03050101 CITY OF CUPERTINOBUILDING DIVISION PERMIT CONTRATUIi INTi�ORMATwTAN
BUILDING ADDRESS: WEBCOR BUILDERS PERMIT NO.03050101
ITS NAME: 951 MARINERS ISLAND BLVD PEFMOT sgEpnA}r),2/2003
PNONE: (415) 349-2727 SANITARY NUO..7/L CONTROL NO.
ARCHITEC(ENOWEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
300 LICENSED CONIRACPOR'S DECLARATION Job Description
(� 1 hereby affirm Net 1 am licensed under Provisions or Chapter 9(Commencing P
with&.do.7M)of Division 3 or Ne Bummers and professions Code,and my license is
+� in full farce and eRett
jgz License Case Lie.. REVISION--IN HOUSE USE ONLY
f Date Contractor NO NEW PERMIT ISSUED, ORIG. #03010090
ARCHFfECrS DECLARATION
1 ummetand my plans shall W Card m public records
Licensed Profeasianal
OWNER-BUILDER DECLARATION
1 hereby aRrtm Nn C i am exempt from the Contnmors Liecnw Law for the
OO following reason,(Section 70315,Business and Professions Code:Any city or county
5$ which requires a permit in construct,alter,improve,demolish,ars repair any sternum
zy prior to its issuance,situ requires the applicant forsmh permit to file a signed natemem
< Met he is licensed pumumat to the provisions of ft Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
$ (commencing with Section 7M)of Division 3 of the Business and Proressions Code)or
Nat he is exempt therefrom and the basis for the alleged ewmption.Any violadan of
Section 7031.5 by any applicant fm a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mare Nen On hundred dollars($500).
❑1,a owna of the properly,or my employees with wages as their tole Compensation. 31609036 . 0 0
will do the work and cite s=more is not incendedver Offered ter sale(Sm.7044,Business Required Inspections
-
and Profeastona Cade:The Contrectercense law
s Lidose ..not apply te so of g P
properly who builds.,improves Memon.and whodausuch work himself or thoeugh his 101 - FOUNDATION
howemployee ,er.Mping.,ipd Met teOnch.I is semenuinmorma not l at dcaoRaed fervle.IL 102 — PIERS !��
cam
mee buitoo vide improwmau Is told within ono year deed aroffnad Ne.war. \
REBAR
budder will have the burden of posing Nat hs did na,build a,improve far purpose of 103 — UFER
tole104 - ANCHO
❑1,as owner,of the progeny,am ucluiwly contrenin{with Iittnutl mnuanma to 10 5 - ANCHOR BOLTS. \�
conawn Ne project(sec.7011.Business mtl Rafeaslona Cade:)The C.nlnv:tors Li. v
come law does not apply to an owner of progeny who build,or improv Nemen,and 106 - SEWER & WATER
who convects for such projects with a conumme(s)licensed puraunl incite com actors
License Law. 202 - UNDERFLOOR PLUMBING
I am exempt under Sec. ,B k PC far Nis asom 203 - UNDERFLOOR MECHANICAL
`�AWIF l f� D"`S L t7? 204, - UNDERFLOOR FRAME
WORKER'S COMPENSATION DecLAKATIO
I hereby option under penalty of perjury aro of Ne following declwtiou: 2O5 — UNDERFLOOR INSULATION
IhawendwillasumM.CenilicaleofC.naenttewlhiasurtfter Worker's COmpm. 301 — ROUGH PLUMBING
inion.as provided for by Section 37011 of the LaWr Code,row the performance aline 302 - TUB & OR SHOWER
work for which this pertak is issued. 303 - ROUGH MECHANICAL
❑I ban and will munuin Workers Compensation Importance,6 required by Section
37W of the labor Code.for the performance drum work forwhiclm this Rnnil is issued. 304 — ROUGH ELECTRICAL
My Workces Compression Insurer=canare
is and Policy number are: 305 — FRAME
Carie` Policy No.: 306 - HOLDOWNS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 307 - INSULATION
frets section recd nothecmnpleted if be perms is roronchundteddollan(SIM) 308 - SHEETROCK
or
I Certify Neu In Ne perfnmmmco of the work for which this Permit Is Wood.1¢Mall at 309 - EXTERIOR LATH
employmypersonin n ncrwast.Msommubjecttothe WorkcKCompetnation 310 - INTERIOR LATH
Law,areal arm 311 - SCRATCH COAT
ApPlicanl
NOTICE T t,1 .IL after makin u Ccninnato of EsemPtun,you should 313 - ROOF NAIL
became tunic I to 'oke,',Compcua<on proviti.0 of the labor Code,you most
.JZ forthwith comply with such pot,unes.,Mapermit shall led,deemedmaked. 501 — FINAL ELECTRICAL ENERGY
Z O CONSTRUCTION LENDING AGENCY - 502 — FINAL PLUMBING ENERGY
[...- Ihcmhy arra that there is a communion lending agency for the perfurmsece of 503 - FINAL MECHANICAL ENERGY
!�> the work for which thts permit is Want(Six.3097.Civ.C.1
m O Lemdo(.Name 504 - FINAL BUILDING ENERGY
?z, Lenders Address 505 - FINAL ELECTRICAL
U o 1 Certify Nal 1 have read this application and sum Met dec¢bow informa6un is 506 - GAS TEST
Ice. F COMCL 1 agree to comply with all city and county ordinance,and sus laws relating te
O U building conswetion.and hereby auNodw rtpresenu,iv of this city to color Cram Ne 51N, FINAJ, PLUMBI G
(A aW.-Conotionedproperty far inspection purpom. VrCN8FI L
(We)agree to ave,indemnify and keep hamlcu the City of Cupertino against
L41liabilitio,judgments.costs and Captured which may In any way accrue against said City U.Z in consequence of the granting a(this Permit.
APePeeLICANT UNDERSTANDS AND 1,LL COMPLY WITH ALL NON-POINT Issued by: NG Date
SOC(,REGSISlivS. _
�� 22,"1✓-% Re-roofs
sioraurt ppianucontrmo Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or for.building aceument Tom or Mndlc huudaus material
as defined by Ne Cupertino Municipal Code.Chapter 9.12.and Ne Health and Safety
.Saetion 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes �No
Will Ne applicant or rutum building occupant use Clairmont or device,which If a roof is installed without first obtaining an inspection,I agree to remove
C
'",aAm a circnntsminents as defused by the Bay Arta Air Quality Management all new materials for inspection.
DiuricG (/
❑Yes ®Ju
1 he.mad the hawrdnusmaurials requirements under Chepterh.95 orthc Califon
ria Health&SafetyCode,Scelhms 25505.35533 and 25534.1 understand thatifthc building
does not currently have a cement,Out it 4 rex res tiled I to nodr the aaarml o(Nc
mquiremc uwhich ubcmeipdorwiu. OIaCc�ate.f racy. Signature of Applicant Date
C U,
Owne, aces < agent Dale All roof coverings to be Class"B"or better