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03030082 CITY OF CUPERTINO - :�"r .r: •€xte �-� '�at�•^��.�-s , . BUILDING DIVISION PERMIT C"ONURTNPO TRtCIIiMATION BUILDING ADDRESS:" _ - LARRABEE & ASSOCIATES INC PERMITNO. , SNAME: EMIT TSU 3275 STEVENS' CREEK BLV, # 6E2 pD ONATHAN Pt E: (4 08) 985 SANRARYN OL NO. ARCHITECDENOINEER: - - BUILDING PERMRINFO BLDG ELECT PLUMB MECH 300 LICENSED CONTRACTOR'S DECLARATION _ IY 1 hereby affirm that 1 Am licensee un r provisions of chapter 9(commenting lob Description. with Sccllon 7")ofDivislon 3 ofthe Busia and pnfcsslnns Code,aodmylicensels FIV�►1�E® " n(u0mmean art 3 FOUNDATION REPAIR G { z,� Lianrc Clw Lk.�gqufir �..Sv�� . ARCHITECTS da pts ARATION MAR 2.1 2003 5s IundcnunJ my phos shall he usedapuhlic records � - k Llvenacd Pmfcaional - , ` q OWNER-BUILDER DECLARATION Contractors ON BUILDING qyy I hereby olBrm Ihe1 I em exempt fors me Consncors License Law for the pV L 'v Lp0 following moon.(section 7001.5,Business and Prefcsslans CWC:Any city or County - 5$ which mquim,a permit to constram.eller,improve,demolish,lir mpsn Any stmetum prior to its Issuance.also requims the Applicant for such Month to file A signed sulcmcnl ,,1 G that he nncenscd on pursuant Come pmvIAAAA of the Com,gcu',Ucenm U.(Chaptm9 Sq. F[. Floor Area $SValu`0 8 (cmnmoncing with Section 7")n1Division 3 of me Bulaux.rd ProfwinmCode)At vUU mu he isexempt therefrom and the bats for the Alleged caempJon.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of ,3, INW-41*r 0 0 ... Occupancy Type not mom than five hundred dollen(M). . ❑1,As ownm of the property,army employees with wages As thelrmle compensation, - - will do the wart,and she swctem is nut intended oroffered for We(Sec.70".Business 101 — FOUNDInspections and Profwimu Cade:The el m t eore License law does nut apply 10 an owner of _ propenywhe builds",improves thereon,and who dwsuch wart himulfm though his 102 — PIERS wmemployms.provided that such Improvements Are not intended oroaued fm sale.If. 103 - UFER - however.the building or Improvement is sold within one year of completion,the mane- builder will haws the burden of proving that he did vol bund or Impmw for purpose of 104 - REBAR sal"')' 105 - ANCHOR BOLTS ❑1,as owner of the property,am exclusively contracting with Ilo nsed concurs to construct the pmject(Sec.7044.Business and Professions Code:)The Contractors Lt. -' 106 - SEWER & WATER cense Law does not apply to m Owner of property who builds or imposes Bmmon,and 202 — UNDERFLOOR PLUMBING who contracts far such projects with a contrAam(a)licensed pursuantro the Contracmrs , License Law, 203 - UNDERFLOORS MECHANICAL 1306 exempt under Sea .B&P C for this,won 204 - UNDERFLOOR FRAME Date WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION Ihereby afmm under Penalty of perjury aro of the following declarations; - 301 - ROUGH PLUMBING ve and will maintain•Cenificnteoe aceta o self-Insum fooWmkers Compen 302, — TUB & OR 'SHOWER a provided for by section 37M of the Labor code,for the perfarmau of the � 303 - ROUGH MECHANICAL r which his permit ldssued. ve and will maintain Workers Compensation Insurance,u required by Section 3 04 -ROUGH ELECTRICAL . f the Labor code.for the Performance or the work for which this permn is Inued. 305' - FRAME rkers Compensation Inwnnce ari.and Policy nominal us: — HOEDOWNS Comer, 4CAIEEUQ1O Policy -7x3-02 CERTIFlCATE OP P.%EMPr10 OMWORKERs' 307 - INSULATION - COMPENSATIONINS`URANCE 308, SHEETROCK (Tnhsection need not hecomphmnnh dineparmfor one hundred'aenm e (SIM) 309' - EXTERIOR LATH lir leas.) 1 mNfy that In the perfmmanco of the work for which this permit is issued,I shall not 3 10 - INTERIOR LATH employ any person In my rammer an as At become subject to the Warkers'Compensation 311. - SCRATCH COAT Laws of Callfomia.Data Applicant 313 - ROOF NAIL NOTICE TO APPLICANT.If.after making this Certificate of Exemption,you should 501 — ' FINAL ELECTRICAL ENERGY become subject to the Workers Compensation provisions of the LAhor Code,you muss ,Jz fonhwih cumply with such provisions ar this permBmall be deemed mvnkcd. 502. - ,FINAL PLUMBING ENERGY , zit , CONSTRUCTION LENDING AGENCY 503 _ FINAL MECHANICAL ENERG 'Tr I hereby alrien that there lac contraction lending agency for the performance of 504 - FINAL BUILDING ENERGY C> mew,.rkfor whmthhpemuhwucd(sec.3097,Co.e.)' Lendar505 - FINAL ELECTRICAL W q s Nmne �z `"deriA°°e" 506 - GAS TEST U Q - I cenify that 1 have rad this application AM gum den the above information Is - cones.l agree o comply with all city and county On innces and sou laws abrins to 507: - FINAL PLUMBING 0 bulldingconswetion,and hereby authorimmpe"maiivaofda.city Walter upnnthe - — FIN MEQ CAL W Ahnvc-mentioned property for Inspection purposes. LL (We)agree to cave,Indemnify And keep esrmlw the City of Cupertino Agelnn 09 FI N IIab1110a,jud menu.costs ane expenses whit buy In buy accrue against to City 5 NGin C)"` APo C ec UNDERSTANDStAND rid L CO LY WITH ALL NON-POINT Issued by:5 �' W RKS Date URC EGULATIONS. w Re-roofs n fAPPIiesnVComr Date • - HAZA OUS MATERIALS DISCLOSURE Type of Roof Willtheapplium future building mcupaslorc or handle haudous material Mad by the Cu Ina Munl{IpI Cade.Chapter 9.11,and the Health and safety ed ' Scon155 an � All roofs shall be inspected prior to any roofing material being installed.. QYea ©No Will the applicant or mwre ildinp a cupame u equipment or Devices which If a roof is installed without first obtaining an inspection,I agree to remove Amit hmNna oir c mu al. U defined by the Bay Ame All Quality Management all new materials for inspection. DinrictT ❑Yrs Nu ' I have reed the hanNtms materials requirements under Chapter 6.95 of the Califor. Hulce ctyCode,Secdons 21X15, 534.1 undersand thatifhe building Jut cu Oy haw a mnmL het h' IMlity b noJl'y the ottupms of Ne m uwhich munb mel pd nu ar.ctmrw oratupant. Signature of Applicant Date v Xl 3 17 Q3 woe auhom<degcm Ovte All roof coverings to be Crass"B"or better