02070022 CI'T'Y OF CUPERTINO h f a
BUILDING DIVISION PERMIT �CUNTRACTOR INFORMATION
"D124NB,VTR"YeIILFORD DR PERMTrNg.2070022
E'F3P9PfiER LAWRENCE L AND SUSAN 0 APPLICATOIySYI®rx�. 002
PHONE: SANITARY NO./ / CONTROL NO.
ARCHI'IECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MI';CH
One,00 LICENSED CONTRACTORS DECI.ARAI'[ON JobDescri Description
p I hereby affirm that 1 am Iiccaed under provision of Chapter 9(commcrcing p
tya2 wishSection700(bofDivision3ofNeBusinessandProfeasionCok.andmylicenseis ADD 320 P. T.
in full forward effect. F
.87n? License Class Lica N
Oz—p Dam Contractor
ARCHITECTS DECLARATION APR 2 4 2003
I understand my plans shall he used as public records
060
t—W Licensed Prommional
OWNER-BUILDER DECLARATION �'' n'�� $60000
I hereby.(lien that 1 1. exempt from the Contractor's Care:License Law for thc ��"Ys/ L0
i OO which ing Terson. ermit t ](HLA Business and ve,de io li h,oAny city'a county
�e$ which nrtquires a Permit m construct,erne improve,demolish,or repair any structure
at
Fz< poor to its issuance,also requires Ne applicant[tit such Permit o file a signed statement
xx that he is licensed pursuant in Ne provisions of the Commons License Law(Chaprer9 32l6EItlIF16162AM Valuation
F$ (commencing with Section]fl(111)of Division 3 of the B usiness and Professions Code)or
..
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 11131.5 by any applicant for a permit subjects the applicant to a civil penally of i UAPN NEWTRIRDATION Occupancy Type
m
nmom dun five hundred delta.($!i00r 102 — PIERS p y YP
1,as owner of Ne progeny,or my employees wish wages as their sole mmpenvdon,
will do for work,and the attraction isnot intended or offered for sale(Sec.7W.Business
and Professions Code:The Contractors Limn.Law dna not apply m an owner or 104 - REBAR Required Inspections
gropeny who builds ormains asthereon,and whodms such work himselforNrough his
noun employes.provided that such improvements arc not intended marred Emirate.If, 105 — ANCHOR BOLTS
however,the building or impro ,mem is sold within one year completion,the rohe owner- 106 — SEWER & WATER
builder will have the burden of proving that did not build or improve far purpose of
sale) 202 - UNDERFLOOR PLUMBING
❑I,as owner of the proper.am exclusively cmareting with licensed con timbrs to 2 03 - UNDERFLOOR MECHANICAL
construct Ne project(Sec.7(H4,Business and Profcasiom Code:)The Contractors Li-
eveLaw does not apply toanownerof propcny who builds or improws thereon and 204 - UNDERFLOOR FRAME
LCense 4wu for such pmjcc.wiNacomrumr(sHienud pursuant to Ne Contractor's 205 — UNDERFLOOR INSULATION
I am c. mgt undo Sec. ,B&PC fm is n 301 - ROUGH PLUMBING
nor Iwc, Dat 302 - TUB Sr OR SHOWER
WORKER'S OMPE SATIO ATION 303 - ROUGH MECHANICAL
Ihereby aRrm under penall, perjury one o the mlloesiog dmismalkns: 304 - ROUGH ELECTRICAL
❑ 1have and will maintain aCertificate ofConsent toanif mature for Woher'aCopper 305 - FRAME
rn
nation,as provided for by Section 37M of the labor Code,for the perforce of the
work farwhiminpermitisissued. man306 - HOLDOWNS
❑1 have and will maintain Workers Compensation Insurance,as required by Section 3 07 — INSULATION
3100of the laMc Cale,fur Nc performance of the wn k for which this Permit is issued.
My Worker's Compensation Insurance carrier and Policy number am: 308 — SHEETROCK
carrier: Policy No.: 309 - EXTERIOR LATH
CF.RTIFICATE OF IIEMPTION MOM COMPENSATION INSURANCE RKERs' 310 - INTERIOR LATH
(Dissenim need not re completed inn ennu is honor hundred dollars($100) 311 - SCRATCH COAT
1f1eaa') 313 - ROOF NAIL
I cenify that in the Performance of the work for which this permit is issued,l shall tool 501 - FINAL ELECTRICAL ENERGY
em,',i any Person m an anner} t eo esu e' I e Wakens'Corn,minion
lawn ar cafifor 502 - FINAL PLUMBING ENERGY
Applicom (6 d
t�hel f�ETon 1 AI If,aftermaking lhiI oisificmo tof he Labor ode.you
503 - FINAL MECHANICAL ENERGY
OObe�fwish comply it Wnhem isimmo,this p ulnas nl' do Whnr Coded. must 504 - FINAL BUILDING ENERGY
bushwith comply with such Provisions or this permit shall heJccmcJ revoked.
z CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
I hereby affirm that them is a construction lending agency for the Performance of 506 - GAS TEST
y, 9
the work for which this permit isissued(Sec.309],Cot.C.)
Lender's Name 507 - FINAL PLUMBING
fg10
j Z Lender'sAddrtss 508 - FINAL MECHANICAL
U O 1 cenify that 1 have with
this application sod more that the above information is 509 - FINAL GRADE
U F correct.I agree m at I plyhave
wird this a and county a moreth ordinances and emm laws retinformation
to
Wilding construction,and hemby authome rep ixurefivcs of this city to court upon the 54- FIN
AL PLANNING
eMwememinneJ property for inspection Intricacy.
(We)agrec to save,indemnify and keep harmless the City of Cupenina again. 5 IC W RKS C
!'n liabilities,judgments,costs and expenses which may in any way acemc against said City
U 7 i a consequence of the granting of this Permit
�—r APPLICANT UNDERSTANDS AND WI.L COMPLY WITH ALL NON-POI Issued by: Date
SOURCE RPG ATIONS-
�D 9 Re-roofs
store(it Applicanl/Conuactor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Nc applicant or furore building occupant store or handle hvafdon material
defined by the Cupcoino Municipal Cale.Chapter 9.12.and the Ilcalfh and Safety
Ic.Section 25532(.)1 � - All roofs shall be inspected prior to any roofing material being installed.
Yca fs�I
k Will the applicant or ffuu'tuuNo
re building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cart hicardaus air cnn.minants u defined by the Bay Area Air Qualify Management all new materials for inspection.
Disuict7 ...�LLL2
❑Yes No
I[taw read the heraNnusmaterials requirements under Chupterfi.95 ofthc Califn> ,
nia I Icullh&Safcty Gale,ScNons25505,25533 and 8534.1 undcrswnd Nat if thc building
docs nor currently have n tenant,Nal it is my responsibility 1n modify Ne occupant or Nc -
requ • mswhicbmunf he met Pon,In las ane nfa Cc milicafear acuFoxily.
(D Signature of Applicant Date
cr or eurhorivcd agent Date All roof coverings to be Class "B" or better