03030098 CITY OF CUPERTINO ft ' 's' #a-e r 9' w =w= k O rg'nd^d ,L
BUILDING DIVISION PERMIT CONTRACTOR INF0 UTIUN "
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9uILDINOA0DRE5s: ATLANTA CONSTRUCTION INC PERMITNo03030098
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ER'SSNNAMME: 342 DAISY DR. P02Mr` N7bl/2003
V C/
NE: (408) 205-5520 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby arfrm that I am licensed under provisions of Chapter 9(commencing
0 with Section 7")of0ivision 3 ofthe Businessand Profoomm;Code,and my licessou
infull rnnreandercee REVISION-TRUSS CAL. -IN HOUSE USE ONLY
Z4z License ClassLk.g
MDate Cunuumr NO NEW PERMIT ISSUED, ORIG. 402100041
££ ARCH17ECrS DECLARATION
'W u I undeunnd my plans Mall W used u Public records
6
C Licensed Professional OWNER-BUILDER DECLARATION
1 hereby affrrm real 1 am exempt from the Contractor's License Lew for the
Ea O following means.(gratia"703 1.3.Business and Profusion Cade:Any city or county
n22 which requires a permit to convect,alter,improve,dcmulkh,of repair any structure
Fly prior In in issuance.also requires the applicant for such permit in Ne a signed statement
FF o that he is licensed pursuant tothe pmvisiounfthe Conuacmr'sLicense Law(Chapter 9 Sq.Ft.Floor Area Valuation
tl $ lost W Luing wpm Seniman and of D alis for
of the egad exe and on.Anynms Code)or
le WI W u aampt thertfrom and We beau for Ik alleged exemption.Any violation of So
Section 7031.5 by any appliesnt fare permit abjecta the appllcat m•civil penalty of APN Number Occupancy Type
not mom than Ow hundred dollen($5001.
❑I.aawmnardepropnr.mmympmywwisw.gneathebalemmpeation, 35601037 . 00
will do the ,it.and me auuude I not intended m dirtied for ale(Sce.7044,Budnev Required Inspections
and Professions Code Tie Comraemes License Law don nos apply m an owner of 101 - FOUNDAT ION
p
property who builds or momewss countermand who dose such ,it himself or tiuough his
own employees.provided mat such improvements are not Intended oroBemil for sak.If. 102 — PIERS
however,me building or improvement is sold within one year of completion.the owner. /S \
Wilder will have the burden of proving that he did not Wild or Improve for purpose of 103 - UFER
.in.)
. 104 - REBAR b
❑1,esownerofine See.7property.am,Business
and contrPmfuong withlicensedcontractors m 105 — ANCHOR BOLTS \
construct me r of the
(property.,Businw and Protracting CodeO The contr mos Li-
censeLewduonotapplymanownerofpropenywho Wilds or improm disunion.and, 106 — SEWER & WATER �{
who contracts for such projecu with a eontnemrts)Horsed pursuant in the ConuacmYs
License law. ! 202 - UNDERFLOOR PLUMBING �v\
❑ 1. ""pi'munsee. .B&PCforthumeaon 203 - UNDERFLOOR MECHANICAL
er la p - �I a w�`"� 204 - UNDERFLOOR FRAME
ORKERSCOMPL�SA770N OSCURA
I hereby alarm under porosity of perjury one of me following 205 - UNDERFLOOR INSULATION
1C33737W
have and will main W n•CeniOaM of Cometh wseIRW um for Wancr'aCompcn-
301 - ROUGH PLUMBING
n.u provided or by Section 3700 of the LaWI Code.for the performance of me 302 - TUB & OR SHOWER
for which this permit is issued. 303 — ROUGH MECHANICAL
have add will maintain Worker's Compensation Insurance.as required by Sutton
of me labor Code.forme performance of the work for which this permit is Issued. 304 — ROUGH ELECTRICAL
Worker.Compensation Insuraue carrier and Policy number am: 305 — FRAME
Carrier. Polley""': 306 - HOLDOWNS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 307 - INSULATION
Oltissectien nod not W completed ifmc permit is return hundred dollars(SIM) 308 - SHEETROCK
cries') 309 - EXTERIOR LATH
I cenify that in the performance of the work far which this permit Is issued,1 Msil not 310 - INTERIOR LATH
employ any person in any manner an u m subject become subjeco the Woness'Compnuadon
L.waofCalifornia.Date 311 - SCRATCH COAT
Applicant
NOTICE TO APPLICANT.If.after making this Certificate of Exemption,you Mould 313 - ROOF NAIL
become subject to the Worker's Compensation provisions of this Labor Code,you meq
oZ forthwith comply with such previsions;orthHpermiShall Wdeemed invoked. 501 - FINAL ELECTRICAL ENERGY
z C
CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
E.... I WmbyalTummat more is a constmcOon lendingageuy for be performance of 503 — FINAL MECHANICAL ENERGY
C> the work for NamehichNlaPermit isiuud(Sn.3097.Civ.C.)
Leder.Nam.
504 - FINAL BUILDING ENERGY
W�Q l
Dz endnf'tAd° " 505 - FINAL ELECTRICAL
U O 1 cenify that 1 have mad this application and sum mat the above information is 506 - GAS TEST
LT.0 E' cortctt I agree m comply with all city and county ordinances and sun laws mdatinghe
OU building construction,add FINA PLUMBI G
6e
W above-mentioned property for inspection purposes - O 8 ELN
L
(We)agree m ave,indemnify and keep harmless me City of Cupcnino agaiat /
Iiabilides,judgments.costs and expn ms emwhich may In any way seeAgainst said City C,
UPE
utter egratingatthispcfmit.
^ NT U ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by5 NG Date
EGU ATIONS. ,r0/iV —
1 Re-roofs 602 - OOF PLYWOOD NAIL
f ApplicaVComfumr Date �r,�'
HAZARDOUS MATERIALS DISCLOSURE Type of RC'U 3 - ROOF BATTENS
I the applicant or future building occupant roc or handle huardoua material
by the Cupertino Monte al Code,Charm,9.13,end the Health and Safety 604 - ROOF IN-PROGRESS
on 25533(a)7 All roofs shall be inspected prior to any roofing material being installed.
ea ol the applicant or future but ing=upon,use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
dna air contaminau u Bled by the Bay Arta Air Quality Ma igemcm all new materials for inspection.
Di t cl7
Yes
I hoveread the huallousmgerialarequimmcnB umdarCMpter6.95 atthe Cable,
ria Hwlth&Safer Cede.Scedau25505.25533a 25534,1 cuuMmui(Lte Wilding
dose n t c mly have a Moat.that it u my o spongihitity m Way IW occupant of me
requi c whi mush bcmetpriarwiuvamxofa[.nifnateorocupacy.KV/ ignatureofApplicant Date
wnorur umorized egem pare All roof coverings to be Class"B"or better