03010090 & 03050101 CITY OF CUPERTINO `�`` € ; mow "-
BUILDING DIVISION PERMIT �CONTRAC"TOR INP'ORMxpq
8Y11 9SffD1ffs:TANTAU AV WEBCOR BUILDERS PERMIT NO.03010090
951 MARINERS ISLAND BLVD F`"Mr`d`E'3r/"` 4/2003
(415) 349-2727 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
°o LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provisions of Chapter 9(commencing .lob Description
i with Sccti n7 )af Division.).(the Bust 'rad Profcuinns Code.end myliccnx is
i 1. in full force fleet. /
Z. Lmm.Cl a 817 ADD EXTR WINDOWS PAS SANGER E � t. '
iq° SEISMIC RETROFIT
records ARCHITECT LARATION
I emy.nmaaahell�o.uuUespuhlicrccnrds 9 2003
SEP 0
°Q. Liccnu'rPmlcesioneI
3 Oat I am exempt
U rept from
DECLARATION
ZOO hereby
Maso "(firmtore1amcxcmplfrommeCamns,Code:
s :AnycLaw for the BUILDING
00 which requires
permit
703:.5,BualneamrPn.dcomns Co dc:Any city or county
$ which requires issuance,permit a consume,,alcor.impmw,h Permit,or repair soy tatement
-¢i shPriare its ensed pursuant
to renhovisioso for such Permit to Lim eLawUnammem
exp m(commencing
mmeningwit Pursmion 700,of Division
ivionso the or
Contractor's LIRaxssW(Chapter Sq. Ft. Floor Area Valuation
e� thammene xempthhereirom and
the basis for of the B ed exemptus and Professon.Any vi Cao)of
$ the,he h exempt therefrom sod are basis for the alleged exemption.Any violation of
Section 7071.5 by any applicant for s permit subjects me applicant in a civil penally of APN Number Occupancy Type
not more than Eve hundred dollars($500).
p y yp
01,as owner of the property,or my employees with wages as their sale compensation, 31609036 . 00
will do the work.and meawctue is rimimanded or offered for sale(Sec.7044,Business Required Inspections
and Proressions Code:The Contractor's Liam Law dors not apply a an owner of p
property who builds mimpmws thruomend who doeasuch.,it himself.,through his 101 — FOUNDATION
own employees,pmvidcd that such improvements are not intended or offered for use.If. lO2 — PIERS
however,Ne building or improvement is sold within orm year of completion.Ne owner
builder will ban the burden of proving that he did not build of improve for purpose of 10 3 - UFER
ale).
❑1,as owner of the prnpeny,em exclusively chronicling Wim licensed conuact.r.to 104 - REBAR
construct the project(Sec.1044,Business and Professions Code:)The Contractor's Li. 105 — ANCHOR BOLTS
crime Law docs not apply to in owner of proper who Wilds or improve thereon,and 1O6 — SEWER & WATER
who contracts for such projects with a contractor(s)licensed pursuant to the Canva°aM1
License La
Law.exempt - UNDERFLOOR PLUMBING
❑tare cmpt under Sea .BkPC for this recon
203 - UNDERFLOOR MECHANICAL
Owner ata
WORKER'S COMPENSATIONDECLARATION204 - UNDERFLOOR FRAME
I hereby afftsm under Pcmlty of perjury ore or me following declaration.: 205 — UNDERFLOOR INSULATION
Thaw and ww mainuinaccmr¢ase of Conxnuouu.i....far WmksOe Cumpcm 301 — ROUGH PLUMBING
.,tion,he pmvidcd for by Section 37M of me labor Code,for the performance of the 302 - TUB & OR SHOWER
work for which this permit is issued,
1 Mw and will maintain Workers Comprnsnion Insurance,as required by Section 3 03 - ROUGH MECHANICAL
P or the LaborCoder,for the Performance orrise work for which this Permit isissued. 304 — ROUGH ELECTRICAL
My Workyces Compensation insurance comm sed phi
n rame305 — FRAME
Policy N !
UhM IFICATE OF EXEMMON FROM WOR KERS' 306 — HOLDOWNS
COMPENSATION INSURANCE 307 - INSULATION
(ThiSSer ionneed not hecompleled Rise permilbforonchundmddallan($INII 308 — SHEETROCK
ar loss.)
1 comfy mot in the perfmmanee of the work for which this Permit is issued,10411 not 3 09 — EXTERIOR LATH
employ any permn in any manner sh as w whom subject to be Workcrs'Compoeation 310 — INTERIOR LATH
". ofcidifamia.O.W
Applicant 311 - SCRATCH COAT
NOTICE TO APPLICANT:If,aper making this Ccnincam of Exemption,you should 313 - ROOF NAIL
become support to the Workers Compensation provisions of the Labor Code,you must
] z fmthwi,henmplywimeuch provisionsor this Permitshail he deemed mated. 501 — FINAL ELECTRICAL ENERGY
L CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
I humpy amrm that there its comtme,inn lending agency lot the Performance of 503 - FINAL MECHANICAL ENERGY
X
me work for which the permit Is issued(Sec.3097,Civ,C.)
Lar"m 'oar"" 504 - FINAL BUILDING ENERGY
z Iamrr4Adarea —
;JQ 'IcenifyNetIhave readthis application and...,he,memove information is 505 FINAL ELECTRICAL
yF
correct.I agree to comply with all city tod county eminences and Slim 13WS himing 1. 506 — GAS TEST
�U building conswnion,and hereby amhome representatives of mis city to enter upon the — FIlatING
shove-hoop one!pmxriy for inspection purposes.
(We)agree m save,iedommfy and keep h.less the City of Cupertino against O 8 F+'I AL
r� liabilities,judgments.cosu and expenses which may in anyway accne against said City
in
of the granting of
J z
APPLICANT CUNDERSTANDS tAND WILL COMPLY WITH ALL NON-P wr Issued by: 5 Date
SOU EREGULATIONS. _
Re-roofs 514 CVINAL PUBLIC WORKS
ignstu of Applicam/Contfamor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant ur future building occupant stare or handle hamdous material
a defined by,he Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes - XNu
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hazardous air contaminants a Ucfncd by the Bay Area Ai,Quality Management all new materials for inspection.
District?
❑Yes �Nu
I have read me huraNnus mesrialsreyviremenu under Chapter 6.95 of me Califor-
niaHcahh&SafmyCudc,Sccdam25S05X533 an125534.1understand,hmifthe pudding '
Urea no,currently have a Lenam,mo,it is my hapomibility m notify the uccupan,of me
myuintments which must be met relator issuance ofa Cerdncaf of empan Signature of Applicant Date
4��O�L/
Um atim.m cd.,em D„e All roof coverings to be Class"B” or better