01030028 CITUOF GDIVISION
t PERMITCONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
17825 ORION LA LOT( 01030028
OWNER'S NAME: APPLISATION DATE
B. K. DEVELOPMENT CORP. 03/ 07IYO"Ol
PHONE: SANITARY NO. CONTROLNO.
(410)) ►3
re0 O ARCHITECT ENGINEER: BUILDING PERMIT INFO
w— L LUM1IB MEC
VU 'KJb�C\AK `�C1b`8h
ret Q d1,-
trtr LICENSED COM1TRACTOR'S DECLARATION
O✓+ I hrrcb IBrm thin 1 am Iicen,eJ under Job Descri tion
°i-° rv,h,mm,.f.hapter9icmmmC1Cme 3172 SQ.FT. CONDITIONTD SPACE
F,—ef-w with Senion 7000)of Uiri,ion Jnfine Business and Professions Cala and myliccnu
zrc F, is in full force and
z ueensec , Lic.k fX�1 (INCLUD 741 SQ. FT. BASEMT. )
°d Dale �j�t�-- G"mraelm Q
w 3 a —g ARCHITECT'S DECLARATION 4 3 2 SQ. FT BASEMT.
° 1 uad...umd my plans shall be used as pnbre record.
r '
y a O O Licensed Pmfesxiondl '
OWNER-BUILDER DECLARATION
^_ I hereby a1Rrm thin 1 am exempt from the Contractor's License Law for the
F"?a following remand.(Section 7931.5.Business and Professions Code:Any city or county
E x O which requires a permit to construct,alcor,improve.demolish,or repair any structure
n3 Pnonoits issuance.also requires the applicant fur zuch,e di Iotilcaxlgnrdvammeni _..
that he is licensed punu5mmthc provisions of the Connors Licemse ww(Charter 9 S Ft. Floor Area luation
aommencingwith Section 7011BlofDivision 3nnheBusiness and professions C"de) t 4 $3688 3
or that he is exempt therefrom and the basis for the alleged c mm,tiom.Any violation
of Section 7031.5 by any applicant fora permit su e qppp�c�ryq�al pqmdq
of eta mote than five hundred dollars(55001. �69l8d�L�M1r, 3623 iditTbq Occupancy Type
Cl 1,as owner of the property,or my employers with wages as their sole compensation,
-will do the work:and the',mueturc is ern intended or o1�qrvptTra1g(M1� yp� - -
'Bnsme„and professions Cede:TheCemracmr,Lmi,metlVA1ts`A'. 11= 101 - FOUNDATIB�uiredInspections
r of property Who bonds m,improve,memo,,and who doe,such work himself 102 - PIERS
or through his own employees.provided that such improvements art not intended or _ _
offered for sale.If.however,the building id mrpmwemem ;.W�,�p ,Tye 6 103 - UFER - -- - - - - -- - -
coniplction,the ownerbuildcr will time the burden of prvvi. d
improve mrpm,wc,d,we.i. 104 - REBAR
r ❑1.a,nwk;of m�property.am exnm,-t - ANCHOR BOLTS ---
105
105 ... _._.....
.- —
a the project(See.law.Besides,and Pmre,sm.,code:)The Cmaricar s 106 - SEWER & WATER .
