03070212 CITY OF CUPERTINO ; ' �
BUILDING DIVISION PERMIT cON, ,__ ' TOR INk'(ORMATION ;
,
BUILDINGADDRESS: FRED BOITANOPERMIT N003070212
l
'R'S NAME: PERMIT ISSUE DATE 07/29/2001
FRED B AN
PHONE: SANITARY NO, CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECIi
l� t�
i00 LICENSED CONTRACTOR'S DECLARATION- JOb DescriptionLw 1 hereby affirm that I am licensed under provisiom
ns of Chapter 9(comencing
`2 with Section 70NE of Division S of the Business and Professions Code.and my license is - W�
infnBforeeand effect. REPLACE WINDOWS/SIDING ��
jtjZ License Class Lle.k SLE®
Date Contractor—
ARCHITECTS
f¢ ARCHITECTS DECLARATION q �a ,g
� I understand my plana shall he used as public records MAY 4." 2OOq
SW6U r
L. Licensed Professional
=0OWNER-BUILDER DECLARATION s
eI 1 hereby affirm that 1 am exempt from the Cnmractors License Law for the �1�'�®IY�1/1 tl{�
C20 o following reason.(Section 703 1.5,Business and Professions Cute:Any city or county
e m� which requires a peril to construct,alter,improve,demolish,or repair any structure
poor as its issuance,also requires the applicant for such permit to rile a signedstatement
as that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation -
2Ha (commetming with Section 7000)of Division 3 of the Business and Professions Code)or
Q R 5 that he Is exempt therefrom and the bans for the alleged exemption.Any violation or 35624003 . 00
Section 7031.5 by am applicant for a permit subjects thc applicant to a civil penalty or APN Number _ Occupancy Type
not more than five hundred dollars E1500). - - -'-- - '-' -
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure,is not intended of offered for sale(See.7044,Business i U L tUUN
—
And Professions Code:The Contractors License Law does not apply to an owner of 10 2 - PIERS d Inspections
Property who builds or improves thereon,and who does such work himself onhrough his
own employees,provided that such improvements are not intended or offered for sale.If, 103 — UFER
however,the building or improvement is sold within one year of completion,are owner. '
builder will have the burden of proving Nat he did not build or improve for purpose of 104 - REBAR
.I.J. 105 - ANCHOR BOLTS
E] 1.as owner of the prol am exclusively contracting with licensed contractors to 106 - SEWER & WATER
consumer the project(Sec.7044,Business and Professions Code:)The Contractor's Lt
seem taw does not apply to an owner of property who builds or improves thereon.and, 202 UNDERFLOOR PLUMBING
bwho menm Lawafor such proJecu with ecomrmrmr(gu
licensed pursuant the Contractor's 203 - UNDERFLOOR MECHANICAL .
pam exempt derc. ,B&PCfor this aeon 204 - UNDERFLOOR FRAME
Data -
i WORKER' COMPE TION DECD m" UNDERFLOOR INSULATION
` 0 205
I hereby affix under penalty or perjury one of the fo wing declarations: 301 — ROUGH PLUMBING
302 - TUB & OR SHOWER
❑I have and will for by
a Certificate of Consent toCode,fore for Workers ce of the -
sation,uprovided far by Seaimn 3700 of the Labor Code,far the performance of the 3 03 - 'ROUGH MECHANICAL
work ter which this perir is issued. 304 — ROUGH ELECTRICAL
❑1 have and will maintain Workers Compensation Insurance,as required by Section
3700 Afthc laborCWo,for the performance of the work far which this permit is issued. 305 — FRAME
My Worker's Compensation Insurance camicr and Policy number art: 306 — HOLDOWNS
carder: Fail Nis: 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK '
(Thuacetion cited not beemmplmed INN,permit is format hundreddollars($INE 309 - EXTERIOR LATH
arless.) 310 - INTERIOR LATH
I certify that in the performance of the work for which this Permit is caued.I shall not 311 SCRATCH COAT
employ any person in any manner An as to hm
ecoe subject to the Workms'Compensation
Laws of California.Dem
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT:IL after making this Compeue of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation provisions of the Labor Code,you most
_z forthwith comply with such parawrinsorthis permiushallbedeemed revoked.
SO2 — FINAL PLUMBING ENERGY
ZO CONSTRUCIONLENDINGAGENCY 503 - FINAL MECHANICAL ENERGY
I hereby affirm Net Nice is.construction lending agency lot the perfutmancc of 504 — FINAL BUILDING ENERGY
x> the work for which lhiaperitisissued(See.3W7,Ci,C.)
Lender's Name SOS —
FINAL ELECTRICAL
'3) A
� Z LnderaAddrea 506 - GAS TEST
I sanity that I have mad this application and state that the above information is 507 - FINAL PLUMBING
correct.I agree m comply with all city and county ordinances and state laws relating to
0Ubuilding construction,and hereby aurhorive representatives of this city to enter upon the FIN MECHA�NG CAL
Na .hove-mentioned property for inspection purposes. O9 FI
(We)agree to save,indemnify and keep harmless the City of Cupertino against
fA liabilities,judgment,ensu and expenses which may in any way genua against said City C, ]`A
JZ in consequence of the grouting of this permit.
r..t APPLICANT UpyE NOS AND SWILL COM Y WITH ALL NON-POINT Issued by:5 C WORKS Date
S LI ATR /LDS
7 Re-roofs
Signal mf ApplicantrContra for am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant ser rmurt building occupant acre or handle havaNuus material
As defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
secttonzss3z(a)? All roofs shall be inspected prior to an roofing material being installed.
lives KIN. P P Y 8 $
Will the applicant or future building racialism use equipment or devices whicM1 If a roof is installed without first obtaining an inspection,I agree to remove
.5 colt baeartlnua air contaminants u JcrincJ by the Bay Area Air Quality Management all new materials for inspection.
emithDistrict'
❑Yea �16m
I have mail the Assailant;materials requiremcnu under ChaptereS.95 of the Califor-
niaHealth&Safety Cues,Seauuns 25505,25533 anJ25534.I understand thatif thc building
Joey not v'urnlly h. a tenant,that it is my rasps I it try m andly the occupartl of the
mgicemen YS1tCmeI IWlsmance .cersreaw foeeuanty. Signature of Applicant 'Date
"'' All roof coverings to be Class "B" or better
Owner ser ntbo dsgcm arc
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