00080206NO
CI BUILD
CONTRACTOR INFORMATION:
NG DIVISION
PERMIT
BUILDING ADDRESS:
PERMIT NO.
10858 SYCAMORE
00080206
HOEYAME:
APPLICATION
08/29/2000
PHONE:
SANITARY NO, CONTROL NO.
ZO ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
r
BLDG ELECT PLUMB MECH
i LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby vRirm that l am licensed under provisions of Chapter 9(commencing
With Section ]000) of Division 3 cribs Business and Professions Code, and my license
PATIO
COVER
is in full farce and effect.
ULicense Class Lia g
Data Caroted.,
fn
ARCHITECT'S DECLARATION
5 1 understand my pions shall he used as public tecom
-
X Licensed Professional ,
OWNER -BUILDER DECLARATION
v, I hereby affirm that I am exempt from the Contractor's Licen for eV
71
following rearan. (Section ]0313, Business and Professions Code: Any i or co
$5000
O which mquim a pewit to construct, alter, improve, demolish, or mpai y suuc e
r'
$_prionoslicauardfustorequires thovisiosof for Conamrmiuoi ui (Cha t
- NauhiisliecnrWipursu3i'utothe 'pmvisionsofthe Cantmn.,.,.dise (Chaps
'onsC
..
-- - - ----'-on '
pO 5'T'r t, Valuation
(commencing with Section 7099) of Division Sof,he Business,and Pmf
or that he is entrust tjhamfrom and the basis for the alleged ek. iipUon. A
-ofSeetlun 7031.3 by any applicant fora permit subjects she applicant m sell
of not mom than eve hundred dollars (S500)
.r.tw�
lOIAEN tbTISATION
" Occupancy Type
❑ 1, as owner of the pmperty, or my employees with wages as their sole exmpensvtian,
-
103 -
UFER Required Inspections' ' •'
-will-do the 'wosk, and-the'sweture is not intended or uttered for sale (Sec. 7000;
Professions Cale: The Contractor's License Law does to an
Business and not apply
owner of property Who builds or improves Ne on, and who dm such work himself j
104
REBAR
o through his own employees provided that such improvements arc not intended or
"- - '
-"'- - - _. _. _-. _...-_ ..._.
- offered for side.moil ever the building .r m'rovemeni a sold within orie year of
g p Y
105 -
ANCHOR BOLTS '
improve an, pu owner W tldtt will have ilia burden of proving that he did not Wild or
improve ter pamom at sme.).
'--
106 -
SEWER & WATER
❑1.asowner ar�prol=re--c.._,._.yco.tractie_,...--
nwacmtor's
,amasiness
..._..202_=_UNDERFLOOR--PLUMBING---
1�••
-constru- _ - --- -
ns Code:) Thensed e
and Contractor's
the project taco, ]094, Business and Professions CWeO The
203 -
. C f
UNDERFLOOR MECHANICAL'`'
improves
License Law dart not apply to an owner of property who Wilds or improves Narcan„
License
.. and who.contrmas for.suah.prijacts with.a coinracmr(s) ucersW.puntmm.m.Ne.._
_ _..._. 204----
-UNDERFLOOR '-FRAME"""
' Conractols License law. .
- ❑IamexennnumlcrSea'''i •' � � `.B&'PCfor Nismason
205 -
UNDERFLOOR'`TNSUliATION
owner. •''-'"' "Date" """'
301 -
ROUGH PLUMBING
WORKER'SCOMPENSATION DECLARATION
302 -
TUB & OR SHOWER
-lhembyafliwvnderpenaltYarperjarypnearNemlmwmgdalnmvnn::
303 -
ROUGH MECHANICAL
n 1 have and-will'maiinnin a Ccnificum ef'&hoam w self-im.. for Worker's
304 -
ROUGH ELECTRICAL
--Compensmion,- as provided for by -Section 3100 of the Labor Code. far the
'performance of the work for which this pewit it ixwW..,
305 -
FRAME
❑ I hale vnA will maintain Worker's Compcmaimrn Insurance, as required by Section
of the Cabor'Code, for the performance of the work for which this' wi
iswed' My Worker'sCompention Ins term amarad PolityrFPal cYNapIFlC"COM
306 *HOL
j3000
�ATION
OF EXEMPI'IO UFROMANC a5'ORKER]
INSURANCE
A
I Y1
rN rsr we
(Thissent nneedn the omp e
P<
dll r(5100)
11.
