00040173 CITY unEONO
BUILDING SSINPERMIT CONTRACTOR INFORMATION:
'BUtiffffRE RALTA CT/U4-1 PERPUTN'O, 00040173
01� T GROUP nrU4AjLbq/ ��� 0
10NE: SANITARYNO. CONTROL NO.
I
O z0 ARCHITF.0(ENGINEER: BUILDING PERMIT INFO
u BLDG ELECT PLUMB MECH
yai
z IS
LICENSED.baCON'nRACTOR'S DECLARATIONChapter
obp 1
E Iherebyefnof ivil1amlicencedunderprovisionsofChapter9(commencing 1431 LUNG SPAC 3 �p�Q�. FT. GARAGE
+- with Section 7000)rid effect.
civilian Business and Professions Code.and my license
0 ; is in nal fba<end effect. BMR DUPLEX LOT (S) 18-19 NAMED CHANGED FRO
a Dale cera Co tr MARYKNOLL TO PERALTA CT 10/17/00
O a U Dae Contractor
ARCHITECT DECLARATION
O g I und<rsdand my plans shall be used as public records
T
i p O Licensed Pmfessionvl
Oat I wo BUILDER from
DECLARATION
E?m 1 naso affirm that 1 am exempt from the Contractor's :A License Law for the
(_?a following season,(Seaton]condo t.ales and Pafe cinch Code:Any city or county '�`
ad x O whist requites a permit re<nnsww,pins,,improve,demolish,ar npuu unY structure
c. hather to slits censed also requires the applicant for.urch Commeb ditmBles Law(Ched a ent
(Chapter
Nat hgiahttnxa PS,mw,othe00 pof Doinao the 3find n Business
and
Lawm,;Code)
O $q.Ft. Floor Area , , 143Ml8ation
or thin eis cormo c<i firaceoo to rhe hainn]oallsiod exemption,
Professions Codn , 1 t t .
or mat he i:exempt merermm ana me nada for me aresea exemption.Anr+golaion �
of Section 7031.5 by any applicant for a permit subjects me applicant to v civil penalty
., of not moa man rive hundred caned:ts5ool. APN Number Occupancy Type
❑I,m owner ofine pmpcny,ser my emPloyeu wins wogcs auhcir sole compensation.
will do the work,and the.structure is not intended or offered for sale(Sec.76N, iOl _
Buslne'is and Professions Code:The Contractor License Law does not apply m an (Led 1❑SpeCh OHS
or of pr.,n,Who builds or improves thereon,and who fora such work himself 102 — PIERS
through his own employees.provided that such improvements are not intended or
offered I,,,agile,If.nowdv<,:me building or nttvrnvatt<nt is xnld within one caror 103 - — -UFER.. _ . .. .. . .
mnmpletion.the owner.wilder will have me burden of proving that he did not build or 10 4 — RE BAR
prove for purpose of tale.).
_ .. . _.__.. .. 105 -- ANCHOR- BOLTS
❑Lax owner of the P(Sec.7 am eusinessla eonnuc ssi wins licensed contractors to
nnsmtm Law ors i (apply to a owner of and property who ills or impTheroves
ves hic Contractor's 10 6 — SEWER & WATER
'— and,oh L.aw docs not Apply to an owner of acod won Halide or improves thereon,
': -and,who contracts for such projects won v.<onuucee(s)licensed pursuant m the - _.. 2 02.. - .UNDERFLOOR..PLUMBING
Commodes Liono,Law. 203 — UNDERFLOOR MECHANICAL
_ [I1 am exempt under Sec. .B&P C for this station
owmdr Dam 204 — UNDERFLOOR FRAME
WORKER COMPENSATION DECLARATION205 — UNDERFLOOR INSULATION
I hereby affirm under Penalty of i,erjurron<of following dedaations: 301 — ROUGH PLUMBING
I have and will ,nalatain a Cwsficmc of Cnacm to self-insure for Worker's 3 02 — TUB & OR SHOWER
Z./ Com'doolon. as provided for by Section 37W of the Labor Code, for the 303 — ROUGH MECHANICAL
perfonnanc<of the ism),far which,hie Permit is iso ed.
