03020099 CITY OF CUPERTINO ^> _ +
BUILDING DIVISION PERMIT ` ., ' ;, '�# RMAT,UN^
BUILDING ADDRESS: ROCKWOOD CONSTRUCTION CORE 7ERMITNO,
0 NAME: 248 BELDEN DR. PERMIT ISSUE DATE
OCK VALDHYANATHAN 003
PHONE: (408) 227-7999 SANITARY NO. CONTROL NO.
ARCIT ECUENGINEER: BUILDINO PERMRINFO
BLDG O pO O
D6 LICENSED CONTRACTOR'S DECLARATION IbDescription
1 hereby&farm that I am licensed under previsionsO
of Chapter 9(commencing
with Section 70W)of Division 3ofthe lhedam s.nd Professkm Code,and my license Is
I fdtfaree.nd It, KITCHEN REMODEL WINDOW REPLC
as—Glen Ca'aUsom�rN /
`e A s ffECeS VO•publili.rec ON
Ianderatsnd my plans Mmlmaad Mpublk records - MAY 12 2003
d Licensed Pme3aionsi j
OWNER-BUILDER DECLARATION �y y�/�
a I hereby&farm that 1 I. exempt form the feWomConneactCo License law for Ire BUILLY.sa)A.A
Ao followingreturn.lemic i 7113 onsucS.Bumnwmp Pmkatloli Code:Any city or lure ,
$� which requiw.permit to eonmruct titer,mpmm,demnl4h,or repair any shame
��' prior bluff atuadp pursuant
tan appllanttbac CoM1permit toummLmd uatement 5Y,410 Ion
5< Icalmme lcensed punuanttothepmvisiom nftmCB.Iu .dPGrusio Chapur9 _ SQ.FI. FIOOC Area �'
$ (cam he
exawit therefrom
ndsh basis for theaBedexempton.Anyvi Cmk)of
S.. Nn M1e k eampt therefrom and the buts for ea alleged exemption.Any violation of
Section 70713 by any applicant for a permit subjects the applicant to a civil penalty of g 0 0 Occupancy TI pe
not mos than five bundled dollen($700),
❑1.uewnuoftmpmpcty.armymployeawllhwaesutheirwlawmpewdon,
will do the wok and theamumue lsnolmmukW orelfeed terrak(See.7W1,B.W. — IInspections
and Prorwioru code:The conmemoe,License Law doret apply a an owner or 102 — PIERS
property who builds orimprom thereon,and whodoes&uch work himselfor through his
own MoPlOyees,provided thauuch improvements ate not Intended aro@red foremn.if, .103 UFER
howem.the building or improvement Is sold within am year of ampie0an,the owiar-
builder wiB have Use burden of pmving that he did an,build or Improve for purpose of 104 — REBAR
sale')' 105 — ANCHOR BOLTS
❑I,.a owner of the Propem am exclusively connecting with lkewd camnnon to 106 — SEWER & WATER
construct the pmjea(Sec.7044,Business and Profession Code:)The Contractor's Li. -
came Law dean notapply toanowner ofpmpwywho Wilds orlmprovuUamon.and. 202 — UNDERFLOOR PLUMBING
who contracts for such pmjecu with s Can=,.(.)licensed pursuant in the cm,mmaM1 203 - UNDERFLOOR MECHANICAL
License law.
lamacmptunder See ,Bh PCforthisrcuon 204 - UNDERFLOOR FRAME
0410111, Data 205 - UNDERFLOOR INSULATION
Wm under SCOMPENSAr1ON DECLARATION 301 — ROUGH PLUMBING
hendwillmby aiuMwpenticateorty of rjuryomofthefnikwingdmicescm 302 - TUB & OR SHOWER
ando~an and
ld fornby Secu�n 3700 of��iabo c lona forme performance of Me 303 - ROUGH MECHANICAL
work sur which this permit Is issued 304 - ROUGH ELECTRICAL
3700 of Out Labor Code,for the part...1 how and will maintain Waker's r is.woaia nin thin requiredby305 - FRAME
MyworkeesCompenationkaurancearderandPolicynumberAM: 306 - HOLDOWNS
Carrier. . Policy No.: 307 - INSULATION
cERnFlCOMPEENSATIONINNFROM SURRANCE RR�a 308 - SHEETROCK
(rdssection mod not m completed if ft Permit is for am hundred dollas(gldp 309 - EXTERIOR LATH
arta`)
I
as
that k the performance of tie work Iso which this perm0 n leaned.d,l shall not 310 - INTERIOR LATH
employ any Parton In any manna at as to become subject in the Woftes Compensation 311 — SCRATCH COAT
Lawsof t as
a
min313 - ROOF NAIL
Applicant
NOfICB TO APPLICAND IL after making thin QmUlc a of Exemption.you shmld 501 - FINAL ELECTRICAL ENERGY
become subject to the Wmka's Compensation provisions of the labor Code,you mum
i0 forthwith comply wWsmhprovimnnsor this permit shall mdcemcdmooked. 502 — FINAL PLUMBING ENERGY
coNsrnucnoNLllNolrgGAGENCY 503 - FINAL MECHANICAL ENERGY
I hereby Affirm that them It.commotion leading agency far the perrormana of 504 - FINAL BUILDING ENERGY
'> the work for which this permit breacted(Sea 3097,Cir.C) 505 — FINAL ELECTRICAL
Q fenders Name
Z Lend,hAddmsa 506 - GAS TEST
1 1«nily that lhe"mad this implication and team that the show Information Is SO7 — FINAL PLUMBING
cencct l tgree It comply with W city and county ordinances and Aude laws ratting to —
rV^
building conmmction,and hereby authadmrepresentatives ofthis city tocater upon Ua FIN L MEC ICAL
W smvt-mendoned lnopeny for Inspection Purposes
(We)dame a save,and amcro end kap may
in m Ute Clay of against
aasinst O F I
M liabilities, sato andapfyand keep
maykany wy.amaq.lmtnlS❑tt NG
io eansegmnec of the granting of this permit �. 2
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 5 C WORKSDate
SOURCE REOUL/// N5.
2-2G' 03 Re-roofs
signmae of 1 en ntnctor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant more orlardle mca doe material
ud< ed by the Cupertino Municipal Code,Chapter 9.11,And due Health and Safety
C, ,ren 255324)?a All roofs shall be inspected prior to any roofing material being installed.
rima
Will the applicant or future building=open%use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harmdons sur cwumlants u dcaned by the Bay Ara At,Quality MansSemem all new materials for inspection.
Divot"?
Oyu,
I hive mad the hvadnusm&tedak requinmums under Chapter 05 of the Califor.
nla Health g:Safety Code,S00m,25505,75577 and 25534.1 understand Can ifthe bullding -
das not curtently hue a 4 that B is my responsibility in nodry the ay.•upant of No
requiemcnawhkhm tPriortoluuana Cedncaaofoc cy, Signature of Applicant Date
4,0
Owner or author' J e rat Date All roof coverings to be Class"B"or better
Owner iuwt�g