01060033:. _.
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CONTRACTOR INFORMATION:
DING DIVISIONPERMIT
BUILDING ADDRESS:
PERMIT NO.
20748 RODRIGUES AVE.
01060033
OWNER'S NAME:
APPLICATION SUB DATE
NG STANLEY
06/06/2001
IPHONE:
SANITARY NO. CONTROL NO.
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ARCHITECTIENGINEIiR:
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Descri [ion
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It!oz
's -to
I hereby affirm that l am licensed under provisions of Chapter 9(commencing
with Section7000)ofDiv6fun3ortheBusiness and Professions Code. and mylicense
ADDITION 246 SQ.FT.
in full force and effete.
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3 u
Limn se Class Lic. p
DamCommem,
DECLARATION
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ARCHITECT'S
1 undersmnd my plans shall be used as public record.
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Licensed Professional
OWNER BUILDER DECLARATION
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I hereby affm,hat 1 a exempt from the Contractor's License Law for the
following reason (Section 7031.5Business and Professions Code: Any city or county
$25000 2
which requires a permit to consumer. alter, improve, demolish, or repair any anucmrc
Print tots arc Iso "Wrair thr.,ficartf mpenl file. signed!unemem
,w•• .-,• I FI r Ther• l Valuation
g'�r C.35 �O;1V ';��.q5
,hat tielicensed pnuwu to they n. of the Contractor'sL La(Chapter9
Sect 7(%jtll fl is 3 f,he Bitroes. JP fe.imo Cale)
(cam g with
or that he is exempt t1ma om and the basis for the alleged exemption. Any violation
_ ,}�V,r ..�1
--of Seams 7031.5 by any appllrom fora permit mhieere the applieam m n civil pcnnity
of at,nmethan fivehundred dollar, (s5W).
101AI v� ATION Occupancy Type
❑I. as owner miss, property,o, my employees with wages as their .to compensation,
I_ I
103 - UFER Required Inspections '
-will do',he work: and Ne .uaeturc is no, intended or offered for sale IScc. 71NW,
Busii,ers und•Prokssions Cole: The Contractor's License law does no, apply in an
owns, of property Who builds or improves ,hereon, and who Jac. such work him -self
104. REBAR_.
or through his own employees. provided that such improvements arc not intended or
- oRei14 for sale. If. however, ,ti buildingroem m is sold w thin one er of
build
_..� ._._ -... ___ __.-
105 - ANCHOR BOLTS
comple,on the owxt-bulde 'ill have , burden of moving Ill., he did or or
improve far"arpns, or ale.).
106 — SEWER & WATER '
--- ... - — _
__hep.pi(Spens.ail.Buiniss and,maingwinrcenedeThe
— -- -- — — — ----
202 — UNDERFLOOR PLUMBING
Contrcta,n
Wlds or„passesm Contractor's
Lcenee�we does not sml7m an owner of and Professions
oPr p
203 — UNDERFLOOR MECHANICAL'
rid who comracs fors ch projects with ,mlums).l seep nt _tame.._
......._.204'--..UNDERFLOOR-:'FRAME'——--'---....- ----- --... --
Conmcror s Lic
❑l mexem u B&Pero mi.rc nn
p
205 — UNDERFLOOR'iTNSULATION
owner D.n,eP'�yw
3O1 - ROUGH PLUMBING
-
WOR PENSATION DECLARATION
-
302 - TUB & OR SHOWER
Inerebyarr,munde,penalryorperjuryangnnnefollowingdecm,summa:
303 - ROUGH MECHANICAL
❑ I have ride wul'maintain a CerW&um of sondem to self.insum for Worker'.
3 04 - ROUGH ELECTRICAL
Compensation, as provided for by Section 3700 of Ne Labor Code. for ,he
performance of the work for whim his permi,, is j ... ed, .
3 05 - FRAME
01 have and will'mhinmin Worker'i Compensation Insurance, as required by Section
3 06 - HOLDOWNS
3700 of due Labor code, for the Performance of work for which this Permit is
3 07 - INSULATION
Insurance carrier and Policy number arc:
tssuyWorker's Compensation , o re
^ _. _.-.-,. ...
