03030013 CITY OF CUPERTINO rri�<
'BUILDING DIVISION PERMIT « NT CTOR I1 .O1tMATiQ
BUILDING ADDRESS: SOUTH BAY CONSTRUCTION CO fl&CTNO.
R'S NAME: , 511 DIVISION -STREET PERMITL4UEDATE
LIMAR REALTY CORP. 429
ONE: (408) 379-0400 SANITARY NO. CONTROL NO.
ARCHITECrfENO1NEER: BUILDINO PERMIT INFO
PLUMB MECH
3o=o LICENSED CONTRACTORS DECLARATION JobDescri tion
r� 1 hereby affirm Nn provisions am remand under provons of Chapter 9(announcing p
with Section 7000)of Division 3 of the Butimeand Profcsslua Codo.and mylicene is A ��®
Ire full roma and effen, NEW EXTERIOR STREFRONT DOORFIV NA
k�3a�meChss co tractor IN EXISTING WINDOW OPENING
A LRATION
incored,
MAR:1 9 2003
w o tl OWNER-BUILDER DECLARATION BUILDING<� I hemby art..Nn I am wempt Imre tie Cominumes License Law for the
D o following rearm.(Section 7031.5.Business and Profasiom Cade:Any city or county
$
which ru puma a permit ,,construct,almr,borrow,demmlxh,Or mini,any mntemre
prior in Its Issuance.also requires the applicant for such permit to file a ]$nod mimment
< that he Is licensed pursuant to the provisions sur the Comncur'e Uceme Law(Chapter 9 - Sq.Ft. Floor Area Valuation
o (commencing with Section 7000)of Division 3 of the Business and Profession Code)of
Net he Is eempt themrm n and the buts fes W alleged eaatnptian.My vlau0on or 813280
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty or APN Number Occupancy Type
nes mom than fin hundred dollen(5500).
❑T.a cwma of the property,or my employees with waw as their eu compmesmon, 36610132 . 00
wiBdrthewori:and Nesuunumh not Intended or offered for sass(Sec.7044,Business •p��yg
and ProfeWom an
Code:The CuseLt.=i Lt.=Law doss Inst apply u an owncr of 101 — FOUNDA 1 S it Inspections
property who bud Ids or improma thereon,and obit does ouch work himself or through his
ON
awn employee,provided that such Improvements ve notdnended oro@mA,wale.If. 102 — PIERS
however,she building or Improvement In old within one your of completion.Nn owner.
builder will Nw the herder of proving that he did not build or improve for purpose of 103 — UFER
ale')' 104 — REBAR
1,as owncr of the property,am exclusively eoutrnlng with licensed camnctem in
coatnmt the pmjcn(Sec.7044,Business and Proraaons Code:)The Committees U. 105 — ANCHOR BOLTS.
=me law does nor apply in an owner or property who builds or improves themon,and, - 106 — SEWER & WATER
who Common,for such projects with a rnnveer(U licensed putswin flus o ConuanMe
Licerslaw, 202 - UNDERFLOOR PLUMBING
amts .BRpCfathtsreann 203 - UNDERFLOOR MECHANICAL
r Dam 204 - UNDERFLOOR FRAME
OND RATION _
mby aEBm under penalty of perjury arc of Ne following deelarWoa: 205 - UNDERFLOOR INSULATION
❑1 inand wmlmsinulnaCadfiwmofComentmaelf.laumrwWorkce Compen- 301 — ROUGH PLUMBING
cation,u provided fee by Section 3700 ar the labor Code,fm the performance of the 302, - TUB & OR SHOWER
wao
warkforwhichNinpernuBmued. 303 - ROUGH MECHANICAL
3❑'lWlof the laborban and lCmaJ�nWtion
rntionW�rmpenaOonInnunnmename cruse work i narration this as required by 304 — ROUGH ELECTRICAL
MY Workers Compensation Insumma Cartier and Poiiq number art: 305 — FRAME
Carrier. Policy No.; 306 - HOEDOWNS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSAnON INSURANCE 307 — INSULATION
(Thus section wend not he completed brie permit Is(in one hundred dollars(S 100) 308 - SHEETROCK
- —
or aa1 - ` -- -3b 9' - EXTERIORLATH --'— — --
1=try that In the performance of the work for which this Permit Is issued.l shall not -
employanypeninin b uteWorkcri Compoma0nm 310 — INTERIOR LATH
yVapp iof Gllfomla.at R � �, 311 - SCRATCH COAT
NonCL'�� APPU .1,af�f-fn sing en cam of Exemption,you ahnuhl 313 — ROOF NAIL
bccmg Ject m orker's Compensation provisions of the labor Code,you mum
,Jz forthwith Comply with such provladom w this permit man be dismm mwked. 501 — FINAL ELECTRICAL ENERGY
z 502 - FINAL PLUMBING ENERGY
CONSIRUCr10N LENDING AGENCY
E503 - FINAL MECHANICAL ENERGY W the work for which this permit,wwd(sec.3E97,ci..c.)
Lenders Name 504 - FINAL BUILDING ENERGY
Q
az Lenders Address 505 FINAL ELECTRICAL
U0 I ceNfy Wt I haw rend rids application and rete that the above Information is 506 — GAS TEST
is,r' conal.l agree to Comply with all city and county ordinances and sum paws minting N
0 kS�J building construction,and hereby authodm nprnonram of this city to cover upon the FIN PLUMB G
above-motioned to law.(m Impaction pugmea
(We)agent b can.Indemnlry ad kap hssmleu tite cur or Cupertino ageimt 0 8 F I 7.GAL
r'n liabilities judgments.encu and expenses which may In my way aecmn against said City 5
C.) in ernsey?WM"M=LL
APPLIC COMPLY WlT ALL ON-PDj[7f ISSUCd by:5 ING Date
LCTIONS �j �. i Q LWal' e, Re-roofs -
r HAZARDOUSMA7F7UALSDISCLOSURE Date Type of Roof
MPWIII Ihoappliwm arfutom buildingaaupantmarew Nndk havardow matertsl '
S- by the Cupertino Mu pal Code.Chapter 9.13,and the Health and Safety
Section 25532()7 All roofs shall be inspected prior to any roofing material being installed.
OYcs No
Win Nc applicant or fwure building ociuwm rte ciuipmem or device,which If a roof is installed without first obtaining an inspection,I agree to remove
emit Mardow air cenmml n defined by the Bay Area Air Quality Management all new materials for inspection. '
District?
[Dyes r/0 No
1 ban rad the hazardous msteria4 mquimrncnu under Chmucr 6.9S of the Caller.
nitsHCalNk Salm Code.Satiom73505.25533and755N.i NNIfNc building
rices rent cunem a anent Ute my mapowimllty u a site upon,of Ore
require emu usnce ora Certificate of
Signature of Applicant Date
owncf .w Irene . not D.te All roof coverings to be Class"B"or better