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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
'CONTRACTOR INFORMATION:
BUILDINGADDRIUS:
J. M. OINEILL, INCa
PERMITNO.
10275 N DE ANZA BLVD
02120052
NER'S NAME:
5880 W. LAS POSITAS BLV, #
APPLICATION SUB DATE
TOM DE DIVITTORIO
12/12/2002
HONE:
(925)225-1200
SANITARY NO, CONTROL NO.
ARCHITEC17ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
9
Job Descri (IOn
p
1 berchy nfifon that I am licensed under provisions of Chapter (commencing
with Section 70h0ol Division Sof Ne Busir�iand Professions Cude,and my license is
in lull fnrtm a fon. A
Lieerne Cl a �
Date Conuxmr
TEN IMP yO,E E
�
RCHITECI'S DE ATION
1 undcrsunJ my plans shall he uscJ a blit morda
l
J
Licensed Proutsimnal
DECe RNI [ON
OWNER BUILDexempt
'A
1 hereby alliect that 1 fr Contmeto License Law Bn me
exempt from the fessions
-�...
C's
following reason. (Section 7031 1. Business and Professions G,de: Any city orru
which 2yuisu a permit um dNL improve, repair any Lure
cores
taNclum
the
prior m ice sensed p also myuires the applicant fur such permit m Gln s signed statement
re h Permih, file
that licensedpursuantmtheofDiviouofthe Comsinets LicenseLaw lChapter9
Sq. FL Floor Area
$600�}QI(htion
(commencing With Section ]fan)) of Division3 the Business Code) (it
me
the exemption. Any
Nat he u exempt therefrom and the basis for the alleged cxcmp,imn. Any violuion of
e
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of
nos more Wan five hundred dollars (850 B.
❑ 1, u owxr of tite property, or my cmployua wiW wage u Heir sole mmpewtinn,
—
equlred Inspections
will do Be work. and the structure is not intended oroffemd instate(Sec. 7044, Buuncss
Cash: The Contractor's License Law does
and pretentious not apply m an owner or
102 - PIERS
pmpenywho builds or improves Norton, and who doessuch work tonsillar through his
own employees, provided Was such improvements are not intended or offered for sac. If,
103 — UFER
however, We building or improvement is Sold within one year of completion, We Owner -
104 - REBAR
builder will haw Be burden of praving Brut he did not Wild or improve for purpose of
I)e-)-
105 - ANCHOR BOLTS
01. as owner of the pmpeny. am exclusively contracting with licauei contractors to
106 - SEWER & WATER
construct she project (Sec. 7044, Business and Professions Code:)The Contractors Li.
cense law does not apply to an owner of property who Wilds or improves Station, and
202 - UNDERFLOOR P UMBING,
who contracts such projects with anmtrecmr(s)licensedpursuam to the Contractor's
203 — UNDERFLOOR M CHANICAL
❑ I am exempt under Sm. ,B&P C for this rcunn
204 - UNDERFLOOR FRAME
Date
205 - UNDERFLOOR INSULATION
Net
WORKER'S COMPENSATION DECLARATION
301 - ROUGH PLUMBING
Ihereby affirm under Penalty ofNquryone ofon, following dxluatmM:
302 - TUB & OR SHOWER
❑Ina vsandwill edforbinecen3700ate oftheLabrCodeConsent to marererwrfannicompene
satimn, u provided far by Section 3)Igl of the Labor Code, for me performance of the
303 - ROUGH MECHANICAL
work for which this Permit is issued.
304 - ROUGH ELECTRICAL
❑ 1 have and will mahouts Workers Compensation Insurance, u required by Section
305 - FRAME
3700 of tho LaIWrCodc, for the performance of We work for which this Permit is issued.
My worts Cnmpcnsasiovvnssa ee earrierand PoFynumher are:
306 — HOLDOWNS
307 - INSULATION
a/'r CF.RTIFICAEXEMPTION FROMWDRKER$'
COMPENSATION INSURANCE
308 - SHEETROCK
maitseetumneeIII not becomNetediflhc Permit is formic, hundred dollars ($100)
309 — EXTERIOR LATH
leu')
310 - INTERIOR LATH
1 unify Nat in the Performance of the work for which this permit is issued, 1 shall not
311 - SCRATCH COAT
employ any Person in any manner so as to becomSubject Warne Subjeco the Workers' Compensation
Laws of California. Date
313 - ROOF NAIL
Applicant
501 - FINAL ELECTRICAL ENERGY
NOTICE TO APPLICANr:If, after making this Certificate of Exemption. you should
Wmme subject to the Workers Compensation previsions of the Labs Cale. you must
502 - FINAL PLUMBING ENERGY
forthwith comply with such provisions or this Permit shall be domed revoked.
503 - FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
I hereby affirm shas than is a mnstmaim lending agency lin she performance of
504 - FINAL BUILDING ENERGY
the work for which this Permit is issucd(Sec. 31197, Civ. Cr)
Lender's Name
505 - FINAL ELECTRICAL
506 - GAS TEST
Lender's Address
I unify that 1 have mad Be, application and nam that the shove information is
507 — FINAL PLUMBING
conte,. I agree to comply wit all city and county ordinances and state laws relating to
building construction. and bercby ambmrim representatives of oris city to enter umrn me
5 FINAL MECHANICAL
above-mentioned property for inspectionpurimacs.
O9 FIN
(We) agree m sive, indemnify and keep harmless the City of Cupertino egoinst
liabilities, judgment, costs and expenses which may in any way Same against said City
Cj �j G
in to yuenceufsh S ANDSSe S AND WILL COMPLY WITH ALL NO -POINT
Issued by51 - WORKS Date
SOUR E S,
Re -roofs
Type of Roof
64 z
tar pp c -no Date
1 AZARDOUS MATERIALS DISCI.OSURE
Wi me applicant or future building Occupant more or handle haearduus material
as defined by the Curenino Municipal Code. Chapter 9.12, and the Health and Safety
1r, Section 25532001
❑ Yes
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, [agree to remove
Will she applicant or future building Occupant use equipment or devices which
emit hazardous air conmminanu as defined by the Bay Arca Air Quality Management
all new materials for inspection.
District? r
E] yea, /blA
1 have mW the hvaNnus materialareyuiremenu un@r Chapterfi 95 of the Cali(nr
nice Hcalm AsNety Cudc, tiou255(IS,U land 753.1.Iumkraund thatiDhchmIding
m
ores Tors cu lyha a rte mar it is resPeuibility 'Cry dte rccupanr of We
myuimmc irn prtm tis anec orw artmca Tae ancr.
Signature of Applicant Date
3
All roof coverings to be Class "B" or better
owner ser mm< <d stent Damo