03100026 ":CITY OF CUPERTINO °' £' % � _
BUILDING DIVISION PERMIT ,CO NTRACTORINF.ORMATION �-
DING ADDRESS: NIELSEN/AIRE CORP PERMIT NO 03100026
OWNER'S NAME: 1601 GALVEZ AVE PERMRLSSUE DATE
NE: (415) 643-8930 SANITARY N0, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
100 LICENSED CONTRACTOR'S DECLARATION lob Descri tion O O O O
%w❑ I hereby affirm that 1 am hoonsed under provisions of Chapter 9(commencing p
with Section 7WO)of Division 3orthe Business and Pmfcssiuos Code,and my license is
< in full force and effect.
6
Lic
Danaclas LR.N TI--PENINSULLA BEAUTY (2 Q,, �®
1 Da¢ Lic.0Contractor Q,,
ARCHITECTS DECLARATION
i I undersand my s II a ¢retards
iUp
:o G Lie d Pmreasiom MAR 2 5 2004
S OWNER BUILDER DECLARATION
f I hereby of um that 1 am exempt from the Contractor's License Law for the
.00 following Lesson.(Section?031.S,Business and PmfcuinnxCode:Any city orcounty
BUILDING
j g E' which requires a permit to construct.alter,improve,demolish.or repair any structure
_it, Land,toits iasuaace,alsumq.i.thcappfnnt torment permit to file asigucd Stotoment
s a that he is licensed pursuant m the provisions Of the Contractor's License law(Chapter 9 Sq. Ft. Floor Area ValUati00 -
1mF0 (commencing with Section 7")or Division 3 oftM Business and Profession.Cade)US
'RE Nal he is exempt therefrom and the basis for be alleged exemption.Any violation of
Section 7031.5 by any,applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
nm more man five hundred nonan(SSW). Pane Y YP
❑I.as owner or the progeny,or my employee,with wages u their sole compensation,
will do the work.and the ant,ante is aot intended orofremd roraem(See.7044,Business 101 — DA '�Q d Inspections
and Pmfeaions Cade:The Conlroetor's License Law does not apply to an owner of
property who builds or improves thereon.and who does such work himself or through his 102 - PIERS
own employees,provided that such improvements art not intended or offered for ale.If, 103 — UFER
however,the building or improvement is sold within one year of completion,be owner-
builder will have the burden of proving thal be did not build or improve for puryose of 104 - REBAR
ale). 105 - ANCHOR BOLTS
es owner of the progeny,.B exclusively contracting with licensed contractors to
co wctthepmjcct(Sec.roanma
ineanePmfuxions code:)TheContractor's Lt. 1O6 — SEWER & WATER
cense Taw dors not apply tom owner of property who builds or improves thereon,and
who contracts(orsuch projects with a contractor(s)licensed pursuant to the Contractor's 202 - UNDERFLOOR PLUMBING
uatvt law. 203 - UNDERFLOOR MECHANICAL
❑e em exempt under Sec. B k P C for this reason
1 O Dete •Z'e 204 - UNDERFLOOR FRAME
1 ORKER'SCOMPENSATION DEC}.ARATION 205 - UNDERFLOOR INSULATION
I homy afnnnunderpenaltyof perj pesf/the fallowing dechumioas: 301. — ROUGH PLUMBING
I hove and will maintain eCenifeamotConsenuaatf-lummmr Worker's Compcn- 302 — TUB tic OR SHOWER
,don.u provided far by Section 37M or me labor Code.for the performance of the 3 0 3 - ROUGH MECHANICAL
work far which this permit is issued.
❑ 1 have and will maintain Worker's Comperoslon insurance,as required by Section 304 - ROUGH ELECTRICAL
37M o(mc labor code,for be petformance of the work for which this Permit is issued. FRA
My Worker's Compensation lnsursn 305 - FRAME
ncarrier and Pol icy number am: 305 — DOWNS
Carrier. Policy No.: _
CERTIFICATE OF EXEM MON FROM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
or Less.)(This Section need not he completed if list pared is for one hundred dollars IS l W) 309 - EXTERIOR LATH
I certify mal in the porramounct of the work fon which this Permit is issued,I shall not 310 — INTERIOR LATH
employ any Person in any manner so ae or become subject to the Workers'Compensation 311 — SCRATCH COAT
Laws of California.Dow
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT:If..(mr making Ibis ComfiClte of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
income subject to the Worker's Compensation provisions of be Labor Code,you must
7zmnhwith comply with such provisions or this permit Shan be deemed revoked. 502 — FINAL PLUMBING ENERGY
Z0 CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hereby affirm met then is a consunction lending agency for the performance of 504 - FINAL BUILDING ENERGY
X F�-t the work for which this permit Is issued(Sec.J09),Civ.C.)
ll landcr'sName1. 505 - FINAL ELECTRICAL
D z L nder'IAddms, 506 - GAS TEST
J Q I unify mu 1 have end this application end state that be above information is
y Pcartersle
.IagreetoComplywithallcityadCountyordinancesandSolawsmlatingto 507 - FINAL PLUMBING
Z)U building construction.and hereby authoriseMPresentatiW3ofthis City toenter upon the FIN MECTNWG'
L
shove-mentioned to saw,fmiesPecdan keeph
ti a (We)agree to ave,indemnify and keep ntarmlcu the City of Cupertino against 0 9 FI
N liabilities,judgments.costs and expenses which may in any way accmcagainst mid City 5 Jz inconsequence of the granting of this permit.APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued bY:5 ORKS Date
SO17 REGULAT}oN.
/ + e•a•o
Re-roofs
aturc ofA icmYConlractor Dole
4 HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant stem or handle harudous material
US deGnetl by the Cuyenl no Municipal Code,Chapter 9.12,and the Health and Safety
Code.seedca2ss32(a) All roofs shall be inspected prior to an roofing material being installed.
❑res Na P P Y g
If a roof is installed without first obtainingan inspection,I agree to remove
Will she applicant or(atom building by the Bay A co Air Qu or Minas which P ,�
it hazardous air conmminents u defined by me Bay Arca Air Quality Management all new materials for inspection.
i,trict? �
❑Yes Nu
I have real the hvaNnus maerials myuirtmenrs under Chapter 6.95 of the Califnr-
nieHculmdrSefetyCttle,S¢does25505,23311 and 2553x.1 undcrstard Not if the Wilding
docs notaneatly hve
aen t.Non sus my resWnsihilily m noul'y the oceupmt the
require ctswhim met ' aCcnlMaxofOccupancy Signature of Applicant Date
/e•2
Owner or aathorived agent Dare All roof coverings to be Class "B" or better