00050175 (2) CITY.
BUIwDIVISION cuPE
tmuCONTRACTOR INFORMATION:
,uc vtSION stov PERMIT '
BUILDING ADDRESS: PERMIT NO,
OWNER'S NAME: APPLICATION SUB DATE
18922 FORGE DR JEFFREY O' NEILL- CON TRUCTIONO@@50175.
PHONE.. SANITARY NO, CONTROL NO.
RATIONAL 4125 GLADYS AVE 05/24/2000
P,-oARCIII"n?C.PIIiNGINF.F:R, - BUILDING PERMIT INFO
c w (8?1 ) 479-1144 NLDC, HLECf PLUMB MECH
<ua lJ '' IJ I� IJ
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LICENSED CONTRACTOR'S DECLARATION
z 5 H E n Job Description
O z_O I hereby affirm that 1 am licensed under pnrvisin sof Chapter Rommcncing
p mew with Section 7000)afDoon 3oe BusinessanJP rnsio C&andn licence '
m es, y j Is In full fart[and[fleet.
ea ca< Licrnse Class Lin.N _
3 d Cr Use Commcan
t— ARCHRC ECLARq'ION
I pEric sit. TENANT IMPROVEMENT TYPE III—N/ B OCCUPAtJ
wa roto
i i p O Li've'ed
OWNER-BUILDER TO: 1.ARATION
hur.by affirm,hal 1 am exempt(race the Como,,ho,s License Low fill the.
Efollowing reason.(Sentinn 70315,liu.inue anti Pmles.ions C.Je:AnY eiry or county
FCwh Iott ttdl ' demolish. p - y,ln,mor
i 3$ pr t l a1 requires(lie1ph u t r. Fermatt 1 1Signed statement
— t11.1 limlm,edp art In the ImMoon,ol t c nt t r' License Law(Ch,pter9 S Ft. Floor AT Valuation
6x, g lhSet n701g1) fDi J 111 [Inkiness and Profession,Cale) q'
or that he is exempt therefrom and the basis for the alleged exemption.Any violation -
of Section 7031.5 by any applicant for a permit subjects the applicantnon civil penalty
of m,more than five hundred dollars(a500). APN Number Occupancy Type
❑1.as owner of the property,or my employees with xngn as their wie compensation, 16@8@@@
will Jo he work,and the s,mnurc is not intended or mnerea for sale Sce.7041F. Required Inspections
Business and Professions Cradle:The Connector's License Law does or apply to an
owner of prapcny Who builds or improves,ismo,amt who d„es such work himself 31609030. 0@
nr,hrnugh his own employees.provided tom such im pro,rusent.are not intended nr
offered for sale.If,hmvever,the building or improvement o sold within one year of
Lnnmpletion,the.wnef-builder will have,the burden of proving that he did not huild or
pmvc for pit,.,,o1 -1:01 — FOUNDATION r .
Cl I.as owner;r the proPerry,:n„exclusively enolra,rng with h.en,ed comrnnors to 1.02 PIERS
.i'nlarunl the project(Sec.71R ,Business and ProliNions Code:)"I'he Contmcmr's
ieen,n Law ane,nm npplr to nn nw�,er orpmh.rly who nnilds or improve,d,amon �rJ i.@3 — UFER
Co who commas for such pmiecu with a mm�ucmrts) licensed pu,suom m the — .
01 Commences exempt under
Sec 104 — REBAR
❑lace exmnpl under Sec. ,B&PCfor this mason 105 ANCHOR BOLTS
Owner Datil 1.06 — SEWER & WATER
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty nrperj.D one none rmmwmg a«mmnnn„ 20?_ — UNDERFLOOR PLUMBING
❑ 1 have and will maintain a CemEcaw of consent to self-m,me for Worker's 203 — UNDERFLOOR MECHANICAL
Compensation, he provided for by Seaton 371X1 of the L,wr cone. rr the 204 — UNDERFLOOR FRAME
pertimmunce the work for which this permit is issued.
