00070075 CITY UILDINGOIP@RTNPERMIT NO CONTRACTOR INFORMATION:
BUILDING ADDRESS: """I'No.
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OWNEE VISTAAPPLIG'1'ION SUIS DATE:
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,[ONS: , SANITARY NO. IONIT101.No.
IfieZO ARCHIT[CI/IiNGINr:ER: BUILDING PIiRMIi'INFO
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BLDG F.LCCI' PLUMB NIECE]
�vj LICENSBDCONI'RACfOWS DECLARATION Job Description
1 hereby affirm that I..IiccmcJ un,kr provisions of CTaper Y(u,m,Iencing
��r� with Sed,ion 7lHHq of Divisinn3 nth'Bu,inexsand lhnlc,xian,CWc.and my littme
s��x oraexn16LHIC 6 Col NBt-tri/
i:i°`".eclat. (�^� Lic."- (99 VINE SPACE. 494 GARAGE
Dmc g_3a__40 MF1I'S DECLARA s,- iq N ��IF3
v5 3 A C
C 0? I unJcrranr Iny plans.hull he used a.puM1lic mcONs '
wYy
h o a I.i,FF d Pmfir,.i,mnl 'U14 2 4 2002
OWNER-RUILDER DECLARATION
vl=' 1 hereby affirm that I am esmnpt from the Contractor's Licen,e law for Ne
C Y fallowing reason section 7031.5.Bnsincsx and Prnre2,ions Core:Any city Or county
x O which requires a permit n,construct,elle,,improve,Jcmnhrh,or repair any xnnaure
WI-,, prior bids issuence.also mquirome applicant for,N1,permit,,Blcaxigned onlemon,
L,.3— that he is liccned parmat to rbc provisions of the Contracwrs License law(ChapterY 4, Ft. Floor Area Valuation
(commencing with Section 7")nf Division 3 of the Business and Profes,ians Code)
or that he is cxenmt Ihcrulron,and the huxis for the alleged ewroption,Any violation
ur Sen ,al 7031.5 by any applicant ha a froni,xw,ieeu the xPplkant m a civil panahy -n
Occ`upancyType
,if nolmore than live bardm,]daft.(85a). - APNNumber`
❑1.us owner of the property,or my employees with wages a their sale enn,pensatinn.
will do the work,ani the sfm,a re Is not intended or offered for .to sea.7044,
Bnsme„sad Pnaeashma Cole:That Contractor uCenxo Law does 1101 appy to all � '— "r equired Inspections
of pro eny Who builds O ",prat cs mare and who doe such work himmu
orvthrough his Own empinyces,provided that such improvements an not intended Or
offered for sale.If,however,the building or in,pmvemcn:is sold within one year or 101 — FOUNDATION
dnnPICro,I,the Owner.builder wdl have the burden of proving than he did am band IF 102 — PIERS
il,pn vc rnr gaga, ,.r.axle.).
01,as Owner of point am exclusively contracting with licensed contractor or 103 — UFER
,nsvne,the project(Sec.7044.Business and Professions Cale:)The Contractor's
i`iccn,C Law,mea sol aliply to an owner of property who bade.Orlmproves thereon, 104 — REBAR
C:uu1who amass,for such prnjecls with u enno-a,r ud licensed pun."an,to the
tmcbir's Littmm law. 1.05 — ANCHOR BOLTS
❑I on cavmpt under Sec. .B&P C far his... 1,0E — SEWER & WATER -
Dw"`'r Lou, 2202 — UNDERFLOOR PLUMBING
WORKER S COMIIHNSAI'[ON DECLARATION
Ihereby affidmunder penalty ofp joryoneofthefollowingdeclamtiom: 203 — UNDERFLOOR MECHANICAL_
(D 1 have and will mnma"h, a CerghF:rte Of C...Lo.( 1,,.ell-insure to,workers 204 — UNDERFLOOR FRAME
CL la,lwdm,. ::, provided far by Rection 3710 of the hnMm Core. lin the 2205 — UNDERFLOOR IhISULATION
r:rr"rmancc nt,be work for which his permit is i,saed.
