01070015 CITY OF CUPERTINO
BUILDING DIVISION. PERMIT :CONTRACTOR_INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10745 S DE ANZA BLVD 01070015
OWNER'S NAME: APPLICATION SUB DATE
ORECK FLOOR CARE 07/09/2001
PHONE: SANITARY NO. CONTROL NO.
O O ARCHITECTMNGINEER: BUILDING PERMIT INFO
z u— BLDG ELECT PLUMB MECH
Z'�y Z LICENSED CONTRACTOR'S DECLARATION lob Description
O Z_ 1 hereby affirm that f om licensed under provisions of Chapter, (commencing
Fyt� with lull lamean"tof Division 3of the Business aneP fess;nna and my heense TENNANT IMPROVEMENT.
e,Y ¢in full fast n ffcct.
iO i� License Class .Lit.#
w 3 e.y Date S DELL
ARCHITECT'S DECL
I underssio my plans shall be used as public car s
Y �j
Licenced Professional � r
°'°i o LL OWNER-exempt R m the Contractor's
I_m 1 hereby affirm the 11. exempt from the Contscsr'n License Law for the
F Z a following uires o(Section]onstr Business and improve.
de io demolish.
Cade:Any city or county- $6468V
f D which requires a permit to construct.alter.improve,Jemnlish,or repair any structure
.ioCr
m_
promannij bate,also terrorist the appl'cntoersteds permit to file 'g edstatement. -
flartabe is licensed pursunt to theprovisions of the Contonator's License' Law(Chapter 9 s.+r�-[ 1 P a • ValUatlOn
nt
(commort with Sect V000)aI Di 7 f the Businessand Professions Coda) 'y a ±-•� 3D7L'3' Oat /�.•^ F y-0' 'w£ / P-'+�
or that he is ci&ript thomfo 'nnd the bass for the alleged exemption.Any violation
or Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty gN �,r,h�����
lot net mprethan fivehundred dollars($500). 101'4PNF'�UNDATION c`D OccupaneyType
°1,as owner of the pmpeny,or my employees with wages as their sole compensation,
will do he work:'and the mutation,isor intended or offered far sale(Sec.70,14,- 102 PIERS
Required Ins ectionsl"�
'Bus ess and Prdfessions Core:The Contractors License Law does not apply to an 103 — UFER 9 p
owner of property Who builds or improthereon,and who does such work himself
ba,hr.c,h h- n employees.provided tht such improvementsaren not t d d or __.._._...__104....r-.._.REBAR-.. —.._.
.
'.off df a If fib toff-ldig mP ere sold within can y Y .. —
completion,the ownerbulderwll have the burden of proving that he did not build or 105 - ANCHOR BOLTS
improve for purpose of sale.). 106 - SEWER & WATER _
-p -col ec ofthe p(Sean7 m h. ly contracting 01 bad contractors on202t Iia.l' -- — --
onswm the pmjen(Sec ]W4,Business dna Proreastona enee.)The contmrtors - UNDERFLOOR PLUMBING :"1
License Law does not apply to an owner of property who hadds or impasses thereon, 203 - UNDERFLOOR MECHAN I CAL.
'. ._and who contracts f ects.wuh.a.contracmrod,l used pursuant.m.the ..-.. _.._.._. ...---UNDERFLOOR-
.._ ..__'._.,. ....._._. _ _..-._.._
h poi
Contractors License La 204 - UNDERFLOORS-;FRAME" -
❑1 pt ones ' ''' B�Pcrr�pia an 205 - UNDERFLOOR' INSULATION
owner
"Da`° " 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
Ithi byafffmtaa p,_ltynfp 3 y rmerll gdelamtions: 302 = TUB & OR SHOWER
303 ROUGH MECHANICAL
° I hn a will mandarin a Comfit t of Carseatself-insure for Workers 304 ROUGH ELECTRICAL
Compensation, asprovided for by Section 37W of he Labor Code, for the
- 'performance oihework fnrwhbhthispegnyisiseuea. _ 305 - FRAME
❑Ili ea ill iia tam Workers Co pesto Isum required up^ 306 - HOLDOWNS
PIW f theL bbec de fio 1h peife c f dw wrak f which this permit Is
issued M ilia IPICATION OFE necart¢rand Pol cynumbe ' 307 INSULATION_
pe 6 1 5 ...,. _
G mer / bl,yN.( ) 2/� 20 t/ 30'8.. SHEETROCK 1 ..ire
EXEMPTION ROMWORKE�^ ' ' ` 309' : 1 EXTERIOR ' liFATH
" COMPENSATION INSURANCE _
310 INTERIOR LATH , .
(Th section c d not lw completed if the pcfm t is for one hundred a llars - -�^—-~
rs1W1 1�s) 311 - SCRATCH COAT
partial'i'.. _
ce as I 3'13.,_ ROOF`NAIL'.,.