1kt,IIs
Irated
3- -
'ROOF --NAIL ,.,.
' 1 n f th n the Rowwice of the w br%for whl h this, t is issued; 1
t� shall not crop oy any person in any manner so as to become nwnrke.pl
mh
501 -
f rY
FINAL ELEClTRI CA'li' ENERGY
C n pe rot n L acs of Cnl for in. Date
A Imam ' -
-n
- - 5.02 -.FINAL.-PLUMBING
-ENERGY---- - - -- ----
NOTICE TO If, after ak gNP c Fl� te.r exempnan,
" y.ushpmd'
bac I T A to the APPLICANT.
IWorker's Compensation w s ons bf the labor Codc, yos mum
503 -
FINAL MECHANICAL` ENERGY
'fbahwiNramplywiNsuch provisions orthispewnshall xdeemadrevaked.
504, -::-.FINAL
BUILDING ENERGY-., ........................
3 l CONSTRUC71ONLENDING AGENCv
505 -
FINAL ELECTRICAL,.,, N' t ,
i h oy attilm that there iv a con w t n Ieidin8 vg y for ilia perfomwnce
'afth
506 --
GAS TEST
rk f which th pewit is issued IS a JD9] Civ C 1 t yiu .0 t _ a
.L d N" •`.
-PLUMBING ._..
Land r s Add -
507 -
FINAL
50
d
FINAL MECHANI CAli
s Icrtify that l have mad this application and swat that the above information is
�epmect. I and asese laws rtleun8
5 -
INAL G DE
agrtt,ip,cortiplywithsll ciry.epd caumy ordinances
mbuildingconswnion,end�embyautharizdreprcsenwtivesbf(hiscitytoenterupon
5 0 -
INAL NG
}] i the above m<miuneo properly fur.inspedion purposes.
if (We) dgr'ee to save; indemnify and keep harmless deCityrf Caper ino again,
51 -
I NAL RKS
n liabilities, judgments, casts and expenses which may in any way scarce against said
ZCityy in consequence of Ne Rrvming of this pewit. '
WILL COMPLY WITH 60th-POLY'T"
ATPL'ICANT UKDERST�'1 NDS AND A'LL
SOURCE REGULATIO,•$s�."„s'.'I::r•'
Issued by4
Date
SignatUreof Applicant/Commctor, ." Date
Re -roofs
- ,,.,,'HAZARDOUS MATERIALS DISCLOSURE ' ... ,
Will the applicant or futurmbuilding occupant stare or handle hneerdommaterial
Type.of Roof.
< _•-... •.
u defmW by, the Cupertino Municipal Cale Chapter912 and the Health and Safety-
r , Y
_ r P.'•. � I -1
Cd1! 5 cion. 25533.(m V 1 t1 t ) f! •
"orei' i ' ❑Na .'
, ,'. 1 %.AI.
' ' ected prior.to.any. roofing materUbeing installed.._ _.........
All roofs -shall be insp
-,Will the applicant or future building eacupantuse a,.ip.aat.,devices which
If a roof is i'n`stalled`without first obtaining an inspection;,I'dgiee-to'reinove
emu heO YC9 Bair rmria ts0 by g
Dismct. t Mona amens
Bmenu
all new materials
,
for Inspection.. Applicant understan_d_s and will.comply, with
Nnfined
4e
Chap
a,
all non- Olnt SOurCe re ulatloos.. � i t
P g
oder
I have the ha materials re ire ter of Nc
I,h Coate: 2 8533 and 1 undemand slut
nil & Safety Cade; Sections understand
if tngbuilding des ria currently have atenanl, shut it is my rtsPdnsibiliry td notify she
ifita; do ad, that sponse
Wilding
cic6pant of the. requirements which must be Ric. prior to issuance of a Cenificato of
-
J ocaa priby: ,. , ,
p � "" ' ' � ° ' � � '_ • �
SignatureA licant Date
of PP
All roof coverings to be Class"B". or better' ,
,owner araam.naed aunt ,;I;;
.Date
._ - ,-- �- -- --- - --' OFFICE .._. .... .. t - - ......_ .