03070079 CITY OF CUPERTINO ai«x '?a ?+� =� w' '� a•," �` •° - t<
BUILDING DIVISION PERMIT KC0NTRACTOWINF.ORMATION
h•„..P>z .i...«.^adyTR�.k?.cy A•.�§;K$"ffi .�T ..:4�@. s'3'f e'
BUILDING ADDRESS: """"03070079
ERMIT"030,70079
10697 10HA�NgRN
.RS` NAME: PERMIT ISSUE DATE
F,ANE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+00 LICENSED CONTRACTOR'S DECLARATION
W.5 1 hereby affirm that I am licensed under previsions of Chapter 9(commencing Job Description FINAL
��
with Section 7000)of Division'of B.Siressand Professions Codc.and.1 he..is r Y<`21 L
^ in roll c and erfect.
5'q? Lirm a Lie sa �'. - IZgO ADD 636 SQ. FT. q
Data Contranm Y.(�J 2004
A HI CPS DECLARATION L Y
$c 1 rad tan y laps all umd,afludilic records e..��1� R t��
lot; vViseJPm ssional OWNER-BUILDER DECLARATION BUILDING
to I 1 here affirm that 1 on exempt from the Curnmeo rs License Law for the
00 following reason.(SCNun 7(D 1.5.Business and Professions Code:Any city Or runny
<m ff which requires a permit in construct,Simi,improve,demolish,or repair any stmclare
q=6 prior to its issuance,also requires the applicant for such permit to Ne asignedsuument
That he is licensed pursuant in the provisions ofthe Contractor's Liecnx Law(Chapter9 Sq. Ft. Floor Area Valuation
yf� (commencing with Section 7000)or Division)or the Business and Professions Code) '
i JUL be is aempt therefrom and the basis for the.Ilegcd exmpdon.Any vkladan of 37537065 . 00
Section 7031.5 by any appliant for a permit aubjeeu dm applicanuo a civil penalty of APN Number Occupancy Type
Am mom man five hundred dollars(55007.
D I,As owner of the preficay,or my employees with wages w Heir sole compensation,
will do me work,and me simulate is not intended or offered fork(See 7014,Business —
And Professions Code:The Contractor's License Law docs not apply to an owner of d Inspections
property who bui Ids of harrows thereon,and who does such work himaelfor through his 102 - PIERS
own employees,provided that such impmvemenu are not intended or offered for sale.If, 103 — UFER
however,the building or improvement is sold within one year of completion,the owner
-
bmlder will ban the burden of proving that he did not Wild or impmw for purpose of 104 — REBAR
sale)a.aL 105 — ANCHOR BOLTS
W .as Owner of the proper,am elusively contracting with licensed contractors m
construct the project(Sec.70a4,Business and Professions Code:)The Contractor's Lt. 106 — SEWER & WATER
rtAAA Law does not apply m.n ewer or property who builds or improves themon.and, 202 — UNDERFLOOR PLUMBING
who contra rsuc uje=6 wi contrumr(q licensed pursuant tome Contractor's
License w. 203 — UNDERFLOOR MECHANICAL
❑lam setup trod e. _.BxPC n t%smanum 204 — UNDERFLOOR FRAME
at° Dom' 205 — UNDERFLOOR INSULATION
WOR(EN'S Oh .'SATION TION
I hereby affirm under penally Of pmjary one of the following declarations: 301 - ROUGH PLUMBING .
❑[have and will mainuin a Certificate of Consent to xlr--insum for Wmkeri Compen- 302 — TUB & OR SHOWER
Zon,as provided for by Section 37M of the labor Code,for the performance of the 3 03 — ROUGH MECHANICAL
rkforwhichthisPermitisismed. 304 — ROUGH ELECTRICAL
D I ban and will maintain Wurkcri Compensation Iruurmta.Or required by Section
37W ofthe Labor Code,for the performance of the work for which this permit is issued. 305 - FRAME
My Workers Cnmpenaation Insurance amier and Policy number art: 306 — HOLDOWNS
Carder: Policy No.: 307 - INSULATION
CERTIFICATE OF EXEMP:ON FROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK
mruxctionneed autbeeomplemdiftbe Permit isforo^ehundmddollars(slan 309 - EXTERIOR LATH
°f k..) 310 - INTERIOR LATH
1 certify that in the pc,f,,...c of the work for which this permit us issued.1 shall out
employ any person in any manner an as to become subject to the workers'Compensation 311 — SCRATCH COAT
Laws Of California.DamApplint 313 — ROOF NAIL
NOTICE
mICETO APPLICANT.Worker's
after Cohere ationrCisions of of Eacmptiode.you
you
501 — FINAL ELECTRICAL ENERGY
become h Comp to the Worker's visons Or 11111 Provisions of the Leber Code.you mull
.JZ rnrdtwim=pmplywimseen pfnmsmnaorthHpermBshall bedeemed mvntm. 502 - FINAL PLUMBING ENERGY
Z0 CONS IRUCTIONLENDING AGENCY 503 — FINAL MECHANICAL ENERGY
I hereby affirm mat lhert is a corawction lending agency far me Performance of 504 — FINAL BUILDING ENERGY
rL > thcwork for which this p.it isissued(See 3097,Civ.C.)'s Na
Len505 — FINAL ELECTRICAL
fkl A
Lent's
= z nderinddm s 506 - GAS TEST
U O I certify that 1 ban mad this application and sou that the awn information is 507 — FINAL PLUMBING
ry P conch.1 agrc,la comply with all city and county ordinances and sok laws relaning to
pU building construction.and hemby authorise mpmxnertives of this city to enter upon the FIN MECHAN CAL
r ahov, e I it property fm impcmon purposes. 0 9 F I
Wc)agree m saw,iodemnify and keep harmkss the City O(Cupertino against
F" N liabilitie.judgmc .cps ante permes which they in any way accrue against said City 5 NG
U z mconx ounce th gmp'ngu Nn permit.
'—' APPLIC NT U D RSi ND AND WILL COMPLY WITH ALL NON-P01[1�T Issued by:5 C WORKS D e
S URC REG A ION . �`t D/g
Re-roofs f
gnazurc pplicaH ZARDOUSMATERIALSDISCLOSURE am Type of Roof
WILLS,applicant or furore building use.,nummor handle hvmdous material
As dcrmed by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Sermon 15532(.)7 All roofs shall be inspected prior to any roofing material being installed.
DNn
Will
me.pNiam nr f/w—re building necapant use equipment nr d=vi=es wre=n If a roof is installed without first obtaining an inspection,I agree to remove
mit hvallous air contaminaAx AS,Jcfincd by the Bay Arca Air Quality Management all new materials for inspection.
District,
e
dth by d sma rials teyvimmcnu under Chapter 695 of the Califoo-
�M- nj.
tyC ,�cei ns NIS.15537 anJ255}q,lunJcrsmnd thaifthc huilding
y ho a khan th tit is my respumibilily m entity the rueupant of the
ien stiben; 0 0,issa nncemE=atom anon=r. Signa[ureofApplicant Dale
i '� e o- All roof coverings to be Class"B”or better
Ownm or sumo iacJ agcm Dam