1 c n fy that n the perform ce f the w rk sl f of which thiss issued, 1 'h,V
shall not employ a'y pe y manna so to become s blect to the Workers'' 501 — FINAL ELECTRICAL ENERGY
Com t Law,of
INGTICETOAPPLICANT if Rer mkt gth C naps 6t the Labor Applicare
-' 502 ---`FINAL-PLUMBING--ENERGY- --- ""-
m a Date
'becomsubjecttot Worker's Compe t p 503 - FINAL MECHANICAL ENERGY
O forthwith comply with suchp Mona or thispem,itshall nel drevoked ..
Ii . I c
mc) . .._. . ..504--. F-INAL--BUS..L. _D...ING--ENERGY
NERGY
" r• CONSTRUCTION LENDING AGENCY
n by �rm that
. t t I ❑ g ag Y f to pe f e 505 - FINAL ELECTRICAL
eofth kfor 'hmice ' idts31N
` — " _, ,__ ._ .. .__506._-....GAS ..TEST...L a t Nam
.-.-_-•.-- _-
....__-
.-
..
p,Z L nae Agar« 507 - FINAL PLUMBINGI ,[ ,;.n
U OI certify that 1 have read this application and stete that the above information is 5 0 8 - FINAL MECHANICAL
'imancs.I agree to comply,with all city and county ordirearea,and state laws relating 509 - FINAL GRADE
'tobuilding construction;and botchy authorize represenmtivesofthis city to enter upon
]n 1s f _ep petymr'npecto a ce 510 - FINAL PLANNING
�r . IW) g t a sdemnifyand keep hmmlessih City of Cupertino gains[
vat liabilities,las th i J.expense, n h.my,inany way otaepgantsaid 514 - FINAL PUBLIC WORKS
U rZr C ty n cons' cure f he g t of th pe in t "_
51PPi ICA' IN RSTAh NDWfLL COMPLYNITH AL1. N- DINT'- Issued by: Dale
S URO I fl t .,
u
,Sig to APP, ° MATERIALS
Re-roofs J1s /p
ur .H ABODES MATERLS DISCLOSE E
.E llI a t r fhome building occupant son.,o h ndle h"a s mat rid ..... Type of.ROof .. ._ m,..:,.. w.,..: .. ...:. .. .....
,as dein J by the Cupertino M and Safety r
Municipal Code.Chapter..12 d the Health y, _ -
Caae sect on 25s3p[) , - r +: ^(" pll roofs shall be inspected Cl
❑Ye6 °" ' prior to.any.roofing-material-being installed.-
r --
• W u to ppl t r future bre Id g occupant eq p e t rate i�pa h ph If a roof is is without first obtaining an inspection 4'4gree to remove - -
emth d Management;
c t n t carried ByAreaA rQ or
-District all new,materials for inspection ,Applicant understands and d will comply wihr,o
1 I have read ctio s 25505 25533 and 25534.1 understand Y` ° it-
No allnon point Source regulanona
'the hazaN us meieri Is requirements der Chapter 6.95 of t& 1,
li I lithe m a ing lth&due, Sal ty Code as rsund the
r,oprldmg does utc tl haveb tenant,that t"aiy po, bltyi 7fy he _.._ _ ._,......_......__ ... -__ ... _.. .... _ ___.. .. .
oc app ntc fth'rcq :rcmet heti most at P,!.,to .. of Ce ilm' f
OFe - .. -
O Signature of Applicant Date _
All roof coverings to be Cl„ " "
Own rare uJ g m..! !r.. .. ;Date u
Class, B or better
,.:_ -. ...... -OFFICE--. . _ ..... ._ _. ...... ....__ -. ._ __.. ..._. ..-, _. . _ _..