01020030 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10491 SERRA ST#2-19 01020030
TON 5 IB DATE
owlNsNMBAPPLIC I
RIEN GROUP 02,06/2001
`s PHONE: SANITARY NO. CONTROL NO,
Cl s z ARCHITECTIENGINEER: BUILDING PERMIT INFO
O C BLDG ELECT PLUMB MECH
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Hi LICENSED CONTRACTOR'SDECLARATION Job Description
Ition7Chapter 9 CONDITIONED SPACE : 4103 , GARAGE SPACE 494
F_Ew with fall
IDndefect. onlofthe Business and Professions Code,coil my license
s in full force and effect.
0 a U i<en lass L"tContro s
uxl u3. h ac ARCHITECT'S DECLARATION
1 undemand my Dlans shall be used as public records
so
NY
to i p O Licensed Professional
OWNER-BUILDER DECLARATION
tLr o I hereby affirm Sha 1 am exempt from she Cessions or'a License Law far the f
Cacti whihreuiresa(Section]03L5, t.alter. anddeiolih,orAnycityorcounty $408725
4Lp whichrequiresperms toconstruct. hMahorea -ropatir anym to _
r°isa 3 prior to's ss c.alw req iru theapplicantf Gs pemdst fl gned suarament, -
Nath ;I as dpurtuam to ltu!P rsi s fth Commctor.Li LwlCh ps 9 f.,--1 1 i3�H,-Rs,..Ti��-A�a ,{.,+ 1 1 ` Valuation
(cmmmcng with Secton:7000)of Division 3 of the lial,iness and Profession Cod.) - s„- , s'J
or that he is exempt therefrom and she basis for the alltgfd enemption Any violation - - 1
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of not more dun five hundred dollars($500). 101APN PATI ON Occupancy Type
01,as owner Of Ne property,nr my employee with wages their sole compensation, 102 - PIERS
win c
-do the work;and the is not ines
tended or offered for salelSe<:'](w: 103 - UFER Required sections'
Bo'sand Professions Code:The Contractor's License Law does not apply to an qired Ins Ii
Owner of property Who Wilds or improves themon, d who does such work himself 104 - REBAR
Or through his own employees pro ided that such improvements am not intended or
ffered for sale.If,lidwiven.the build ng or improvement is sold within ne year of - ” ' 105 - ANCHOR BOLTS_I '
completion,the owner builder will have the burden of proving that he did not Wild or
improve for purpose of sale.l. 106 - SEWER 6e WATER
DI
am 202 =`UNDERFLOOR...PLUMBING ___._...
owner of the progeny y contracting with densT contractors m - - -
construct the project(Sm.]0.14.Business and Prof=ssions Cale)The Contractor's
203 - UNDERFLOOR MECHANICAL "
License Law does not apply to on owner of property who Wild, improves thereon,
- , dna who commar for such Dmlmm wuh n.eomm<mns7 licented..pursuanlao the _....-.. ..2.04- --UNDERFLOOR'-FRAME .... ...... ....__. ---.. ...... . .._
ClameTaLi<cnse Sec. 205 - UNDERFLOOR"INSULATION
_ - ❑1 em eaegtpt under Scc. � •:9&P C for this reason
owne a �Q E ` 7^6' k 0� 301 - ROUGH PLUMBING
"WORKER'S MPEN TION DECLARATIO 302 - TUB tk OR SHOWER
Ihereby affirm under p<taltyofp<rjuryagyorthe following dalarmmn:: 303 - ROUGH MECHANICAL _
0 1 have and dill'm.iniain'o''ccdiecat='of cnnsrnt to aelemanm for Worker. 3 04 - ROUGH ELECTRICAL
Compensation, as provided for by section 3700 or rhe Labor Code. for the 305 - FRAME
perform6nce of the workfocwhichthis permit 1.is iuucd.i
have
. t< req 'rdbys r 306 HOEDOWNS
❑Ih d Lattice
W k sC p sat I 308`
3]00 r e Labor ewe f .n pearl r m k forwhich thisPen"` -- _ :INTERIORKN
C FIsm!"o e dP�num,e ` - -. - ... ...
