02050027�eZZsz
o<y�o
X0�u
m3LL
FLLQ
toc0
e, E
0z
z
aZ
a�
Z)z
UO
OF
U
CITY OF CUPERTINO
'""
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION.
IRE UILDING ADDRESS:
-
PERMIT NO.
10201 STONYDALE DR
02050027
ER NAME:
APPLICATION SUB DATE
JOSEPH G. WILSON III
05/06/2002
PRONE:
SANITARY NO. CONTROL NO.
ARCHITECDENGINEER:
BUILDING PERMIT INFO
BLD0 ELECT PLUMB MEOCH
LICENSED CONTRACTOR'S DECLARATION
1 hereby affrm that I am licensed under provisions of Chapter 9 (commencing
Job Description
with Section 71(X1) of Division 3 of the Business and Professions Code, and my lemic is
in full to= and effect.
ADD 340 SQ.FT.
& KITCHEN REMODEL
License Clara ue.a
Dale Contractor
CEILING PODS
ARCHITECTS DECLARATION
understand my plans shall be used as public records
SEp )- 1 2003
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that l am exempt from the Cnmracrot's License Law for the
Following reason. (Section7031.5, Business and Professions Cade: Any city or county
�UILflli� ,
which requires a permit to corearucl, alter, improve, demolish, or repair any structure
prior In its issuance, also requires the applicant for such Permit to file a signed statement
that he is licensed pursuant o the provisions of Rom Comrawr's License LAW(Chapw, 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 711(10 of Division 3 of the Business and Professions Code) or
$190000
Nat he is exempt therefrom and the basis for she alleged exemption. Any violation of
APN Number
Occupancy
p y Type
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penally of
not more than five handled delta. ($5x).
32637019.00
❑ I,00wner of the pmpeny. rr my employees with wege es their sale compensation,
101
- FOUNDATT ed Inspections
will do the work, and the structure is not intended proffered for sale (Sec. 70,14, Business
and Professions Code; The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who doessuch work himself or through his
own employees, provided thmsuch improvements we not intended reoffered for rule, If.
102
— PIERS
however, me building or improvement is sold within one year of completion, the owner
103
— UFER
builder will have the burden of proving mat he did not Wild or improve for purpose of
AsIe''
104
- REBAR
r 1, as owner of the property, am exclusively contracting with larmacd contractors m
105
- ANCHOR BOLTS
convect the project (Sec. 7144, Business and Professions Code:)The Contractor's Li.
cense law does not apply to an owner of property who builds or improve thereon.and
106
- SEWER & WATER
who contracts for such projects with a conmetor(s) licensed pumaant to me Contractor's
License Law.
ZO2
- UNDERFLOOR PLUMBING
❑1AmAxem code, Sce. B&PCforth'rtmnn
203
- UNDERFLOOR MECHANICAL
204
- UNDERFLOOR FRAME
R :'SCOMPENSAO E RAi�
205
- UNDERFLOOR INSULATION
I bereb mmunder penalty of perjury one of following declarations:
301
- ROUGH PLUMBING
f -1I have and will ..ma in a Celli ftcau of Consent In self -insure for Worker's Compere
ration, as provided for by Section 37W of the labor Code, for the Performance of the
3 02
- TUB & OR SHOWER
work for which this permit is issued.
303
— ROUGH MECHANICAL
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3 04
- ROUGH ELECTRICAL
37(1(1 of the Labor Code, for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy another am:
3 05
— FRAME
Carrier: Policy Nii
306
- HOLDOWNS
CERTIFICATECOMPENSATION INSURANCE ORKERS'
307
— INSULATION
(This entranced mnto, completed if mal.ermit is fortune hundred dollars 4100)
308
- SHEETROCK
309
- EXTERIOR LATH
I canthat in the fie romance of the walk mr which this permit is isomed, I shall not
310
INTERIOR LATH
cmpluy any( yma as A, subject to the WorkerYComiamsetion
_
La rrca nate y.71e�` �--
311
313
SCRATCH COAT
- ROOF NAIL
ICE APPLI� : If. D, making this c rex of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
501
- FINAL ELECTRICAL ENERGY
forthwith comply with such previsions or this Permit shall he deemed revoked.
502
- FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY
I hereby ani roe Nat there is a construction Irmh ng agency for the perfurmance of
503
- FINAL MECHANICAL ENERGY
the walk lin which this permit is issued (See. 3097, Civ. C.)
504 -
FINAL BUILDING ENERGY
Len= Name
505 -
FINAL ELECTRICAL
lender's Address
1 certify that l have mad this application and stem that the above information is
506 -
GAS TEST
correct. l agree to comply with all city and county ordinances and state laws relating.
ction, and hereby authorim representatives or city to enter upon the
building construction, f N
5
FINAL PLUMBING
alwve-mentioned property for inspection purposes.
O8 -
FIN C L
(We) egret m save, indemnify and keep harmless The City of Cupertino against
llabili ties, judgments, costs and expenses which may in any way accrue against said City
5
N D )
in consequcncc of the granting of this permi 1.
APPLICANT UNDERSTANDS AND WILL COMPLY Will] ALL NON -POINT
Issued by51
NG Date
SO .GULATIONS.
2 -70
Re -roofs
Type of Roof
urc pImanV ammCLmr a
I IAZARDOUS MATERIALS DISCLOSURE
Will me applicant or future building occupant store or handle haaurdous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
ale, sclera 25532(a?
❑Yes P<""
All roofs shall be
inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant ar future building tscamall use equipment or devices which
emit hazardous air contaminants as dclincJ by the Bay Arca Air Qualify Management
all new materials
for inspection.
District?
❑Yes!
I have read the haardnus materials requirements underCmIne, 6.9.5 of the Cold.,
ria Hculth & Safety CGNc, Sections 25505, 25533 and 25534,1 undersand Nm HOW building
does not m
currently have a tenant, m it is my reslnnsibility to n the occupant of Nc
req.incipirgaybeh most M met poor to ishoW ofe Cenifu:am of vane
Signature of Applicant
Date
All roof coverings to be Class "B" or better
<d agent6