date
SO EREGU LATIONS.
l 6/ r L u/d2
re or ApphenriCeta
or — Date Re-roofs
f1A'J.ARDOUS MATE RI ALS DISCLOSURE Type of Roof
Will me applicant par fu'or,building occupant store or handle hararJous material
m dcfned by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
1Wc.Semen 25s72(n)" All roofs shall be inspected prior to an roofing material beim Installed.
Yes ❑No P P Y P g
Will the applicant or future,building occupant use equipment or devices which If'a roof is installed without first obtaining an inspection, 1 agree to remove
emit Tema dous air contaminants as Jerined by the Bay Area Air Quality Management all new materials for inspection.
DiMricll
p Yes 0N
1 have read the mention,materials m,nomer 000rder Chaplcr 695 of the Callon
ria Ilcallh&Safety Coale,SedonQ5915.25533 and 255M I umkrid that if IM Wildng
docs not currently haw a tenant,that it is my responsibility to notify the occupant of he
cqutm hlchnimeInn Ipriortoissu;tneeofacenineaeoft clipaner. SignalureofApplicant Date
r
o�omorr.eda� b,W'c All roof coverings to be Class "B" or better