03050106 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 0CUNfR C-ffiINFORMATION ;
BUILDING ADDRESS: A+' PLUS CONSTRUCTION PERMIT No.03T0��50106
NER'S NAME: - 70 S WHITE RD P``"rEa��/ 22/2003
SAN KRTRRNAMTTRATTjV
PHONE: (408) 251-3733 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
100 LICENSED CONTRACTOR'S DECLARATION JbDescri tion
1 hereby aBbop
m that l am licensed under prevision of Chapter 9(commencing
hap Section 701X11 of Division7of the Bwi and Professlum Cado,and my"""'a
in full f en affect.
;gZLlaencc L . REVISION--IN HOUSE USE ONLY
Date c achemeNO NEW PERMIT ISSUED, ORIG. 403030137
' \ ' ARCHIIECTSO ARATION
I 4h,/I mMeuund my pins shall he used u public records _
G� Licensed Prtttcaoi...I /)
OWNER-BUILDER DECLARATION C
j<x 1 hereby mnrm that I am exempt from the Contractor's Ucenco Law for the
OO following reason.(Section 7031.5.Business and Profrssioas Cale:Any city or county
ISO! which requites a Pamela at commas,slue.improve.demolish,m mrs it any structure
-iy prior an its Worse.,alsonquima tape applicant for such Permit at flea signed mtemen"
that he is licensed pursuant to the provision of me Common's License law(Chapter9 Sq. FL Floor Area Valuation
pG (commencing with Section 7")of Division 3 of the Business and Profusions Cnde)or
L that he is exempt therefrom and the basis for the alleged exemption.My vacuum of
Section 7031.5 by any applicant for a permh subjects the applicant to a civil penalty of APN Number Occupancy Type
not more man Eve hundred dollar(6500).
pl,uownor of site propeny,mmy unpl.ycu w0h wguutheir sok c.mpencotim. 36908043 . 00
will do timmak and the strunurt is not intended oroRered for ask(Sec.ION.Business q
and Profession,Coal The Caricatures License law does not apply m an owner of 101 - FOUNDATION
Inspections
property who builds or The Qu rcun,and who don such work himse If or mreugh his
own employees,pawlded that such improvements are not intended aroResed for age.If, 102 — PIERS
however,the building or improvement is rola within one year oteompletion,me owner.
builds,will have the Innocent of preying dat he did vat build m Improve to,purpox of 103 — UFER
"k')' 104 - REBAR
❑1.as owner of the propeny.am exclusively contracting with licarm d comncmn to
convect the project(See.7096,Business and Profuuons Code:)The Comuctote Ll- 105 — ANCHOR BOLTS
ane law does not pply to an owner of property who build,or improves thereon,and, 106 — SEWER & WATER
who contracts for such p bjeca with a canwcmr(s)licensed punctual m the C.nuactoes
License law. 202 - UNDERFLOOR PLUMBING
❑lam exempt under See lig Pefor this reasm 203 - UNDERFLOOR MECHANICAL
1 r-2
204 - UNDERFLOOR FRAME
WOR ER3 COMPENSATION N L
I hereby aRhm under penalty of Injury mat of de following dakntion: 205 — UNDERFLOOR INSULATION
❑Ihaw and will maintain aCenifncau of Consent m self-inure far Worker's Carper. 301 — ROUGH PLUMBING
color.as provided for by Section 3700 of me labor Code,for the performance of the 302 - TUB & OR SHOWER
work far which this Permit isishad. 303 - ROUGH MECHANICAL
1 have and will maintain Workers Compema d.n Insurance.as required by Section
3700.1'mc Labor Cade,for me perfmmuce of the work for which this .a,is 304 — ROUGH ELECTRICAL
My Worker's Compensation Insurance carrier and Policy number are: 305 — FRAME
Carrier: Polley 306 - HOLDOWNS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 307 - INSULATION
(11d,=am need notal completed if me permit is rear am hundred dollars is 10.7) 308 - SHEETROCK
orI...) 309 - EXTERIOR LATH
e certify that person
me performance of me wad for which this the,W is issued.I shoal not
employ C.lifu iAmany mmnarsnum become mbjau.me Wodori Compensation 31O — INTERIOR LATH
laws of Celif.mia.Dau 311 - SCRATCH COAT
Applicants
NOTICE Subject
APPLICANT:If.atommusing mu Crnoncau of Exemption,you should 313 - ROOF NAIL
become subject y it Worh ro Compensationonsor sprovision of the rredr Code.you renal
,J'� foMwi"h comply with such provisimrmthis pmcmtuhallWdccmrA ranked. 501 — FINAL ELECTRICAL ENERGY
z O CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY
(., En I hereby&Man that them is a construction lending agency rot the,Performance of 503 - FINAL MECHANICAL ENER Y
Ca > aine far (See issucd(S .J097.Civ.
UndoesCJ
Name 504 - FINAL BUILDING ENER
r[1 Q
Undoes
= z snaraAaam.• 505 - FINAL ELECTRICAL
U O 1 modify that i have read this application and sum that the above information I. 5 0 6 - GAS TEST
0 !'. cancel.I agree to comply with all clay and county ordinances and rule laws relating m
rV' building convection,and hereby authorize representative,of this city mortar upon dm — FIN L PLUMB G
r W shove-mentioned property for inpccoon purprm•
a4 sju agree m cont,indemnify red keep harmless the City ru Cupenito against VO F I AL
F"0. Iisblliti(We)
cru and expenses and beep
in say x City ore.gsinno,g City
1'J Z in...xqucne.f the Samuel of this peranit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: TNG Date
SO RCER GUL ONS.
a S-z z•, Re-roofs
tinuurt of Applic tacter
HAZAR OUS MATERIALS SIECLOSURDate Type of Roof
Will the applies'"or future Wilding occupant use as handle heurdow material
u&flood by the Cupenim Municipal Code,Chapter 9.13,and are Health and Safety
Secti..35533(0)7 All roofs shall be inspected prior to any roofing material being installed.
0Y Nu
r will the applicant or rut m building occupant LLW equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hnu l...air conuminenU u by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
I hew road me bmardaua mamdals requirements under Chapwr6.95 of the Califor-
his Hcal"Safely Cads,Section 25505,35533 and 25539.1 undemand that if the.Wilding
Jars wee cumntiy haw a tens that it u my responibiaity mutify Ju Occupant rf me
mqu' menu which mug be riorWbar .raartifea fatapa'ty. Signature of Applicant Date
A All roof coverings to be Class"B"or better
water m amhomcd agent Dow /