00060192 CITY OF CUPERTINO
BUILDING: )IV VPNnHAI .RMIT CONTRACTOR INFORMATION:
00060192
BUILDING ADDRESS PERMIT NO.
x6/30/2000
OWN'12R'S NAME: APPLICATION SUIT DATE
iON1i; SANHARYNO. CONTROLNO.
M n,0 Z0 ARCIII'1'r:CIAHNGINIiIiR: - I1UH.DINO I'ERMI'IINI2)
_ BLDG ELECT' PLUMB M6CH
F U f _I L7 U IJ
0
�yw' LICENSEDC(1NTRACfOR'S DECLARATION ILD WRUbb Description
b 4.., I hereby aRmn that I an licensed under provision,of Chapter 9(commencing p
Omt-m wllh Section 7tl00)ol Dlvisioninl"the fullness line Polfe"Has Coda and my license
6,y^,j nvcapsel torso OM ulna t. /
z re0 a u Date Class Lm.g
B Date ContractoI'S
_ �
ARC(II'I'[C'I"S DECLARATION
f–t= o j 1 undemarnd my plans.hall M used as public record,
lie–
S p 1p Llccn.cal Pndcsio oil
OWNER-BUILDER DECLARATION lVl
='A 1 hereby aRrn teal 1 am exempt form the Contractor's License Law for the
C Y following reason.(Senior,711.11.5.Business and Professional Code:Any city or county
5_
w
x p elch«qui res a permit it,consundiner,er,improve,dcmofi,h.or mut repair any re
ca
prinnn its i.wance.ann requires the.,,iron,fn,such perl file a.sm
signed rateer, $2500
n 3— that he is licensed pursmnt m the provisions of the Contrdcm's License law(Chapter 9
(enmmenco,with Scullon 7000)of Division Sof the Buinca I I profession.Codd Sq. FI. Floor Area Valuation
or that he is ewmpl therefrom and the basis for the alleged exemption.Any Aulanna — P3
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
oIto,more than fi,,handred dollar,(g5g0), APN Number Occupancy Type
❑I,as owner of the property.or my nnplayme with wage,as theirsole cumpnainn. 101
will In the work,and the swctum is nor intended or offered for sale(See.7144,
Baltics and rdCl nal
cot Code:'Ilie Caaa,Liecn.c Law does not apply to 102 — P I Eftuired Inspections
oner of propcny who buildm
,or ,proves thereat,and who does such wort.himself .
or through his torn employeesprovided that such impmamems am not intended or 103 — UFER
vitiated for salt.If,however,on,building or improvemcnu is sold within one year of
iimpletion,the—rup-buildei will have the Horden of proving that he did nal build or 104 — REBA R
mprove for putt,w or,ale). las — ANCHOR BOLTS
f of IbnI pent'.um cxclnsively mmnaah;,w hh lieenned contractors m
on1hruct the pmjeet spc.044.Baine,and Prodsion,Cale)The Corlmelar 1 a6 — SEWER & WATER
License Law does not apply lit an owner of property who builds or impel formal.
and who comma,lbr such paten,stud It eatmnnrtsl liect,cd pursuant to rhe 202 — UNDERFLOOR PLUMBING
Coulmno',License Law' 203 — UNDERFLOOR MECHANICAL_
O l am cwy�9dc B P C 1irz this rcaxm
(� Dw,,,.J[�— ate �e 204 — UNDERFLOOR FRAME
C/t' /wuzKER's co5trervsnrlon•DEL.nN noN 205 — UNDERFLOOR INSULATION
creby moria ander penalty or pzriury true of hd,rwmg declarctlbas: 301 — ROUGH PLUMB I NG
I face sad will maintain a Certificate of Cancan m,elem.are rill Wnrkef a 302 — TUB & OR SHOWER
Conlpenaninti, as ull"HEd fr aby Section 371x0 ul de Labor Cold, for the
p«mrnarce of the work fir which Ili,per�td i,.Blued. 303 — ROUGH MECHANICAL
❑1 hove and will maintain Worker's Cmnpenation Insurance,as required by Section 304 — ROUGH ELECTRICAL
371X1 or the Labor Gxle,for the pafunn:acu of the w'od.far wh¢h this per nu .
