02030104 CITY OF CUPERTINO - - -'
BUILDING DIVISION PERMIT CONTRACTORINFORMATIO
BUILDING ADDRESS: PERMIT NO.
11387 LINDY PL 02030104
OWNER'S NAME: APPLICATION SUB DATE
YEHOSHUA ROM 03/20/2002
it ZONE: SANITARY NO. CONTROL NO.
WOO ARCHIMCT/ENGINEER: BUILDING PERMIT INFO
Ej BLDG ELECT PLUMB MECH
r<y
ss.. Z LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm Oat 1 am of she B under provisions of Chapter and
mmexing P
v,t:!3 wainSccuorceandefDivision SofUteBusiruuadd ProfessionsCode.andmylicense BATHRM REMODEL. (ADD SHOWER)
D in full force end efien.
xe�6 License Class Lia.N
3 LL G
Data Contractor
ARCHITECT'S DECLARATION
O� 1 undersand my plans shall be used as public rttards
R O Licensed Professional y fO�
OWNER-BUILDER DECUBATION
w 1 hereby aRnt rthat 1 am exempt from the Contractor's License law for the
C Z< following mason.(Section 7031.5,Business and Professions Code:Any city W county IW
$3000
IN which requires a permit to construct,alter.alter.improve,demolish,or repair any structure$ -pd.,to its issuance,oho inquires the applicaut for inch permit to file uigned stmmam,
that be islicMudportionuathe provlsionaofdue ConoectorsLicense Law(Chapter 9 .,,,t p. t, p,Asq�p,�@q I Valuation
(commencing with Section 7(1 of Division 3 of the Businessand Professions Cade) t }••, ; rs3�D YUl7 L•:[7 V, ?`;41'',, .
Or that he Is"crops thdefsom and the basis for the allfged exemption.My violation - •- ' " ' "''
of Section 7031.5 by arty applicant for a permit subjects the applicant to a civil Penalty
of notdorethinfivehundreddanars(g5M). 101!PN dDATION Occupancy Type
rI,as owner of the property,or my employees with wages as their sale compensation, -
PTEER
-will del thowmk:andthe structure is not Intended or offered for sale(Sec.704 ,
Business and Profession Code:The Conwcror's License law does not apply to an 103 - UFER Required Inspections
owner of property who Wilda or improves thereon,and who does such work himself 10 4 _- REBAR
or through his own employees.provided that such improvements an not intended or
.offered(or ale:If;howam,.the Wilding or improvement is sold within one year of BOLTS'
-'"- - - --- - -- - - ---- - -- -
completion,she owner-builder will have the burden of proving that he did not Wild or lOS - ANCHOR BOLTS
improve forp.r,omiifsale.), 106 - SEWER & WATER
❑1:asawnefort(Sec.7070".Business 202 - UNDERFLOOR' PLUMBING 7.
construct the does
o (Sec.70x4,Business end Profession Code:)The Connector's
a
And
icense dwhoLaw
commesnmr.suc apply toanowner of propenywho Wildaseor d'provcattwits, 203 - UNDERFLOOR MECHANICAL , -
.and who rs License
fa.mch projaa with e,comanor(s),IiccmW'punuent m.the
Conwnort License Lew.,•. •. _ -'204- - 'UNDERFLOOR 'FRAME......--- . ....... .. .. ..... .. .._...._.. . .
❑Iam< pt an rse B&Pcmrthisren° 205 - UNDERFLOOR" 'INSULATION
° n Dam 301 - ROUGH PLUMBING
_ - RER'SCOMPENSATIO 302 - TUB & OR SHOWER
IbenhyaRrmande,parauyofperjuryone othe following declarations: 303 - ROUGH MECHANICAL
tff� O I neve sod'will maintain a CenlficelC of Cement to self-insure for Worker's 3 04 - ROUGH ELECTRICAL
Y Compensation, as Provided for by Section 37M of the Labor Cade, for the
perfamance'of the work for which Chia permit is issued. 305 - FRAME
❑1 have Lndwill mamim Worker's Cou ocaubas lnsumnce,as required by Section 306 - HOLDOWNS
37M of the Labor Code,for the performance of the work for which this pemdt la 3 0 7 - INSULATION
Issued-MyW rkersCo pen u nlnsmance
.dPouay mbrat ., 310a - 'SHEE.TROCK•';' , 1
art > ...'r:. . Policy No .'1st
CERTIFICATION OF,E)(EMPTIONFROM WORKERS'I' - "-309: '- "EXT'BRIOR'-LATH:
_..._. - COMPENSATIONINSURAMCE'..�r...:.
