03050142 CITY OF CUPERTINO *° yg ,n' /��v1k�'+^' '� � " ♦may"��� �,
BUILDING DIVISION PERT.111,*7,TRACTWtI }ORM la01\ .
BUILDING ADDRESS: PUTNAM GROUP PPRMITN003050142
199';n STEVENS rRRFK RT,yn
NER'S NAME: 526 MOUNTAIN VIEW AVE PERMIT E"`UgAjj 8/2003
IRC GROUP RIB CRIB
ONE: (650) 922-0262 SANITARY NO. CONTROL NO.
ARCHITEC I]INGINEER: BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
0 0 0 0
Sop LICENSED CONffid under
nDWS derPDECons of ON Job Description
rd I Imreby affirm Iha,1 em haunted under .fta or Chapter 9(commencing p .
a¢ with Semi 7gp)ofDivlalon Sof dte Bualrmss�ofessiom Code.and mylicenmh
<< Inrallrorep°Sodefte -I p t REVISION--IN HOUSE USE ONLY
Dam clays Lie.
NO NEW PERMIT ISSUED, ORIG. #03030043
[[ Oeste Con—
ARCNr1EC1'S DECLA TION
�s Nall be use m mcnrN n
LLi- Licensed�el'` \
503 OWNER-BUILDER DECLARATIONr
ie I I hereby afrnm that I am exempt from On Cmuanofs License Law for the
pO following mamn.(Section 7B]IS,address and Pmfessiom Cade:My city or county
1 g 9 which".I.a permit in emoruti,alcor,Improve,demaltsh,or repair any sammro
_ prior i%isuance.also requites the applicant for such most to rile a signed statement
�< Nat he is licensed pursuant to the provisions of the Comactorb Licemc Law(Chapter 9 Sq.Ft. Floor Area Valuation
r�,zC3 (commencing with Section 7BBB)of Division 3 of the Business and Profasafes emCaM).,
tical he is exempt thmrmm and the basis far the alleged asemption.Any viol Wo $5l
n of Y
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom than five hundred dollars(5500).
36905009 . 00
❑I.as owner ofthe prepcny,ormycmployca with wages as theirselecompematlon,
willdotheworlt and lhesumune is net Intended oaQami fonak(Sec.7044,Business Inspections
and Professlom Code:The Convaebts License Law dm m,apply te an owmr of 101 - FOUND AReM 1dins p
,pm,who Wit&.,irepow thereon,and who dao such work himself or Waugh his
own employees,provided Nat such improvements art an,intended cr offered for sale.If. 102 — PIERS
however,the building or improvement is cold within one year of completion,the owner.
' builder will have the buNen of proving that he did nm build or Improve for purpose of 103 — UFER
.10.)' - 104 - REBAR
❑1.u awaer of the property,am exclusively contracting with littmed eonaactera as
convect Ne project(Sec.70 .Business and Profassiom Code:)The CommcteYS Lb 1O5 — ANCHOR BOLTS
mine law does not apply in an owner of property who builds or Improves Owner.ad. 106 — SEWER & WATER
LNon Low.fonuehproKcuwithac.ntracter(.)li.nutlpursuanitolxConuemoM1 202 - UNDERFLOOR PLUMBING
lamexemptundesSee. ,B&PCforthisrcndn 203 - UNDERFLOOR MECHANICAL
net Date 204 - UNDERFLOOR FRAME
WORRER'SCOMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
_, 1 hereby affum under penalty of perjury am of the following dedvellons:
❑I have and will maintain a CenlOate.&Como.,mssILiaum for Worker'.Compo- 301 — ROUGH PLUMBING
.tion,as provided for by Sectime 3700 of the Labor Code.fm the performarrce of Ix 3 02 - TUB & OR SHOWER
work far which thispermivai.aed. 303 - ROUGH MECHANICAL
❑1 naw ma will maintain woxr's Campen.,Ion rover..,u required by Section 304 — ROUGH ELECTRICAL
3700 of the labor Code,for the performance of dte work far which this permit Is issued.
My Wmkees Compeovedon Imuran.carrier and Policy number am: 305 — FRAME
ca'riet Policy No.: 306 - HOLDOWNS
CERTIFICATECOMPENSATION INSURANCEEMPTION ORKERS' 307 — INSULATION
(This section ncedmn bccmmplmed if the permit is forme handrail dollar(SI00) 308 - SHEETROCK
orksa.) 309 - EXTERIOR LATH
l unify the,In the a eros of On woh for which his permit ts issued,I shall nw 310 - INTERIOR LATH
employ eny person ma anaRl^xmmc rvbjecl 1.the Wohen'Compense0an
Laws of Caltromia. :ZG "� 311 - SCRATCH COAT
ApPli��aappt
Nglon,7r' PLICANT:IL after making 444 Ccni0cate of Exemption,you Nould 313 - ROOF NAIL
We me subject in the Worker's Compeesation provisions of the labra Code,you most
.JZ forthwith comply wit such provision or this perms shall x domed mvnted. 501 — FINAL ELECTRICAL ENERGY
z0 CONSMUCDON LENDING AGENCY 502 - FINAL PLUMBING ENERGY
54 1hereby affirmOat them isacaawcdnnlending agency for the performanceof 503 • - FINAL MECHANICAL ENERGY
W Lender,Nurse> drew.rkmrwhich this permit 4i.md(Sec.3097.Civ.C.) 504 - FINAL BUILDING ENERGY
0,0 Z Lend,eaAdd1ess 505 - FINAL ELECTRICAL r
U O I modify that I have lead this application and state that the shove infmm at is 506 - GAS TEST
corms,.I agree to comply with all city and county onfinances and state law,misting to
OIu building construction,and hereby authorise representatives or this city to anent vine Nc — FINAL PLUMBING
W
shove-mentioned property for inspection purposes O FIL
G (We)agree m save,indemnify and keep harmless the City of Cupsnino against
UI liabilities,judgments,costs and expenses which may to my way seemagainst aid City Ilia.
[�7 in consequence of the granting of this permit. _`
t1— APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 NG Date (>
SOURCE REGULATIONS. _
'5- Re-roofs
Suurc ofA ° _HAZARDOUS MATERIALS DISCLOSURE Date Type of Roof
Will the applicant or future building meupmtnom or handle haatdoa material
.defined by the CapeNno Municipal Code.Chapter 9.11,and On Health and Safety
.Section 25533(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya No
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardnm air coriarn, nu�y defined by the Bay Area Air Quality Management all new materials for inspection.
Di,lrict1 j/�('
Oyu
I have mal the hasardtmsmateriab rcquiromcnu underChapmr 6.95 of the Califon
niaHcalth8,SafctyCode,&cUons255O5,25533od25534.1.de.mdthuif Ne Wilding
does not currently Mn a u n ue,that it u my on ansihility to nearly the occupant of the
mqui��ryrymIS whkh muuxmel priormissuutec ofa Cmtifmam of f Oc.putey. Signature of Applicant Date
r'3.-+ —�4 , 47��
All roof coverings to be Class"B" or better
O euthorir gem pate