02100140 CITY OF CUPERTINO n " i ' �.. 4
BUILDING DIVISION PERMIT :CONTRACTOR% ORMAINFTION:
BUI 1 ESN TANTAU AV PARAGON MECHANICAL, INC . PERMITN(02100140
MPAQ HP 2460 DE LA CRUE BLVD APPLICATI.1"6"2002
P14ONE (408) 727-7303 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u�Flpp LICENSED CONTRACTOR'S DECLARATION
mdr I hereby Arlon that l am licensed sent,provisiotoof Chapter 9(commcnem, INSTALL 2 A/C J 'F�IPtIOn
F¢8 wf6$eption7fM1())nf Division3nf Ne usi sand nfcsssjit CA onJmyliccnscis +
Zo<Z i.fulseClown Uc.N —IM (SERVICap
oML rFgNA CHILE LARrcI understand my plans shall W used as public rods
Licensed Professional
OWNER-BUILDER DECLARATION -
rc <� I hereby affirm that I am exempt from the Contractor's License Law for the
w¢00 following reason(Section 7031.5.Business and Professions Gale:Any city or county
e• $ which reyuircs a permit to construct,after,improve,demnlish,or repair any Bmctum 2 7 )0 0
FI< prior to its issuance,also requires the applicant for such Permit o file a signedsmmmem
tom W is licensed pursuant to be provisions of the Contractors License Law(Chapter 9 Sq. Fl. Floor Area Valuation
se $ (commencing with Section 70018 of Division 3oftheBusiness and Professions Code)nr 31618025 . 00
`s F that be is exempt therefrom and Jr basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil Penalty of APN Number Occupancy Type
not more Nan five hundred della.WWI. 101 — FOUNDATION
❑I.as owner fthe property,or my employees with wages as their sole compensation,
will dothework,and thebe corms notintendedo Lawdoforolepplyt an hoderof
and ertywhoW code:The ver t.mera and
Law dues net apply to an.weer is 103 - UFER Required Inspections
property who builds or improves ch imp,end who am not intended
himselfedthrough his
own employeea,porvided that such improvements ere not inkndea or olfema for.]a.If. 104 — REBAR
however,the Wilding or improvement is sold within one year o(completion,me owner- 105 — ANCHOR BOLTS
Wilder will have me burden of Forcing that he did not Wild or improve for purpose of
.fora). 106 - SEWER & WATER
❑L as owner of the propeny.am exclusively contracting with licensed coinscmnlo 202 — UNDERFLOOR PLUMBING
construct the project(Sec.7034,Business and Profession Code:)The Contractors Li.
cense law does not apply to an owner of property who Wilds or improves themon.and 203 - UNDERFLOOR MECHANICAL
who contracts for such projects with a commetor(s)licensed pursuant o me Comracmr'.' 204 — UNDERFLOOR FRAME
License Law.
❑I am exempt under Sec. .B&PC for moon 205 - UNDERFLOOR INSULATION
mer Dam 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby affnd under Penalty of perjury one of The following declarations: 303 — ROUGH MECHANICAL
❑l have and will maintain a Certificate ofcnnsenuo self-insum for Worker's Compcm 304 — ROUGH ELECTRICAL '
.tion,as provided for by Section 3701 of the Labor Code,fill the pofforammon of the
.,it for which suis permit is issued. 305 — FRAME
❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3 06 - HOLDOWNS
37M of the labor Code,for the performance of the work for which this Permit is issued.
My worker's Compensation Insurance carrier and Policy number Ii am: 307 — INSULATION
Corti : Policy N% 308 - SHEETROCK
E' CRT FI ATE OF EMFFION COMPENSATION INSURANCE 309
309 — EXTERIOR LATH
(Thissection need nolbecompleted litho permit is toorm hundreddollars(5101) 310 - INTERIOR LATH
orless.) 311 - SCRATCH COAT
I witify that in the performance of the work for which this permit is issued,1 shall not 3 13 — ROOF NAIL
employ any Person in any manner sat as to become subject to the Workeri Compensation
Laws of California.Dam 501 - FINAL ELECTRICAL ENERGY
Applicant
NOTICE TO APPLICANT;ll:after making this Ccnilicam of Exemption,You should 502 - FINAL PLUMBING ENERGY
become subject to the Worker's Compensation provisions of the Labor Cmlq you must 503 - FINAL MECHANICAL ENERGY
z forthwith comply with such provisions or this permit shall W deemed revoked.
O 504 - FINAL BUILDING ENERGY
CONSTRUCTION LENDING AGENCY
[—i ti Ihcrehy affirm Nat mere isaconstruction lending agency lot(be performance of 505 - FINAL ELECTRICAL
ai > the work for which this Permit isissued(See.3NI,Civ.C.) 506 — GAS TEST
Wp Led er's Address eraAame 507 - FINAL PLUMBING
U O LendI ceNfy that I have mad this application and soak that the above information is 508 - FINAL MECHANICAL
cortecL.I agree to comply with all city and county ordinances and state laws relating to
U buildingconstruction,and beren authndr re actives of this cit to entero the 5 FINAL GRADE
Y ores.. Y pun
{tl
above-mentioned(Wo)agree
to rtysave for emnify an purposes. 1 O FIN PLANN I G
LL (We)agree ho save,indemnifyandkeep human the City or Cogent id City
y liabilities,judgments,cosuodexpevcswhich mayinenyway aceoreagainatoidCity 5 F N LI WORKS 6 �•
eSOURCER
cnc me granting of this permit.
NDERSTA DS ND WILL COMPLY WITH ALL NON-POINT Issued by. Date l
T NRe-roofs
A,plican anuacmrDHAZARDOUS MATERIALS DISCLOSURE Type of Roof
I the applicant or future Wilding occupant shorenr handle ha.rdos material
by me Cupertino Municipal Cale,Chapter 9.12.and the Health and Safety
en zss3z(.)+ All roofs shall be ins ected rlor to an roofin material bei. Installed.
e: �r+e P P Y 8 gl 1W applicant or fuwk building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit heoNous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0W XNa
I have mad the W.Neusmaterials requirements under Chapter 6.95of the Calibre.
.is Hcalth&,stet ak.Section255115,255J3 anJ25574.I undcrwnd motif the Willing
doesnm current( hast a¢nam,that it u my rnponihility ho notify Lbe occupant of the
requirements c v m 1 rim ss bwa ricenifin of Occup rmy. Signature of Applicant Date
ow r rir<dagent All roof coverings to be Class"B" or better