00040046 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUUDINGAiW535 STERLING BLVD PERMIT NO '
� Kc �� 00@4004Cr
OWNER'S N/91 SELY, JOSEPH APPLICATION SUB DATE
SAN I'rARY NO. CO )I.
S N
C ARCHITECnENGINEER: BUILDING TERM]TRIED
F 00 RLDG ELECT PLUMB I'll
J S y p LICENSED CONTRACT OR'S DEC'LARA'TION lob Description
O'G 1 hereby ntfinnmat In I'votowd under prmi nal Chupmr 91c, ns ing
mF with Semion7WU) fDivisionJof the Business anJ Professions Codon anJ my litems
< is mfull force and erce 51ySS�
m caLittme y Lic.a
W 3 u
Date S DECLARATI
ARCfiITECf' om,", RATION
Ca O 1 u acts and my,la o shall W u.wd us public records
"tea' ucenwaprnresannd 51.8 SO. FT. ADDITION /
S
OWNER-BUILDER DECLARATION
ivil= I hereby affirm that I am exempt Irons the Cammemr',s Uca,sc Law for the
following teaam.(Section 7031.5.Business and Professions Coda Any city Lir county. /
x
which q peons to consurrufalmr.improve.dersolish.or repy'msnurc
ce 'rI11111 INOle y IM1 li Ifor such pe but Ill file a signedstatenem
a. mats I .ed pa r.," II n p .int: l i L t tnr 1 1 (Chapter9 Sq. Ft. Floor Area Valuate
(commencing with Section7000) f Division i ofthe R ne d P f .'ons Cedc)
or that he is exempt therefrom and the basis lin the alleged exemption.Any vitiation
of Section 7031.5 by any applicant rni u permit subjects IhcapplicanI to a civil penally
,if a„Imom11m.Bell hundred ddma(a50(B. AP �eOt'1 .� 001 Occupancy Type
[11,as ownv,of the propeny.or„iy min,loycc win,waits ax m..r sole,or,pto,alint.
will do the work,and the slmclam is Ern intended or offered for sale(Sea 70al,$.
Business and Pmfcsxiuns Code:The Cmunt rt License Low docs am apply to an Required Inspections
I'll of prom
,crty Who Kul lds or iproves Ihcrcon,and who deals such work hi mwlf
orvthrough)its own employees,provided that such Improvements arc not intended or
offered for sale.If.however,the building or improvenem is old within one year of
completion,the owner builder will have the burden of proving that he did not mild or 101 — FOUNDATION
mproa for pur,ns,of sale.).
01,a,owner of the pro,ertr.am exclusively contracting with licensed commettra m 102 — PIERS
a rhact ma prulav'I(Sce.Ewa.Rads..oda Loves.....Core: 'the Ctmamur's 103 — UFER
License Law does not apply or an owner of property who builds or improves thereon,
and who contacts for such pmiects with a comrammf9 licensed parsoant m the 104 — REBAR
Contractors Licanw Law. -
0,woexempt andmSee .BmPClot III,maxon 1.05 — ANCHOR BOLTS
outer Date 106 — SEWER R WATER
WORKIIMS COMPENSATION DECLARATION
I hereby affirm under Penalty of fall one of the following declarations: 203
203 — UNDERFLOOR PLUMBING
yy{{ I have and will maintain a Cenircme or Con.cm Io self-in.sum for Workcr'x — UNDERFLOOR MECHANICAL
C,mpenmlmni as provided for by Section 3700 or the Labor Code. for the 204 — UNDERFLOOR FRAME
perlonn:mceelite workforwhichthis perniois%wed. 205 — LINDERFLOOR INSULATION
0 L have and will nminmin Worker's Compensation ltnumnce,as required by Section
37W of the labor Calc,for the perfnrmame of the work for which this permit is 301 — ROUGH PLUMBING
issaed.My Workers amgansado,h,wraaca tavier:,na Policy tmnWra - 302 — TUB & OR SHOWER
Carder.used CtV� Policy Nua 191/7 1/S
Cr:R'I IFICN1'ION EXEMPTION FROM WORKERS' 303 — ROUGH MECHANICAL
COMPBNSAnONINSURANCE 304 — ROUGH ELECTRICAL
(Phis secnoo need not be ,at ellsd if me pemait 1,haute htmdred dollars 305 — FRAME
(s Hxp nr lescl
I certify that in the psrfonmance of the work for which this permit is issued,1 306 — HOLDOWNS '
'hall not cm,lny any r'o i is ally ,at cr'n a, ,,beer I,amycat Io the worker 307 — INSULATION
Comperacamp L,ws of Caliromiu.Dam
A,phcam 308 — SHEETROCK
NOI[CP.'r0 APPLICANT:IL alta making anis Ccnircme of 13xcmpaon,fou ihnold
Zbecome subject to the Worker's Cominclusinhal provisions of the I.awr Code,you must 309 — EXTERIOR LATH
Q QG,nbwith comply with such Pori or this permit Mall W deemed revoked.
