03060133 CITY OF CUPERTINO -'
BUILDING DIVISION PERMIT 9NIRACTORANF'ORMATION `'S
0u1LDINCADDRESS: C rid HANSEN CONST, INC. PERMIT NO 03060133
.BC) 9 ANZA BLVD
' NAME: 1175 LAFAYETTE ST PERMrr Lssue DATE
ONE: SANITARY NO. CONTRO7N
(408) 248-8120
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BOELO PLO MECH
O
3066 LICENSED CONTRACTOR'S DECLARATION
O 1 hereby (rims Nal 1 am licensed under provisions or Chapter 9(commencing Job Description
ETj with Siniuma7pk))of Di'lion3of the Business and Poressi aC�pdoydmyliccncis
o. infema, Lid.e a rrceh. s- LS TENANT IMPROVEMENT
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L.
�e„ Dale Ce'
e unticrsun my plans AR 1 1 se
S DECu Is \ ®
y0 Li sed Pm son,l ■ INA�60
OW NER-BUILDER DECLARATION
2 1 hereby affirm that 1 am exempt tram the Contractors License Law for she pUG' 92003
CO O following mason.(Section 7031.5,Business end Prnfessiom Colic:Any cis,or county
5$ which mquires a permit to construct,alwp improve,demolish,or repair any Structure
Zf" prior to its issuance,also ragman she applicant for inch Permit o rile a signed statement
m�
that he is licensed pursuant to she provisions or the Conhacmri License Law(Chapter 9 Sq.Ft. Floor AreaD Q� tion
I- (commencing with Section 70D))ofDivision 3oftheBusiness and ProressionsCrack)ur BUILD
f;S that he is exempt therefrom and the beau for Ne alleged exemption.Any violation of 3694 0015 O
Section 7051.5 by any applicant for apemah&objects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500).
❑Lu owner o.nd property,or is emplende with wagesa Nelr rete 7W.Business
will dodawork,end the eCmianot intended Law
Torula(Sec.70a,,B a.,of
and Pofessions Code:The ConVactor'&License taw does not apply to an owner of d Inspections
propenywhob.proviim thatuthimprovndwho dousuehwmkhimueedthroogb 102 — PIERS
howcrumemployeWildinior idies such improvements within
not intended compleerte she owner,
builder
103 - UFER
however,the have
the
i u improvement is sold within aro year of completion.for die owner-
builder will hew Ne buNen of proving Net be die not Wild or improve for purpose or 104 — REBAR
ulc.).
E]1.as owner or Ne property,am exclusively contracting with licensed contractors to 105 - ANCHOR BOLTS
comlmn the project(Sec.70aa,Business and Professions Code:)The Cenbacur,Lb 106 - SEWER & WATER
cense Law does not apply to an owner or propeny who Wilds or improves thereon,end, 202 - UNDERFLOOR PLUMBING
who contracts for such projects with a conwcter(s)licensed puumnt no the Conuacsor,
Liven=Law. 203 - UNDERFLOOR MECHANICAL
❑Ism exempt under Sm. ,B A,P C(m this mason
204 - UNDERFLOOR FRAME
I
Data
WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
I hemby alfum under penalty of perjury one ofsW following deelwion,. 301 - ROUGH PLUMBING
I haw and will maintains Cenlfnu of Cemenuo self-insure far Worker',Compen- 302 - TUB & OR SHOWER
rasion,as provkhol for by Section 5700 of IW Labor code,for the performance of the 303 - ROUGH MECHANICAL
work for which this parsed is issued. 304 - ROUGH ELECTRICAL
❑1 haw and will maintain Workers Compensation Insurance,u required by Section
7700 of the laborcode,ser Nc perform ce of the wmk fu which Nis permit isiuue0. 305 - FRAME
My Workcr pusionl mutt ca icr`.rd PP.,cy num rarer,_ 306 - HOEDOWNS
Ca CERTIFICA EOFEXEM ONFROMWORKE S• 307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
or Mev)ffTls,eali.aced not becompowil if hbe permit a fm one hundred unit.I$IM) 309 - EXTERIOR LATH
1 certify diel in the performance of the work for which this permit is issued,l shall not 310 - INTERIOR LATH
employ any person in any manner an as be become subject to the Workeri Compcuatlen 311 - SCRATCH COAT
lawsof cant California Data
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT.If.after making this CettiOeam of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compcwtion previsions of Ow Labow Coal you must
.Jz rnnhwi.,comply with Such Provisions or Ni,permit shall be deemed revoked. 502 — FINAL PLUMBING ENERGY
z 0 CONSRUCf10NLENDINGAGENCY 503 - FINAL MECHANICAL ENERGY
(•"rte.. 1 hereby offum Nal Neu iso conslructinn IcnJin{agency I'nnbe per(ormauc u( _
oe> diewvrkfar which this permit isissued(Sex.J097,Civ.C.) 504 FINAL BUILDING ENERGY
w q LenderaName 505 - FINAL ELECTRICAL
. z <mersAtldma 506 - GAS TEST
U0 1 century Nat I basic read this application and mw that the above information Is 5 0 7 - FINAL PLUMBING
correct.14gme to comply with all city and county ordinances and sots laws retailing to
OU Wilding cementation.and hereby authorlae mpresentstive,of Nis city hoarier upon be - FI19RWORKsDat AL
w abovomentioned propiny for impenion purposes.
(W)agree to ave,in mni(Y and trey hannlev the city or Cupenine gains& 0 9 F I /
VI liabili0e udgmen¢eo&tse me&which may inany way..a.,ain&raid City 5
con race of Ne grana fhiapermit.
ti APPL NT UNDERSTA N 1 OMPLY WI ON-PO Issued by:
SO E REGULATIONS.
Re-roofs
Sig "ore oWIcAnUCOrnschOr HAZARDOUS MATERIALS DISCLOSURE are Type of Roof
Will the applicant or future building acupvnt&sere or handle hrrallous mewnal
defined by the Cupenine Mugcipal Code,Chapter 9.12,and the Health and Safely
. [3 enzss3zsa)7 - All roofs shall be inspected prior to any roofing material being installed.
❑Yes u
Will the applicant or fu c building occupant mac equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
7M.H.1do
hamodous air comm n u dcrincd by the Bay Area Air Quality Management all new materials for inspection.
ria?
❑Yes ❑No
i have mol Ne hvaNyyyyyymsmawrialS uyuiumcnts under Chaprerh.95 of Nc Califon. .
SafetyCodc,Sc an/25505,25555and2553a.luni send aifen,building
not u dyhaw a re en alit ismyrespomihilitywand aaarea ofNeiem hichmustb m �h is , ;I.CcNfcase �f0 Signature ofApplicant Date
ermaNhoriacdagem D he� All roof coverings to be Class "B"or better