00060118 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
N 00060118
OWNER'S NAh l: RESULTS WY APPLICATION SUB HATE
S11 nTuTrTnN STRIFE 06/16/2000
PHONE: 1 SANITARY NO, CONTROL NO.
(408,I77q— 4001
pp z i ARCHITECLENGINEER:
I{DILDINC,PERMIT INFO
00 BhD ELECT, PLUME MECH
dU I_I I_1 l=1
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loNz LICENSED CONTRACTOR'S DECLARATION Job Description
z_ 1 hereby of inn Ilea I am licensed under pronm
vi.,kne,of Chaplar 9(emencing
Y N6. with Section 701N11 of Dlvi,ion l of he limuac,an t Prole, Calc,and Illy Inverse
=Y i,Etm Class a 'u:<,. �L EXIT RAMP'
a Lmenxc cls,, Lm.x_Oa1" -
X 3 E- a c./°_S-7 a Contractor
—
1- I)ECLARxnoN
ta 0 I onlle"en l my,lams ehull be used an public nnml,
y zO O Luca,ed Prol'e,xiamed /
a' /y,2
a_ OWNER-RUILUER DECLARATION
1 hereby uaimt that I am exempt Earn the Contmnnr'x License Law far the
F z t FJlnwing rca,oa hivoiun 70315.Hu,inev,and Prole,eimxs Calc:Any city or cotmty
zz a which require,a permit m varsvucl.Eller,improve,demolish,or repair uny Ilorlmm -
a,er ,in on ne.s i....nualso requires the applicant forxnch rtiuo
emrile a signed smlna
etnl
mat he ix Licensed punuanun the now i,;on,of the Connectors Lhrense Law(Chapter 9 Sq. Ft. Floor Area Valual
(commencing win,Section 700)of Division tot IM Business and Profession,Csdq
later,he i,Lia uEm nutlet'rnm and the luno for the alleged reen,tion.Any violation
of Section 7031.5 by uny arplinnn far a permit subjccn the applicant to a civil penalty
of am marcman Bee hundred dollars(S500). APN Number Occupancy Type
❑I,as owner onhe pral or my emphyces with wages as their sole eorapenmtion.
will do Ileo walk,and It,nlmone I,nut ineendcd or nu,,d fur sale[Sec.7144, ,-t•- t—
na.ine,and I'ndc,lan,Code:The C.... is License Law duo,not apply le It •Required Inspections
m r of PmpcaY Who(wild,or immt
pnmu,men.and rhes does such work himsell
,,t through his own employee,,pmx+ded that such httrmxementx am not imtended or 101 — FOUNDATION
ollemd for sale.If,however,the building or improvement i,sold within one year of
Latplelinn,ton"re,faddcr will huva rhe Itardea or pro ug tont hedm Eat build or 102 — PIERS
mpmvc far puEmse of sulci.
01.as owner of the properly.am exclusively contracting is ill licensed contractors to 103 — UFER
construct the project(see 7044,Business and Prole.,,ions Ctdco The Contractor, 104 — REBA R
lece,c Law dna not apply ah an owner 1,I propcdy 1111,bdddx or improve,thereon.
and who comr..s lin,,aces project,wilh.rmthrulanxl Iiccaxed pursuant Ise he 1.05 — ANCHOR BOLTS
Comraator,Liccme Lax'.
0 l am exempt under Sec. ,R&P C for this reason 106 — SEWER & WATER
Owner Dale 202 — UNDERFLOOR PLUMBING
WORKER'S COMPENSATION DOT ARATION
203 — UNDERFLOOR MECHANICAL
I hereby affirm under Penalty of x,my one of the following declaration%: 204 _ UNDERFLOOR FRAME .
E] I nave and will h a Cc micate of Cmnent I1, ,elf.insum sur Wmker, 205 UNDERFLOOR INSULATION
Compensation. a, ,...sided for by Section 9700 of the Limit, Cale, far the
,er4moanee of me wark far which this .it,in ioued.