e«tind��e not b<6ampincd if she permit is rm one hundred aaB.rs. ..__.._...- _-. 10.,="'INT.ERI'OR._LATH....._-_._......-
(sloo)o<Igas.) 311 - SCRATCH COAT '
a. 313-.ROOF-NAIL
I c m Net in the perlormance of th work for whicb this Permit a issued,I
pan t employ any Amon in any manse ao as to became a63«t,o the Worker, 501 - FINAL ELECTRICAL
Compensation laws of Cal!undo Date
.Applrunt .... _
NOITCE TO APPLICANT If eftu makutg thts'Cemhcat of Exempt on you Nould
- - FINAL PLUMBING E GY
OZ necomesublcttonewokee,CompamationProvisions ofthe LmorCode,you must 503 - FINAL MECHANICAL N R
O foMwth comply with such provisions or the parmttshan be deemed revoked _ SO4, -..FINAL BUILDING E G _ .,-
E > coNST.isacoN�NDbundivcv 505 - FINAL ELECTRICAL14_ AR 2 0 2002 D
14 r h I hereby which that thea is a consw u n Iendin ajency for the performance s
. of the work for man that pcmnt is tuned(Sea.309] a.c.) " 5 0 6 - GAS TEST
L Q 'lzndtts Name _ _ ._ .__. __..... .
p Z LcndersAeereu 507 - FINAL PLUMBING B
U'O ..Icduty,l tIhavereadthu...flaaunandstemthauh abovemimnausionis 508 - FINAL MECHANICAL y
�far. toWild1agreetocoon:addheellcityhadcountyordioencesandstemlewdrelating 509 - FINAL GRADE
. to Wilding construction:end hfrcby euthodmreprcsenadva ofthiscitymentttupon
w sheabave-mernimmpproamr,forinspectionpurposes.- ,. 510 - FINAL PLANNING
fY. fWe)agree to eve,sndemhify and keep hurt she City of CLpenlriodgiudo
-vU liabiilities.jpdgmenu costs and expenses which may in any way accrue against,mid 514 - FINA PU I C WORE S
U' 'APPLICANT UNDERSAND ungo0f Urs permri' "' "
.,t
SOURCE BEc n nno ,INTI. COM YWTTH ALC
NS.r " NON-PO Issued by: Date ' Z
Signature of AppranU
aConmc ', ..Dau. .'
- ,,HAZARDOUS MATERIALS DISCLOSURE Re-roofs
`
we'tWapphcium orhnae balding occupant,,M 6,hand],haterdinas material ,'Type of Rooft. . .
n defiru4 by the Cupertino Mumapal Code.Chapter 913 and the Health and Safety - " - - ' - --
Cade 5 cion 25532(a)o pin:. . .
❑Yea - j No ., r- -, " .All.rop s shall.be mspected poor to.any rgofing material being installed._.
Will us airconatdifuture Wilding occupantuseequipmentotyMana which If a roof is installed without fust'obtainin an ins ectioli, I a ree to'remove
tbaMll the upliFis r or for m defined by them use
Armen gr Management g P g
inlet
' all new materials for inspection.. Applicant understands and will complywith
T� _ I have reed she huerd�rgaands req rcmenu under Chapter 6.95'0(The - - -
all non-point source regulations;
Ctlifomra HcaM&Safer Code Section 25503 23533 end 25534 1 ndemand that
'.thC Edln donamcumnU Neet nmt On ttumy rat ponnbtlrty to really the
(.I tpI . . r.-. 1 esu ht h m t ate m t poor to Isiuence o a Cen T e of
oK Signature o_f Applicant Date
��� 'T ? All roof coverings to be Class "B"or better
rte amh need agent
. a
t . .� r• t.a r..
.OFFICE---..