03040054C
CITY OF CUPERTINO�a
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BUILDING DIVISION PERMIT
�'XON1 MZTUR IN O MA CIfQN
BUILDING ADDRESS:
PERMITNO.
10275 N DE ANZA BLVD
03040054
OWNER'S NAME:
PERMITISSUEDATE
DI VITTORIO GAETANO S AND mkRY
04/09/2003
)NE:
SANITARY NO. CONTROL NO.
ARC HITECTfENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
' I Comity.fBrm that I am 1,1= under pm WlaH archepmr 9 (aammeneng
Job Description
wish Otani of ivldon lof NCBudneu fcasion c.andmylicomot
in full fmoee d, Y
e.I'
TENANT IMPROVEMENT
�<,aD
ARCH I cos Ect AnON
CONTRACTOR:
METHOD CONSTRUCTION
Ancient ndm planes I P. On publlcauards
G
Licensed Pmfesional
OWNER BUILDER DECLARATION
1 hereby affirm that 1'a exempt from the Contractors License Law for Re
following reason. (Section 7031.5, BuNne . and Pmfusinns Cade: Any Nty or County,
^
which requires a permit to caasmnt, Rlmc Improve, dcmnllah. or repair any structure
prior in its Issuance, also mqulme tbe applicant for NCh permit to rile a signed Klement
that he Is licensed pursuant tribe previsions of the Contractors License Law(Chapter9
Sq. FL Floor Area Valuation
(commencing with Section 7000) of Division 3 of the Buainusund Profession Code) or
that he is exempt themfram and the hula for the alleged exemption. Any violation of
"
Section 7031.5 by any applicant for a permit objects Ne applicant to a civil Knotty of
APN Number
Type
not men than fl. hundred delta. (E50B.
y
❑ Las ownerof thepmpeny, army employees with wagesu Neireala Compensation,
will do thework, and the swctum Is not Intended oro@rad forule (Sec. 7W. Business
and Prefeulam Cade: no Caatrcmrme Law doer net apply to an r UceOwner of
Required Inspections
propeny who build, or Improves Herron, and who doeuuch work himself or through his
own employees. provided hat such Improvements are nminumical At offered forsas.If.
101 —
FOUNDATION
however, Ne building or improvement is sold within one year ofcompletion, Ne owner-
102 —
PIERS
builder will hew the burden of proving Nu he did net build w Improve for purpose of
nm.).
103 -
UFER
❑ I, As owner of the property, am exclusively contracting with licensed eonbactms to
104 -
REBAR
cOmtract the project (See. 7044, Business and Pmfous ons Coulee) The Conlncurs Lb
come LAW dor nat pply mm owner of pmpeny who bdlds or improver Nemo..and,
105 —
ANCHOR BOLTS
who contracts for.uch Projects;with a contnnor(s) licensed paawanfto the Contractors
106
SEWER & WATER
License Law.
-
❑ I am exempt under Sec • B E: P C far this rrsson
202 -
UNDERFLOOR PLUMBING
Owner Date
203 -
UNDERFLOOR MECHANICAL -�
WORKERS COMPENSATION DECLARATION
204 -
UNDERFLOOR FRAME
I hereby atnrm under penalty of perjury ane of the following dalanialom:
205 —
UNDERFLOOR INSULATION
wend will maintain a cenlncK or consent to sel0lnsum for Workers Compere
u Provided for by Section 3700 of the Labor Code, for Ne pMfom mCA of ft3
for which this permit is issued.
01 —
302 -
-I
ROUGH PLUMBING
TUB & OR SHOWER
❑thow and Will maintain Compensationby Beckon
by
Imus whi Ards
' 303 -
ROUGH MECHANICAL
Issued.Section
3700 of Ne Labor Code, far NepeR's
epeffrC.nc Tuve woh inwhich Ads per
My Workers Compensation Insurance carrier and pall umbenm:
304 —
ROUGH ELECTRICAL
c.mn = AN -,6 polity a.
305 -
��\v
FRAME
CER FI COSOFEXEMMON MOM MPENSATION INS RA CEORKERS'
306 —
HOLDOWNS
(This section need not hecomplmed Bthe pmmb la forone hundred dollen(SIM)
307 —
INSULATION '
oriel)
308 -
SHEETROCK
1 sonify that in the performance of the work for which this permit is issued, I shall not
309 -
EXTERIOR LATH
employ any person In any manner an As an become subject m the Workers Compensation
`
LAW.f mia.Delo
310 -
INTERIOR LATH "
Applicant
311 -
SCRATCH COAT
NOTICE TO APPLICANT., If, after making this Cenincale of Exemption, you Mould
become subject to the Worker's COMPOmMma previsions of the Labor Code, you mut
313 -
ROOF NAIL
fonhwith Comply with such prnvisinu or this permll Molt be deemed rooked.
SOl —
FINAL ELECTRICAL. ENERGY
CONSTRUCTION LENDING AGENCY
I hereby affirm that Nem Is a eunnme0on lending agency for the performance of
502 —
FINAL PLUMBING ENERGY
the work for which this permit Is Issued (Sm. 3097, Civ. C.)
Lantloes Name
503 -
504 -
FINAL MECHANICAL ENERGY
FINAL BUILDING ENERGY
Leaders Address
I cenuy that I have read this rppnaaon.ad rum that the Above mrommadan 1.
505. —
FINAL ELECTRICAL
COMM. l ague to comply with all city and county ordinances and sate laws relating to
building conversion, and hereby aulborin mpm antaliws of NB city to enter upon the
6 -
GAS TEST
ahove-mentioned property for impeetion pumigses
5Q —
FI L PLUMB NG
(We) agree m save, indemnify And kap I It City Of Cu cnin0 Against
,
Ilabllines,judgments.eOKtad Masowhlch syMan wayaerueagaintuidCity
$
I M C' CAL
in earmaequcn eEranling llhh permit.
5
APPLICA UN ERSTAN SAN WI COMPLY ITN=O�Id+
SOURC EGUL ONS.
Issued by:
Date
Re -roofs 514
Type of Roof
INAL PUBLIC WORKS
Sig Art ppllcentlCon Cor Dem
HAZAR OUS MA IAIS DISCLOSURE
Will the applicant or lot= Wilding Occupant am or handle husrdous material
As donned by the Cupenino Municipal Code, Chapter 9.11, and the Health and Safety
Code, Section 75577(e)?
❑ Ycs
All roofs shall be inspected prior to any roofing material being installed.
— Will the applicant or fwure building occupant use equlpment or devices which
If a roof is installed
without first obtaining an inspection, I agree to remove
wardnus air contemimnu As dcnned by the Bay Arca Air Quality Management
all new materials for inspection.
T
❑Yns �n
thew road the hnardausma"rm (re "M creta Antics Chepter695 of the Glifnr.
nla Hcalthg:SmctyCWc, Sccdons7550 75533��^^d 15534.1 undt"Ard that Noun building
^
Jas not cuncnlly haw ant, that Il a my msppnsibliny w nodl'y the acupanl Mthe
rcqu nwinmA be petpriort laauance aCeturma roe /_'0
Signature of Applicant Date
All roof coverings to be Class "B" or better
O ncr onwhorizcd a ht -- Dp,p