301 — ROUGH PLUMBING
❑I have and will maintain a the
Comniece Inn Insurance,m required by Section
?70x)of ton Lmnr ease nhr me pmrthnmanae 1,.r the Ind,ro; wlnm Ibis peo,dt i, 302 .- TUB 8 OR SHOWER
i...ed.MyWor r,cooil lna In,amne,latterand Polaymnmerrate 303 — ROUGH MECHANICAL
canier.0�-rS IL policy Sec:
CER GPICATION 017 EXEMPT ION FROM WORKERS' 304 — ROUGH ELECTRICAL
COMPHNSA'IIONINSURANCE 305 — FRAME _
flbi,section need not fir conipletw if the permit i,for ane hundred dalliers 306 — HDLDDWNS
(aI(xn nr less.)
Iacan,mat..I On,ped,unrecc It he work lar 1Idc1,1111,look i,eaed,l 307 — INSULATION
shall act employ any Peron in anv ntaoner v,as to hemme whlecl In the Worker, 308 — SHEET ROCK
Compensation Wats of C.1ifnmi..Dae
Applicant n1,hd 309 — EXTERIOR LATH
Nal ICE 10 APPI,ICAN 1':If,after making this Cenhicam of Exempt iu I you,
necome,nniea due e Wakes e
Cmnpeamnn pr... lon,,)I he Labor Code.In -,,a,'a a,t 310 — INTERIOR LATH
Q O Ionhwitn enne,11 web such provisions or this recent shall M declined revoked.
Z
311 — SCRATCH COAT
^
CONS emUCT10NLENDING AGENCY
C n,aIn,whichIn,memf, amnmee3aN7.C.agcmernhrmapedlhmta^cc 313 — ROOF NAIL
Lea a work rm which Illi,pcmm a i„ucA(Scc.lfhJ7,civ.C.)
y p
Leader's Name 501 -- FINAL ELECTRICAL ENERGY
i7. 7 Lcader',Address —
u o 502 . FINAL PLUMBING ENERGY
cagily mm Wmc read and ,it;adermethaltted ,am na,ellai" MECH CAL ENERGY
tot t✓ emrcet.I agree to emu„Iy who hl shy and anl�ay mdnnaaa,Lina stole mw,rclming 503 — —
O U In in ing....Nmet Mherenynmmomerrytrc>enmtive•,nfthi,citymenterurym, Sta4 FIN BUIL i G ENERGY
} W the.Muir-amatinn, pro toy forimpeebarlIagxnes.
Fy96 (W agreed . indemnEyand keep hunnln,the CiryofCupcninl agolnsl —
m
ler if nags,1,I b.M Ix'aw,winch ted:ay in, my xxn mama ag:daxl,aid 505 F I ELE T CAL
U Z City in , ,.qu aft gm ng nfthis pcount. _ O
^ Air E A SANDWILLCOMPLY WITH ALL
aaNON-PO/�TN��f •ISsnedby: 506 'ST DeIC
'f LA
:loco clef A, lilanveomoLlhur — Dale Re-roofs 508 FINAL MECHANICAL
HAZARDOUS MATERIALS DISCI
Will lea applicant or future building recreant Nom or handle hanudmusmamrial Type of Roof 50 — FINAL GRADE
a,defined by the Cupcnino lbmicipal Code,Chapter 9.12,and the Health and Safety
cull,S,.wn 25532,,'1 r1 q
❑Ye, oNn All roofs shall beG1���s ected r{TTcl�1xxill�t�Qt''�an[p�Yp[llTito 1 Ir�7(n,�ltW'egr�(.Jl�'}{1��I �!ng installed.
Will the applicant or mum building occupant use equipment or devices whet ifaroof is lnstallBU` Ithoul fS'POtl[a1I11� �n IiSpCCINII agree to remove
call harardoes an conmmimna a,delincd by the Bay Area Air Quality Management
Dllim” all new materials for inspection. Applicant understands and will comply with
El yes ❑Na all non-point Source regulations.
&have
material, 101,1 111 a under(.Tarter 6.95 ofhatduc
Smateri,255p5.25511,underchaptedemmnd thatch mtmI be e v pri hr ah i,suanee 1,I a Corllfcme of Signature of Applicant Date
I�, All roof coverings to be Class ••B"or better
Vier 1,r��anmrired:ago,,,