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00070130 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: . HUILDINOIrVXA P5 RANCHO DEEP r-L! DR PERMIT NO OWNER'S N .. HH1 KLNH I-- APPLICA'O IJA C ONE SANITARY NO. CON 1 Rod.NO. BUILDING PERMIT'INFO �+0i O O ARCIII'IECI'/IiNGINEER: RLIx F:LECF LL) M1IEcil w u — I-1 aaa Z S y LICENSEDCONI'RACfOR'S DIIChARATION cal Pilon o z= 1 henb,anh,n mat 1 amt Eccr.ed anter prov.,...is m Chapter 9 it, icn..... KITCHEN REkbb a u:t-uJ •;th faceless!ti](NXp or Dlvtannlnrthc Uadnes and Pmfesi,ma Cole.and mylian.e in ffall ull flled. X Q w V Lic.X [).at Cluny w 3 Umc SDECLARnnular ATION / C=°4 I I :pJ yfl 1 IIh le DECLAJ pal 1: u 4ccnwd Profiroilarl OWNER-BUILDER DECLARATION 1 hereby by Il th t c'enpt t theContractor's Licen,c Law Iia theIle l-Z>• following ri(Section 7031._Business d Pmf -' Cadei Any city orecarty pwh sl,requires it peen t to colhoolet.cher. mpm e.dem 1.h pu any vuucmre namrioo pr to in mmawu,ul. rcyulre,me applicant forsmch penult In ta he signed stmcntem mat he is beemed punuan,it,the pmvtsinne or the Comme"s Licen.m Law(Chapter 9 Sq. FL Floor Area a uatlon (cmnmencing will,Section 70001 of Division 3 of the Husinms and Pmfeesinn,Code) or that he it caemry tmrcefnrn and the basin lin the alleged exemption.A,ry violation of Section 7031.5 by any applicant for a permit subjects the applicant b)a civil penalty - of not more than Five hundred dollar,(5500). A "1 te Vj Occupancy Type 01,as owner of the propcn,or my employees with wases as their sole compensation. will Jo the work,and the,heactme is not intended nr offered for sale(Sec.7044, 10 — FOU N Isn,i w%s and Proles,on,Code:'I Contractor'%Llecnee law does out apply m an r speCllOns nwnet of property Who build,or I...rvve,mereum,and who does such work:himself 102 — PIERS or through his own employee..provided that such impmwerm n,s are not intended of alfated ka eldc.1f.however,the houd'mg or impmvemem is sold within one year of 103 — UFER co.nplefinn,the owne,-Wilder will have the tune,of prod....the,he did ora norm nr mpm,efnrpntplat.f%ale.). 104 — REBAR 0 L as owner of file pre,wily.am esclasively contracting with licensed molmeom,o 105 — ANCHOR BOLTS Lmi the project(Sec.71114.Eunimes,and Prife—ons Cwdc:)The Canmacan, ieeaneLaw dws not apply It,aa rwnorof,aulny who Haim,orimpmves thereon. 106 — SEWER & WATER cmal who commcl% nor cant project%with .t eomrnUon,) Ileen,ed panumm to the omment's Licersc 1-ax 01 am e,cntft under Sec. ,H&P C farhis mason 203 — UNDERFLOOR MECHANICAL ow°" WORKER'SCOMPENSATIONDECLARATION 204 — UNDERFLOOR FRAME I hereby affrin order poliallsol perjury onenf he following feel...tum,: 205 — UNDERFLOOR INSULATION L' 1 have .and will maintain a certificate of Content to,elf-mote for Workc.. 