03090072 CITY OF CUPERTINO X.x �,'
BUILDING DIVISION PERMITCONTRACTOR INFORMATION `
BUIL INGADDRESS: MC GUIRE PATRICK J AND ELLI flltlff"63090072
ER'S NAME: PERMIT ISSUE DATE
ONE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+00 LICENSED CONTRd underSDECLARATION
fZEtit 1hirclay ion70arfifmthatIamrdueBuunderprovisionsofsCChapter rs, 9(commencing Job Description
with Scaift,and 1pof DivisionJof NC Business and Professions Cotic,and my license is
��ZLfull enmmassdeffect. ADD 10 SQ. FT. /REMODEL
Dare
License Class LiaN FINALE®
�t--a Date COn DECLARATION r ��{#V�SI01
As star N TS DECLARATION
f R I understand my plans shall w used as public records
)WU
[o� Licensed Professional MAY 5-2004
S OWNER-BUILDER DECLARATION
<y I hereby affirm the[I am exempt from the Contractor's License Law for the
a o following mason.(Section 7031.5.Business and Professions Code:Any city or county
4oof which requires a permit to construct,alter,improve,demolish,or repair any structure BUILDING
maor mor O its issuance.also requires the applicant(orsuch permiuo file agigncd stmcmcnt
-�' that heisliecnsedpursuanttothepm.isiomoflheContractorsLlanmlaw(Chapter9 Sq. Ft. Floor Area Valuation
cFo (commencingwith Section 70W)or Division J of the Businmand Professions CWc)ur
that he is exempt therefrom and the basis for the alleged exemption.Any violation of 36229001 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(SSW). - - - - -----
❑1,as owner of the property,or my employees with wages m their sole compensation,
will do the work.and the structure is not intended or offered for sale(Sec. Businm _
and Professions Code:That Contractor's Licerva Law does not apply to an Owner or ed Inspections
property who builds or improves thereon.and who docssuch work himselfor through his 102 - PIERS
own employees,provided that such improvements are not intended or offered formic.If, 103 — UFER
however,thc building or improvement is sold within one year of lompLe ion,the owner-
builder will have ren burden of proving that k did not wild or improve for purpose of 10 4 — REBAR
s1c') 105 - ANCHOR BOLTS
1,as Owner of the property,am exclusively contracting with licensed contractors to
comwa the pmjca(Sol.7044,Business and Professions Cade:)The Contractors Li- 106 — SEWER & WATER
come law does not apply in an owner or property who wilds Of impmw thomon.and. 202 - UNDERFLOOR PLUMBING
who contracts for such pmjecu with a comiactor(s)licensed pursuantto the Contractor'a
LiCenae Law. 203 - UNDERFLOOR MECHANICAL
0lam�^tunda5 c. _,B&P C for this reason
r Yh am1-�0�-03 204 - UNDERFLOOR FRAME
WORKERS C ENSATIONDECRAT 205 - UNDERFLOOR INSULATION
I hereby affirm under penalty of perjury one of the following decimations: 3O1 — ROUGH PLUMBING
137M
aveand will maintain acertiEcamofConsenttoaelr-imumfor Worker,Comptn- 302 — TUB & OR SHOWER
.as provided ror by section 37M of the Lather code.for the perfortna„m of the 303 - ROUGH MECHANICAL
33 for which Or,permit sissued. 304 - ROUGH ELECTRICAL
ave and will maintain Worker's Compensation Insurance,m myuirctl by Section
of the Iawr code.ror me Performance Or the work red which this permit is issued. 3 05 — FRAME
orker's Compemalion lnsumnce carrier and Policy number am: 306 — HOLDOWNS
Carder: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS307 — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
This section=oil not so completed inwPermit afor amhundred dOnars(Slm) 309 - EXTERIOR LATH
na leas.)
I Certify mat in the performance Or the work for which this Permit is ismad.1 shall not 3 10 — INTERIOR LATH
employ any person in any manner an m or become subject to the Workers Compensation 311 — SCRATCH COAT
Laws of California,..Dam
Applicant 313 - ROOF NAIL
App
NOTICE TO APPLICANT:If, Her making this CcNficme or ExcmpGon,you shouW 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation previsions or the Whor Code,you must
DZ rofthwimcomply with such provisions orthis Permit shall to,trimmed mvoked. 502 - FINAL PLUMBING ENERGY
Z0 CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hereby affirm that there is a constmelion lending agency for the Performance of 504 - FINAL BUILDING ENERGY
x? thcworkfor whiChthis Permit isissued(Sec.JW7,Civ.C.) 505 - FINAL ELECTRICAL
1) 0 Lcndcr's Namc
Z anaeranda�a 506 - GAS TEST
1 certify that I have read this application and state that the above infmmatiun is 507 — FINAL PLUMBING
collect.l agree to Comply with all city and coumy urdinen.,and sum laws relating to
'jU buildingConswction,andherebysuthorir,opresentivesOfthisCity10enterUponthc FIN MECHA(NG' L '
C abovcmc s)ogre to ctlysave for arrify an keep hs
Wes)agree m save,indemnify and keep harmless the City of Cupertino against Q 9 FI
Cie, liabilities,judgments,costs and expenses which may in any way accrue against mid City 5'Z in consequence of the granting of this permit. .AP�PLI�CA3NTT UUNDERSryT.A�NDS AND WILLL COMPLY WITH AALLLLPOINT Issued by:5 ORKS Date
S (l.l'.e�..l /1�� c.iClf u ieQ /-/y-03 Re-roofs
ignemrc of ApplicnnUContractor HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof
Will the applicant or furore wilding Occupant store or"note hvaNuus material
as defmml by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safely
I,.Section 25532(a)' All roofs shall be inspected prior to any roofing material being installed.
❑Ycs
Will the applicant or row¢building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it wrardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
istricR /
p Ycs )RINu
1 have mail the wvardnustrawrials requirements under Chapter 6,95 Of the Califon
nimHealth&SofetyCode,Sme..25515,25573and25574.1un&k ndthatirthe wilding
does not cuocntly have a tenant,Out itis my re�}}ppryrrsssnsihility I nndly tw tweupant or the
Oim swhichmust mpnor.ry,,asuvAdmmmficateorO,,, cy SignatureofApplicant Dale
boner or authorized agent ( Dama All roof coverings to be Class "B"or better C