02100066 CITY OF CUPER'CINO " a.= ' ,
BUILDjNc DIVISION PERI T CONTRACTOR INEOR _ ..ION'
Bmpp'Q�4RESN DE ANZA BLVD GRANUM PARTNER PERM1TNg2100066
FRIM PARTNER APPLICATP�SpfY 2 O O 2
PHONE: SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ca.,
00 LICENSED CONTRACTOR'S DECLARATION - �tp6n
s 0 rf I hereby affirm that l am licomed under provisions of Chapter 9(commencing 30 DAYS TEMP PibgkR frtption
G�n with Section 7")of Division 3 or the Businessand Pmresxiom Code.and my license is
„ ;n ll force EXPIRES ON 11/07/2002 , ORIG. 402090002
Z O$t2? License Class Lic.a
g H=W Date Co...,
ARCHITECTS DECLARATION
_�a
w< 1 understand my plans shall ta
3 o ured as public records
cll
uai a.Cs Licensed Professional
H t=O< OWNER-BUILDER DECLARATION
sq 1 hereby Or.Out 1 am eumpt from the Contractors License Law for the
to nO following mawn.(Section 7031.5.Business and Professions Code:Any city or county
e X 9� which requires a North ,construct,alter,improve,demolish,or repair any structure $0
or—'^ prion;¢ permit issuance.also requires the for such pit to file a signed statement
that he is licensed pursuant to the provisions or the Conwclor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
� 0 (commencing with Section 7")of Division 3 ofthe Business and Professions Code)or
i 3$ Our he u exempt mcefrom and tw'.bssis for the alleged exemption.Any violation of 32634070 . 00
Section 7031.5 by any applicant for a permit subjects Nc applicant to a civil penalty of APN Number �• ane Occu
not tome Nun rim hundred dollars(S!KXE. 101 - FOUNCAITION Occupancy Type
❑ L as owner of the properly.or my employees with wages as their sole compensation, ..
will do the work,and Nm structua is not intended or offered for sale(See. BusinessR R
,Busine
and Professions Code:The Contractors Liana Law don wt apply to an Owner of 103 - UFEquired Inspections
pmpcny who Wilds.,improve Ormonand wh.d.,..h work himself.,through his \
Own employees.provided that such improvements are not immnded oroRemd forsale.If. 104 — REBAR
hnwevm,be building of improvement is sold within ane year of completion,the owner-
builder will have the burden of proving Nat he dm not wild or improve for purpose or 105 — ANCHORya+ 0 TS
k.) 106 SEWER & WATER
1,u owner of the progeny,am exclusively contracting with licensed conformers to 2 UNDERFLOOR PLUMBING
c nsuun Ne project 7044.Business and Profeavom Code:)The Contracers Li; s.
c mic Law does not apply to an owner of property who Wilda or improves thereon aimed, - O — UNDERFLOOR MECHANICAL
who contracts for such projects with a cnntracer(s)licensed pursuant m the con dacior
L;men.Law. E, 4 — UNDERFLOOR FRAME
I ex plunder�p$ee. .Baa Perm Nisre /'205 — UNDERFLOOR INSULATION
rte � 301 - ROUGH PLUMBING
WORKS COMPF,NSATION DECLARATIO
I hereby under penalty of perjury one of the following d` 302 — TUB & OR SHOWER
❑ Ihaveandwillma;ntain Can louts rcmmammau.;murefo,work racomp n- 303 — ROUGH MECHANICAL
sation,as provided for by Section 37W or due Labor code,for the performance of mo 3 04 - ROUGH ELECTRICAL
work for whim this permit is issued. 305 — FRAME
❑I have and will maintain Worker's Compensation Insurance.as m nird by SeNun 3 O 6 — HOEDOWNS
37M of the Labor Cale,for the pcomm ince of the work for which this permit is Issued.
My workers Compensation lnsumnee carrier and Polly number am; 307 — INSULATION
Carrier: Pol;cyN., 308 — SHEETROCK
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 309 - EXTERIOR LATH
(Thissecdnnncednot bocoforetu dheremnitisforomhundredJollars(SI(p) 310 - INTERIOR LATH
"r lCst.) 311 — SCRATCH COAT
1 unity that in the performance ofthe work for which this permit is issued,l shall not 313 - ROOF NAIL
employ any person in any�p u\v Onn subjen aNe Workers Compensation
Laws orcali a.Dam.,!!`: iS 501 — FINAL ELECTRICAL ENERGY
Nn�a�, APPLICANT;Jr�— u� 1 WM�mp should 502 — FINAL PLUMBING ENERGY .
