03030033 CITY OF CUPERTINO ' '' t '
BUILDING DIVISION PIJRMIT CdNT`RA.C�',C�,R, INT' RMAT,I0N `,
BUILDING ADDRESS: PERMIT NO.
'R'S NAME: PERMIT ISSUE DATE
SIA
PHONE: SANITARYNO, CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
i0o LICENSEDCONnRACnOR'SDECons of CON
i I bemby affum that I am licensed under provisions ofChapter9(mmimma is Job Description
hh Sectirn 70(Np ofDiW,lon 5 or Ne Budnwmd Prefcsdom Code,and my Iittne is
In fullfome and �/
i' Lratnmcl Lla.r/ VOLLINTARY SEISMIC RETROFIT '
De/ cams CONTRACTOR: LAZER CONSTRUMNALED
eARCHITECT'S D
` - I UMeraund my pia"..hall he reed a AUM1I c e ardl
50000 LicenedPmfc.sloul ON MAR- 12 2003
OWN ER•BUILDER DEthe Cma tat
E 1 hereby maso .(firm that I am exempt faro the Cosions C s :Any c taw for the
0 O which
means(Scotian]o sum Business and Har. adnm Code:Any oily or county
`v$ which its issaaPermit e.al.Inuires ucl,alter,nt farWdcas ermit1 fi¢Asir any swctum
tprior Whathe BUILDING
iuluuanm.aaumquire lhovisionor d.Coeur Permit 1l.. Law(ed mlemcnl
< (comae licemMAuranmtlatheOfDidomoftftConusinesssLlauclaw(Cmpmr9 Sq.FL Floor Area Valuation
E5
(commencing exaim arefon70W)tarDasisfrion 3 th the Business ander,Any vi Code)or
` that o 7 carmpt Memfmm and the burs for the subjects
the eanmpumv Any Wotadm of $1850
Section any APN Number Occupancy e
not more Nen Ore hundred torten(5500} � P y TyP
0 I,u mvner of thepropeny,army employee with wages u thelnole compensation, 35716057 . 00
will do Outwork and the struecYre is notlnended oraRerea fonele(Sec.7041,Random,
and Prefesslons Codi The Comnctor's License Law dots not apply to an owner of 101 ' Required— FOUNDAT gONInspections .
property who bullas orlmreo
proves then,and who doeuuchworkhimselfor through his
own employees,provided that such improvements.renot Intended croffered for tile.If. 102 — PIE,R.S,
however.In.Wilding or Improvement B said within one year of completion.the owner-
builder will have 1,burden of proving Mut he did not build or Improve run purpose or 103 — UFER
we.). 104 — REBAR
❑h A.owner of Ne property,.m sin. Ad concocting with The nnvumn m
eomwel the pm3ctt(Sec.]061,Business ane RofusionsCMe:)77e ConlnctorY U. 105 — ANCHOR BOLTS,
cense law does not apply tom owner of property who Wilds or impmvxa Mariana.and, 106 — SEWER & WATER
who contracts for such Pori with a conuacmr(s)licensed Potsdam to Me Contractor's
Licence Law. 202 - UNDERFLOOR PLUMBING
lam exempt under Sm:. ,B&P C far this Mason 203 - UNDERFLOOR MECHANICAL
A� Data
-
WORKER'S COMPENSATION DECLARATION 204 — UNDERFLOOR FRAME
I herebyafnrm under penalty or perjury ane of the following declantiom: '205 — UNDERFLOOR INSULATION
01 haw and will maintain accrdnnmofCement tosaE-insumrorWorker'scampm- 301 - ROUGH PLUMBING
sailor,as provided for by Section 3700 of the labor Code.far the performance of the 302 - TUB & OR SHOWER
work for which this permit is issued.
0 I have and will maintain Workers Campensatlon Insurance.As Acquired by Serio" 303 — ROUGH MECHANICAL
37M of to Labor Code.for the performmcc of the work forwhich this permit is luded. 304 — ROUGH ELECTRICAL
My Workcfs Com enudon Insurance tamer and Policy n kr em: - 305 — FRAME
0�
Ce CERTIFICATE OFEXEMITIONROOMWORKERS' 306 — HOLDOWNS
COMPENSATION INSURANCE 307 - INSULATION.
or leu.)(This¢mien need sat he completed if the permit Is far we hundred dollars($100) 308 — SHEETROCK
1 modify that In the perfnrmuee of Mm work for which thH p rrm0 U issued,I shall not 3 0 9. — 'EXTERIOR. LATH.
employ any person in any messier an As Or become subject mbe Worken'Compmuden 310 — INTERIOR LATH
ApplicantCalifornia,Dam 311 - SCRATCH COAT _
NOTICE TO APPLICANT:If.after mair,this Cemnn¢of Exemption,you should 313 — ROOF NAIL
,come suhJat to Ne Worker's Compensation provision,of Ne Lobo Ceec,you most '
=,Z forthwith comply with such provisions or this Permit shall bedccmedrevoked, 501 — FINAL ELECTRICAL ENERGY
rO CONSTRUCTION LENDING AGENCY SO2 — FINAL PLUMBING ENERGY
l hereby alarm that there is a construction lending agency for the Performance of 503' - FINAL' MECHANICAL ENERGY
Y. the work for which this permit Is Issued(See.3097.Civ,C.)
i]QndersAatnc
LonderaAdemn 504' - FINAL BUILDING ENERGY
jz Le505 - FINAL ELECTRICAL
J C 1 cenify that 1 have maid this application and,tato that Me.Ware Information is 506 — GAS TEST .
•y coOmcL I s:me to comply withall city and county ordinances and sue totaling to
building construction,and thereby authorize mpmmnmivn of Nis city to enter upon the
OC) akvs.mmadnee Aropeny for Inspection Aupesea FIN PLUMB G
(We).gree to seve.indem"uy ard keep harmlen Me city of Cupertino against %54
7, L
fn IlAhimics,Judgments,costsandeapemes whichmayin Anyway memocagaintudd City
04
in eon lienee of the Starting of this Permit.
F7 APP U RSTANDS AND WILL COMPLY WITH ALL N NPOINT Issued by: INC Date
GU A
_ 10 q Re-roofs 4 NAL PUBLIC WORKS
I g fA ` AROOUSMATERIALSDISCLOSU at` Type of Roof
.4 Will the Applicant or future Wilding oecuMm nom or MMIC huareou mataud
:Oiled by the Cupmd.O Municipal Code.Chapter 9.12,and Me Health and Safety -
.0y.255]3(.)7 f� No All roofs shall be inspected prior to any roofing material being installed.
r `ml the applicant m future building occupam sate rquipmart or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havarenuf air comuninarts As,dermcd by the Bay ARS Air Quality Management all new materials for inspection.
District?
0 Yes Q}Nu
I have mad!Me bem
raous'materuts requirements under Chap¢r 6.95 of the Califon
` ORHCal 14SAfety ode,ScNms25505,25533ad2553d.lundcr thmirthehuilding -
don I ntlyl e.arta¢.Nalitbmyresponslbilitywnouf Mea cupantorlhc
ratio m which Iprior it)issuance ofaCorollate o0ccup cy Signature of Applicant Date
haMva ,m All roof coverings to be Class"B"or better