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03030004 CITY OF CUPERTINO ('�'"�*,y'�°`y"�pk^�w� �"'�7'�°f',Np � '` BUILDING DIVISION PERMIT � ,;,� �'" Iy�yl�"+a ATIO ^'. BUILDINO ADDRESS: CONSTRUCTION INC PERMITNO. 20355 STEVENS CREEK BLVD 03030004 'S NAME: 3360 DE LA CRUZ BLVD PERMIT ISSUE DATE FINANCIAL TITLE CO. 03/03/2003 E; —4 4 2 2 SANITARY NO, CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO DIDO ELECT PLUMD MICH 0 t� atop LICENSED CONTRACTOR'S DECLARATION JobDescri tion 1 hereby affirm Our I am licensed u' r pmvulons of Chapter 9(commencing P with Section 7006,ofDiviAon 3 of 60 Bug,' and pretenium Code,andmylicenseis P��a in mnro a effect. z�J� Dia. M , Conti 5 '3 0 �r ARCHITECTS RATIO fd✓/� I u%n)05Nnd my plam shall be used as public records j Licensed Professional D OWNER-BUILDER DECLARATION YV 1 hereby affirm that 1 am exempt from the Coutractoei License Law for the p o following name.(Section 7031.5Basincess W Professions Code:Any city ar county $ which requires a Permit to conwwI,alcor.Impmw,demolish.or repair any strunune _----+ ,— Fzs' prim to its iaswnco.tlw requires the applicant fortuch permit to rile a signed statement .. dm11�� I�IOn ggFF< heiiii.m puuuentmththe epmvisiomofCuecone.ummelAw(Chaptor9 Sq. Ft.Floor Area a $ (commencing with Section7000)of Division 3 of the Busnassand Profeasimu Cade)or �s that be is exempt ulemfrom and the basis for the alleged exemption.Any viclaeon of ` Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty or r Occupancy Type Int more Nan five hundred dollars(S5o0). oI,as Owner of do property,a my employees with wages as theh sole compewtion. / \ will do the wark.andW structure is Act intended maQered fat Ask(Sec.70th,Budneas lred inspections and Prefeaaloru Cade:The Contnin mor's Lime Law does rem owner Act apply an or 102 - P I ERS a9uP propenywho buudsorimpro estbumn,and w'hodoasswh work himselforlhmoN hu _ __ ownemploym,provlded Nmmahimpnm'amenu=wtintwedmaauWfmule_IL Y03 — UFER'--- - hawem,the building at improvement is sold within oro)ear of completion,she owner- 104 — REBAR builder will law the buNen of proving that he did not build or improve far purpose of 9�+ba). 105 — ANCHOR BOLTS 1,As owner or she property,am exelualw)y contracting with limased contractor,to 106 — SEWER & WATER mmtnect the project(Sec.7044.Bminasa and Professions Cade:)The Con cie ce&U• esmeLawdoesnotapplytoanownerofpmpenywhoWild,orimpmmtMrem.and, 202 - UNDERFLOOR PLUMBING who corm,eat for such pmjcm with aconuactm(s)licensed porevant to NeCenuanors 203 - UNDERFLOOR MECHANICAL License Law. exemptander Sec. .Bk PCforthamasnn 204 - UNDERFLOOR FRAME 205 - UNDERFLOOR INSULATION WORKERS COMPENSATION DEC M 301 — ROUGH PLUMBING I herby afrbm under iamlty or perjury one of she fa11ow1iImwom: 302 — TUB & OR SHOWER IluwaMwillmaintiaCeNOauofComentm.if.i mrmW.,k e$Compem 303 — ROUGH MECHANICAL urian,as provided for by=.3700 of tie Labor Code,for the Performance Of Ne work for which this permit is Issued. 304 - ROUGH ELECTRICAL ❑1 haw and will maintain Workan compemation Wassong,a required by Section 305 - FRAME 3700 of de IAborcoda,for tie performance oftin wan forwmcb Nu permit u Imwd. My Worker ea pemPaI lmm.y Iv�ydp�Iry num an/: 306 — HOLDOWNS 1 esrt hiley-na TRS, 307 - INSULATION ceRnFlaT OFE%FMP170NFR RKEas 308 — SHEETROCK COMPENSATION INSURANCE trials serum need notWoompleled if the ranch Is foranc hundrldollan(5100) 309 — EXTERIOR LATH mwa) 310 - INTERIOR LATH 1 unify that in the perfomance of de work for which this permit is Issued,l Nati not 311 — SCRATCH COAT employ any person in any mannerso as to become subject to the Worker'Cmapemation Law of CaRromia.Dam 313 - ROOF NAIL NPOlican TICEtTO APPUCANT.IL after making this Certificate of Exemption.you should 501 - FINAL ELECTRICAL ENERGY. become subject to the Workers Compemation provisions of the Lahor Codc,you muss 502 - FINAL PLUMBING ENERGY Z forthwith comply with such Provisions Or this permll shall M memcd mated. �0 503 - FINAL MECHANICAL ENERGY CONSTRUCTION LENDING AGENCY J--i thereby affirm that there is a mmtnetion lending agency for the perfomame of 504 - FINAL BUILDING ENERGY fYr�„ thewank for which this Permit a Issued(Sm.3097,Civ.C.) 505 - FINAL ELECTRICAL W Lender's Namc az LendersAddreas 506 - GAS TEST Uo Icertifythat Ihaw mad this application sadmtothat the show InformWmb 507 - FINAL PLUMBING O U mrmct.l agre N comply with all city and county ordinances and auto law relating to FINAL MECHANI CAL building construction,and hereby authorize representatives of this city m enter upon tic W above-mentioned property for impemion purposes 0 FIN DE (We)agree m tow,indemnify and keep harmless the City of Cupertino against ` L.tq Ilabilitics Judgments,costs and exposes which may In any way acome apinatseld city I U In consequence of the Stenting of this permit. APPLICANT UNDERSTANDS AND ILL COMPLY WITH AL NON-POINT Issued by:5 WORKS Date SOUR ULATI S. Q� , Re-roofs 3gindurt,of ApplicaZ mr ate 'Type of Roof H DOUS MATERIALS DISCLOSURE Will the applicant or future building occupant nom or handle haeardous material nod by the Cupertino Munid I Code,Chapter 9.12,and the Heald and Safety $1, Section 35532(an All roofs shall be inspected prior to any roofing material being installed. ❑Yea oWill the applicant or future building occupant use mulpment or devises which If a roof is installed without first obtaining an inspection,I agree to remove ayardaus ser conuminmu m defined by the Day Arca Air Quality Management all new materials for inspection. m7 ❑Yes I haw mW the hazardous materials mqullemenu under Chapter 6.95 of the Califon- me Health&SalmyCade,Seen om25505.355 end 25534.1 understand that If to Wilding docs not tonally have a ant.Net It Is upon slily Io mN'y Illi mxupent o Na rcyulr mnmait met dorNi a a f enilicaneofOm Signature of Applicant .... Date Owner or auarired agent U m All roof coverings to be Class"B"or better