01030152 CITY OF CUPERTINO
BUILDING DIVISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7851 ORION LN LOT4 01030152
OWNER'S NAME: APPLICATION SUB DATE
BRIAN KELLY, INC. 03/27/2001
It PHONE:.•�-la'✓I O r J �u�7 SANITARY NO. CONTROL NO.
O ZARCHITECYIENGINEER:J V BUILDING PERMIT INFO
w O DG E CT P UAIB M CH
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LICENSED CONTRACTOR'S DECLARATION
Z b y= Job Description
O Z_G 1 hereby affirm tM1m I am licensed umJer provisions of CM1apmr 9(commencing
�_Fw isithSection7000)ofDivision3oftheBusinessandProfessionsCode.andmylicense SFDWL, 2296 ABOVE GROUND LIVING
ayE� ain fine for«nnd elre<,.
NS u at- License Lica 7 5 6 BASEMENT,
NT,
LIVING
SPACE
427 GAP-AGE Data comm
ARCHITECT'S DELARATI N
su.Om TI underlined my plans,mll he use 1.public recordsac
ac is y
aa O Licensed Professional
HE.E. OWNER-BUILDER DECLARATION SEP
1' O q
t�+ '-i 1 hereby atlirm that I am extinpt from the Contractor's License Law for the O C f 2002
s-?a following reason.(section 7031.5.Business and Professions Code:Any city or coumy
i x O which requires a permit to construct.alter,improve,demolish,or repair any structure
a 3 ae
_ 'poo tots'. a also requires theapplicant for Path permits rk signed statement - --- -'hit he licensedp tto the provisions of the Contractors License La lChapter9 5 FG Floor Area-. c V luation
Ica ncangwithSecton70(k)ofDivson3ofsheBuine. dPod e...imiCaJe) S, ;q'' , I 30551.E
or that he is exempt therefrom and the basis for the allegro exemption.Any violation .•
of Section 7031.5 by any applicant for a permit.subjects the applicant to a civil pewlty
of not more than rive hundred dollars I550q. 362���'1'Tmb6 i t" Occupancy Type
❑1,as owner of the property,or my employees with wages as their sale compensation,
will do the work,and the structure is not intended or offered for sale(See:7041:'
Business and Professions Code:The Contractor's License Law does not apply to an 101 - FOUNDATI ONuired Inspections
owns
r of property Who builds m improves thereon,and who does such work himself
or from Is his own however
emodin that such vement memo are not intended or 1102 _ P I ERS _-
for vie If.huwuilde the l have
n - mens n sold within one of -
-ofrtree g or improvement year 103 - UFER '
i
completion.the owe of saIa�r will have the burden of proving that he did not build or
,improve pulpa• 104 - REBAR
-. .,. . --- -- - - ' - - -
pLw.
aaaner.of meproperty.tan�.awe,elytantmmngwdnbsensm<ammtromta 105 - ANCHOR BOLTS t
construct the project(Sec.70,34.Business and Professions CmeO The Contrxmr's 106 - SEWER & WATER
License Law does not apply to on owner of property who builds or improves thereon,
and wha Loam is for such projects wit.a contmetoral.Ransel p uant.ta the __ ... -202 _ UNDERFLOOR PLUMBING
Comnaor's License Law. ,
❑Iamexempt under Sed
" B&Pcfor this reason 203 - UNDERFLOOR' MECHANICAL
Owner
Date' 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 - 'UNDERFLOOR INSULATION
I hereby affirm under penalty of perjury one of the fallowing declaration:: 301 - ROUGH PLUMBING
O 1 have and will maintain a'Ceniricaie'or Camara to self-ireurc for Warker'e 302 - TUB & OR SHOWER
Compensation, as provided for by Section 3700 of the Labor Cods. for the
perrarmanee atone work for which this Panama a,issued. P 303 - ROUGH MECHANICAL
-'l ❑Ihuve'undwill muimainWorker,Cainpcnolionln.vurxnes,a,mquiredbySee tion 304 - ROUGH ELECTRICAL
3700 of the Labor Code.far the performance of the work for which this permit is 3 05 FRAME
.= Issued.My Workers Compensation Insurance currier:nd Policy number mi
;L
1� .- , . . - ' '306 = ' HOLDOWNS
care .SQw _ ;walk`. PircyN : zx11�1^OWQ7 ..
