01040025 CITY
DPEROrvo
NPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
10550 STERLING BLVD. 01040025
OWNER'S NAME: APPLICATION SUB DATE
04/06/2001
PHONE: SANITARY NO. CONTROL NO.
1
z z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
00
,y— BLDG ELECT PLUMB MECH
b LJ L_J C
yji
o S r,z LICENSED CONTRACTOR'S DECLARATION Job Description
O z L I hereby ).f that 1 n 3licensed under provisions of sw Code 9 nd mmencing
Fen F-w wim5ection]IXndafDivisionJof the Business soil ProfcssiomCWe.and myliccnsc REMODEL & 1308 SQ. FT. ADDITION.
z m I Is to full to.and<RCCI.
c re a License Class Lic.p
ad O n U Date Cnntmcmr
w 3 u 7; ARCHITECT'S DECLARATION
5 1 understand my plans shall w used as public mcorc s
forf forte
w z C O Licensed Preterit...I
e. OWNER-BUILDER DECLARATION
X
C t aw I hereby affront that I am exempt from the Commoners License law for the
fallowing rcawn.(Section 703 L5 Business aM Professions Cade:Any any or oso $127000
O which requires a permit m=anima alter,impmrt.Jeumd,h,or repair:n.structure
-y poom no ro-anic...d.o fsuch p l Id.,ned,nue an
nbat he is li,earedf sent to law peroliliLsolol Ccurairaclon,1 L '(Chapter 9 y��t-,7 r 3 tti Valuation
(commencing with stun 7yk)(p of Division 3 of the Business d Profensnons Code) 37
or mat he is exempt thnn fmm and the basis for the alleged exemption.Any violation
f Section 7831.5 by any applicant for a permit subjects the applicant to a civil penalty
ornot more than rve hundred dollars(sSoo/ lOIAPN V"fDATION Occupancy Type
❑1,as owner ohne property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(sec.704,1.
Business and Professions Cad:rhe Contractor's License law docs not apply to an 103 — UFER Required Inspections'
o, r of progeny Who builds or improves Merton,and who does such work himself
through m,awn employees.provided that such improvements are not intended or 104 — REBAR
offcml for eek.IL however the building or intprovcmcnt is sold within one year of 105 — ANCHOR BOLTS '
completion.the ownenbuilder will have the burden of proving that he did not bwld or
m-pjrov rorpurpoaeof„le.), 106 — SEWER & WATER - __ _
"[9'f.e.ow,Rranne mwertr:ante«ws;.•e1r<ommeing+.itlt wertscd contractor,ro 202 UNDERFLOOR PLUMBING - '� �'I'T
instruct the ons no(Sec.]04J,ownBtoer o and Professions G%or)'rwimproves
ves thr tw, 2 0 3 — UNDERFLOOR MECHANICAL
License law dues not apply to 0,an owner of and
who builds or improves thereon,
and wba.e.m act.for_such,projec,.w 1 a sammctnnal fiaased parsuaft to he 2 04 — UNDERFLOOR 'FRAME _ _-
Conumenos Lic<nw law.
❑I amIhn"b1fino
Sec. ,B&p C for this reason 205 — UNDERFLOOR INSUliATION
Own
301 — ROUGH PLUMBING
tumm.lty
O PENSATI ECLARATION 302 — TUB & OR SHOWER
allperiarywear,mernlmwmgaeaamran.: 303 — ROUGH MECHANICAL
• ❑ 1 haintain a Cenuie.1,of Consent to sellimart for worker. 3 04 — ROUGH ELECTRICAL
Compensation, as provmw for by Section 3700 of the Labor Code. for the
_ performance.1 the work for which this permit is is,ned. „ 305 — FRAME
❑I nave and will maintain Workers Compensation insurance as men mad by section 306 — HOLDOWNS
3700 of the labor Code,for the performance of the work for which Nis permit is 307 — INSULATION
issued.My Workers Compensation lmurone<carrier and carPolicynumber are .._..__.....—"_ _ .... .._
carie,:, t n •-polieyohn: ' . 1. 308 'SHEETROCK
'CERTIFICATION OF,EXEMPTION FROM WORKERS' 309 — EXTERIOR LATH"
COMPENSATION INSURANCE__ ' . . .... _" " _. ..
_ — 310 - INTERIOR.-LATH ---
finis section wed not be completed if the pemml is rot one hundred dollars 311 — SCRATCH COAT .
IS 100)orlasd - -
1 certify that in the perforomnec of the wink Yoe which this permit is issmd,1 313" — ROOF NAIL - -
shall not employ any person in any manner so as to biccome sabjact to the Workers' S01 — FINAL ELECTRICAL ENERGY
Applicant nn Law.allcaliromp.Dam 502 — FINAL PLUMBING ENERGY
Comfort
..
.NOTICETOAPPLICANT:H.aner'nakingmi,e<mnmtesrEaemptrom,ysa,h..Id 503 — FINAL MECHANICAL ENERGY
C Cbecome,da,,,m the Workers Cmnwer,ia nn prov,i ons of the Lahr Cade,you must
fnnhwim enmply with such mwvamr,or this parmi, hot]be deemed invoked. 504 — FINAL BUILDING ENERGY
;:. CONSTRUCTION LENDING AGENCY 505 — FINAL ELECTRICAL
a > 1 work
for ah m me chert is
mold(Sort lending agency for me performance — -
�y-C or ewarkmrwmcnmi.pamtiai«sediseesi97.cmc.i 506 GAS TEST
y Leder',Name 507 — FINAL PLUMBING.,
Lender's Addm,, ,
U O 1Icioythatlhmereada
mi, pprand state mm
plication a , at e above information is 508 — FINAL MECHANICAL
G. (.. cbncc.t.I ag¢e to cmnply.with all city and county memarems and side laws miring 509 — FINAL GRADE
O.V to Wilding constranon.and hereby atuncriza retircoartnies of this city to enter upon 510 — FINAL PLANNING
r� the above-m<pthored pntpeny for Inspection purpose,.,.
[,n 1. Wcl agree m save,indemnify and keep harmless the City of Cupertino against —
liabilities,judgments,cons and expense, hi<h may in any way acerae agalna said 514 FINAL PUBLIC WORKS
City in cttn"wrien oftre8ruming of t roof
\ -
APPLICANTUN :RSI'ANDSAND LLCOMPL H ALL NON-POINrt' Issued by: Date lJ
RCE It-0D TIONS. y'
igmdnrscan omra or - Re-roofs
O
I] ZAR USMATERIAS ISCLOSURE
W aappfiwto awbuddingocc t.mrtarWndlehamdoasmaterial Type of Roof
a define the Caper;to Municipal Gide.Chapter 9,12.and the Health and Safety _
Cwc:Sc on
O Yes 2553^ml'!, Pi O No -
.. All roofs shall be inspected prior to any roofing.material being installed., _
-�
Will he applicant or houre Wilding occupant use equipment or device,which If a roof is installed without first obtaining an inspection,l•agree to remove
emit haaardous air roa aminama as darned by the Buy At.Are Quality Management
Dtsa;e^ all new materials for inspection. Applicant understands and will comply with
CD Yet, ❑Na all non-point source regulations. t
I have read the hamNour materials require encs under Chapter 6.95 of me
California Hcalfh&Safety Code.Sections 2550,25533 and 25534.l und...road tan
if me building dews a pt cummly havua¢ that it is my respomihllitymnmify the
occupant of the requirements which'nu n our m' ,nee of u Cenirea¢of
oecup Signature of Applicant Date
owners , o d; enc All roof coverings to be Class "B"or better
t., - OFFICE
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