03030020 ;BUILDING
Y OF CUPERTINO "^ * '
BUILDING DIVISION PERMIT c0lv;er= .e' 0R INVO�MA,�T'IO.,�N
ADDRESS: '� PERMITNO.
WS NAME: PERMIT ISSUEDATE
WESTRIDGE COE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
REDOELECT PLUMB MECH
0 Q Q
300 LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that l am licensed under provisions of Chapter 9(commencing
with Seedon 70(10 of Division 3 of the Sudnegaand Prof.W.Cada,and my littnu4
in cull forwmd e ,I— CLUB HOUSE REMODEL FUNALED
n LlanaCIS42Z2 'CONTRACTOR: RAWSON 'CONSTRUCTION .
De I understand myphm idillhe sed As public maks MAR 2 3 2003
ir Licensed Prot.Wnnal
^ OWNER-BUILDER DECLARATION
i E I hereby affirm that I am exempt from the Conuacmes License Lew for the BUILDING
DING
Do fallowing reason,(Section 703M.Business and Professions Code;Any city or county 1Y
$ which requires a permit to construe(.alcor.Improve,demolish,or repair any sumclum
prior m its luuanco.dm rcquim the applicant for.mh permit la file•signed slammenl
g that he it licensed purmantinthe Provisions;oftkConlrum',UccoseLaw(Chapter 9 Sq.Ft. Floor Area Valuation
$ (commencing with Section 7000)of Division 3 of tk Business and Profcsslnns Code)m
�.. Nu he is exempt thercfmm and da but,for Ne alleged exemption.Any violadmn of 825000
Section 7031.5 by any appllunt for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more Nen Eve hundred dollars($500). „
y` ❑I.a awneraftheproperty,army wployomwithmgesastheBwkcompenu0on, 34232042 DO
t will do thework and thesWeaux 1.mumanded uraffered fanaaie(Sac.7044.Budnesa Re aired Inspections
n.
and Professlans Code:The Commune(.Lianm law does not apply m in owner of 101 - FOUNDATION
ON P
property who Wildtorlmpeves thearco .nd whodnessuchwork himmirm through his
Own employam,provided that such improvements rte not intended orortered fertile.If. 102 — P,IERS
{I" however,the building or lmprevement is within oro year ofcompledion.the owner.
Wilda will hoe the human of proving that NO did not build m Improve far purpose of 103 — UFER '
"l`')' 104 - REBAR
I.u owner of the Progeny.am exclusively contracting with licensed comnnon m
mwmtk pmker lSec.7Wd.Business and Profusions Cade:)The Conoacue't U.
lO5 — ANCHOR BOLTS.
arta lawdma not apply man ownerofpropenyw•ho wildsorimimutamemoq and, 106 — SEWER & 'WATER .
ho cortrects for such project with a contractor(A)lkene 1 pursuant m the Contractor's
seen=Law• 202 - UNDERFLOOR PLUMBING
iron exempt
under Sec. .B&PCfor this
rosea 203 - UNDERFLOOR MECHANICAL
Dat` 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DELLA TION
hereby.must ander penauy of perjury mad th all lag declarations: 205 — UNDERFLOOR INSULATION
I haw and will maintain a CeAEaa orComenuo self-Imum rorworker'acampen• 301 — ROUGH PLUMBING
sation.u provided fm by Section 7700 of the labor Code.fm the performance of tic 302 - " TUB & OR SHOWER
work for which this permit Is issued.
❑1 haw end will An
Worker's compensation insurance,u required by Section 303 — ROUGH MECHANICAL
3700 of the labor Code,for the larformmcea(the work tar which this permit is Issued. - 304 ROUGH ELECTRICAL
My Worker's CompensNan Insurance carrier and Policy number am: 305 •— FRAME
Carrier. Policy No.; 306 - HOEDOWNS
CERTIFICATE OF EKEM MON FROM WORKERS
COMPENSATION INSURANCE 307 - INSULATION
(ndswilannecdnot kcompleted time permit l.Intone handreddollar:($Im) 308 - SHEETROCK
or fetal
-- _1, .._3'09- =-EXTERIOR`-LATH--r--- — =-
1 certify that in the performance of the work for which this permit is issued.I shall not
empl�10
la ill ym rm been abjeetmane Worken'CompewRon 310 — INTERIOR LATH
Lamifom
A.. (�4eL:n.y s 311 - SCRATCH ' COAT .
NOTAPP (CANT;IL aMr makl ti.CenlRcne of Exemption,you should 3 1;3 — -ROOF' NAIL
IN ject m the Worker's Compensation provisions of Ne labor Code,you must
Oforthwith comply with such provisions or this Permit hill k decmW milked. 501 — FINAL ELECTRICAL ENERGY :
CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
�► l hereby alDnn that them is a coawninn landing agency for the performance of 503 — FINAL MECHANICAL ENERGY
Ik �„
Una work far which this permit t,issued(see.7097,Ci,e.) - 504 FINAL BUILDING ENERGY
W Q Lenderi N.
_
;0 Lader'.Address
aZ 505 - FINAL ELECTRICAL
UO 1cavity that lhave read this Application and.tsmthat the Also.information Is 506 - GAS TEST
{i...+ correct.i Agree to comply with all city and county uminuaes and sum laws relming an
O V building contraction•and hereby authories represenisalM Of this city to enter upon me FINUE PLUMBWG
{77 above-mentioned Property for impecdon purposes.
(We)agree m an,indemnify and keep harmless the City of Cupertino Against 0 8 F I L
ra'A
liabilities,judgment.emu and expcmu which may in any my acerae against aid City 5 t
U"� in consequence of the granting of small. r\\J
.. APP NT UNDERSTAND A D WILL COMPLY WITH ALL NON-POINT Issued by:5 ING Date
SOU C REGULATIONS.
,Z 0,1144ALT Re-roofs
gnuurcofAlpli HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof
Will the applicant or future Wilding oaupant antro Or handle hsysrdous material
As dcfinrA by the CupertiFN
Iryi Code.Chapter 9.17.and the Ha1N and Safety
.Section 75537(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ye.
-
Will the applicam building occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hatuminus air contaminants As defined by the Ray Arca Air Quality Management all new materials for inspection.
iwicti ��
❑Yet - 2 Nu
I haw real the hAzatious\materials rcquircmcnts unJcrCMpmr .95 of tk Giifo,* -
nlaHealdgtSdmyCodc,sections 255(13,25533 and 75534.1 unJcmtand If the building
does nm cue dy bew a tartan Net It 1 y respomlbllity m notify the of the
be mm hill mostlx•.mctpdor IcuuaeanCcmkamofOcctgi Signature of Applicant Date
r �
Winer amhod¢de em Data All roof coverings to be Class"B"or better