CONSTRUCI I ON LM DING AGENCY 310 _ INTERIOR LATH
I hereby alarm than them is a onumction lending agency for the perfmmate 311 SCRATCH COAT
of the work for which Iti larmit is is'ued IScy 3(19 C'v.C
d p Lender's Nainc c� ahs ,—).I ke'4 313 — ROOF NAIL
D 7 Lander',Address i
UO
IcmhfymmI free read dui':mplicano,and orae endo the army.inR....oii is 501 — FINAL ELECTRICAL ENERGY
6. p. correct.1 agree us comply with all city and county ordinance'and elate laws reludng 502 — FINAL PLUMBING ENERGY
Q (� rebuilding construction.and hereby amhorim representative'of this city to enter upon
he above.tmah,med progeny for in.gned'm loop vs. 503 — FINAL MECHANICAL ENERGY
F' C. (We)agrcc m.aave.Indenmify and kec,harndo.the City of Cupcn'mnugainw
Z Iiahililie,,judgments,cast,and expense,which may in ony way accrue against said 504 —
FINAL BUILDING ENERGY
U z City in nsmequence ohne granting of this permit.
APPLICANI'UNDERSTANDSAND WILL.COMPLY WoLlALI,NON-POINT Issued by-
?—/
y: 505 — FINAL ELECTRICAL Date
7 � S/22/ao bOc, GAS TEST
Signamreof nl mnnVCo u'uctor Dnte Re-roofs
I HAZARDOUS NIN17HRIALS DISCLOSURE 507 — FINAL PLUMBING
Will the applicant or future building nia'.,inm.or lutdle IumNrw,mmcdal Type of Roof508 — FINAL MECHANICAL
In dcfocsl by the Cosor a Municipal Codc,Chapter 9.12.iL d the I Icalth and Safety
Curie,Section 25532(x):'
0Ycx KNo All roofs shall Pe`hnspeEtA 6r t�q�ofing material being installed.
Will n,eapphcanlorhome miilaingoccuptm,,.weyaipmctuordevieoswhidt If a roof is inN'IAI@d Witho, oRFaWk11rN6s'pection, I agree to remove
•mit hmandous air contaminants as defined by the Bay Area Air Quality Management
l? all new matcr`AS4forinf5&N1d1L F4WpMaf$pndA •nd will comply with
ClYc^ n all non-point source regulations.
1 have read the h heal s mamrialx remiremems under Chortler 6.95 of the
Culihanla Ilcallh al Ste ly Code.Sect 1,25505.25533;...125534.1 u ilk,...slid but A
it the building does nm currently have a mount,that 11 is my responsibility to orally the
cupanl of the requirements which must the ran prior to issuance of a Certificate of
Occup"Hey' '/ Signature of Applicant Date
•x/m All roof coverings to be Class 'B" or better
(lwncr nr atuhorind ag I D m
OFFICE