00050038 OF
C'BU D NG DIVISION O PERMIT CONTRACTOR INFORMATION:
Buibf�fVf&DRONE CT/3-23 _ PERMIT
NO.
N. 00050038
PHL"AMRIEN GROUP APV / �`SS`r26rb0
r PHONE: SANITARY NO. CONTROL NO.
O O .ARCHITECT/ENGINEER; BUILDING PERMIT INFO
z F BLDG ELECT PLUMB MECH
LJ LJ
i,w i LICENSED CONTRACTOR'S DECLARATION �Tp�y
=o I hereby eRrm that i nm Imensed under provisions of Chzpte19 lcommencing 3299 LIVING SPI tbEJ] �{'y�1j,e5 /7 0BGARAGE
,ytne wish Siwiam 7000).f Division Sof the Business and Parexions Cade.and my license
is in full force and effect.
.m0Licen,r Class Lic.N I RE
ke
i 3 u i_ Data Comraciar
ARCHITECT'S DECLARATION
1 a O< 1 understand my plans shall be fined as public mcoNs I
i ue1 Q f - f o.. j;
i rc O 4 Licensed Professional
'°'rH OWNER-BUILDER DECLARATION r
1 hereby:(rmm thin 11. exempt from the C Professions
ti e x law f e t $331622
l=?a fallowing reason:(Section]031.5.Business and Professions Code: m
F C which requires a permit m construct,alter,improve.demolish, fi repair any swcwre
a3� thathes for to icass used parstimgo the theapplicant soffarxich Commrminoicensle.e ned Law(Chapter
mmhei,regwithSe,ln7000)rodsion,anWconnactar.ueenselaw(usComl .. Sq. FL.FIoorArea Valuation
(commencing with t thcmf,700a)of Division 3 critic Business and Profusions Code) t.
- or that he is exempt thercfroni and the basis for the alleged exemption.Any violation "I '
of Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty p yTyp
of not mom than five huntlrcd dollars 185110). pId
Occupancy e
°1,as owner of the property,or my employees with wages a,their sole compensation. 102 — PIERS
will do the'work,'and the swcmre is n n intended or offered for sale(Sec.7044.
Business and Profusions Cade:The Conrmcmr's License Lew docs not apply to an Required Inspections
owner of property Who Wilde or improves themon,and who does such work himself 104 — REBAR
or through his own employees,provided that such improvements are not intended or 10 5 - ANCHOR -BOLTS
offered for sale.If,kmxcvcr,the Wilding or improvement is sold within one year of -
completion,the owner builder will have the border of proving that he did not build or 106 — SEWER & WATER t
improve for purpose of sale J.
°I,as Owner of the property. 202 - UNDERFLOOR PLUMBING. - - -
p per y,urn exclusively d N.fi contracting with licensede Connect to ,' -
mnewm the project(Sec. to an
Business and Profession Coder The vesthemr', 203 - UNDERFLOOR MECHANICAL
and who
Law does not apply span owner of property who builds se improves thereon,
.arta who convacB for soon projects.with a convecmds)licensed pursuant m the 204 - UNDERFLOOR FRAME - '. . . .. . ..
Comncmr',License law. 205 - UNDERFLOOR INSULATION
°lam exempt under Sec. ,B&P C for Nis mason
301 - ROUGH PLUMBING
Owns Data
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby affirm under penalty of perjury one of the following declarations: 303 — ROUGH MECHANICAL
�fr ° I have and will maintain a Cenificum of consent m self-imine for worker', 304 - ROUGH ELECTRICAL
°�:.. Cmnpenaation, ax provided far by Seedam 3700 of the Labor Cade, for he 305 — FRAME
performance of the work for which this permit is issued. 306 — HOLDOWNS
°1 have and will maintain Worker's Compensation Inmmnce,as required by Section 307 - INSULATION
3'71 of the tabor Code,for the Performance of Ne work for which this permit is
. issued.My Workerx Compensation Insurance carrier and Policy qumber are: 308 — SHEETROCK . . - .. . _ .
carrier:+ Poky",,. 309 - EXTERIOR LATH
CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPENSATIONJNSURANCE. 310 -- INTERIOR...LATH
(This section need not he completed if the permit is for one hundred dollars 311' - SCRATCHCOAT `
8100'ur1"') 313 . - ROOF NAIL. .
tI certify that in the performance of the work for which this permit is issued,1 315 — EXT SHEAR '
shall not employ any person in any manner so as to become subject to the Workers'
-
CompensnionliwsofCalifomia.Date 316 - INT SHEAR
Applicant. . .
NOTICE TO APPLICANT.If.after makingthis Certificate of Exemption,you should 501 — FINAL ELECTRICAL ENERGY
zCbecome subject the Workers Compensation Provisions of the Labor Code,you must
forthwith comply with such provisions or this Permit shall he deemed revoked. 502 - FINAL PLUMBING ENERGY
ECONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hereby affirm that them is a construction lending agency for the performance 504 - FINAL BUILDING ENERGY
r of that work for which his permit is issued(Sec.3097,Civ,C.)
y.❑ Lender's Name 505 FINAL ELECTRICAL -
a z Le°der,Addres 506 - GAS TEST
U O 1 certify Oat I hely read this city
and
and swat thin the above laws,tion is 507 - F I NAL PLUMBING
fas F correct.1 agree tr comply with all city and caumy,Natives s antl xmte lows relating
OU theatrave-construction,
pertyfrinspectionpeposemativesofNiscity toenmrupon 508 - FINAL MECHANICAL
ow the above-mentioned propend for inspection purposes. —
S eWe)agree to save.indemnify and keep harmless the City of Cupertino against 509 FINAL GRADE
K_ City in ca judgments,costs end r, fffii which may in any way accurate against said 51 0 — N I NG
U z APPLICANT
CANT UNDERSTANDS
litheTANDS A D th ILL C it.
SOURCANTUWTIONS.DSANDWILLCOMPLY N'ITHALL NON-POLY(' Issued b�14` I RKS Date
SOURCE REGULATIONS.
muvr
sigmatane of Apphcantrcamreytar Date Re-roof 03 - ROOF BATTENS
HAZARDOUS MATERIALS DISCLOSURE
. : ' Will the applicant or Drum huilding moopini store in handle houtimus material .Type Of qff :ROOF' IN-PROGRESS ' '-
u defined by the CupenmmMorneipal Code.Chapter 9.12,and the Health and Safety
Coda,Sectiony2ss3zlan :' ' 7%
3 t- '.MIN LLANEOUS
Dyes °"° All roofs all,be mspec e prior to any roofing material being installed. _
OWill the applicant or future Wilding°ccupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
Mit herardons it,contaminants as defined by the Bay Area Atli Quality Management
Dnu;eri I all new materials for inspection. Applicant understands and will comply,with
0YC5 ON. all non-point source regulations,
4.•-' I have read the hazardous materials requirements under Chapter 695 of the
Califamin Health&Safety Cale,Sections 25505,25533 and 25534.1 understand that
if the building does not currently have m tenant,that it is my responotol ity la notify the
occupant of the requir mems xhich most be at prior to issuunce of a Ccnificate of
Occupancy' - Signature of Applicant Date
Owner ore ilimmadngent Dam All roof coverings to be Class"B" or better
' OFFICE
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