02120007 CITY OF CUPERTINO ' "�` A
BUILDING DIVISION PERMIT !dCONTRACTOR INFORMATION
Bm12)06 0grsSTEVENS CREEK BLVD MENEMSHA DEVELOPMENT GROU PERMITNO2120007
rPUREPEBEAUTY SALON 525 S . DOUGLAS ST. APPLICATl1)NZSYnTY2002
IONF.: 31O 343-3430 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O`•+mOp LICENSED CONTRACTOR'S DECLARATION �fh
czF 1 hereby affirm that l am licensed under provisions of Chapter Y(commencing TI--W/PARAn/TI TI ON59R1 /_P-LUMB-/; ECH.
<N
with Scct ion]DII(Icc and Professions Code,and my license is — /
is full nd effect ---� f�"3
Oz�Z License s Lic.X7.
-- Dale Co t •� \ ' 1
I<—"� ARCHITECT'$ ARA ON f t--"''
a 1 understand my plan.¢Wall Be used as public menrU.e
FSO Licensed Profusslnnol
OWNER-BUILDER DECLARATION kk9l
o� f I hereby affirm that I am exempt from the Contractor's License law for the — $80000
m_M 0 following moron.(Section 71131.5.Business enJ Pn+fessions CWc:Any city ar county
n•�$E� which requires a permit to convect,alter,improve,demolish,or mpair any structure
I^ prior oo its issuance.also requires the applicant for such Permit file asignednatemem
S�S�< that be is licensed pu mum m the provisions of the Contractors License Low lChapter9 33g910810dfa8A@m Valuation
(mmmencingwith ficnlnn]tkgpnl Dlvlslon3nf tho 0ueinees and Profeesinns Clmc)nr
Ihat he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Persil subjects the applicant to a civil penalty of 1uApN`NW9RFD=UN Occupancy Type
not more fears five hundred dollars(5500). 102 — PIERS
I,as owner of Ne propeny,or my employes wit wages as their role compensation,
will do the work,and the suracture is not intended oroffcred torsade(Sm.7004.Business 183
and Pmfesdons Cede:The Commences License Law does not apply to an owner or 104 - REBAR Required Inspections
property,who builds or improves thereon,and who dressuch work himself orthrough his
own employees,provided that such improvements am not Intended moRered Intrude.If. 105 — ANCHOR BOLTS
however,the building or improvement is sold within one year of completion,the owner. lO6 — SEWER & WATER
builder will have the burden of proving that he did net build or improve for purpose of
.1.1. 202 - UNDERFLOOR PLUMBING
❑1,as owner of the progeny,am"elusively contracting with licensed contractors m 203 - UNDERFLOOR MECHANICAL
construct 0c project(Sec.7004,Business and Profession Code:)The Contractors Li-
mose,Law does supply to an owner of properly who builds or improves thereon,and, 204 — UNDERFLOOR FRAME
who comment for such pmjecu wife a contnetor(s)licensed pursuant o the Commissars 205 - UNDERFLOOR INSULATION
License Lew.
I am exempt under Sec. .B&P C for this Yemen 301 - ROUGH PLUMBING
net Dare 302 - TUB & OR SHOWER
WORKER'S COMPENSATION DECLARATION 303 - ROUGH MECHANICAL
I hereby" im under Penalty of perjury one of the following declarations: 304 — ROUGH ELECTRICAL
I have and will maintain a Certificate of Consent self-ituute for Workers Compcm
13700
on,as provided for by Section 37M or the lahnr Code,for the perfonence of the 305 - FRAME
rk for which thispenitisissued. 306 - HOLDOWNS
I have and will maintain Worker's Compensation Insurance,as required by Section 307 - INSULATION
of the Labor Code,for the performance of the work fm which this permit is Issued.
worker's Compensation Insurance ce ler end Pol�iy number am: 308 — SHEETROCK
card �n`l ���aN6:_lAL` O iq 309 - EXTERIOR LATH
C•RTIF COMPF SATIO� NrSLISAONCEORKERS' 310 — INTERIOR LATH
(This section need not k completed link penit is forone hundred dollars(SIM) 311 - SCRATCH COAT
orless.) 313 - ROOF NAIL
I cerify,that in the performance of the work for which this Permit is issued,I shall not 501 - FINAL ELECTRICAL ENERGY
employ any person in any manner so n In Become subject to the Workers'Campsnsation
Lawsof California.Dam 502 - FINAL PLUMBING ENERGY
Applicant
NOTICE TO APPLICANT:If,after making This Certificateof Exemption,you should 503 - FINAL MECHANICAL ENERGY
become subject to the Worker's Compensation provisions of the Labor Craft.you must 504 - FINAL BUILDING ENERGY
,z forthwith comply with such provisions or this Permit shall k deemed revoked.
0 505 - FINAL ELECTRICAL
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a convection lending agency for the performance of 506 - GAS TEST
a the work 4+r which this penis is issued(Sec.3(9].Civ.C.) 507 - FINAL PLUMBING
f41 Lender's Name
z Lcnder'sAddmss 508 - FINAL MECHANICAL
U 0 I certify that I have read Nis application and sum that the above infonetion is 509 - FINAL GRADE
nines.I agree to comply wit all cit and count ordinances and some laws relating to
OU buildings nswnion,andherebyaufeonnerepresentativesofthiscitytocorerUpoo he 5 FINAL PLANNING
W above-mcatinedpmpeny for inspection purposes. 14 — FIN C W RKS
(Wit)agree m save,indemnify and keep harmless the City of Capcninn against p
hhabilitics,judgmenu,costs and expenses which may in any way accrue against said City I (�
Vimconscquenceofdailim ngofthispermil. L/•s
APPLICANT UNDE ANDS AND WILL COMP Y WITH ALL N N-POINT Issued by: Date
SOURC REGUL NS.
-Ig•eL3oL Re-roofs
Si rare of pp ican Conerini Data
HAZARDOUS MATERIALS DISCLOSURE. Type of Roof
Ill the applicant or future building occupant store or handle fixations mamnal
defied by the Cupertino Munigipat Code,Chapter 9.12,and the Health and Safely
e,Section 25532(a)'7 nVM/ All roofs shall be inspected prior to any roofing material being installed.
❑Ycs
Will the applicant er(marc 1�Belding occupant use equipment or devic"which
If a roof is installed without first obtaining an inspection,I agree to remove
it Ini ael air emiture anter _i J by the Oay Area Air Quality Management all new materials for inspection.
Disnnn7
C]Yea; No
I have mail the haz000ws mamrials"mr,mcme under Chapterti95 of the Cubic,
iia llculmh&Safety Code, mv25505,25533 and 25534.1 understand tbmifthe building
mica not eennlly buv Icnnnl,NeI itis Ing resrymsihiliny Io noddy Ibe Iccupant nl Nc
ong,romentswhi- 'tralbonnettablPen rmof nllicamof c ane. O Signature of Applicant Date
wncr or authorivcJ agent ' at All roof coverings to be Class"B" or better