03060087CITY OFCUPERTINO
BUILDING DIVISION PERMIT
�CONTRACTORNFORMAC,ION
.
BUILDING ADDRESS:
NOVO CONSTRUCTION
Pr"MRNO03060087
OWNER'S NAME:
420 MAPLE
ST
" `E`Me%'11 2003
E,
(650)701-1500
SANITARY NO. CONTROL NO.
ARCHITECT(ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
I bteby affirm that I em liroved under Provisions of Chapter 9 (commencing
with Section 77q) of Di Ion 3 of Ne Dust.. and Profecalom Code, and my license is
i I.Lksnfallwcrtle pd eC' Lk,� tl22-
TENANT IMPROVEMENT
Ds —
ARCHITECTS D A ION
I understand my pots shall w used u noire recmdt
ry Z06
JUL I.V
Licensed Professional
OW NER.BUIIDER DECLARATION
1 hereby alrnm that I am uempt from the Co°tnctoe. Lieen¢ Law far the
following moon. (Section 7031.5, Business and Profession Cole: Any city or county
BUILDING
v
which requires a permit to construct, alar. Impmw, demolish, or repair any swctum
prior a its issuance. also requires incompliant far such permit to file a signed statement
that he is licensed pursuant at the provision of the Conuehor'sI-cosec Law (Chapter 9
Sq, Ft. Floor Area
$ 3 3'bibj@tion
(commencing with Section 7000) of Division 3 of the Business and Rofeuinu Code) or
th.t he H exempt themfmm and the basis fm the alleged exempJon. Any violation of
3 @3Vaf>k8er0 0
Occupancy T
P y y�
Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of
nm more Nan It. hundred dml (M).
❑ I,uawnu of the proprny,osmy cmploycca with vnguuthcir sok cmnpew0an,
iui
—dinspections
will do the work and thesiol is not intended Conflicted! foruk(Sec. 70", Business
Cade: Canuumrs ucarese taw does
and Pothole. The not apply in an owner of
10 2
PIERS
d who doeuch work himself or dough his
property who builds or Improves thereon, ans s
own employees, provided thatauch lmprowments are not intended oraRamd forssle.If.
103
— UFER
however. the building or improwmem Is sold within ane year of completion. the owner
builder will have the human of proving that w did not wild or Improw for purpose of
104
- . REBAR
"le')'
105
- ANCHOR BOLTS
Cl I, a wrcr of the property son ucluta ly cm u acting with liecued contractors to
106
— SEWER & WATER
Construct IN project. (sec 70th. Business and Professku Cade:) The Conusmors U.
come Law does not apply he an Cower of propeny who Nil" or improves thereon, and.
202
— UNDERFLOOR PLUMBING
who contracts for such projects wit aeonoacmr(U licensed pursuant m the Conu.etors
License law.
203
'
- UNDERFLOOR MECHANICAL
Con ❑ I aucmpt under Sec ,B&PC for this won
204
- UNDERFLOOR FRAME
tuner DAC;205
- UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
301
— ROUGH PLUMBING
I hereby dfmm under penury of perjury am of the following declarations:
302
.
- TUB & OR SHOWER
h.wand will noi.W.. Ceninate arc a ment a. sau.lesure fm wmk<ra campen.
cation, u provided for by Section 371M of the labor Code, for the perfarmamc of de
303
- ROUGH MECHANICAL
work for which this permit isWool
304
- ROUGH ELECTRICAL
❑ I hive and will maintain Worker's Compensation Insurance. as required by Section
305
— FRAME
37W of the Labor Cade, for the performance of to work for which this Permit isi ame.
My World s C. enation IaaYAa c csmu and POIIL' ata Ito
ca"°r' P°'��
306 306
- HOEDOWNS
307
- INSULATION
CERTIFlGIE OF EKEMPf10N OM WORKERS'
COMPENSATIONINSURANCE
308
- SHEETROCK
(Thusexcennad notwcompleted lfthe Permit isforonchundroddmlars(SIM)
309
- EXTERIOR LATH
aricat)
310
- INTERIOR LATH
1 unify Net In the perfmmarce of the work for which this permit it ustud, I slash not
employ any person in any mm sn°crm u w become subject the Worker' Compensation
311
— SCRATCH COAT
Laws of California. Date
313
501
- ROOF NAIL
- FINAL ELECTRICAL ENERGY
Applicant
NOTICE TO APPLICANT. If, afar making this Certificate of Exemption, you should
become subject to the Workers ComMm.Iion provisions of the lahttr Codc. you must
502
- FINAL PLUMBING ENERGY
forthwith comply with such provision or this permit shall be doomed ranked.
503
- FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
IMmby Jr.adoor IN. its mosmmdon kndtnggctwY(0, rite perform. of
504
- FINAL BUILDING ENERGY
the work sur whim this pencil isiasued(Sm. 3197, Civ. Cd
Lenders Name
505
506
- FINAL ELECTRICAL
- GAS TEST
Lender's Addw
I ttnify that l hive rtad this ppllestlon and ma this the above Information is
507
— FINAL PLUMBING
contract. I alma in comply with all city and county eminences and sum lawn relating to
building construction, and hereby authorise reprommumivu of his city to enter upon the
FINAL MECHNANICAL
ahow.mcnuomed property for inspection purposes.
egme m ave, indemnify and keep homeless Oto City of Cupertino agaiut
/liabilities,judgments,
cats and expereea which may in any wy we= against said City
%9FIN(WC)
I A G//in
ca"mor c of the granting of Nis permitAPPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by:
WORKS Date 22
SOURCE RyeuLATIONS.
'
I 1 , t (( (Y) �Q- 03
Re-roofs
Type of Roof
Type
I�rt pits HAZARDOUS MATERIALS DISCLOSURE
Will die applicant or future building occupant store or hamlk heyemous material
as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
aria.S-I Yss3z(a)7
All roofs shall be inspected prior to any roofing material being installed.
YNo
[-I Y.
If a roof is installed
without first obtaining an inspection, I agree to remove
Will the applicant o )Hare wilding aec.,.I me aqulpmam or devices which
ammmos air contaminants as colored by Um Bay Area Air Quality Management
all new materials for inspection.
Disuict7 11 ^
C] Yes No
I have mad the huanloua materials requirement under Chapter 6.95 of the Califor.
hie Hulth& SnfcryCede. Scctims 25505,25533 and 25534.1umimmod the if Ne wilding
does col currently haw a tenant, that It u my responsibility a notify the occupant of the
mptimmcn mhmeaNMCI pdor afaCcnlnaaofOcaaney'
n �
Signature of Applicant
Date
I � _ �
. ���(" `
All roof coverings to be Class "B" or better
Ow V
uthCmcd agent Date