M)Tgtl TO APPLICANT; after Commakingthisvisi cmc the Exemption,You
WCO ithcomlywwwoe,hrocompenradmnpmvitihallWdLabo,cafe.yourun 503 — FINAL MECHANICAL ENERGY
O ,Z forthwith comply with such provisions or Nis permit sh.IlWdamcd¢vnkcd.
Z CONSTRUC ION LENDING AGENCY 504 — FINAL BUILDING ENERGY
1 hereby affirm that there is a construction lendi Off agency for the Performarom or 505 — FINAL ELECTRICAL
> Ncwork for which this permit isissued(Su.3o97,Civ.C.) 506 — GAS TEST
D.1 `n Lender's Name
= z IendersAdd. 507 - FINAL PLUMBING
U O 1 array Out 1 have read this apprmatinn and term that the shove information is 508 - FINAL MECHANI CAL
CL E-^ correct.I agree to comply with all city and county ONinanees and sac c laws relining e
building construction.and hereby summon mpromenmtinano(this city ecrurupnn fire, 5 FINAL GRADE
} above mentioned pm ay for imroction purposes. 10 FINAn PLANNI G
(We)agree to save,indemnify and keep harmless the City of Cupertino againn
habiliticajudgmenu,costs and expenses which may in any way accmc against said City5 N U LI WORKS --7� pY�
U z in consequence Of the granting of this permit. V /)
AP CANT UN ERSTANDS D WILL COMPLY WITH ALL NON-POINT Issued by: Date ((//
S CE REGU IONS.
Re-roofs
Signature ofnpplicam/ ntranor ate
HA.ARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle haardous material
as defined by the Cupenino Municipal Code.Chapter 9.12.and Ne Health and Safely
ode.Section 255121x)? /l All roofs shall be inspected prior,to any roofing material being installed.
Asan Q*
Will the applicant or furore building occupam use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District? 1�M�
❑Yes
hese read the ha'a,dous materials requirements under Chapter 6 95.f the califor-
maHal &Safety Cnik.Stttions 25515,25533 and 25534.1 understand Out if lw Wilding
Jens cuocm y a e tenant,Net it n pomihilky a notify mm occupantof me
renes slwmnpd. "MC F, mf0.eup my. Signature of Applicant Date
g 2
woe,or authorized agent ate All roof coverings to be Class "B" or better
CITY OF CUPEWHNO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION.;
BU1Jj)@lQ0rlREsN DE ANZA BLVD GRANUM PARTNER PERMIT NO2 10 0 066
UM PARTNER APPLICATTk)sXU rt777 2 0 0 2
PHONE: SANITARY NO.!! CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGF.LECp PLUMB MECH
0 0 0
not, LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing 30 DAYS TEMP PWTTYtption
�¢6 wth SC court 7RXB Of Division 3 of the Business and Professions Code.and my Banco is
row i^fulllorcea^Jefrect. EXPIRES ON 11/07/2002 , ORIG. 402090002
Zpv�z License Class Lim.4
2pZ—O Date Contractor
='-tj ARCHITECT'S DECLARATION
9 a< I understand my plans shall M used as public records
apc,
vi 3 W f" Licensed Professional
OWNER-BUILDER DECLARATION
ap 1 hereby altirm that 1 am exempt fmm the Contractor's License Law[Or the
m M following rea..n.(Section 7031.5,Business and Professions Calc:Any city or county
%� which requires a perrof In corcl.ct.alter,improve,demolish,fir repair any suunure 0
F2 poor..its issuance.also requires the applicant for such peourA to lilt a signed statement
that be is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
—t: men ' with Section of Division 3 of the B usinees and Professions Cale)Or
(commencing"ng
3— deal he is rumps memfrom and NC Kazis for the alleged exemption.Any violation of 32634070 . 00
Section 7031.5 by any applicant for a Penne subjects the applicant to a civil penalty of APN Number
not more than five hundred dollars PiNY). Occupancy Type
1.as owner of me101 — FOUNDATION
❑ property.someco,my or
f offered
sale compensation,
will do the work.ands: he Coma notintended proffered forsale
pplyt0da,Business ±e2 PiERS
andProfessionswho
Code:The Contractor.License Law does
or applytoan ownerof 103 - UFER Required Inspections
own enywho builds orimproveschamp.and who acesBach work bimsrlred through his
however,thew.ping oranat such owmemps sold within
in not ear of
completion,llcreu for r- 104 — REBAR
builder,,dee ave tiebrien ofpmem ianlawiiinoteyca or improrme 105 — ANCHOR BOLTS
owner-
builder will have the burden Ol proving mal he did not buil)or improve for purpose of
rak) 106 - SEWER & WATER
I,as owner or the property,am exclusively contracting with licensed contractors to 202 - UNDERFLOOR PLUMBING
c Orman the project(Sec.9044.Business and Professions Code:)The Contrato
crLi
s -
cerise Law does not apply to an owner of property who Wilds orimproves hereon,and. 203 — UNDERFLOOR MECHANICAL
who cord acu for such projects with a contractor(s)licensed pursuant to the Contractor a
License Law. 204 — UNDERFLOOR FRAME
Ism ex plnndrrncrc. —� B&P C for this mason 205 — UNDERFLOOR INSULATION
Dat` A 301 — ROUGH PLUMBING
�WORKE 'S COMPENSATION DECLARATIO 302 — TUB & SHOWER
OR SHO
1 hereby affirm under penalty of perjury one of the following decla mons: 3 0 3 — ROUGH OR SHOI CAL
❑1 have and will maintain aCenificam of Consenuo self-insum for WOrkrr's Compete
.if on.as....idea for by Seemm oro of the labor Codefor he prrtamaoce ofine 304 — ROUGH ELECTRICAL
work far which tax perem,is issued' 305 — FRAME
❑1 have and will maintain workers Compensation Insurance.as required by Section 3 0 6 — HOEDOWNS
37011 of me Labor Codema
,for the perrn, nce of the work for which this permit is issued.