CERTIFICATION EXEMPT NT MM WOR 't BO9 + EXTERIOR liAT&
COMPENSATION.I SURANCE
" "rrhi:,,Lu"reedriotbeooinpiereainnep=rmhi,ouranenawreuJnnars 311 - SCRATCH COAT
r.-a a pont ...313 -. .ROOF--NAIL-... .._.._ ..?... ... .. . e _:.... ..,,, . .
(SIM) . )
I n f (h t the iandarm,of the o,k(or wh h du, s is ;,ed.I t
shafinos employ any tK any m no as to become subject to the Workers 501 - FINAL EliECTRICAli� ENERGY
C p . t ,n aw rcmrorna,dat " 'licant t ..502..-_. FINAL _.PLUMBING .ENERGY.
NOTICETOAPPLICANT If fter makgth C Sion l _- _- - - -- -
PP
r <n¢ rExemPf n,yn should 503 - FINAL MECHANICAL' ENERGY
be oma: Itb W k! Coion,a t ripo softh Labo C Je y' must
O ran 'mcomply wth hp .'onsonh':peemitehnlln Jena nk<d 504 -„ ..F,INAL BUILDING. ,ENERGY
coNSTRUCTION LENDINGAGENCY 505 - FINAL ELECTRICAL
a-7 lh rebs R that sh acontructon lending agency'fit,iM1e perfo- ace 506 - GAS TEST
ry of she k for hick to pe 1, t s issu d IS iriq],Civ.C'I
y,'p `Lendr Nam. '. - - -"' _. .—.. . . , . .. .50T - FINAL PLUMBING '
_ . . _........_ . . ... ... _...._... ._ .
.7fZ L d Address... . ..
V O Ivwifythatlhavereadthisapplicationandsurethattheaboveinfnmsmi.nis 508 - FINAL MECHANICAL'
I.F.t cbrren:I agree.to nmrply with all city.and county ordlmuices and.state laws relating 509 - FINAL GRADE
Q_V tabu' consuu<tlOn,and hereby n rmn,empresenmmesofthiscitytoenter.91 510 - FINAL PLANNING
-W the ve- cmiun=d properly for inspection puryoses.
.rF.-0. - (Wel greensave.indemnify and keep Wanless the City of Co'penino against 514 - FINAL PUBLIC WORKS
M I1-ol
ju ant' t d expert I' h y in;any y cane agai nu said
UZ Ct a ccs teemm got this perm
t 602 - OF D NAIL
F \NT E ANDS NO WILL COMP LY WITHALL NON-POINT
Issued 1@0 - Date
Sgn urOnlAppic' o memrtive ,Dam "i' RC-r00 - RO GRESS
H\ZARDOUS MATERIALS DISCLOSURE s
Will the ai Ppl ni future buildingoccpant store o n ndle naaard- a.mat -I -
Type of Roof - - - .-- ...
- - sd fn Jby th Cpn M epalCd Ch pier 9.l2 dlh He lh nd Ssfty
Code,Scvli.n Z5532W1 r - I 'I 4.'ti l ii-�A - � . Sat. ..,
❑Y.' �,1 o•N I:`% I� 4 -} _ All roofs.shall be inspected.prior.to any-roofing material..being.installed. _..
wo rn poll t or future Wildg oc.pato me emii,omot ordeviuesw'hich If a roof is installed without first obtaining an Inspection;'Fagree'to'remove
aoit h d us air corlurnnan,us def d Inlh B Area A t Mara,.rm.,
Dr.t' t �` y Y ° Y ---all new materials for inspection.•Applicant understands and-W.ill comply_with
ore. o - all non-point source regulations.
Calf Heals t u
1 r ail 0 Safety
tl :Swi q.25533 a rid Ctr pied a est hr the
&Safety Crul It ti, 5505 t I v and 55\4 b. yn.mir Nat
g - --mly hhre vmaninhatitis my responsibilirymnotify the - - --- - -
irNebilOf do snot cu -
pa t of the qui rtm i which est be m s prior m v. ante of a Cenia<ate of
°" p° Signature of Applicant Date_
O er authorized agent Da¢
All roof coverings to be Class"B of better
i'" OFFICE ”