03030036 CITY OF CUPERTINO
BUILDING DIVISION PERMIT P�CUR .CQRIN 'UI2MAIO1V
B1n1.o1NC
ADDRESS: PERMIT NO,
MARVIN DAVIS CONSTRUCTION
i.S NAME: 1450 KOLL CIRCLE PERMIT css A
E: (408) 975-0200 SANR .ARYN ON ROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MHCH
l00 LICENSED CONTRACTOR'S DECLARATION Job Description
.10 thercbY !firm that 1 am limned under provision of Chapter 9(commencing P
wiNSectl. ] )ofDivhion3 of thoBnsines. of uinro Cn wind mylkenu ie
WmRto_ erne FIRE DAMAGE REPAIR F'N/4LIED
j'�zuceme uc.N
De the
DEC, ATIO ..f p ,g
I I understand my plans shall he used a pu lie records APR 1q2004
L oy
.0 Licensed Pmfessioul
OWNER-BUILDER DECLARATION
Y I hereby alRmh that 1 am exempt from the Contraeror's License Taw for the - BUILDING
D o following recon.(Section 7031.5,Business and Professions Code:Any city or county
b$ which mquiru a Permit to construct.alter,Improve,demolish,or repair any structure
pdorw its iuuarec.alwrequires lheappllcant forsuch penniUO files slgnedeuument
that he is licensed Vanuatu m the pravisimu of the Compactor's Law(Chapter 9 Sq.Ft.Floor Area $6��I�a�ion
(commencing with Section 7000)of Division J of the Business and profession Cnde)or
that he is eompt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne effluent to a civil Penally of 3 �191O�T 0 0 Occupancy'Tye
not mart than fin hundred dollen(SSW). P y ' Pe
❑i.uotoner.!thepmpenymmyemployeuwiNw guuNelrmlewmpeuation,
will do the work and Nuwmu ,cwt intended oroRered funle(Sar.7041,Business 101 - FOUND79 d Inspections
and Profusion,Cade:The Contractor's License law does of apply to an owner of
propenywho builds orimprons thecem.and who doe.such workhimeelforthmugh his 102 — PIERS
..,.play...pacvided that Such impmnmenu tee netittended oroffeed forsde.If. 103 - UFER
howenr,the building or irepronment is old within ane Tau of completion,the owncr-
builder .will hat Use burden of proving that he did not build a happen for purpose of 104 - REBAR
sal.j.
❑I,as owner of the property,em exclusively contracting with licensed mntrac1on to 105 - ANCHOR BOLTS
construct the project(Sec.7014.Business and Prefeulom Code:)The Contractor's LI- 106 - SEWER & WATER
censelaw does not apply to an owner of property who Wilda or improves thmom.and, 2O2 - UNDERFLOOR PLUMBING
who contracts for such pacjects with a contractor(s)licensed puuuant to the Committees
Lkeue Law. 203 - UNDERFLOOR MECHANICAL
I un e.emData ph under Sec. .B @ P C for this rtuon
204 UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
I hereby affirm under ponaltyof Rdmy em of the fallowing declarations: 301 — ROUGH PLUMBING
❑I hen and will maintain a Cedficateof Comcntto self-mure for Worker's Compen- 302 - TUB & OR SHOWER
cation,u remitted fm by Section 37W of the Labor Code,fm the performance of the 303 - ROUGH MECHANICAL
work for which this permit is Issued.
I
and will maintain Worker's Compensation Insurance,a required by Sudan 304 - ROUGH ELECTRICAL
37 of Nc laborCndc,for Ne perfomhance ofN work far whkh this pemhit is iuued. 305 - FRAME
MyW.rk;ea Comenul.n lmuryhco carrier and else umber am: 306 — HOLDOWNS '
h Policy : OOD -2
CERTIFICATE OF EXEMPL7ONFROM WORKERS' 307 INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK '
or loss.)(This sodden need not he completed if the permit is fm one hundred dollars($1 W) 309 - EXTERIOR LATH
-- 1 certify that in the performance of the work for which this Permit is issued.I.hall not - - 310 - "INTERIOR LATH----
employ anypereen in any mannmrm as in bceemc subject to the Werlen'Compenuton 311 - SCRATCH COAT
Laws of Celllornie.Date 313 - ROOF NAIL
NOTICE
Applicant ocnincau,
OTICETO APPLICANT.theWorI'sCompensati titlerdsmusof of Labor iod,youmst 501 - FINAL ELECTRICAL ENERGY
bmane Suhjmt to Nc Worker's Compensation pmvisiom of the hahnr Cade,you must
�z forthwith campy with such provisions or this Pmaritshal)lx deemed k.d. 502 - FINAL PLUMBING ENERGY
CONSTRUCIIONLENDINGAGENCY 503 - FINAL MECHANICAL ENERGY
I hcreby.fErm that them isa construction lending agency for the Performance of Y 504 - FINAL BUILDING ENERGY thewurk for which NB pennitumad(See.3W7,Civ.C.)
Leader'. e 505 — FINAL ELECTRICAL
Urdeor'ses Address
_
31 A '
lamu
L)z 506 - GAS TEST
UO 1certify
necethat 1haverend1Metyandcounand cumom.the,bonInformation1. S07 - FINAL PLUMBING
S. building 1 agree to comply with all city and county ordi ocs of and cute laws r upon
e
building mn.wcuien.and hereby authorlm rtfruenutn.of Niuity m enm upon the
Wshoo-maraboedfactory for inspectionpurpesev FIN MEC CAL
(We)agree w un,indemnify and loop leannleu the City of Calamine.against 0 9 F I
Ilabilitiu,jud nu,coeue xpmnua which may in any way eccmc agelnu cid City
Inconoquen o e a Lo hHPermit. 5 NG J'
�7 APPLICA UN S DS ND WILL COMPLY WITH ALL NO Issued by:5 C WORKS Date
SOU C UL 0
0Re-roofs
., gnetumof PI HAZARDOUS MATERIALS DISCL SUR ` ate Type of Roof
Will the applicant or future building acupmtaacrt or handle havadou material
-dimRind by the Cupemno Municipal Code.Chapter 9.17,and the Health and Safety
s tint 2ss32(.)7
C]You All roofs shall be inspected prior to any roofing material being installed.
yao
Will the applicant or future building occupent use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
roll havadous air contaminants a dcOncd by the Bay Ane Air Quality Management all new materials for inspection.
Disuict7
13 Yes Nu
IhrveuWthe huardous materials requirements under Chirwr 6.95 of the Calif.,.
nu Has Saley c,Socio gg 25577 and 25534.1underswb tiuif the lacking
dose nm curmnll�be a un at it, my ro endi llity w nail Uc.coupe!of Nc
u'veme sw c at b siorw uuanccofaCeNO roof c w Signature of Applicant Date
ownermam.na. > Date All roof coverings to be Class"B"or better