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03050125jo� gU.z. ';1 c �a= Cyt: t�H �Oa qqqN— CDC ,go 0^v —za CITE' OF CUPERTINO BUILDING DIVISION PERMIT£'� �� 5. .� BUILDING ADDRESS: PERMIT NO. S & S TILE INC 03050125 RPIMPAN-fft BELL P ri13ERMIT ISSUE DATE 1720 ANGELA.STREET 05/27/2003 SANITARY NO. CONTROL NO. (408)293-6004 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing P With Section,70(�P) of Division 3 of the Business nd Professions Code, d my license is in full force ah4cffe .'i( t, f LicenscClas L ADD SKYLIGHT/JACUZZI/BATHRM UPGRADE Date C OMO r R ARCHITECCS D ATION 1 c'stand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor AreaValuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $5000 5O00 that he is exempt therefrom and the basis for the alleged exemption. Any violation of ,�j�-,jam j�j be� 5 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of hot more than rive hundred dollars $500). 3 L �"(J O ❑ I, as owner of the property, or my employees with wages as their sole compensation, 101 FOUNDA'ied Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law docs not apply to an owner of - property who builds or improves thereon, and who does such work himself or through his 10 2 — PIERS own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner- 103 — UFER builder will have the burden of proving that he did not build or improve for purpose of 104 — REBAR sale.), ❑ I, as owner of the property, am exclusively contracting with licensed contractors to 105 - ANCHOR BOLTS construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li- 106 — SEWER & WATER cense Law docs not apply to an owner of property who builds or improves thereon, and , who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's 202 — UNDERFLOOR PLUMBING License Law. ❑ I am exempt under Sec. , B & P C for this reason 203 — UNDERFLOOR MECHANICAL 204 - UNDERFLOOR FRAME Owner Date ' WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION I hereby affirm under penalty of perjury one of the following declarations: 301 — ROUGH PLUMBING 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen- 302 — TUB & OR SHOWER sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 303 — ROUGH MECHANICAL I have and will maintain Worker's Compensation Insurance, as required by Section 304 — ROUGH ELECTRICAL 3700 of the Labor Code, for the performance of the work for which this permit is issued. 305 — FRAME Coompensation Insurance carrier and Policy ny�+�ber ate: My Workeress Ca 'c �.� � PolicyNo-��7f>755 2e- 306 — HOLDOWNS �J( CERTIFICAMOF EXEMPTION FROM WORKERS' 307 - INSULATION COMPENSATION INSURANCE 308 — SHEETROCK or less.) (This section need not be completed ifthe permit is for one hundred dollars ($ 100) 309 — EXTERIOR' LATH I certify that in the performance of the work for which this permit is issued, I shall not 310 - INTERIOR LATH employ any person in any manner so as to become subject to the workers' Compensation 311 — SCRATCH COAT Laws of California. Date Applicant 313 - 5 01 - ROOF NAIL FINAL ELECTRICAL ENERGY NOTICE TO APPLICANT: r' Co making this visions o of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 502 — FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - F I NAL MECHANICAL ENERGY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (See. 3097, civ. C.) 504 — FINAL BUILDING ENERGY Lender's Name 505 - FINAL ELECTRICAL Lender's Address 5 0 6 — GAS TEST j I certify that I have read this application and state that the above information is t correct. I agree to comply with all city and county ordinances and state laws relating to 507 — F I NAL PLUMBING m building construction, and hereby authorize representatives of this city to enter upon the 1 above-mentioned property for inspection purposes. 58 - ' F I NA ME CHAN CAL (We) agree to save, indemnify and keep harmless the City of Cupertino against 5 9 F I N j liabilities, judgments, costs and expenses which may in any way accrue against said City ' 51 in nsequence of the grantin of this permit. AP CANT U ST DS AND WILL COMPLY WITH ALL NON -POI — Issued by51 Date _ K Re -roofs Type of Roof T rgoat c li L`ontractor E5atr HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? �JNo. All roofs shall be inspected prior to any roofing material being installed. ❑Yes If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or toluic building occupant use equipment or dcviccs.which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes �'vu [havercad r`hvardousma rialsrequiremcn1sunderChapter6.95ofthcCalifor- niaHealth&Sad Cod ,Sectio 5505, 25533and25534.1understand that ifthebuilding does not curreo y ha a nam at it is my responsibility to notify the occupant of the requir anis ate