03070056f
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
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t CONTRACTOR INr9RMA.TION a
BUILDING ADDRESS:
HOWARD WRIGHT CONSTRUCTION
T6703070056
OWNER'S NAME:
PIER 9, THE
EMBARCADERO #1
PERMrrIsuE DAT,
NE:
(206)447-7672
SMITARY NO. CONTROL NO.
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CHITEC (ENGINEER:
[WING PERMIT INFO
_ LT PLUMB MECH
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LICENSED CONIRACIOR'S DECLARATION
1 herehy affirm that I am ]IevM under visions Of CNpmr 9 m.normaing
with Safiaq) OOf Divl.ion3ofthe Bud of i m Cade..Mmylice....
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f Ob escr1 t
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in ren rnracype errat. S
Chir Lic. N
TI --S EAM D
Dae� ��'/ �;( 4
Dam
- F(CHITECTS DECLARATION
,
I uMcratanJ my phos shall be used a public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 herehy affirm that I am exempt from Ne Contractor', License law for the
fallowing reason. (Section 7031.5, Baia.s and Pmfcainm Code: Any city nr county
which requires a Permit to construct. shop Impmve, demolish, Or most, any strucmm
'
000
prior h, its issuance, also inquires the applicant for such permit m Ole a eignM statement
Sq. Ft. Floor
Area
Valuation
that he is licensed peremotto the provisions or Ne COnmmm's License Law (Chapter 9
.
(commencing with Section 7") of Division 3 of the Business and Professions Code) or
Nat he ts exemPL therefrom and Ne basis for Ne alleged exemption. Any vlolNon of
16901020
00
APN Number
Occupancy Type
Section 7031.5 by any applicant for a Permit objects the applicant to a civil Penalty of
not more Nan five hundred dollars (SSW).
❑ 1, a owner of the propeny, m my employees with wages as their sole compensation,
101 —
FOUNDPITe;Wid Inspections
will do the work, and the swcture is not Intended of offered for sale 7044. Business
and Professions Code: The Contractor's License law does not apply to an owner of
property who builds or improves themon,and who dmaauch work himselfor through his
102 -
PIERS
Own employed, provided that such improvements arc not intended mortared for sale. If,
103 —
UFER
however. the building or improvement I..old within one year of completion, Ne owner.
builder will have the burden Of proving that he did not Wild or Improve for purpose of
104 -
REBAR
ah.).
105 -
ANCHOR BOLTS
❑hes aver of ct property, , B sinessv exclusively cofessi n s with ) TheM common's t.
eamwm the projen (see.7044, Ba.meas and Professions eMe:)Thc can0aemrk u. �
106 —
SEWER & WATER
cans, Law dam not apply 19 an owmr of property who build, or improve. thereon, and
202 -
UNDERFLOOR PLUMBING
who summers for such projects with a eontnetnr(.) licensed pursuant In d¢ Contractor's
Lm,mc Law.
203 -
UNDERFLOOR MECHANICAL
❑ l am exempt under Sa. , B k P C fm this rcuon
204 -
UNDERFLOOR FRAME
Owner
205 —
UNDERFLOOR INSULATION
WORKER'S COMPENSATIONDECLAR TION
I hereby arm under penalty of perjury aro or the rellowing declantiaa:
301 —
ROUGH PLUMBING
ave and will melnuin a Cenirtcete of Consent to WIGlnsure for Wicket Camino.
302 —
TUB be OR SHOWER
a providM for by Section 3700 of the Labor Code. far Ne performance of the
303 -
ROUGH MECHANICAL
for which Nis permit I. issued.
304 -
ROUGH ELECTRICAL
❑ 1 have and will maintain Worker's Compensation Inonnce. as requited by Semon
3700^(dm labor Codc. fm the pedomoneeof the work tat, which this .I. is issued.
305 —
FRAME
u
MyWolai"Cion'.6im lno�nna//.pi.,sM P^firy m are:.
�^'��Os"A
lOIZ 306' -
HOEDOWNS
Grtier� MM ✓1✓f paliry No.. u��fr�
"CER TEOFE%ENPIONFROM WORKERS'
COMPENSATION INSURANCE SC/1
3O7 —
—03 308 -
INSULATION
SHEETROCK
(This account =ad not M completed if the permit is fm one hundred dollars (SIM)
309 -
EXTERIOR LATH
nr less.)
310 -
INTERIOR LATH
1 sentry Net in the perfnrmanee of the work for which this Permit h issued, l shall nut
employ any person in any manner. a m become subject re tete Workers'Compemition
311 —
SCRATCH COAT
laws or Celifarnia.0ercAppli
Law' am
313 -
501 -
ROOF NAIL
FINAL ELECTRICAL ENERGY
NOTICE TO APPLICANT. If. after making this Certificate of ExemPlion. you should
become subject m the Worker's Compensation provision of the lab. CMe, you must
comply with such provisimmonhispermi.hallhedeemed mvokcd.
502 —
FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY
503 -
FINAL MECHANICAL ENERGY
I hereby affirm that More is a emlruminn lending agency for the performance of
504 -
FINAL BUILDING ENERGY
ndZ,shorwhich this pertnitlaissuM(Scc.31197.Civ.C.)
1<Mork Wmc
505 -
FINAL ELECTRICAL
Lamler'.Addrde
506 -
GAS TEST
I cetify that I hive read this application and state that the shove Information is
507
FINAL PLUMBING
correct. l agree to comply with all city and county ordinances and state laws relating to
-
building co^stomion, and hereby subunit representatives OfMil City to enter Upon the
FIN
ahmnmeminned property for Inspcnion purpose.
(We) agree to neve, indemnify and keep harmless the City of Cupertino agein.l
FIliabilities,judgment,costsandcs,enseswhich
may In any wayaccmaagainn.aidCity
%09
in consequence of the granting ofthis permit.PP}L�IcCA
AND WILL CO PLY WITH ALL N INT
Issued by:
ORKS DNte/
E ATIONANDS
�� 7'03
Re -roofs
Type of Roof
Sign urCdflcpp ire RDO Datc
HAZARDOUS MATERIALS DISCLOSURE
Will the nr (mine building sore orandMele
Heat anrs d
as deOnM by the Cupenlno Municipal Code, Chepmr 9.11, and the Health and Salcey
a Cupertino a Char
Code. Section 15531(a)1
❑Yes
All roofs shall be inspected prior to any roofing material being installed.
�fo
If a roof is installed
without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipment or devices which
'I h..mnus air contaminants as defined by the Bay Arca Air Quality Management
all new materials for
inspection.
let?
❑YesNo
I have read the lunrdtws material, requirements under Chapter 6.95 of the Califon
nieHnalthsty COM, Scrl 15505,15533 and 15534.1 uMcroub Nu if the building
alma trot rren ha tenant, t i1' m respomihiliry to notify the cecupant of the
qu'Ceniftnam`a
mn w c ma ca9n
Signature of Applicant
Date
All roof coverings to be Class "B" or better
Owner
or sioloo red agent Date