03060111 CITYOFCUPERTINO - "^�'� r� + `+ •�
BUILDING DIVISION PERMIT CONttAkC'l"UR INFU'[tM�1.TIQN
BUILDING ADDRESS: PERMIT NO.03060111
OWNER'S NAME: PERMIT ISUa pAAn')$ ,7/2 0 0 3
P' Ub/ 1
r - SANITARY NO. CONTROL NO.
ARCHI7ECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Opp LICENSED CONTRACTOR'S DECLARATION Job Description
Ou 1 hertby anion TNI 1 am liceosed under provision of Clupuer 9(commencing
who Section 70)0 of Division Sof the Buslnrypd Pmfessiom Code,and my licensee
° y in full(. d J`
382 Lmmxa ,, J.a ARBOR/TRELLIS/BBQ PIT W/GASL �D
qDa Co CONTRACTOR: CORINTHIAN LA�
n p'Y ARCHITEC 1t DE� TION L/- .v Q -
5`ui5 7 I undermorl my plans shall be used as public records
'C� Licensed Professional SEP'
nTy5OWNER-BUILDER DECLARATION
2 2 I herchy aRrm deal I am exempt from the Contractor's License law for the y
0 O following rouon.(Section IID 1.5,Business and Profmsi.m Code:Any city or county '�Ga
5$ which requires a permit m commoner,eller,improve,demolish•or repair my atmetum ILD
-Zi prior m its issuance,aim require the applicant for such permit to role ulgned mlement
m< MetheislicensedpurmenttrigprovisionsOfMeC.mraclMilianmlaw(Chapter9 Sq.Ft. Floor Area Valuation
yF$ (commencing with Section 700))of Division 3 of Ne Business and Professions Code)or
TNI he Is exempt thm,from and the hams for the alleged exemption.Any violadon of $3000
Section 7031.5 by my applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy Type
not more Nan five hundred dollars(5500). 34261021 . 00
❑1,as owner of the property,a my employees with wages as their sae compression,
will do the work and the suucmr Is not Inandmi or offered for sale(Sec.7014,Businav Re
and Pour asiom e so
Code The Comouctoes License law dot apply to an owner of 101 - FOUNDAT 41�ed Inspections
prepeny who builds chi m prosy tharecn.and who does such work h im a1 f or through his
own employees,provided that such improvements art not Intended or offered for sale.If. 102 - PIERS
however,the building or improvement Is sold within one year of completion.Ne Owner.
builder will have the burden of proving Net he did net build or improve for purpose of 103 — UFER
ale.I. 104 - REBAR
E)1.as owner of the property,em exclusively contracting with licensed contractors to 105 - ANCHOR BOLTS,
construct the project(Sec.7044,Businrss and Plefesiom Code:)The Conmeur7 Li
cense law dao no,apply to an owner of property who build,or Improve themom.and, 106 - SEWER & WATER
who concur for such projects with a contractor(s)licensed pursuant to the Commodes '
License Law. 202 - UNDERFLOOR PLUMBING
❑I am exempt under Sec. .B k P C for this human 203 - UNDERFLOOR MECHANICAL
Owner Data 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
l hereby affirm under penalty of perjury one of Me following decimations: 205 - UNDERFLOOR INSULATION
aveand will maintain a CeNOate of Consent to self-insure far Worker',Compcn- 301 - ROUGH PLUMBING
anon,u provided for by Section 37110 of the labra Code,for the perfomtamx of the 302
- TUB & OR SHOWER
work for which this permit is hosed. 303 — ROUGH MECHANICAL -
❑I have and will maintain Worker's Compensation Insurance,a required by Section 3 O4 - ROUGH ELECTRICAL
3700 of the Labor Code,for the performance or Me woks for which this permit is hmed.
My Wore is o perosethyy sunnaorrier dPdtt'��pprrumper are: 305 — FRAME
CaeliI V° nry7:,U. Y�l foxiop'j 306 - HOEDOWNS
CER FICATEOF (EMPInON FROM WORKER S'
QpRFgM ENfoN�Iq�yR��cops 307 - INSULATION
=ties n«Er�t becomp UIYIk`reltiSft(41oP hundmdd.11.SIBo) 308 — SHEETROCK
micas.) 309 - EXTERIOR LATH
I certify the,in the perfurrow,of the work for which this permit is issued.l shell not 310 - INTERIOR LATH
employ eby person in any manner m u to nem
oc subjecuo tin Worker'Compensation
Laws.fCalimmn.Date 311 - SCRATCH COAT
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should 313 - ROOF NAIL
become subject to Ne Worces compensation provisions of the labor Code,you most
>Z mrthwiMcomply with men provisiomnrOur peorit0.Ohedcemedrevoked. 501 - FINAL ELECTRICAL ENERGY
z° CONSfRUCTONLENDINCAGENCY 502 - FINAL PLUMBING ENERGY
I herchy.M.Nal thusre its construction lendingag,nry for the Nor.. 503 - FINAL MECHANICAL ENERGY
Me, rwMahthis pertnhRissued(Sec.3097.CieC.)
larder'sndersName 504 - FINAL BUILDING ENERGY
t7 Q
jz
Umber Addes505 - FINAL' ELECTRICAL
J p I certify that I have sad Misapplication and sure,that the abase information Is 506 - GAS TEST
].F correct.I agree to comply with all city and county ordinances and sea laws relating to
OU building construction.and hereby mthorice representatives or this city m oar upon the — FINAL PLUMBING
N 0. shave-mentioned popery for imp ifyapuryosn. 0 FI L Al indemnify and keep ha in a tie City us Cupertino against e_C/l/[•Jl/"/'
fA Ilebititim,jedgmenu u dempe"-•which meyinany wyuoNageinn said City I
J Z in co eeuf ting.fthispermi4
^ APP U RST
ANDS AND WILL COMPLY WITH ALL N N-P INT Issued by:5 NG Dat27
SOU RE TIONS. _
Re-roofs
S nature Ap on—tor Dae,
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
11 the applicant w ream building occupant some or handle h mucous material
ar dcarmd by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
W
e.Section 25532(.)? All roofs shall be inspected prior to any/kiroofing material being installed.
�Ys
Will the applicant or Future building occupant ua equipment or devices which If a roof 1$installed WItl10Ut first obtaining an inspection,I agree t0 remove
zaair contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
tYes uIavere99e here mmrials requirements under Cheplerh.95o(thcCalifor-
cmlthApdpfycodc.5 am25505.25533anJ255341 undawndthwif Nc building norc (ily hem an4 Nue It u my responsibility to nodly,he occupant of the
Immo whichm b inelpdCtoisBurnccafeCcrtif¢ sotto a •y. Signature of Applicant DateOWb` ' '
e r.uth cd ase �. Dale All roof coverings to be Class "B"or better