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CITY OF CUPERTINO
BUILDING DIVISION PERMIT;CONTRAC�T,OR
INFORMATION:
BUILD(
PERMIT NO.
z''6' SCOFIELD DR
03010105
OWNER'S NAME:
APPLICATION SUB DATE
1STEVE YANG
01/21/2003
ONE:
SANITARY NO. CONTROL NO.
a
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
I that I am ccnmmensing
under pmvisines msCork,r
Job Description
fthemd
i
with Section ]t%%q of Division 3 of the Ousincsa anJ Pndcsaions Cork,mind my license is
ionhereby70 (ditf
infndforceandeffect.
ADD 139 SQ.FL�REMODEL
p�
FINALED
License Class Lic.Mal
Dole Contractor
ARCHITECM DECLARATION
1 understand my shall used as records
APR 0 6 ^004
plans public
Licensed Prou,sinnal
OWNER -BUILDER DECLARATION
License Law for the
1 hereby affirm Nal 1 am exempt from the Cssions
BUIL®ING
following maven. (section ]03L& Business and Co
Professions Code: Any city nrru county
my
alley, improve, demolish, repair any structure
which requires a Pennit m improve. de
ai.s, c h you file
plat, m as licensed ro vision nl /lar Con permll In IIIn se Law s hapten ll
p a1&1 nt to the Provisions
(commecingwitpursumnmmepmvivisnsmlheCmtramoFandProfssionsCptcn9
Sq. Ft. Floor Area $60`Q3�Qtion
(commencing with Batton V1100) of Division 3 oft Professions Codc) or
exe and
on. An
that he is excmpl herefmm and the basis for the alleged exemption. Any violation of
al eged
Section 703in..5 by any applicant for aPermit subjects she applicant to acivil penally of
e
Occupancy Type
na. mon Bvc hundred dollars ($500}
re Na
D I, as ownerof The pmpeny,or.,employees with wagesaslhcasolecnmpensatom,
will do the work. and the structure is not intended or offered for sale (Sec. 7094, Business
an l Professions Code: The Conuaclor's License Law does not apply to an owner of
—
102 —
FObN
PIERS equtred Inspections
pmperty who builds or improves hereon, and who does such work himself or Ihmngh his
own employees, provided That such improvements are not intended or offered for sale. If,
103 —
UFER
however, The building or imposo mens is sold within one year of completion, the oremer-
10 4
REBAR
builder will have The burden of proving that he did not Mild or improve for rpnac of
—
sale.).
105
105 —
ANCHOR BOLTS
❑ 1, as owner of Ne property, am exclusively contracting with licensed contractors to
10 6 —
SEWER & WATER
construct the project (Sec. 70,14, Business and Professions Code:) The Contractor's Li-
Li-
cense
eeLaw cars not apply mheated.
202 —
UNDERFLOOR PLUMBING
o contracts for such projects with a comments) licensed pursuant o me Contacmr's'
License Law.
203 —
UNDERFLOOR MECHANICAL
❑ I am teem,, under Sec. ,B&P C far his reason
204 —
UNDERFLOOR FRAME
Owner Dale
205 —
UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
301 —
ROUGH PLUMBING
(hereby e0ilm under Penalty of perjury one of the fallowing declarations:
302 —
TUB & OR SHOWER
❑ I have and will mainsaina Cenifcate of ConuntmxlLinsum far Wmker'sCampen-
aa.ion, as provided fur by Section 3700 of she labor Code, for the perfotmm
ae of the
303 —
ROUGH MECHANICAL
work for which this Permit is issued.
304 —
ROUGH ELECTRICAL
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
305 —
FRAME
37M of Ne Labor Code, for Ne performance of he work for which this permit is issued.
My Worker's Compensation Insurance carnia and Policy number am:
306 —
HOLDOWNS
Carrier: Policy No,
307 —
INSULATION
CERTIFICATEI
COMPENSATION INSURANCE RERS'
308 —
SHEETROCK
(Thissect5on neednm Mcrmplmed ifthe permitismronc Mndecddonars($100)
309 —
EXTERIOR LATH
toles.`)
310 —
INTERIOR LATH
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner.so as to become subjecuo me Wmkers' Compensation
311 —
SCRATCH COAT
Laws of California. DateApplicant
313 —
501 —
ROOF NAIL
FINAL ELECTRICAL ENERGY
NOTICE TO APPLICANT. I I; after making this Ceniticalc of Exemption, you should
become subject o the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this Form it shall M deemed oinked.
502 —
FINAL PLUMBING ENERGY
503 —
FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
Ihembyamnmout mcmisactammonium Rome, agency lbrthe pemmmanmof
504 —
FINAL BUILDING ENERGY
the work for which this pem,iIisissued (See.3Bv7,Cis. C.)
Lender's Na mc
505 —
506 —
FINAL ELECTRICAL
GAS TEST
Lenr's Address
de
1 comfy that I have read this application and state that the above ialinmation is
507 —
FINAL PLUMBING
correct. 1 agree to comply with all city and county ordinances and state laws mining to
building convection, and herchy announce representatives of this city to enter upon the
FINAL MECHANICAL
about-mcutionedproperty for inspectionpm,nses.
Oes
FIN
(We) agree m save, indemnify and keep harmless the City of Cupenino against
Iiabi lilies. judgments, costs and expenses which may in any way acerae againslsaid City
5
G
in his Permit.
of the granting of
APPLICANTeUNDERSTANDSTAND WILL COMPLY WITH ALL NON -POINT
Issued by:51
WORKS Date
SOURCE REGULATIONS.
Re -roofs 603 —
OOF BATTENS
Signawm o[AppllwnVConuanor Dole
HAZARDOUS MATERIALS DISCLOSURE
Type of R644 -
ROOF IN -PROGRESS
Will the applicant or future building occupant store ns handle haormous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code , sermon 25532(a)r
E] yes ❑Nn
All roofs shall be inspected
prior to an roofing material beim
P P Y g being installed.
Will
P
Pit
Ifa roof is installed without first obtaining P g an ins ection, I agree to remove
the applicant or future building occupant use equipment ndevices which
r
hazardous air contaminants ac defied by the Bay Arca Air Quality Management
all new materials for inspection.
District'/
❑Yes 0 N
1 have read me haserdons materials requirements under Chapter 6,95 of die Califon
ria Health &Safety Code, Sectors25585.25533 and 25534.1 undersand that if me hadding
does not currently have a tenant, that it is my respimsibilily to ami ly the occupant of the
requirements which mustM met poor it) issuance of a Centipede of Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner orauthorized agent Dale