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crrY OF CUPERTINO
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CONTRACT012INFORMATION
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BUILDING DIVISION PERMIT
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Bu1LOm'G ADDRESS:
CUPERTINO
CONSTRUCTION INC
PERMIT N0.03030046
ER'S NAME:
10079 SAICH WAY
PERMIT ISSUE DATE
E
2003
P1ONE
(408)253-9000
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRAC0055'S DECLARATION
9
Job Description
I hereby affirm that 1 am licensed isprevisionsof Chapter (comm[ncing
with Section 7M)) of Division 3o(the Rust nil Profession Codc,and my Ilan.. is
infulltold effect. Q
Licmn lass Lic.N (
Date co Sur
2 STORY SINGLE FAMILYV9 N C�
LIVING SPACE 3332 SQ.`TCgE 8 SQ. FT.
MIXED
ARCHITECTS D ATION
understand mLplana shall he used a pat m records
1
Et
Licensed Pmfessianal
OWNER TION
1 2O�j,
DECGla J+ i
-BUILDER, th, Ccl License Low for the
1 hreaso .(dere 1 am exempts IW Convaam's
Code: Any <an ns t..my
o :
following moan.(secdut IDnstr Business and
on
ve dooms
which after, improve, or repair any Structure
whichrequiresits uas a to tares
t. also the h Permit t ae (Chap( em
poor ht its issuance. rev rtqui res the applicant for such Permit m Glc he Law
that Uacnmlaw(Cosic) 9
Sq. Ft. Floor Area X9000
mencinnwitpufwamaaahapmvNsiononeCotumnss
(commencingwithSection ]land)of Crykl or
am Proon. Any
3 of the Busalleged
de,Division
exs vi
that he is exempt therefrom and Bre basis for the alleged cacmption. Any violation of
that he is
3 AFN NUffiUcr O 0 Occupancy Type -
Section ]031.5 by any applicant for a Permit subjects the applicant to a civil penalty of
not mom Nan five hundred dollars (s5Dd).
--
1, as owner of the propcny, or my Con'I'ma with wages m their sole compensation,
RRe� Inspections
will do Ne work, and the structure is not intended or offered unlade (Sec. ]om, Business
and Professions Code: The Contractor's License law docs not apply to an owner of
101
- FOUNDAT���id
property who builds or improves thereon, and who doessuch work himutf orthrough his
own employe¢, provided that such improvements,lie not intended or offered for tale. If,
102
— PIERS'
however, the building or improvement is sold within one year of completion, the owner.
builder will have the Wrden of proving that he did not Wild or improve for purpose of
103
- OF ER
read`)
104
- REBAR
El 1. as owner of the progeny, am exclusively controlling with limnold convention to
105
- ANCHOR BOLTS
convect the project (Sec ]Dad, Business and Professions Code:) The Conuxtor's Li
term taw does not apply to an owner of property who Wilds or improves thereon. and,
106
— SEWER & WATER
License �µts for such projects with eeantmmor(s)hcenmd pursuant to the Convaaar'e
202
- UNDERFLOOR PLUMBING
❑ l am aempt under Sec. B h P C for this mason
203
- UNDERFLOOR MECHANICAL
sk Date
204
- UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
205
- UNDERFLOOR INSULATION
I hereby affirm under Penalty of perjury one of the following declarations:
301
— ROUGH PLUMBING
❑Ihave and will maintain a Ccrificam ofConaem to stir -inure for workmrsCcmpcn-
sation, as provided for by Section 37M of the labor Code, for the Nonimahm of the
302
- TUB & OR SHOWER
work for whichthispr,nitisissued.
303
- ROUGH MECHANICAL
1 have and will maintain Worker's Compensation Insurance, as required by Section
304
- ROUGH ELECTRICAL
3]DDof the labor Code, for the performance of the work for which this Penult is issued.
yW rkcr'sCompcnsationlnsunnccoricr nae ugnum�ra . -F
gS
305
- FRAME
c :SiA�
306
- HOLDOWNS
OR RC
C RTIFI A€ T FROM WORKERS'
GQMPEN$ATID INSURANCE
307
- INSULATION
(This section =it Out Ise completed if the permit is for one hundred doRus(SI00)
308
- SHEETROCK
°r1C5b)
309
- EXTERIOR LATH
1 mrxiq mat in Be, per(nfm er. of the work for which this permit is issued. 1 shell nut
employ any person in any manner aro v m Wcome subject m the Workeri Compensation
310
- INTERIOR LATH
Laws of California. Date
311
313
- SCRATCH COAT
- ROOF NAIL
Applicant
NOTICE TO APPLICANT. If. after making this Certificate of Exemption. you should
become Subject to the Worker'a Compenxtim previsions of the labor Code, you must
501
FINAL ELECTRICAL ENERGY
forthwith Comply With such provisions orthiapermitshanWdeemed revoked.
-
502
- FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY
hereby that agency (Or the perfurmancc°(
issued(ol.307,
503
- FINAL MECHANICAL ENERGY
i O.
mawork mfwomthis p mi sissmd(sec. A]. Civ. C.)
504
- FINAL BUILDING ENERGY
Isndcr's Namc
505
- FINAL ELECTRICAL
Lemic, Address
1 Caoily that I have read this application and sate that the above inmmoohm is
506
- GAS TEST
Corcct.I agree to comply with all city and county ordinances and sate laws Mining 1.
building conswction,and hereby authminampresemadvesofdo. City mentefupon the
—FIN L PLUMB G
above mendond pmNor y for ins,cuou purposes.
0 8
FI L
(We) agree Or save, indemnify and keep harmless use City of Cupertino against
liabilities, judgments. costs and expenses which may in any way rueroc against mid City
in consequence of the graining of this Permit.
A PLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: 5
ING Date
S REGULATIONS.
*e -roofs 6 2
Type RLQ
OOF PLYWOOD NAIL
1
Dare
Signature of APPlicaHAZA
HAZARDOUS MATERIALSDISCLOSURE
DO
of 3
- ROOF BATTENS
Store
r 1,1 or handle Health a material
Will me applicant or future building e, Chapter
def ncd by the Cupertino Municipal Code. Chapter 9.11. and the Health mJ safety
604
- ROOF IN -PROGRESS
Section 35532(a)]
All roofs shall be inspected prior to any roofing material being installed.
CYes RI Na
If a roof is installed
without first obtaining an inspection, I agree to remove
Will the applicant of future building exception umequipmentor devices which
emir hovardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for Inspection.
District?
❑Yes *U
1 have mad the Wordous materials requirements under Cbepterri.95 of the Califor-
niaHcalthlkSafctyCock.Sado.255(15.25533 am25534. linomand mw ifthc Wilding
areas not Content), hate a tenanLthat itis my msponshility m nod(y ft up., of the
requirements which must be met Prior to issuanccofa Cmurim oil Occupancy.
Signature of Applicant - Date
Az;Q— 319
All roof coverings to be Class "B" or better
OwAdFTr authorircdagent rete