03070068 CITY OF CUPER'fINO �' w w'�' �� T �' "+
BUILDING DIVISION PERMIT CONTRACTOR INFORMATIONS
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BUILDING ADDRESS: SOBRATO DEVELOPMENT CO. """x03070068
OWNERS NAME: 19310 PRUNERIDGE AVE � D'�ue DATE
E: SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
lOc LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions or Chapter 9(commencing Job Description
with Section 7M))of Division 3 of the Bss an
usined Professions Code,and my license is
+� inrmuam.maerrec'' TI-1 STORY LOBBY REMODELING &
Class jq— License Lie.#
Dau canin
DECLARATION EXTERIOR LANDSCAPE (SOBRATO DEVELOPMEN)
e
ARCHITECTS ConCL
L I undersand my plan.shall b.used u public records
)yU
e G� Licensed Professional
OWNER-BUILDER DECLARATION
is. I hereby AMOS Nal I am exempt from the Contractor's License Law(or be �r�f . .
O o following meson.(Seedun 7031.5,Business and Professions Code:Any city or county ,� '1
3$r. which rt,dr.s a Permit m ennstruct,atm,,improve,demobh,car repair any structure ' 4_ '
Zr prior to its issuance,also mqulres the applicant for LKh permit to file a signed comment1�Asssw�aa
p that he is licensed pursuant to the Pmvi.iors Of the Comracuo's license law(Chapter 9 Sq. Ft. Flob A "a i CAV 000
y (commencing with Section 7")of Division 3 of the Business and Profession$Cook)of
y $
OUR he Is exempt therefrom and the basis for the alleged exemption.Any violation of 11 QQQ
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 JPTberO 0 jP aney Type
not more Nan five hundred della.($500).
❑1,u Owner of the progeny,or my employees with wages AS their sole compensation,
will do the work,and the[4uctum is nal intended or offered stforsale(Sec.JOta,Business d Inspections
re
and Protestors Cade:The Contractor's Litt ee Law dors not apply to An owner Of RR p
Property who builds orimproves thereon,and who does suahwork himself or through his 101 - FOUNDAT 8r 1
own employees,provided that such improvements are not intended araffered for Sale.If, 102 — PIERS
builder Nebuilding aveteorimprovement is e didn ane year of improveOn.
ihmpurpose
owner
builder will have the burden Improvement
ement i Nat he did not build or improv fur puryose of 103 - UFER
Sam)' 104 - REBAR
❑1,a owner of she property,am exclusivelynd contracting with licensed contractors 1. 10 5 - ANCHOR BOLTS
0 1.as the project(Sea 70a,Business and Professions Cade)The d cont ants to
cents Law does not apply to an Owner of proMmy who Wilda Or improves theton,and, 106 - SEWER & WATER .
who contracts for such projects wish a commissariat)licensed pursuant to the Contractor's
LLr,nta�w 202 - UNDERFLOOR PLUMBING
em ramps n sec. 9kPefmthtAmaon 203 - UNDERFLOOR MECHANICAL 4/
on S ATIONDECLA
D. ] q 204 - UNDERFLOOR FRAME O7 ��Qp
1 byAMM Under penalty ofPerjury one Ordtefollowing decla.tions: 205 - UNDERFLOOR INSULATION
haw and will maintain a Certificate of Consent o self-imum for Worker's Crompton. 301 — ROUGH PLUMBING
union.AS provided for by Section 3700 of the Labor Cade,for the performance of the 302 — TUB & OR SHOWER
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as mquimd by Section 303 - ROUGH MECHANICAL
3700 of the Labor Code,for she performance of the work for which thin permit is issued. 304 — ROUGH ELECTRICAL
My Worker's Compensation Insurance carrier and Policy number am: 305 — FRAME
Carrier: Policy No.: 306 - HOLDOWNS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 307 - INSULATION
Or (This section need not be complctod dobe permit is for one hundred dollars(S Hall 308 - SHEETROCK
Icertfy 309 - EXTERIOR LATH
ecertify shat er the in any mann of she work far which Nis Permit ds issued.m shall not
Lawsoanypowoioanymmncrmssmbccame subject de Warkeri Compensation 310 — INTERIOR LATH
Laws California.Dam
Applicant 311 - SCRATCH COAT
NOTICE TO APPLICANT:If,After making this Certificate or Exemption,you Mould 313 - ROOF NAIL
become Subject to the WOrker'a Compersatian pmvtnom of the Lahr Cnde.YOU must
0z fanovollComply With Such Prowisinn.arthis Perot Shall lac decmedrevoked. 501 - FINAL ELECTRICAL ENERGY
z CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY
[=t tN+ Ili.ropy.Iltrmthstthere is.corsWdinnlendinpgcncy for the,perrurmm.or 503 - FINAL MECHANICAL ENERGY
C t> thor whichthiSpermisisiuoed(Scc.N9'l.Civ.C.1
Lendndc504 - FINAL BUILDING ENERGY
L.na
Igt Q er's ri Name
] Z eriAddm. 505 - FINAL ELECTRICAL
U O I sentry that I have read this application and Aum that the a o w information is
05 0 6 - GAS TEST
f" cooed.I agree to comply with all city and county ordinances and Aide laws relating to
OU buildingconswction,Andheebyauthorienrepresentative,ofthiscitytoenteruponIn, FIN PLUMBI G
W ahow-mentioned property for inspection purposes O8 FI L
(We)agree to saw,indemnify and keep harmless the City or Cupenino against
r h IiabilitleS,Judgmenu,com and cxperscS which may do anyway accrue a gal nal said City 5
U 7 in on. sof she granting ofthi permit.
a
AP LI N NDERSTLOlf)S WILL COMPLY WITH ALL NON-POINT Issued by:5 d NG Date
SOU EPi� UL9}20A(
a Re-roofs
t art of Apel canUContracmr
Dan
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or tutu.Wilding ecebrand nom or handl.h vankna ma¢rial
u defined by the Cupertino Municipal Code.Charter 9.12.and the Health and Safety
Cats,Section 25532(.)7J� All roofs shall be inspected prior to any roofing material being installed.
[D Yet res
Will the applicant Or future Wilding accupont use cquipmanl or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I havadous air contaminants ss defined by the Bay Arca Air Quality Management all new materials for inspection.
tricl7
❑vca
1 have mad the hmaNnusmaterials mquimmcnu under Chap¢r6.95 ofthe Calif r.
nix Hcelm k Suf lycotle•Sections 25505,25533 md25534.1 understand that lfshe Wilding
does not cure It vc a ren is my meporsthility to nndl'y the pmt of the
requi cn to d ."dauAnmofaCcruicalco cu NW, Signature of Applicant Date
w r rets ori're ant - ,QJ All roof coverings to be Class "B" Or better V