02070173 CITY OF CUPERTINO �i 'p T jay ..
BUILDING DIVISION PERMIT +'COL\%11CT «.`IN��A�lYAATAOA\
ai't"BYIS MTA LUCIA RD EARTHQUAKE READINESS . PERMIT No.02070173
EBAUM 236 STANFORD SHOPPING CENT EffMITISEIJE9A7Fy 7/2003
E: SANITARY N101.4 1 CONTROL NO.
(650) 324-3322
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
±00 LICENSED CONTRACTOR'S DECLARATION (_J O O O
m 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
l z,y wilhscetion7") fD'viaion3ofte Rus sa" P1. ammac c a dm liccnscis
;pN in""'arca d t. Y
qz trema 1 « vq�� BASEMENT ADDITION AND P1N�L�'®
p Datc cooNN[[vetoJJ Ea«Klcltr EISMIC UPGRADE
3eeq-i< cm Gs11TE used as
1 't pp q
CyUundcrson yplans�hallhcmcdaspublicrccnrda MAR 1 U 2004
U
oy Licensed Pmarsoonal
S OWNER-BUILDER DECLARATION t, 1
<f 1 hereby Motion that I am exempt from the Contractors Licence Law for the
O B(/UI`®'NO following mason.(Section 7)31.5,Business and Professions Code:Any city or county G
<$e� which requires a permit to construe,alter,improve,demolish,or repair any structure
'!Z< prions its issuance,also requires the applicant for such permit m Neasignedatatemcut
that he is licensed purcuanuo the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section 7")or Division 3 of the B usiness and Profession Code)or
Net he is exempt therefrom and but basis for Be alleged exemption.Any violation of0
Section 7031.5 by any applicant for a pmmh subjects the applicant to a civil penalty of APN Number Oceu ane
not more than fin hundred delta.($500). P Y Type
❑L to owner of the property,Or my employees with wages as their sole compensation, 342 17056 . 00
will do the work.and Ne swctum is not intended or offered for sale(Sec.7614,Business
and Professions Code:The Contractors License law does not apply to an owner of Re uired Inspections
propenywho builds orimprona thereon,and who doessuchwork hrecodfor through his 101 - FOUNDATION
own employees,provided that such improvements are not intended or offered for sale.If. 102 — PIERS
however,the building or improvement is sold within one year of completion,Ne owner-
builder .will have the burden of proving Nat he did not build or improve for purpose of 103 — UFER
sale.).
I,as owner of the property,am exclusively contracting wit licensed contractors m - 104 — REBAR
construct the Project(sec.70A4,Business and Professions Cade:)The Canuacmr's Li 105 — ANCHOR BOLTS
cents law does not apply m im owner of progeny who builds or improve thrown.and 106 — SEWER & WATER
who contracts for such projects with a contractor(s) ractor's
r(s)licensed pursuant the Cont
Lina Law' 202 — UNDERFLOOR PLUMBING -
❑lamexemptunderSec. ,B&P C for this Russian
203 UNDERFLOOR MECHANICAL
Owner ole
WORKER'S COMPENSATION DECLARATION 204 — UNDERFLOOR FRAME
I hereby affirm under penalty of pajury"^e of Our following declarations: 205 — UNDERFLOOR INSULATION
❑l haw and will maintain a Cerificme of Conscm to self-insure for WorkeriCompcn- 301 — ROUGH PLUMBING
sation.as provided for by Section 3700 of the Labor Code,for the perfe,mance of the 302 — TUB & OR SHOWER
work for which this permit is iuuee.
❑1 have and will maintain Workers Compensation Insurance,as required by Section 303 — ROUGH MECHANICAL
3700 ofth,labor Code,for the performance of Lou work for which Los permit is issued. 304 — ROUGH ELECTRICAL
My Worker's Cn pensation Inco,na1 d P"hcy n
Pll 305 — FRAME
CERTIFI'LATE OF EXEMPn0 FROM WORKERS' 306 — HOLDOWNS
COMPENSATION INSURANCE 307 — INSULATION
or Ice.)(Thu action need oat he completed if the pttmit a for ane hundred dollars($1 on 308 — SHEETROCK
1 certify that in the performance of the work for which this permit is issued.I shall not 3 09 — EXTERIOR LATH
employ any person in any manner so in at become subject o the WorkerSCompcnsation 310 — INTERIOR LATH
Laws of California.Data
Applicant 311 — SCRATCH COAT
NOTICE TO APPLICANT:If.alter making thin Cenificele of Exemption,you should 313 - ROOF NAIL
hccome subject do the Work.,a Campcnmion provisions of the loan,Code,you meq
)z forthwith comply with such provisions or this Permit shall No deemed Revoked. 501 — FINAL ELECTRICAL ENERGY
Z� CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY
I hereby affirm Nat there is a congmction lending agency for the performance of 'SO3 — FINAL MECHANICAL E
Yi ti the work fur which this pcnnit is issued(sec.J097,Civ.CJ
z] q Leoder'a Name 504 — FINAL BUILDING ENE G
D z L nder'sAdem 505 — FINAL ELECTRICAL
;J 0 1 certify Net I have read this application and short that Ne soon information is
3r F, CORMLL I some to comply with all city and county ordinances and sole laws relating to 506 — GAS TEST
U building conswchim,and hereby authonm representatives of this city to enter upon the — FINAL PLUMB NG
shove-mentioned property for inspection purposes. 15N I
�" y (We)agree to save,indemnify and keep harmleu the City of Cupertino against 0 — F I AL
N liabilitics,judgmcnts,teats and expenses which may in any way acerae agalnalind City
;J,Z in consequence of the granting of this Permit. S —
APPLIC NT UNDE STANDS AND WILL COMPLY WITH A ON-P INT Issued by: - ING Date
S E A N . D
Re-roofs 514 INAL PUBLIC WORKS
roaclort6^emrcR ApplicaHAZARDOUS MATERIALSDIS OSU E ndlCoDalc Type of Roof
Will Me applicant or future building Returned strindle havardous material
as defined by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safety
Code,ScctYcona 25532(a)?
❑ NR All roofs shall be inspected prior to any roofing material being installed.
<
Will the applicant ful building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hazardous air contaminants as defied by the Bay Area Air Quality Management all new materials for inspection.
Listu ricl?
❑Yes o
I have read the hipindims materials requirements under Chapter 6.95oftheCalifor-
nia Health&Safmy Code,Sections 755(15,i35 3 and]5534.1 undenwd Nod if the building
d t c rten(I haw a d,Nati is m Rea ibilil m no,fy the wcu ant ofthe
rew ni n e thio acL. oroetn A Signature of Applicant Date
Rr amnanvee agent a,c All roof coverings to be Class "B"or better