02110134 iIICITY OF CUPERTINO €�
BUILDING DIVISION PERMIT CONTIRAC-T-OR INFORMATION:
i,CITY
CREEK BLVD PINN BROTHERS CONSTRUCTIO SIRMITNO211O134
RIENAMEBROS CONST. 1475 SARATOGA AVE APPLICAT1101sP oiTJ2OO2
ONE: 4 0 8) 252-9131 SANITARY NO./ CONTROL NO.
ARCHITECT/ENGINEER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MEOH
LICO O O O
mi�+a a fird IOL
I a CONTRACTOR'S DECLARATION I�,}k pp �u3t
z� Ihcmhyaffirmrhmlamftheedunder
o,vaan Chapter orle. 9(commencing REVISION--IN HUUS�c VSl2n ONLY
with Smion nd of of Division 3 of Joe Business and Professions Gwlc.and my license is
Gy inbnmreeandeuec'. FIRE PLACE CHANGE
License Class Lie.0
0Z�a
; q Dale QonUTCL ORIG.#O107OO13
Q ARCHITECT'S DI!CLAR ATION
�oaU IunJcrsmnJ my plans shall beused as public rttordc
FLLO Limned Professional (f`l
OWNERBUILDER DECLARATION V
iC 1 hereby affirm that 1 1. exempt from the contruscon'sCor Licensee Law for the
p O billowwhich
nquires a Permit it)co tai r.alter,Improve,
demolish,
Code:Any city ns county
$� which requires a permit m ennnrun,spec improve,demolish,nr repair any structure
as prior m its isamorce,also req.i.a the applicant for such Permit o file aaigned statement
�th that he is licensed pursuant to the provisions of the Contractor's Lice na:Law(Chapter Y Sq. Ft. Floor Area $5789 Y®tlation
(commencing with Sccdnn 70x)of Division 3 it]the Raciness and Pndc.Won.Cmic)or
$ that he is exempt therefrom and the basis for the alleged exemption,Any violation of
Section 7031.5 by any applicant for a permit subjects Use applicant m a civil Penalty of
not more man five hundred doom($500).(5500). b Occupancy Type
C]1.aowner of the properly,or my employees with wages as their sole compensation,
will do the work,and the structure is nm intended or offered for sale(Sm.7044,Business
and Professions Code:The Cormicmrs License Law does nota to an owner of ;equired Ins ections
propenywhobodds nr improves thereon.and whodocasoch work hodseffonhrough his 102 — PIERS P
own employees,provided that such improvements ate not intended proffered for sale.If, 103 — UFER
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving mat he did not build or improve for purpose of 104 - REBAR
sale). 105 - ANCHOR BOLTS
❑1,as owner of the property,am exclusively contracting with licensed contracton to 106 - SEWER & WATER
construct the project(Sec.761x,Businem and Professions Code:)The Contractors Li.
cense Law does not apply to an owner of property who Wilds or improves therson,and 202 - UNDERFLOOR PLUMBING
who contracts for such projects with a contractors)licensed pursuant to the Contractor's
License Law. 203 - UNDERFLOOR MECHANICAL
I am exempt under Sec. ,B&P C for this mason 204 - UNDERFLOOR FRAME
net Data 205 - UNDERFLOOR INSULATION
WOR K ERS COMPENSATION DECLARATION 301 - ROUGH PLUMBING
I hereby aRrm under Penalty of perjury one of Ne following declarations: 302 — TUB & OR SHOWER
❑Ihave and wiumamtamacemficamp/cnmmntm lf-inxpmfprwprkeracnmpn- 303 - ROUGH MECHANICAL
cation,as provided for by Section 3700 of the labor Code,for the performance of the
—Itforwhichmiaptisissued. 304 - ROUGH ELECTRICAL
❑I have and will maintain Wmker's Compensation Insurance,m required by Section 3 05 — FRAME
".of the Ichor Code,for me performance of the work for which this Permit is issued.
My Worker's Compensation Insurance carrier and Policy number ate: 306 — HOLDOWNS
carrier: Policy No.: 307 - INSULATION
CERI'IhICCt E OF COMPENSATION INSURACEIPI ION FROM DRKERS' 308 — SHEETROCK
(rhis.section need nor b,completed fthe Normo isforouchunded dollars($1O) 309 - EXTERIOR LATH
,it less.) 310 - INTERIOR LATH
I cenify mar in the Performance of Ibe work for which this Permit is issued.I shall not 311 - SCRATCH COAT
employ any person in any manner so as m subject become subjeco the Workers'Compcnsmion
Lawsof California,Date 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT:If,after making this Cenifcae of Exemption.you shouW 501 - FINAL ELECTRICAL ENERGY
become subject n the Worker's Compensation provisions of the LuWr Code,you most 502 - FINAL PLUMBING ENERGY
oz ft no comply will such pOwislons or this Firm if shall he deemed revoked.
z0 CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
P n Ihereby an!nor ma1there is.ennswnionlending agency for the piondsonrof 504 - FINAL BUILDING ENERGY
x4 the work for which'his
permittrimmed(Sce.NAG.Co,C.)'s Name
W Uni505 - FINAL ELECTRICAL
Unit's
a z Lcndcr'sAddress 506 - GAS TEST
U O I certify mat I have read this application and scam that the move inmtmmion is 507 - FINAL PLUMBING
(: comovi.I agree to comply with all city and county ordinances and state laws relating to
V abovementio ed on,ondhcrenspicunrircrvors. mtivcsatthis city mcmcrupon(be 5 FINAL MECHANICAL
U
abovementionedprop end hereby
byadtionpurposes. 509 5"
FIN
Ty (We)agree to save,indemnify and keep harmless the City of Cupertino against
h liabifitics,judgmenq costs and expenses which may in any way icervc against mid City 5 N Oi` I
U z in consequence of the granting of this Permit
'—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by51 WORKS Date V "
SOURCE REGULATIONS.
Signature of Applicam/Cntnracror Dam Re-roofs 603 -(-R6OF BATTENS
HAZARDOUS MATERIALS DISCLOSURE Type of 113)04 - ROOF IN-PROGRESS
Will in'applicant or future building occupant store or handle hamodous mammal
defined by the Cupertino Municipal Coda Chapter 9.12,and the 11a1th end Safetyk,Section 255320)? All roofs shall be inspected prior to an roofing material being installed.
pees ONO P P Y g g
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
7n)ia
it h...olous air cnmmumants as dBried by the day Arca Air Quality Management all new materials for inspection.
strict?
❑Yea ❑NO
I have mad me hareNnus materials requirements under Chapmr/.95 ofmc Calim,
Health&SafetyCodc.Scctimts25505,25533 and 25534.1 undersand the ifthe Wilding
s not currently have a tenant,Nat it is my resnroibility m notify lbe Occupant of Ne
uirements which must he met poor m issuance uta Cenincaeof Occupancy. Signature of Applicant Date
nerefaulbon 'da,cut Date All roof coverings to be Class "B" or better