03070091 CITY Or CUPERTINOs*•n
BUILDING DIVISION pERNUT CONTRACTORINF'ORMATION
, k� � �. - E
BUILDING ADDRESS: MARVIN DAVIS CONSTRUCTION PERMITNO03070091
OWNER'S NAME: 1450 KOLL CIRCLE PERMIT ISSUE DATE
i'
ONE: (408) 975-0200 SANITARY NO. CONTROL NO.
CHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
1= 0 t�
LOp LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that I am Licensed under provisions or Chapter 9(commencing p
tete with Sectio W B of Division 3 of the Business Professions Cod,,and my license is
L<<� in fu me, ate . 20 "k` DRY ROT REPAIR �BUV0�9 m1�
�? Lim Lic.x
s„qqW Da Com orSM E I..
q
�< I)Ecl;�WATIEYFP�_ 113
I undcruandmy pins shallllmxd as public records AUG LOOJ'']]
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30 Licensed Prormsional
g OWNER-BUILDER DECLARATION
M0 1 hereby affirm that 11. caemne from me Cmm�cmrs License Law for the ''11 e pp��gg''__+a
pD Which following reann.Permit
lO LS,Businusrad Pmressimu Code;Any city Structure
BUILDING
a�$ which requires s permit m cmm�cr,cites improve,h Permit
fi repair any nmmum
prior In its issunce,also rr'quims the applicant for such permit m file License signed statement
=pm�m'a thmhe I,licensed with
pSeUInL ction7 the Of Divuimons of the eBusi Business and
PridrWwlC iule)9 Sq,Ft. Floor Area Valu on -
NI-� (eommcnc.cro illi Section and of hissison3 of don.1Businessntl Pro(ray vii Cock)or
.- met he is exempt therefrom end me bnia for the Hlegcd uemplion.Any violation of 36946044 . 0.0
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of . APN Number Occupancy e
not more Nan five hundred dollars($500). p y Ty p
❑Las ower of the properly,re is empinyces wire cages as diet(m.nmpenmthn,
will do Professional Code:
and thea o Contra tori Lice. otos,M tom apply to
o3an owner
ss
of - OUND Ptd Inspections
rad Professions builds
or The Co.usmorM1 License oes cora not appy ton owner of
owns ywho lo,ms,provided
enimthemomanewho ammo chwork e himselfonhmugh his 102 — PIERS
own ver.Mebuiprngori improvement
improvements earoftloraffercdforaide.If,Owner. 103 — UFER
however,Ne building or den ovemem le old a did one year of completion.Ne osse of
builder will have Ne burden of proving Nn he did not EUIID or improve for purpose of 104 - REBAR
`]1, 105 - ANCHOR BOLTS
I,as owner of Ne progeny.sin exclusively mesand contracting with:)The Ccontnmon i.
canmmathepmject(Sec.?in owner of
Professions Code:)The sthermn,Li 106 — SEWER & WATER -
whoconwdounoteppytoa with
ofpropenywho WReaorim 10 Me thereon,ape 202 - UNDERFLOOR PLUMBING
who contracts for such pmJe<6 with a cnmranor(q licensed pursuem to Ne Comnclor'a
Licenrel.aw. 203 - UNDERFLOOR MECHANICAL
❑1 am esempt under Sec. .B h P C for this ream.
204 - UNDERFLOOR FRAME
Owner Date WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
I hereby affirm under Penalty of Perjury one of the fallowing declarnions: 301 — ROUGH PLUMBING
av,und will meintainsCenlficamnsrs
of Cemm¢If-Insure for WortrPe
r's Comn- 302 — TUB Ise OR SHOWER
at provided for by Section 3](10 of the Isbor Code,for me Performance of the 303 - ROUGH MECHANICAL
for which this Permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,m required by Section 3 04 - ROUGH ELECTRICAL
3700 of Me labor Code.for Ne performance of Ne work for whim this Isom it issued. 305 - FRAME �.
My WorkSf''a Cn{1n P�ens`ak'inn lm ncc orrier and Policy camber aa: y 306 — HOLDOWNS
trier.J1[�'R..l'ai�l Policy � W(JZ
CERTIFICATEOFE%EMPTIONFR WOROM KERS' S 307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
if,Iwaq Trois srnion(mrd out he completed irthe Permit le forwo,hundred out].IS 100) 309 - EXTERIOR LATH
1 cenify that In the performance of the work for which this permit is issued,I shall not 310 INTERIOR LATH
employ any Person in any manner so u br become subject n the Workers'Compensation 311 — SCRATCH COAT
Laws of California.Date
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT:IL after making this CcolEcate of EXaption,you should 501 — FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation pmvisiom of Ne fa"Code,you most
.Jz forthwith comply with such provisions orthis Permit shall tat deemed revoked. 502 — FINAL PLUMBING ENERGY
ZCONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
1 herehy affirm Nal Nene is a cons0uctlnn lending agency I'or the Perfurmence of
a >
the work(or which this Permit isissued(Sec.3W7.Civ.C.) 504 - FINAL BUILDING ENERGY
w p Lende:sName 505 - FINAL ELECTRICAL
az lender Address 506 - GAS TEST
U O 1 cenify mat 1 have mad this application and sum that the shove information is 507 - FINAL PLUMBING
lI. correct.I agree to comply with all city and county ordinances and slate laws Tolson,t.
Vbuilding construction,and herehy authorise representatives of this city to enter upon the FIN MEC L
ahadingcostruc propertyion,and foety authonre repree.(wc)agree to ave,indemnify ane keep harmless the City of Cupcnino against 0 9 F I liabilities,judgmenb,costs and expenns which may in any wry accrue against midCity 5 n uqucnceortbegrST1N11'A1 (mit.P CANTUNDERSTANDS AND WILL COMPLY WITH ALL NONPOINT Issued by:5 Cale
U REGULATI
Re-roofs
atr fApPlice tractor Date
k� HAZARDOUS MAT AIS DISCLOSURE Type of Roof
Will the.,,licam or future building occupnt more.,handle haeadous material
as defined by the Cepenino Municipal Code,Chapter 9.13,and the Health and Safety
Code.Section 23532(e)? All roofs shall be inspected prior to any roofing material beim
7 Yes g installed.
Will the applicant car tam building=.part uec w4mpmem or devices which 'If a roof is installed without first obtaining an inspection,I agree to remove
harmdous air contaminanuas defined by the Bay Arca Air Quality Management all new materials for inspection.
n?
❑Ver
I have mad the Woodous maletrials requirements under Chaplcrfi 95 of the Celifnn
ria Health k SaferyCMe,Semlons 25505,25533 rad 25534.1 understand Muddle huilding
drcs not currntly hove a remit,that it is my respo ldhilby to nouly tbe nau erl of Mc
which must in prior to issuance ofa Ccnipct4ffs nese. Signature of Applicant Date
.,I agent / D,te All roof coverings to be Class"B" or better