301 — ROUGH PLUMBING Compensation. a, fascicled for sty Section 3700 of tee Labor Codu. for the 302 — TUB & OR SHOWER perfomence of the work for which his peralit is issued. ❑waecamlwilluminwmWorker,Comper,al aha,urancea. .....edbySttn 303 — ROUGH MECHANICAL 371m of the IaKu care.nor he p dearmance of he work for watch this fermi.is 304 — ROUGH ELECTRICAL ,,,cd My Wader',ClacKiiwtion Insurance currier and Policy number arc: , C°m'/jy_f.�(� Policy No.: ' 3f0T5 — FRAME l-ETITIFICATION OF I XEMPnON FROM WORKERS* ,306 — HOLDOWNS COMPENSATION INSURANCE Mi,soedon need of he con,leed irthe plum,is nor one hundred donate - 307 — INSULATION umonmle,,.1 _ 308 — SHEETROCK I lenity that In the p dfmavi rJ't lit hick this.peonil M issued.l 309 — EXTERIOR LATH sn:dl not c.npl„y...,y vasa,.,m any a r,m nee aagem m the wsdcrh rnpematiom law.oI lehforrl.,,nee t 31.0 — INTERIOR LATH Applicant NOI'ICF:TOAPPLICAN'r:¢ane, akin.mi:cmhica,c,.r cac.tmmm.rou ahamJ 311 — SCRATCH COAT subfac,I,,nee Wo.kr,,Cany,enwuon Pn,v.,ion,of the Labor Gale,you.mut o Iratha'ithcomplywithsuch lowest onsnrthis pem,it,haRhedecmedrevoked. 313 — ROOF NAIL z n CON STRUC'IION 1.ENDINGAGENCY 501 — FINAL ELECTRICAL ENERGY I hereby affirm that there is u emisleudiun lending agency for the pedop...ce — of the woak for which this permG h is issued(Sec.3097. e C.) 502 FINAL PLUMBING ENERGY y q Leade",N""" 503 — FINAL MECHANICAL ENERGY lander'.Address cifyEm,lhaaaread0,.%appficmtornml,mtalll.,theabove ink....ani mtia 504 — FIN ILDING ENERGY Ls• F coerce.1 agree to comply with all city and county orsolances and state law%relating 505 — F RL E ECT R I L C V mWilling cumulation,and hereby authorize represenm,ives of,his city m enter uPon y ha:m,we.o.enEored au nyl,rin,,,i......p...N' 506 — AS TES F. 0. (We)agrce me.indenu.by and keep hannlesv,he Cityar Capenlnn against Vl liabilities, mm�n.c J c.pc which miry in any say wcrve again,.said 507 — I NAL B I 7 / (� U 7YSiSffi.,ur�al the sranta�g orthi,pemJt ivt UND. SANDS DWILL COMPLY WIT �I ©� Issued by: 508 — FINRL CALDatc ue ra sun nm,w ppi,miem'alum U:uc Re-roofs — EALARDOUSMAFGRIALSDISCLOSURE 510 — FIN PLANNING Will the applicant nr future Molding occupant store or handle hazatdnus neutral Type of Roof a,defined by,hc Co,,6 a Mmu,, nl Cole,Chapter 1).12.:.nd the Ilcallh,ed Safety 51.4 — F I' AL PUBLIC WORKS Gale.Section 25532(a)'! Ore, ❑No All roofs shall be inspected rior to any roofing material being installed. Will thcapprcemorfuture building occupant tseequipment orde-icesxahch If a roof is installed witho t first obtaining an inspection, I agree to relrOve mit ha la i air contaminants as defined by me Bay Area Air Vualile Management h.o-ieY all new materials for inspection. Applicant understands and will comply with O Ye, ON. all non-point Source regulations. I have real,he hoaaadee nmmaial,r,mo,cmal order Chapter 6 Y of the California Health&Safely Calc,Section,25505,25533und 25574.1 ll but iOhe buil) g es note ently have a tenant,that it is my m,pnnaihilirymno,if the ,wcufum 'u reynire cat,wnich mus nu me,prior m issu: ¢c 7Ceniti m of wrcr,. modaed agent C mlaO� Signature of Applicant Data 'O All roof coverings to be Class`'F3”or better OFFICE