03040064�p z0
CITY OF CUPERTINO
..
' "'�" "" t° `� F),. '"•''s
�O.NTRtIC'UR T�NF�UttMATIr�..,
BUILDING DIVISION PERMIT
PERMIT N0.
BU1IMPPD9R"K1 DE ANZA BLVD
J. M. O'NEILL,
INC
03040064
'sqT'PTORIO GAETANO S AND MAY
5880 W. LAS
POSITAS-BLV,
37IT�U04/10/2003
P
(925)225-1200
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ARCH17ECf/ENGINEER:
BL00 ELECT PLUMB MECH
l�
LICENSED CONfRACR)R'S DECLARATION
Job Description '
I hareby effum that 1 am licensed under proWuom M Chapter 9 (mmmencing
with Section 70l)(1) of Divluon 3 ofthe Businraeend Profession Code, and my license Is
mfull farm A.deffeel.
License Clore Lie.a
Date Conlraclm
ARCH ITECPS DECLARATION
TI --EXTERIOR
_
STAIR
`) 4 t 1�
l
1 demand h
Ii
l
L 1 %nal
DECLARATION
O,,Iam
attempt CwrectLicense law for m
C Rum Nal I em eumpt from Site
followingw. (Section 7W5. Business and oli Code: Any Illy or ceumy
demolish.
'
which requi* $ permit to cmuWCL alter, imprun, m mMu any atrmMM
pnormlu lnuance. *lata Mquires theapplicant rm$mh permit to file *Signed statement
�
Sq
Area
Wt he t.11=,n unu ,gLtr epmvidom of theCOtncmYs lJcena law (Chapm9
$2�L��on
(commencing with Smtlw7000) of Dlvi,xm 3 of me Businessland Profeuinm QmdOm
that he is exempt therefrom and the but. for the alleged eamption. My violation of
SODIUM 7D31.5 by any epPllesnl rte a permit sublecta me *pplleom to a civil penalty of
Occupancy Type
of 409r. 0 0
not more dins 0w hundred dollen (SSW).
❑1.umum, or the property, or my empioyas with wages u melt wk compensation.
wed do the work and the structure knot Intended mo0cmd for sale (SIC. 701 Business
101 —
FOUND`4, RTgIIfi ill Inspections
and Profession Code: The Com actoes Liceme law does not apply an an Owner of
102 -
.
PIERS
pmpedywho builds or improve innocent, and whodeeaamh work himalforhmughhu
mmemployem,pm,ldcd thalami, lmprovmenu K not Intended mnaeMA for also. If,
103 —
UFER
however, the building or impmwmant 11 told within one year of completion, the owmn
Wilda wl0 haw den burden or proving mat he did not build m Improv for purpose or
104 —
REBAR
UL).
105 -
ANCHOR BOLTS
ner of he pMPMY, am eselunvely emuamint wed licensed eanuatm a
h pro)em(Sec.7014, Business a ad Piefuilom Cmde:)TW ConutneS u.
106 —
SEWER & WATER
does am ppbman aP 'Y •'ha Wild, w hainomflae'Po"' and,
202 -
UNDERFLOOR PLUMBING
mfortuchpmkcuwimawnp ,(Olimmedpmuan,mtheC9ndes
203 -
UNDERFLOOR MECHANICAL
[AW. B k P C rte orb Masco
em under See
204 -
UNDERFLOOR FRAME
205 -
301 —
UNDERFLOOR INSULATION
ROUGH PLUMBING
I KERS COMPENSATION DECLARDat`
e bye nderpemlty of pedury ore or me mlowng dwlm,mnr
302 —
TUB & OR SHOWER
end maintain a CertlOcam ofComen4o alf•imuM fm Wmeef$ Compete
provided for by Section 37W of tirc labor Code, far me performance of the
303 -
ROUGH MECHANICAL
wMeh this permit iaimued.
304 -
ROUGH ELECTRICAL
❑ 1 hew and will maintainWorker's Compewtlon Insunnm, u required by Section
37W of the labor cede. for the pedmmwm of Site work for which this permit It blued.
305 —
FRAME
My Workee, Compensation lntunDee comm and Policy member tae:
306 —
HOLDOWNS
carrier. Policy No.:
CERTIFlGTE OF EXEM moist FROM WORKERS'
-
INSULATION
'
COMPENSATION INSURANCE
308 -
SHEETROCK
(Rrls secti.Decd onlWoompkted lith Pcrmu Is formM hundred donsn(SIW)
309 -
EXTERIOR LATH
"'tett)
310 -
INTERIOR LATH
1 certify that In the perrnrmance of the work for which this permit is issued, I shell am
employ any perann In any manes um become anblml10 the W9rkeM'Cantpeemdm
311 —
SCRATCH COAT
Lew, of California. Data
313 -
ROOF NAIL
Applicant
NGfICETO APPLICAND Ir, arum making this Cenificem of Exemption, you should
501 -
FINAL ELECTRICAL ENERGY
,$
become whjWt to the Worker', Compensation pm islom of the labor Code, you must
forthwith comply with such provisions or his permitahatl W deemed revoked.
502 -
FINAL PLUMBING ENERGY
2
CONSTRUCTION LENDING AGENCY
503 -
FINAL MECHANICAL ENER
lherebyaffirmmattheat.acomvmimlendingagemyfmtheperformanceof
504
FINAL BUILDING ENER
4
he work rur which this permit U Issued (Sec. 3097, Civ. C.)
_
505
FINAL ELECTRICAL
O
Under'$ Name
506 -
5 0 7 -
GAS TEST
FINAL PLUMBING
ZUndeesAdd.
0
1 certify that I have read this, application and tuns that the above Information is
coram. I agree in comply comply with all city acounty or IMIMM, and tuns law Misting h
Wilding construction, and hereby aummla mpraenmin, or this city to enter upon too
.
FIN MEC ICAL
Ii7
yIMbilidm.)udgmenu,eoWarainpemuwhuchaMyMany"yaccucaSaim,WdCity
aW O-meraMned irmpeny fm inspection Purpmax
(we) *gra to taw, indemnify and keep harmless me City of L'ePertinn 82
0 9
F I /
1�
Inco mom ofinegamingofhiapermie
APPLI NT UNDERSTANDS ANO WILL COMPLY WITH ALL NON -POINT
5
Issued by: 5
NG
Date
C O
Re -roofs
TyPe of Roof
SOUR REGULATIONS. .---
764-112-0
gnuu o / I m oCuntnctor Data
HAZARDOUS MATERIALS DISCLOSURE
a immorfuture building Occupant atom or handle haurciout material
u deli ed by the Cupenino Municipal Code. Chapter 9.11, and the Health and Safety
15531(a)7
All roofs shall be inspected prior to any roofing material being installed.
Code, echm
DYm iso
inspection, I agree to remove
.40 Z-1UM
If a roof is Installed
without first obtaining an
WRI the applicant or building Decupani can, equipment or devices which
emithmardnm air contaminants u defined by the Bay Anda Air Quality Management
all new materials for
inspection.
Diu im7
❑ym �No
I hewmsd me hamNmsmwdaltrequhomem under ChaPur6.95 of me Califon
niaHnith&Ssrmy Code.Scaimu75%5.15533ud755N. 1unde twifdc building
1 currently haw o terunk dW Il t. my reapomihillty m nW fY ties occupant lir me
hmuummetpdoramuanceohCeNOc*teofOw
57
Signature ofApplican[ Date
• 1
jgk&�,d
All roof coverings to be Class "B" or better
a cm
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