issued.My Worker's Compensation Insurance carrier and policy conal are: 305 — FRAME
Caries. Pnu,yNo: 306 — HOLDOWNS
CERT IFICAI'LON OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE ' 307 = INSULATION
fjr,see lien need ton beeam,loW H lacpctt san ,fort e buamwl douses" 308 — SHEETROCK
(S1ft)forle,,)
1e,rtay orm del crintionec if he work Is,,w hIvh mice pemm 1,issued.( 309 — EXTERIOR LATH
d
,Ban all nnploy any person in ary planar,n a,In brcorne..bj,c, ,,the worker, 310 — INTERIOR LATH
Compensation Laws of California.Dae
Applicant 311 — SCRATCH COAT
NODCE 10 APPLICANT Il:rile,raking this Cerdlcate or Eserption,you should
hcoum objecnm
ueworker'scompensationProvision,altheLahrCode,Yoo
uust 313 — ROOF NAIL
O G rtrmnw;memnplywith.xaehprovi,ionsrmi,Permit>bannedeemeam.oked. 501 — FINAL ELECTRICAL ENERGY
F Ln CONSTRUCTION LENDING AGENCY
I heathy a0inn ecnt
at then is lending agency for the pelimnance 502 — FINAL PLUMBING ENERGY
of the work Iia which this permit is issued(Sce.3097,Ci,C.1
503 — FINAL MECHANICRI,_ ENERGY
L Q Lender Name '
P 7 Isurds,,Adl 504 FINAL BUILDING ENERGY
v4 1"city four Inoeread la,apprnnlIIJ.late natmeabove inrmnatitniF 505 — FINAL ELECTRICAL
corem.r 1 agme m con,I,with all city and coun
nty oNiraes and slate law.tell
O U mbaildingcun,waion.and heathy authorise repirwakithe,on his city 1.cam,upon 506 — GAS TEST
;4 me above.,is nnnnial property lar ia,Iecrtnn putptncs.
E� 0. (wed agree a so%c,iadanaay and keep harales[lie City(It Cupetanoagainst 507 — FINAL PLUMBING
VJ Iiahilitim.judgments,costs and expenses which U may,in any way accrue against said z City In co,c,luence of me granting of this pemtt. 508 — FINAL IIIF_CHANICR1r�
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. y'
Signalmcof Ap,la,/Cotmnar nate Re-roofs 51.0 — FINAL PLANNING
HAZARDOUS MArl;RIAI,S DISCLOSURE
Will the ar,,imnnt or future holding occupant stom m handle Wanaphws maetial Type of Roof 514 — FINAL PUBLIC WORKS
is defined by the Cupenivo Municipal Code.Chapter 9.12.and the Heallh and Safely
Cod,Section 255321a1"
0Ye, ON. All roofs shall be inspected prior to any rooting material being installed.
wultireapplicatllnrntlaimbuddingaenmantlive".I'llocalordeviecswldch If a roof is installed without first obtaining an inspection, I agree to remove
nit bmardous air conlamirctms r,defined by the Bay Arca Alt Quality Mangemmral
,,trim all new materials for inspection. Applicant understands and will comply with
DYe^ 0 N all non-point source regulations.
I has read the haurdou.actuarial,requimaren(s under Chillier 6.95 01 the
Cali forma Health&Sufety Calc,Section,25505.25533 and 25534.1 mWecdand that
I lot bit filing dues not uormuf,have a tia uol,that it i,lily res ponaibilily Illicitly uhc
curt ill the remenn
gquim ,which muse he tire(prior to issuance of a Ccnilicane of
Opaecupamy. Signature of Applicant Date
Owner or authorised agent Dam All roof coverings to be Class `B"or better