_ construct
Law does not apply to an owner of pope ry who build,or improve,thereon,
❑Iamexco dorsa: sommamos) aemeGpmsms .o he 202. _- .-UNDERFLOOR' PLUMBING
oda sum comma,for,sen Troiece.w;th a -
ComracmrkLicmnulawexempt ekPCfor this mason 203 - UNDERFLOOR 'MECHANICAL
Diener Date" 204 - UNDERFLOOR FRAME
- reWORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
Ithereby afrmtunder penalty ofxjaryoddofbefollowing declarations301 - ROUGH PLUMBING
I haws and wise maintain.Cemficae of Conant m a1f-insure for Worked 3 02 - TUB & OR SHOWER
p'omrenseut n, a, provided for by Section 3700 of the Labor Cede, for the
e,fiorman«of the work,for which this,ami,i,ixwW. ., 303 - ROUGH MECHANICAL
111 have sad will wire in Worke,"Compcmmtlod Insurance,as required by Section 3 0-4 - ROUGH ELECTRICAL
37(gl of the Lothar Cale,for the pvtForrianec of the work ret which this permit i.v 3 05 - FRAME
minicd.My Workers Camps than Insurance carrier send "umber Policy arc: _
came;r-,At�Q...�I','roccrNo.: 224-91-ttAW 306: -_. HOEDOWNS
' CERTIFICATION OF EXEMPTION FROM WORKF.RS'j' 307 — INSULATION '
COMPENSATION INSURANCE _.,
309 SHEETROCK .. -- ..-.__-.. ..__ —... .._. ._
t�ld,xe6mm meed no,bream,leied it prtmil is for..litmidreddnnars EXTERIOR LATH l u
($100h or las.) i
... '.Icertify inmtnrn6;iKrrJrntanrrmnnersola'rmrwhich his pemdt[,ivsaed,'1 310 - INTERIOR LATH '
,hall•dot employ any Tetsuo in any nrarre,a as to kre.me sub ect to he Workers 311 - SCRATCH COAT 1 '
Compensation Laws of California.Date
---313., -_..ROOF NAIL _
NOT ICE TO APPLICANT.II after making this Certificate of Exemption,yoasbould 501 - FINAL ELECTRICAL ENERGY
beronse.mbjee to the workers Compensation pmvisio"s of the who,code.you no"
0 forthwith cordial,with...Itprovi,inn,or his permitdedlbedeemedrev"ked. 502 - FINAL PLUMBING ENERGY
F.4 CONSTRUCTIONLENDINGAGENCY. 503 - FINAL MECHANICAL ENERGY
> 'Iherebyamnmmn.a
atthereisacoroetioniemlingagencyforthexifommnce 504 - FINAL BUILDING ENERGY
of the work for which this permit is issued(Sec.3097.Civ.C)
i u "
"de "a 505 - FINAL ELECTRICAL -
;z.z Lander,Address ..
U.0 Icertify that)have read this application and state that•the above information i, 506 - GAS TEST
ie.. E. correct 1 ague to comply,with J]city and comm,gmmaPee,and ,am law,remtmg 507 - FINAL PLUMBING
0-r> mbut liingconsnvetwo,mod hereby Italiai.morum.6r,wfthi vity1.cnrerupon 508 - FINAL MECHANICAL
�,. W the above-memimmd p omwy for impcaion parry,.,,
F..0. (We).greetosme.imlemniryaddlace,harmlesstheCM,vtCupertinoagainst 509 - FINAL GRADE
K/1 Iiabilincs,yalgments,costs and expenses which may in:my way seen¢against said
U.Z City in soncquenceof3ngmmingoffla e it. - 510 - NA ING
-^ AI'PLICAzr tNDGRST ND NOW' OMPLY.WITH ALL NON-POINT' ISSUCd,}, D
" soURCC ULATIO oh-110%
p t1 0% !y
;, SigwmreofAPPlican omm o - ,Da Re-rot{ - ROOF PLYWOOD NA
III DOus MATE LS DISCLOSURE' c fpp3 ROOF BATTENS
Wise the apPlican,or farm,building let nt,tom or handle has it ma coal Type t( Or
m defined by the Cupertino Municipal Gvde.Chapter 9.12,and the health and safety YP VA` ROOF-IN-PROGRESS ,
Coda.Sectio"255321.1.", ,r,
. ❑ve, ,",❑Nu.. .' i" ..All roofs shall be.inspected prior to any roofing.material being installed. -_... .-
Rtll Ineappllcamorfmurcbuilding,ncupamu,ceyuipmemorJe,icnswMah If a roof is installed without first obtaining an inspection, I'agree to'remove
recti hazardous air conuminanrc as defined by the Bay Arca Air Qualify Mxnagemem
District? . ' all new materials for inspection. Applicant understands and will comply with
0YF "° .all non-point source regulations._
1 have mad he haysrdous oidcrid,mmimoreun under Chapter 6.95 of the
California Health k safety Code.Seaionx_'5505.2551]add 2554.I understand thin _
if the building dues not cunenJy have a¢nam.iha it i,my rexpomihility to ramify the -
decu ,of the require eon whi size,prior m issuance of a Cenificae or
.. O p'nc m
n o Signature of Applicant Date
erm authoraca
- ate All roof coverings to be Class "B" or better
- OFFICE . . -