❑1 hale and will neinnid Worker's Compensation Ina work f r hick ed by Section
304 — ROUGH ELECTRICAL
3IIro or me Labor code.car men IHormnce c n er work for which mice permit is 3 0 5 — FRAME
J_ issued.My Worker's Compensation Insurance comer and Policy numner areHOLDOWNS:
Paii<yn'o_' INSULATION , .
CERTIFICATION OF EXEMPTION FROM WORKERS',
. t ,•. COMPENSAi'. 11 INS URANCB':'., 308 -SHEETROC''K__„-
m s section need not be completed if the permit is for one hundred dollars 3 0 9 — EXTERIOR LATH
(Sl Wlurless) „
310 — INTERIOR .LATH __
h ..... . .
16nify that in te perrom,anec ohne work for which this Permit is iasned:l - 311 — SCRATCH 'COAT
�snall no,employ any pcow in any manner so as to become subject to he Workers' .
Compensation Laws of Cnliforow.Date 313_ — ROOF NAIL
- Applicant .
NOTICE TO APPLICANT;If,after making this Certificate of Ekers,oun,you mould 315 — EXT SHEAR
O 0 become subject subjeco the Worker's ConTencmion provisions of the Labor Code,you must
forthwith comply with inch prevision or this permit shall be deemed revoked. 316 — INT SHEAR
mCONSTRUCTION LENDING AGENCY 501' — FINAL- ELECTRICAL ENERGY - -
1 hereby affirm Nal Orm is a const uctiod lending agency for the performance
� > 502 — FINAL PLUMBING ENERGY
of the work fm which this permir is issued(Sec.1091,Civ.C.)
y p 'L=ad=,..Name' - - - 503 — FINAL MECHANICAL ENERGY -
-D z LeadereAdd`rae 504 — FINAL BUILDING ENERGY
U O lccmfythat Ihave mad this application and s,aetn.'the above information i, 505 — FINAL ELECTRICAL
correct.1 agree w comply with all city dad county ordinances and state laws relating
O U 1.Wilding=onstruaims.and hereby aumodm teprescontives of this city m cnmr upon 506 — GAS TEST
>�,W the above-mentioned property for inspection purposes.
F., y (we)agree msaid.indemnifyand keep limitless the City ofCupertino against 507 — FINAL PLUMBING
Z) liabilities,judgments,costs and expenses which may in any way accrue against said
t..7 .Zee City in consequence of the flowing of this pcirnii. , 508rs— N ICAL
APPLICANT UNDERSTANDS'AND WI LL COM PLY WITH ALI:NON:POINT' Issued Dale
SOURCE REGULATIONS.
Signature of A,,IirtYCowrwmr Date Re-roof
HAZARDOUS MATERIALS DISCLOSURE 1 — FINAL PUBLIC WORKS
Will Ne applicant or future building occupant store or handle hazir'dwl material Type of .. .- . . -
asdefinedby.the Cimeninn Municipal Code,Chapter 9.12.and the Health and Safety 8 -- ROOF. PLYWOOD NAIL
Cod Section 25532wC
oY° ' O" All foo 11 bei d gj'' ��A��ll material being installed.
Hume rcownto mwrenerined ,«Aparuseequip t aManagwmmh If a foo sta71e �¢� tion, ('agree to remove
emit has moos a room mems ss defncd bl tit Bel Arca A Quality hlanugemcm ����ttrrr" dddttt```��� ��(( s�j
htnci all newt [ tats f h nt ods and will complywith
❑Yea Cl No all non-point source regulations.
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code.Se,itions 25505.25533 end 25534,1 undenwnd that
if the building does not currently have a tenant.the it is my responsibility to notify the - -
occupant of the requiremen i which must be met Prior to issuance of,a Certificate of
occupaney. Signature of Applicant Date
_
Owner m:mmor;:<aslier,'., , Dee All roof coverings to be Class"B"or better
- OFFICE -