CERTIFICATION OF EXEMPTION FROM WORKERS'( - 307 - INSULATION
., -, - - COMPENSATION INSURANCE r - - -------- -----
___--308._._.:..SHEETROCK-..---------,- .- . - ;,.
'obi,seetlan nem not the completed if me permit i.for one hundred dollars
ISIM) lessl 309 - EXTERIOR LATH -
.
.. . ..... ......310.. ._.. INTERIOR 'LATH
form, _.
I terror,dial in the pernce of the work for wh ch this Permit is issued 1 s .�
:hall nm employ any pxnm
er,on'in any manner so us to bsubject p,the Worker. 311 - SCRATCH COAT
Compensation Laws of California.Dote '
Applicant. 313' ROOF NAIL -. _ . ...
NOTICE TO APPLICANT:IL after making this Certificateof Exemption.you should 501 - FINAL ELECTRICAL- ENERGY
O pbacons subject,,the Worker's Compcnxmmn provisions of the Labor Code,yea most
tarthwnficomply witPaeM1proviaamaarthis permnanadbeddetnmmvokm. _ _ . . 502 - FINAL-PLUMBING ENERGY
F CONSTRUCTION LENDING AGENCY " 503 - FINAL MECHANICAL ENERGY ',
I berebv affirm that there is a conaruiticn lending agency for the performance
� �p of the work 504 - FINAL BUILDING. ENERGY
. Lend
Z
Lenders Address 505 - FINAL ELECTRICAL ., ,
U O 1 certify that I have mad this upplunion antl.aamthat the above information is' 506 - GAS TEST
lCorrect.1 agree to comply:with all city and county ordinances and state law.relating 507 - FINAL PLUMBING
O U to building co ,,ruction.and hereby authorize r2praimoitives or this city to enter upon
m theavive-cicmionedpropertyforinspectionpurpy.ds., 508 - FINAL MECHANICAL
(Wc)agree to save,indemnify and keep harmless the City of Cupemarm against _
tin liabilities.judgments,cosy and as per, s whim may Ire city way accmc against said 509 FINAL GRADE
.. v.Z anyiatonsegelateathe gim nll7fthis
Lnort. B§rHAliiNON.Povr 10 - FINAL PLANNING �.(�
APP(ICA T NDF STAND a Issue Date � V
SOL Ef U 5 Z, v` P�TRITT
Signal n a t I :Dat Re-roR02 - ROOF PLYWOOD NAIL
nZARDO MATER(SLS DISCLOSURE .ROOF ,BATTENS.,_. _
i W'I the upplicvv nr ren tilting apart.store or handle hacuddas material Type(kuof-
asdcrincJbythccupertinaMunicipilCode.Chapter 9.12.andtheHealthandSafety 604 -' ROOF `'IN-PROGRESS
Code,Sort
25512(x)7' .'.6 O No , , . .
'' _All roofs shall.be inspected prior.to any roofing,material.,being-instal led.
.
Willflacti,plactint or f t'rc railcar,tw,al,na old dq 'l t d tea m<n If a roof is installed without first obtaining an inspection, I�agree to remove
emit hazardous air contaminants as defnd by the Bay Area Air Quality Management
District? all new materials for inspection. Applicant understands and will comply with
❑Ye. I I all non-point source regulations.
I have read the hazardous materials requiremen s under Chapter 6.95'of the
'Cali(omia Health&Saley Cssde.Sections 25505.25533 and 25534.1 understand that -
ifthethaddingdocsn I enI hu taaaninIt 'n is my respomsibili'stonmify the ..
occupant of rhe req in nn sane 11 be in pfior to issuance of a Certificate or
'°`tape. ' I Z' Signature of Applicant .. ,. _- Date . ,.
owner or out :ea g f ant All roof coverings to be Class"B" or better
_. .: .. ..:,. : . . .. .. - OFFICE _.. . .. . ..