❑Iouveand willmaintainWnrker.Congensallonlu.ur:mce,asrequired bySeedon 205 — UNDERFLOOR INSULATION
3700 uI llm Lu IF Code,for the errornmnce ill'the work for which this permit is
. ,iu1, orkeka enmpen,an .b,ammnc easier and Policy mmmhu are: 301 — ROUGH PLUMBING
earner: PolicyNo.: ' 302 — TI.1B & OR SHOWER .
CERTIFICATIONs�fN``OF IiXF'_MITON IROM WOR Ek '
pp,
-A '304
303 — ROUGH MECHANICAL
olds[c,io�neednorbe[mopl�linnep[nni,isfornnenundredMiai, 304 — ROUGH ELECTRICRL
($lfa)on[,,.) 305 — FRAME
1 certify that in the Performance of the work for which this permit is issued.1 -
shall no,employ any Proven in any hemmer so as to become subjeet to the Worker: 306 — HOLDOWNS
Compensation Laws ofCalifornia.Date
Applicant 307 — INSULATION
Not ICH TO APPLICANT.if,afmnnaking this Cenilicenc of Exemption.you should 308 — SHEETROCK
O� Cbecome subject m,he Worker's Cnmpe,omion provisions of the Luhor Code,you I
fonhwim emnply wilt....I tun,ion,or thin pen,dl stmt hetieemed reVOkc`I' 309 — EXTERIOR LATH
� ; 1 heCON is 'IONhI:NUINGAG1iNCY 310 — INTERIOR LATH-
reby [hrm that themThere ix u ennxmmdon lending agen.y for,he performance
W
of the work for which this perme is issued(See,3097.Civ.C.)
Isndcr'a Name 31.1 — SCRATCH COAT
y q
p z 1.[naer:padres 313 — ROOF NAIL
L) 0 1[enifythat Inave,eadthis application road slate that heahoveinformation 1, 501 — FINAL ELECTRICAL ENERGY
Pro„ea.I agree to comply with all city and county ordinances and state laws relating
o 5 urbuilding construction,and hereby nothorimrepresentatives ofthiscity toemeruptm 502 — FINAL PLUMBING ENERGY
} 14the eholeenemiP
o od property for inspection pu, ,ses.
F a liabiliti(We)agreelocave,indemnify a oil keep himleax,becitynfenpe„inoagaino 503 — FINAL MECHANICAL ENERGY
V] es,judgments,costs and expenses which may in any way acme against said
Q z City in consequence of the gran 504 — FINAL BUILDING ENERGY
APP RICE REGUD ONSNDS ANO WILL LY WITH ALL NON-POINT Issued by: `;rA'; — FIWAI € FCTRTCALDate
Sinrapfl,,it App' ' t( o Re-root's' 506 — GAS TEST
HA SMA'IERIALS DISCLOSURE
Will the appuc:mt or mltire budding wmipn I sure to handle hasankah,m:aerial Type of Roof 507 — FINAL PLUMBING
as finned by the Cupertino Municipal Code,Chapwr 9.12,and the Health and Safety
Code,Section25532(ayr 508 — FINAL ,MECHANICAL
ElY[s 0N. All roofs sha11f0tospeciptlimOLtopRpEgfing material being installed.
Will he air oro ntorfumrt b.IWing occupantuscequipmentor lity M...gar an, If a roof is instj110 with}n11 Aq LobpLrT Njgl i3ection, I agree to remove
emit harardnu..air conmminanb ox JcfneJ hy,be pay Arca Air Quality Munagemem g
IT,trino lea oNn all new ma[eriels�(qr jfls[ yppLAAf�ftindedsslnd will comply with,
all non-point sYdree regu a ATfs.
1 have read the hazardnes materials requirements..tier Chapter 6.95 or the
Califnmia Health&Safety Cale,Sections 25505.25533 and 25531 1 understand that
if the building does no,currently have a wnan6 that it is my respon alorty m minify the
oac.pm I of the requirement ich must be met prior to issuance Of Certificate of
(hcupai y ,
Signature of Applicant Date
lune n Data - All roof coverings to be Class B”or better,
OFFICE