_
Cart policy No
'`
f EXEMPTION 1CERTIFICATION RKERS'
p,= �BS$EETROCK..
(-+, 309'f'XTERIOR`L'ATH
COMPENSATION INSURANCE—
- - - -
.310 = -INTERIORLATH —
.. (Th{s'.section need nut he cmnplmcd Hill. perms m
I, for e hundred dollar.
311 - SCRATCH COAT '
l5l0(k I . 1 <
' I lenity hot a h pc lk ma rfh k for whrxh_mIl x „s ismed, l
- -- - --- - - - - - --
313 -,--'ROOF NAIL'7 -- - '
'.shall of my on any person in any r,ro subject bj t u the wnrkert.
501 — FINAL ELECTRICAL ENERGY
c6o,palmmusion aws of C I f .' D te
-:Appl t_ -- - -
- 502 - -FINAL -PLUMBING ENERGY"'-
,NOTICETOAPPLICANT. If. n king this CcrificateofExemption, you should
beco un theta k C pens, p Cale you nun
503 — FINAL MECHANICAL ENERGY
0
hall be ecured
fnnwimrnmplvwhramTRUCTIONLEsDINGAanbed ned,evnked.
it o
_504_.-_FINAL-BUILDING—ENERGY--
CONSTRUCf10NLENDINGAGENCY' - -'" i
'Ihereby for pertomance
505 - FINAL ELECTRICAL
ai >
Ifrm that Imm is a con%unation lending agency the
of the workfor hi,h his Permitis issued(Scc 3097 Cis. C)
506 - GAS- TEST.... a._....
y p
d "
.- . . _ --
507 — FINAL PLUMBING.:
v'O
LenJcr s Address
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508 - FINAL MECHANICAL
1 «nify mm 1 have re:W ,his appllcatinn and same iha me above information
loner, 1 agmen cumply all all ri,, and county nnlinanccs and slams law, rclaang
509 - FINAL GRADE
to building samsuuaion,'and hereby aumsMm mptcxnrrum, f,lii.:q'ur crier upon
the above-intentronedproperty f.peer p rq..
'fyandIme,
510 — FINAL PLANNING
CLI
lin
U
(W) geer, d le.sorCil, rCpn nagTnn
Bab 1, l pg ents , q penins n n y in any y gains and
rourn
f'Hg.DS
C'PLICANT
514 — FINAL PUBLIC WORKS
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ON E DW;L�pyR!OMPLY WITHALL N INp/nINT
U
Issued by: Date
SOUR $EGU I(3 7' `'.' 7/ 41, 0 y
T, (—bat=
Re -roofs y
Signa fApplicanicammcmr
HAZARDOUS NIERI LS DISCLOSURE
.. "'
Will the applicam or future building occupant store' or trundle hazardous material
.- Type Of Roof - --'--_ ...•. - - --. _ '... '�
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
., rh , ; „ • .r ., .,; _,.,, •:
s ' •.... :': s• f. ' a
Cade. Section 155 02(11 .. - •.
. 'ores '1•'^ oNa'•All
' s i : ;
roofs shall be inspected prior to -any roofing material.being.installed._
.Will the applicant ormturcbuilding ocrapantuse cgmpmmtordcvlcc.which
If a roof is installed without first obtaining an inspection;•1 agree to.remove
emit Woura mnit emmundmnts as defncd by ,he Bay Area Air Qualityki.... col
Di ire
all new materials for inspection, understands and will comply with
...
' Cl Yes D"° r� : " .'
,Applicant, -
all non -point source regulations..
1 have read ,he hiaa,dots materals requirements under Chapter 6.95 of the
l
'California Health & Safety Code. Sections 25505.15533 and 255311 understand that
ifineuTdia e. m,mi ly hmc a tenan,Jhat it is my resronsibil'vy to notify the
..
xuT
h which iriun be ret prior m In hale of Cenilicate of
'occupanM."'Cism
-
err a
SignatureofApplicant Date _.
All roof coverings to be Class "B" or better
rtet Din
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::. ,. -.. .. _. _. ... ..._ OFFICE - _— - ---- - ..
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