O I have and will maintain Worker's Connpensa(ion Insurance,its required by Section 301 — ROUGH PLUMBING
37(10 A FILL,Litho,C„ac.lin,the I,L•n,aanancc,,1he work bar whish this reread 1, 302 — TUB & OR*
R. SHOWER
isnacd.My Worker's Conq,ensatlon Ina:nnee carrier and Policy number an:
jr,:5T¢7EF(iJL✓/)_rnreynn.: /3/OD 30 — ROUGH MECHANICAL
TER IIPICAI ON OF EXENPrION FROM WORKERS' 304 — ROUGH ELECTRICAL_
COMPENSATION INSURANCE
305 — FRAME
rlTis section need oat M completed if the permit in for one hundred dollars
suss soca,.) 30E — HOEDOWNS .
Penia,Tact dI the rerra no"..at the work ter wbieh Ili,far ro if is timed.1 307 — INSULATION
shall m1 employ any pervnn in say Insurer or a,b,become.ugci,,m he Wn.krcC 306 — SHEET ROCK
Comistoitho„1aws,,r California.Date
A,,[,,a"t Hoole 309 — EXTERIOR LATH
NOTICE'PO APPLICAN F.IF,after inaki a5 this ccnih.le Or li,cradmn,you s
M1aam,e,uhjccl nn the Worker,C,,.....v v""un pn Loan,a1'Ibc ,mhorCode,yam notal
,O D mnnwithconLplywdhwNhprovoinn,n,hi,pmairambbedecoedmvoked. 31.0 — INTERIOR LATH
CONST RUC`ION LENDING AGENCY 311 — SCRATCH COAT
F" Ihercbyanlm,that nen is a contraction lending agency Far the perinnarce 313 — ROOF NAIL
or the work rnr wLiell Ihis w nal',usual(sec 31097.Civ.C) .
y p Under s Name 501 — FINAL ELECTRICAL ENERGY
= Z i,mI,r's Address
U O 1 crony that I have read this triplication unit state th r the aMrve mmrmation is 502 — FINAL PLUMBING ENERGY
knF., Fnr,rc,.lagrce,n'n,,,pl,w11„aleit,:odForan,orirmaea:ordartclaws elatirg 503 — FINAL MECHANICAL_ ENERGY
O V :"building con,aectior,and hereby aurmda mpmsenta(ive,of this city al enter uls,n ,
he above mentioned prnperyI imperials pow,. 504 — FINAL_ BUILDING ENERGY
[., 6 (Wel agree to save.indemnily and keep harmless the City of Cupertino against
n 1'n1611111es,in Foslc and 1en.w,wed+: ,,a,m only war aFFme again„,Iia 505 — F I NAL ELECTRICAL p . 2 a• Q�
UZ C'nr in Fn sync `f :gra ng of m'I, _
APPLIC, SANUW LCOMPLYWI'1'l1ALLNON1'OINT Issued by: 506 — GAS TES Date
SOUR <EG' ON
y'
'Igd. -,n'npphrannic„.,..moor Dat= Re-roofs
D,.znxnous MA :Blois ulscLosoaE 506 — FINAL MECHAN I CAI_
Will be applicant or more building occupant store or handle lavnNous material Type of Roof
as defined by the Cupertino Municipal CWC Chapter 9.12.Fort Health and Safety 509 — FINAL GRADE
Com.Scctiou 255326)'I
❑ren ,^No All roofs shall$ai' lspectEdTIWIaf-[o[Rht R#tib Ligaterial being installed.
Will the applicnm ur nimbi building Occupant us=eyuipmcm or device which If it roof is ins6l” withouZRmv'ilchtildft.10i:in4j6RW$ Iagree to remove
nit hamodous air contaminants as defined by the Bay Area Air Quality Management
LotnL,torra 91 N,, all new materigJeOr insf*ciolf. SopliddifikMddrlifn7ilLs and will comply with
all non-point se ✓e regu 1 r 4: BATTENS
1 have mud the haatNnus materiak requirements under Chapter 6.95 of the
Calirorn Deahh& "CWF,Sect F 25915.25533 and 25534.1 undersand that 604 •• Kuut- int-11 t- .tSS
if lbs building Jo Int cu I h.o,y nnm.Ih:n it i.s my resrymsimiity to notify rhe
cupmn M she c i unI lir hicp'I a be nm,P., m I,wunu ur"CenlliIam of
occeparcy.
Signature of Applicant Date
—Iwo,ne�algcot [)areAll roof coverings to be Class"B" or better
OFFICE