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02110124 CITY OF CUPERTINO +" A r, + RUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUB. .n )RRAI NB0W DR TIMELINEvCONTRUCTION PFRMTNT2110124 owNYMIDEAN1AUSTIN 14589 S BASCOM AVE APPLICATITN151R / T/2002 ZONE: (408) 356-1790 SANITARY NO. / L CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MP.CH I� 0 00 LICENSED CONIRACIOR'S IJIiCLARAI'ION hcmbyafrmthat lamlactated undcrpmvisionsnfChapmr9(urmmcndng MINOR KITCHEN 'IPt f5TY AS RANGE with Section 7(XX1)of Division 3 of the Business and Promssions Cole,and my license is in leof n lime and d(Nal /n 0 Liccne Cl ss__� Lic.N 9.�- tI <F_—� Dale 10 Lin ARCI IITI:CrSD1�CLAl ION ��L7rnvq K 1 understand my plans shall be used es public cords ppw u.t; LimnsedPromsmona' DEC 2 3 2002 F�•�j OWNER BUILDER DECLARATION f1 hereby affirm that 1 am exempt from the Contractor's License Law lin the $2000 rc o O following reason.(Session 8)31.5.Business and Professions Coale:Any city or county a'N$ which requiresa lKrolil ser construct.alter,improve,demolish.(it repair any structure w prior at its iasaanec,also mquims the applicant for such pssmiuu life a signed statement tt fisc that he isImensedpursuanothe provision,ofthe Contractor'aLicense Low lChapler9 3 2M Valuation m� (commencing with Section 7000)of Division 3 of the Business and Professions Code)or a 3$ that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 8031.5 by any applicant for a permit suhjecls the applicant to a civil penalty of PN'N Occupancy Type not mom than five hundred dollars(SY10). 102 - PIERS ❑1,az owner of the property.or my employees with wages m their sole compensation, ±E)3 TJFEtt will do the work•and the would.is not intended he offered for sale(Set.7W.Business and Professions Code:The Conoaclor's License Law docs not apply to an owner of 104 - REBAR Required Inspections property who builds or improves therein,and who docs such work himself or through his ton employees.provided that such improvements are not intended or offered for sale.If. 105 — ANCHOR BOLTS nnweveo the building or improvement is cold within one year of completion,the owner. 106 — SEWER & WATER builder will have Ne burden of proving Wal he did not build or improve for purpose of safe.). 202 - UNDERFLOOR PLUMBING ❑I,as owner of the pmpcny.amexclusively conuaa;ng wit Licensed contractors to 203 — UNDERFLOOR MECHANICAL construct the project(Sec 1814,Business and Professions Code:)The Conoacmr's Lb erne law does not appy to an owner of property who Wilds or improve.,thercom and 204 - UNDERFLOOR FRAME who contracts for such Amn jects with a conacmr(s)licensed pursuant to rhe Contractor's LicenseLaw. 205 — UNDERFLOOR INSULATION I am exempt under Sm. .B&P C for this reason 301 - ROUGH PLUMBING owner Date 302 - TUB & OR SHOWER WORKER'S COMPENSATION DECLARATION 303 — ROUGH MECHANICAL I hereby affirm under Penally of Perjury one of the following declarations: 304 — ROUGH ELECTRICAL I have and will maintain a Certificate ofConsent to self-insure for Workers Compere 3O5 — FRAME sation,as AmvWcd for by Section 38X1 of the labor Code,for the Performavac of the workmrwhichOi,Neai,isissued. 306 — HOLDOWNS ❑I have and will maintain Worker's Compensation Insurance,as required by Session 3 07 - INSULATION 3700 of the Labor Code,for the performance of the work for which this pe 't is issued. My Worker's C/ao�m�p�e/nsation Insurance carrier and PolicyI n�futemfnberranam4Q:�'sVl✓K 308 — SHEETROCK wrier:STkleIF9U & POIIcyNo.Yy_a6r- 6Jb 0406 309 — EXTERIOR LATH CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 310 - INTERIOR LATH (This section need not W completed ifthc permit is foronchundred dollarin)(10) 311 — SCRATCH COAT ,it less.) 313 — ROOF NAIL I codify lhn to he pedurmane,of the work for which this Permit is issued.I shall not 5 01 - FINAL ELECTRICAL ENERGY empluyany pp< in any mu roras t become subject the Workers ComPensalinn Law,ser carr/J t(inn nd7paWn _'� 502 - FINAL PLUMBING ENERGY nnN;cam NOTICE TO PL CANS:If,after making this Cenilicam of Gxcmption,you sbnuiJ 503 - FINAL MECHANICAL ENERGY become hit, to Worker's Compensation powism,of the Labor Colt.you must 504 — FINAL BUILDING ENERGY O 0 forthwith comply with such provisions or Ihia permit shall he deemed revoked — z CONSTRUCTION LENDING AGENCY 505 FINAL ELECTRICAL [-. Na I hereby affirm Wal Barrels a construction lendingagcncy for the Performance of 506 — GAS TEST Ci > the work for which this Permit isissued(See.31W7.Ce.C.) 507 — FINAL PLUMBING !I] Qcorrects Namc z LendersAddress 508 - FINAL MECHANICAL U O 1 codify that I have read this application and sw¢that the shove infmmmion is 509 — FINAL GRADE lL curtest.I agree las comply with all city and county ordinances and some laws relating U OU holding conslmctinn,anJhereby authnrimmprescmalivesnlthixciymenmrupopnnthe 5 FINAL PLANNING } W wove.menuoned PmPcdy for inspection purlwses. _ 14 FIN I WORKS (We)agree m slave,indemnify and keep harmless the City of Cupertino against F" lobililk,,jmlgmcnu,cosu and cspcnus which may in any way assents against said City 't U inconsectsome of the grantingof,hi,permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALI.NON POINT Issued by: Date ZS - Sm 10 S. / e . / 11�� Re-roofs Signet p�favector Ua HAZARDOUS MATERIALS DISCLOSURE Type of Roof II We applicant or future bei Wing occupant Stoic or handle Health Safet l az defined by the Cupedino Municipal CoNe,Cbapmr 9.12,and the Health and Safety Im.lCude,Section 255321m7 All roofs shall be inspected prior to any roofing material being installed. �Yca 0 N Will thea applicant or future building occupant useequipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove pP g by theo milia? nusair cnmaminan6asJcrncJbytheBay arcaAir Quill gManagement all stew materials for inspection. District? ❑Vcs 7 N 1 have read the hamadmis materials requirements untkr Chapter 6,95 of the Califoo- iialf"Ith&'wcry (rk.&,ctions255O5,25533md255.4.lun&r,u dJ ati[Wehuildiag does arty have atedut.Wal itis myresponelbiliywnotify the oxcu ant of the requ;r Lw ' tmalmmpmuWiaaum,eenracertmcamuf =p Signature of Applicant Date I l l0 0'1. Owner nt thmi ¢agent Date All roof coverings to be Class "B" or better