03010104CITY OF CUPERTIN0
BUILDING DIVISION PERMIT
CO,NTRACT0R,JNFORMATION:�
RIULDING ADDRESS:
J. M. O-NEILL,
INC
PERMIT NO.
10275 N DE'ANZA BLVD
NER'S NAME:
5880 W. LAS
POSITAS BLV, #3
AIPLICATION SUB DATE
DI VITTORIO GAETANO S AND MARY
01/21/2003
'SNE
(925) 225-1200
SANITARY NO. CONTROL NO.
ARCHITECDENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a 0 0 0
LICENSED CONIRALTOR'SDRATION
I hereby affirmmthat nm licensed under provisxioniuri s of Chapter J (,,,..,Oct.,P
t
fob Description
with Section 71XX0of Divi' Sof Ne Busircssand Pg�f rens Cude,ad my license is
in full toren and Brie, H'e�--:?Gf$
30 DAYS TEMP
PERMIT
License Class Lic r is
Contractor .O �•If F e
EXPIRES ON
02/20/2003
ACTS DECLARATION
1 understand my planas Mid
ail th M useJ as pontic rccnNs
Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt time the Cumranor's License Law for the
following reason. (Section 7031.5. Business and Professions Code: Any city or county
which reyuir a Perin u) construct, alter, improve, denudlah, or repair any structure
prior In its issuance. also requires the applicant formed Permian file a signed statement
that he is licensed Pumuanuo the Pmvislium of the Cenlmt'lors license Law lChaprar 9
Sq. Ft. Floor Area
Valuation
(commencing with Sectlon 7WO of Division 3 of t6a Business and Pnsfesslnns Code) Or
[i O
that he is exempt therefrom and Ne basis for Ne alleged exemption. Any violation of
YY
APN Number
Occupancy Type
P Y YP
Section 7031.5 by any appliwns for a Penn it subjects the applicant o a civil Penalty of
net mmrethan fivchundred deta.($501)
32633103.00
I, asownerofthe impeny,or myemployas with wagesas Neirmlesvmpenmtion,
will do Ne work and Ne structure is not intended at offered for sale (See 7044, Business
and Professions Code: The Contractor's License Law does not apply m an owner of
101 -
FOUNDA�Tbj&cd Inspections
Progeny who builds or improves thereon, and whodoes such work himselfor Nmugh his
Own employees, pn idcd that such improvements are not immrided oroffemd formic. If.
102 —
PIERS
builder thebuildingnrimprovementissaltwithinone year or completion, theosse
builder will have the burden of proving that he did not Wild or improve for purpsse of
of
103 -
UFER
.in ).
104 -
REBAR
❑ 1, as Owner of the property. am exclusively contracting with licensed contractors to
105 -
ANCHOR BOLTS
mnstmct the project (Sec. 7044, Business and Professions Co ll The Contractors Li
cense law does not apply to an owner of property who builds or improves demand. and
106 -
SEWER & WATER
who contracts for such projects wifecrmtraclerts) licensed pmsioano .,he earn ncmr's'
License Law.
202 —
UNDERFLOOR PLUMBING
❑ l am exempt under See. ,B& P C for this reason
203 -
UNDERFLOOR MECHANICAL
Dare
204 -
UNDERFLOOR FRAME
WOR KER'S COMPENSATION DECLARATION
205 -
UNDERFLOOR INSULATION
I cerehy alrmdatitle,Pedally of peijary.ne of the fnN,wing declarations:
301 -
ROUGH PLUMBING
1 have and will maintain a Certificate OConsent in
f Conseno sett sure for Worker'aCumpen-
mind, as provided for by Section 3710 of Ne 4hnr Code, for the Performative of the
302 -
TUB Sc OR SHOWER
work for which this permit is issued.
303 —
ROUGH MECHANICAL
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
304 -
ROUGH ELECTRICAL
37W of Ne Labor Code. for Ne Performance of Ne work for which this Permit is issued.
My Wnrkor's C�n.,�a �toren mL-��u9aa�nee��carner and Policy number am:
Carrier:qPolicy NO: :f 3 - b2
305 —
FRAME
=
306 -
HOEDOWNS
CERTIFICATE OF E%EMPI'ION FROM WORKERS'
COMPENSATION INSURANCE
307 -
INSULATION
(Thissection ncednot beeomplemdifthepermftisforone hundreddollars(Slap
308 -
SHEETROCK
eflCm)
309 -
EXTERIOR LATH
1 unify that in the Performance of the work for which this permit is issued.I shall not
310 -
INTERIOR LATH
employ any personaz subject in any mannerso to become subjeco the Workers' Compensation
Lawsof Califontia. Dam
Applicant
311 -
313 -
SCRATCH COAT
ROOF NAIL
NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
Nrthwi to comply wOn such 'revismusm this peorn shall lM deemed revokca.
501 -
FINAL ELECTRICAL ENERGY
502 -
FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY
InerehyamrmMid them isaconatructonleading agency lhrthe orlormanceor
503 -
FINAL MECHANICAL ENERGY
the for which his permit is issued (Sec. 1197, Civ. CJ
tender's
Udder's Name
504 -
505 -
FINAL BUILDING ENERGY
FINAL ELECTRICAL
Lenders Address
I certify Nal I have read this application and sum that the above information is
506 -
GAS TEST
correct. 1 egrec to comply with all city mN county ordidancca and also, laws relating m
building construction. and hereby auNoma mprecnulivesof Nis city to ewer upon Ne
FINAL PLUMBING
1/?I/
above-menlinnedpmPerty for insPeetionpurposes.
OB
FIN&'ML '
(We) agree m save, indemnify and keep harmless the City Of Cupcnlnn against
liabilitics.judgmcnta, costs and expense which may in any way secure against said City5in
consequence of the granting of this Permit.
APPLICANT DE DSA AlWILCOMPLY WITH ALI. NON-POINT
Issued byS 1
G Date
SOURCLR U T t
Re-roofs
Type of Roof
03
Signawrco PPIi U Ont s rt Due
HAZA OU ATERIAfS DISCLOSURE
Will thea Iicanlor u chuilding occupantsmrc or handle haraNnusmatenal
az teBnetl by Ih CuPcrodo Municipal Code, Chapter 9.12, and the Health and Safety
.ate. S❑dan 25532(a)7
p"o
All roofs shall be inspected
prior to any roofing material being installed.Yes
If a roof is installed
without first obtaining an inspection, I agree to remove
Will the applicant nrfuture building Occupant use equipment ordevices which
it hazmdnes air cnnmminama as defined by the Bay Arca Air Quality Management
all new materials for inspection.
Disuiet? V
0Yes _f (N.
1 have read Ne hamodouss\memrials requirements under Chapmr6.95 of Ne Culifor-
'niallcalN&SafclyCN.Sectioms25505,255 and]55W.Iundcrsund Nalifft Wilding
does not cutenll Nat it is mspmsihilily to notify Ibe occupant of the
avec
rcyuimorentsw ten I'....I. Cemfieam of Xupany.
Signature of Applicant Date
All roof coverings to be Class "B" or better
owneraramtadixcd
gent Q�
`l/