03040112 CITY OF CUPERTINO
BUILDING ufvlsloN PERMIT ,1CONTRACTQ,R INFORMATION:,:;
Rff!� `V'Tf'BERTY OAK LN RAWSON CONSTRUCTION PERMIT NO.03040112
§TkfDGE COUNTRY CLUB HOMSE 941 MCGLINCEY LANE PERMIT Lss"H"7!22/2003
.E: SANITARY NO. CONTROL NO,
(408) 377-0600
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t��j\ 0 Q
100 LICENSED CONTRACTOR'S DECLARATION Job Dese tl A� m mea Y..da
I Wrcby affirm shot 1 em lido llu under provisions of CMpmr 9(commencing p
x� with Section]000)o Division Sof the Business d rofcuiom Code,and mylicenach
LiaounlI ` . _ LR.a BATHRM REMODEL JUL 1 8 2003
r Dale Cond
ARCHITECTS DE A N
I crstanJ myplainahallWmcdas pas lie re ,
BUILDING
f o t; m
Licensed Pfesaional
OWNER-BUILDER DECLARATION
<I I hereby affirm that 1 am exempt fru.Ne Ceramics's License law far the
00 following moson.(Section 7031.5,Business and Pofemiuns Code:Any city or county
3$ which re4ulres•pe.if.caasoact,notes,improve,demolish,or term,any,wucwm
_Z>• Phren its issuance.also requiras the applicantorsuch retain to file a signed statement
g� fMet he is learned pursuant the provisions of the Common's Limvc Law(Chapter9 Sq. Ft. Floor Area $1,ySlgzoion
(commencing with Section of Division 3 of the Busincu and Profesaiaas Cache)
[
$ that he is exempt thcmfom end du basis for to alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects are applicant to a civil Penalty of ane ApN Number Occupancy
not mart than five hundred dollars($500). P Y Type
❑1,as owner of the property,or my employees with wages u their sole mon,ammion,
will do the work.and the strumum is not intended or owned for sale 700.1.Business 1 — FOUND( Td Inspections
and Pontifical Code:The Cmiumucri ts Lice se law donot apply to an owner of
propenywha builds or improves thereon.and whadnessucb work himulfonnough him 102 — PIERS
own employees,Provided aminch improvements are not otanded oroRered formal,If.
however,are building or improvement issoid within one you ofcomplesion,Ne owner. 103 — UFER
builder will have the burden of Proving that he did net Wild or improve for purpose of 104 — REBAR
sale.).
❑1.as owner of the progeny,am exclusively contracting with licensed comosc ms to 105 — ANCHOR BOLTS
coastmm the pmjcvt(Sec.7W ,Business and Professions Cade:)The Contractors Li. 106 — SEWER & WATER
made law data ore appy toa for of property who Wilda or Improves thereon,and, 202 — UNDERFLOOR PLUMBING
who contracts for such projects with a eomramm(9Incomes pursuant to the Contmnola
1rup law.
❑ ain La . & mason 203 — UNDERFLOOR MECHANICAL
under gee. ,BPCfor this m
204 UNDERFLOOR FRAME
Owner Data
WORKER'S COMPENSATIONDECLAR TION 205 — UNDERFLOOR INSULATION
I hereby eRon under penalty of perjury one or to following decluetions: 301 — ROUGH PLUMBING
14 I hrveand will mainuin•Cmirlis Cons enuosel6himpefor Wmker'a Compcm 302 — TUB & OR SHOWER
,aam,as provided ter by section 3700 of the Uhor code,for the performrim or the 303 — ROUGH MECHANICAL
work Tor which this permit is issued.
❑I ban and will maintain Worker's Compensation Insurance,as required by Section 3 04 — ROUGH ELECTRICAL
3700 of the Labor Code,fur the performance of the work for which onis p anno is issued. 305 FRAME
My Worker's Compensation Insurance easier and PP,00liiccy number art: 306 —' HOLDOWNS
Ca�CE 1'IFlCAK TEOF ECEMPTIBfrFROM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
or sass)(nil section need not W completed if the Permit is for one Initiated unit. INN 309 - EXTERIOR LATH
1 unify that in the performance of the work for which this Permit is issucd.I shall nor 310 — INTERIOR LATH
employ any parson in any manner an u to become Subject 0 the Werkmil Compensation 311 — SCRATCH COAT
Law,of California.Date
Applicant 313 — ROOF NAIL
NOTICE TO APPLICANT.If.after making this Certificate or Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject 10 to Workers conformation provisions of the labor Code,you must
7z Mm
forthwith comply with such movisamsordhisperm itallhedeeedrevokm. 502 — FINAL PLUMBING ENERGY
zy CONSTRUCTION LENDING AGENCY `503 — FINAL MECHANICAL ENERGY
I hereby oRrm thu there is a construction lending al for the performance of 504 FINAL BUILDING ENERGY
the work fur which this pemnit is issued(Sm.3097/.Civ.C.)
Ledef'°"'"a 505 — FINAL ELECTRICAL
D z Lcm ;Addre,a 506 — GAS TEST
;J Q 1 certify that I have read this application and sum that theshove information is
y correct.l agree to comply with all city and county ordinances and sum laws relating to 507 — FINAL PLUMBING
Wilding construction.and hereby minimum mprumutives of this city to enter upon the
= V aWve-memionedproPcrlyfor immetionpurposes. — FIN L MEC ICAL
a (We)agree to save,indemnify and keep harmless the City of Cupertino against 0 9 FI
liabilities,judgments,costs and expenses which may in any way accrue againslsais City 5 NG x
Z in consequence Of the granting of this permit. ]
APPL ANT UNDERSTAN AND WILL COMPLY WITH ALL NOWPOINT Issued by: C WORKSDate
SO REGULATIO
lamlai V-01 2-- Re-roofs
gnmurc or Applicant/Con serem r Da
HAZARDOUS MATERIALS DISCLOSUR Type of Roof -
Will heapplicant orfuwre building occupant store or "Ovarsous mamnal -
az defined by the Copeman Municipal Code,Chapter,9.11,and the Health and Safety
Code,Settle. 09u
25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Yea y
Will the applicant or future building=upon(use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
haaardou,air conuminams as do acd by the Bay Area Air Quality Management all new materials for inspection.
- DinricO
❑Yes
1 have mad dm bmartbms materials requirements under Chapter 6.95 of dm Calirm,
.is flexion&Safety Cods,Secdoas 15505,15533 and 15534,1 ur dcrsund dam if dame Wilding
Jnes cu.en0y home a tenant.Na itis my mspoasi hility w muly me occupant md¢
myu' nu whichme"am"a roiaay`"ce cudnnte arocmP.ney. Signature of Applicant Dale
owe aumonvcaagem Date All roof coverings to be Class "B" or better