03070073 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDING ADDRESS: - "'"""03070073
ERMIT"03070073
rRC1 T,A MAP T)
NER'S NAME: PERMIT ISSUB OATS
NE: SANITARYNO, CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDO ELECP PLUMB MECH
300 LICENSEDCONIRS DECLARATION
e U I hereby effrm that 1 am licensedd olderunder provisions of Chapter Y(commencing Job DOSCrIpIIOD
`mW with Section 7")of Division 3 of the usires Profclannn dc, nd my He a.is
On fall and fees [Ip REVISION--IN HOUSE USE ONLY
o�A, Littn = .i' Val
-moo Da con or NO NEW PERMIT ISSUED, ORIG. #03030157
ARCHITII. D RATION
4' Iundcrstandmyplanssha11E. nlicrecords CONTRACTOR: STONY RIDGE CONSTRUCTION (07/10/03)
yyU
5A� Licensed Prnfessiond
OWNER-BUILDER DECLARATION
M1 hereby affum that 1 am exempt from the Contractah License Law far the /
cO following mason.(Section 7031.5.Business and Professions Color:Any city or county \V^\
5m which requires a Permit to construct,alter,improve,demolish,or repair any structure
ior prior o its issuance,also requires the applicant for such Permit to file a signed statement
Sthat he is licensed purwonllathe provisions nrthe ContractohLicense,Law(Chapter 9 Sq. Ft. Floor Area Valuation
1-0 (commencing with Section 7000)of Division 7 or the Business and Professions Code)or
u5§ that he Is exempt therefrom and dm breis for the alleged caemplion.Any violad,on of 175000
Section 703 1.5 by any applicant fon permit subjects thc applicant to a civil penally of n
APN Number Occupancy
not more than rive hundred dollars(S500). P Y Type
❑ I.u owncrof Ne property,ormyemployces with wagesu theirsole compensation, 36910019 . 00
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's License raw does oat apply to an owner of Required Inspections
progeny who builds or improves themon,and who doesauch work himself or through his
awn employees.pmvidcd that such improvements Are not intended uroQered for Asia.If, 101 - FOUNDATION
however,the building or improvement is sold within one year of completion,the owner.
builder will have dte burden of playing that he did not Wild or improve for purpose of 102 - PIERS
"I`')' 103 - UFER
❑I.as owner of to progeny,am exclusively contracting with licensed contractors in
construct the project(Sec.7 sol,Busincu and Professions CoaeU The Contrsetah Li 104 - REBAR
cattle raw docs not pply to an owner of property who Wilda or improve.thereon.and, 105 — ANCHOR BOLTS
who contracts for such projects with o contracter(s)licensed pursuant la the Conlreclol,
Lielme Law. 106 - SEWER & WATER
0 I am eaempt under Sec. ,Bit P C for this moon 202 - UNDERFLOOR PLUMBING
COMPENSATION °I
WORKERO 203 - UNDERFLOOR MECHANICAL
'S ATION DECLARATION
I hereby affirm under Penalty of perjury one of the fallowing declarations: 204 — UNDERFLOOR FRAME .
U Ihaw and will maintain ACenificmeofConsent tosalr-insure for Worker'sCompen. 205 — UNDERFLOOR INSULATION
sation,As provided for by Section 3701 of the Labor Code,far Ne performance of the 301 - ROUGH PLUMBING
work for which this permit is issued. 302 - TUB & OR SHOWER
❑ 1 have and will maintain Worker's Compensation Insurance,u required by Section
3700 of the Libor Code.for the performance of N workforwhfch Nispcmaitiaissued. 303 - ROUGH MECHANICAL
(((Myworke' nm nsalio lnsusancecaoicr .1 y herart 304 - ROUGH ELECTRICAL
C}Wer. oliry14
✓
CERrrNCATEGFenMPTIONFROM WORKERS' 305 - FRAME
COMPENSATION INSURANCE 306 - HOLDOWNS
]as..)(Thlsacctinnnecd nolhecomplemJ iffle permltisforrnchundreddollaa(SID)) 307 - INSULATION
nr
1 certify that in the perrusmome of the work for which this Permit is issued,1 shill net 308 - SHEETROCK
employ any person in any manner an As to become subject to the workers'Comr<matlon 309 — EXTERIOR LATH
Lawa orm iramia.D,m
Applicant
310 - INTERIOR LATH
Law
NOTICE TO APPLICANT:If,after making this Ccnifma of Esenclumt,you should 311 - SCRATCH COAT
become suhjact to the Worker's Compensation previsions of the Labor Cnde,you must
.J z mnhsvtN comply with Such provisions or this permit shall lc deemed revoked. 313 — ROOF NAIL
z CONSTRUCTION LENDING AGENCY 501 - FINAL ELECTRICAL ENERGY
Ihereby oMo.that tWoc i,a construction lendingencthe
agency for Performance of 502 - FINAL PLUMBING ENERGY
x > N work mrwhich Nisp mitlasa d(s .3097,Civ.c.) N
W M Lender's Name, E
503 - FINAL MECHANICAL E
= z LcadersAddm'. 504 - FINAL BUILDING ENER
U O 1 cenBy that 1 have read this application and sum that the dhow information is 505 - FINAL ELECTRICAL
g4 correct.I agree to comply with all city and county ordinances and nate laws relating N
O V building consWClion,and hereby autharimMPrCSeatatlMaorNlsCity toenter upon the GAS EST
W above-mentioned property for inspection purposes.
y (We,)agree to save,indemnify and keep harmless be City of Cupenia.against 0 7 F I
t;A Imbilitiu,Judgments,costs AndexisnseswhichmayinanywayAccmcagainstsaidCity 5 ICI
U in consequence of the granting of this Permit.
APPLIC f NDERSTANDS AND WILL COMPLY.N�N ALL NON-POINT Issued by:5 ' t0
S UR R• ULATIONS. �C!
�"5 7_/0
4Z Re-roofs 5� 4 INAL PUBLIC WORKS
Signe m of Applice UCuntrm acmr Da
HAZARDOUS MATERIALS DISCLOSURE Type of Roo
Will the apPlicam tar future building Occupant Store or handle hanrdous material
As dcfmad by Ne Cupenino Municipal Code.Chapter 9.11,and the Health and Safety
A.Section 15573(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It haaardous air contaminants as depard by the Be,Ams Ail Quality Management all new materials for inspection.
trier?
❑Yes ymu
1 have read the havardous materialstnquiremcnd under Chapter 6.95 of Ne Califor-
nia liml,4 Safc,y Coac,Sections 255115,15577 onJ 25514.1 unJcmm�a Na if Ns building
J not c cn ham a arrant,Nat it is my responsibility he asupsnt of Nc `
rt chmualcmetPoortoiuuanceofcCcrdf teof auponey. Signature of Applicant Date
caner rauahanradagenl a,e All roof coverings to be Class "B" or better