My workers Compensation Insurance carrier and Policy number am: 307 - INSULATION
Carrier: P.1 icy 308 - SHEETROCK
CERTIFICATE OF EXEM PPION FROM WORKERS'
COMPENSATION INSURANCE 309 — EXTERIOR LATH
(Thesenton need n^Ibrcomplemd hire lcrmnisforone hundreddonars(SBXq 310 — INTERIOR LATH
orlcax) 311 — SCRATCH COAT
1 sentry deal in the performance of the work for which this permit is issued.l shall not 313 - ROOF NAIL
employ any.wenn in anY'� cr p )aslpbecomerunIIen to the Workeri Compensation
Luwsof Califumia.DOLL'./_0.1 less 501 — FINAL ELECTRICAL ENERGY
AVWW(t aa��I 1 y rtr ml6'e� 1 VA A'a�lt3
NOTE TO APPLICANT It,after making this cf�to Of Exemption.you.should 502 - FINAL PLUMBING ENERGY
Ma ithco comply
hsorh r'ovinmpertuhonpm.isihallWdcl�MuCoked. mull 503 - FINAL MECHANICAL ENERGY
� Z atrmwlm comply with such provinces or permn shall lc deemed revoked.
z CONSTRUCTION LENDING AGENCY 504 - FINAL BUILDING ENERGY
I hereby affirm that there is a construction lending or the performance in 505 - FINAL ELECTRICAL
ga.)
asp mewuraNamenmixprmaixiasam(sea.3an.eros.) 506 — GAS TEST
131 � f<ndrr's Name
5 z Lenders Antics, 507 — FINAL PLUMBING
U 0 1 certify mal 1 nave mad this application and stale that the about information is 508 - FINAL MECHANI CAL
u. cofmcl.1 agree to comply with all city and county ordinances and.slate laws relining to
Ubuilding construction,and hereby amhorim mpreaeomtives of this city to enter upon the 5,044, FINAL GRADE
aatw-mcntinndd property for insp,clion purposes. 10 FIN PLANNI G
H a (We)agree to saw,indemnify and keep barmlev the City of Cupertino agaircd
h ince ouqu acc of the casts and expenses which may in any way accrue against said City 5 N U LI WORKS
U z AconaCANT N ERSTANDSng lhls perms. Issued by. Date av
"^ s CANT ON IONS. DS D WILL COMPLY WITH ALL NON POINT
S CE REGU IONS.
t.._.. L0 02 Re-roofs
Signature of Applicant/ narrow, am
HA.A BOGUS MATERIALS DISCLOSURE Type Of Roof
Will the aPPlimanl Of future building occupant store or handle hazardous material
defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safely
Off.Section 25532(x)9
❑Yes e All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit banrdous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
DomIC �L��,� P
❑Yes —n
'ave read der hvuNnux mamduls requimm,tia under Chapter fi 95 of the CtLoc,
nixes al &Sdcty CtWc.Seemar,25505,25533 and 25531.1 on&-Wood thin if d¢building
•des rte t y a tenant,that it is sp asihility an nodly dec o"al um ,`the
¢nLi altrmrl = ceuracform wracup cy. Signature of Applicant Date
1. CUA ( g 2
r of anthuri,.ed agent ,a All roof coverings to be Class "B" or better