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03060122 CITY OF CUPERTINO BUILDING DIVISION PERMIT CC :!OR'�N�'©�M Bu1LD OINGADDRESS: DPR CONSTRUCTION INC PERMITN003060122 WNER'SNAM . 1450 VETERANS BLV Pte"8'9718/2003 E` (650) 474-1450 SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLO O 30o LICENSED CONIRACIVR'SDECLARATION IobDescription 1 hmcby anvm Net l Am Ila_hh�d�under providow of Chapur 9(ammeeeing with .7 in of =PdPromsdnw Codo.andmythommi, inmlltmC«.nha« Ci �u.P S`I`7B4G 30 DAYS TEMP PERMIT 'fi? Daense Cl_ o•v'z .G rcTQ 2 ARCH RATION EXPIRES ON 07/1 5a ma yph u crtcwOM EXF a g wed Pro oral OWNER-BUILDER DECURA71ON C o F I naso .Hum Nn 1 am exempt from the Cwuanar,License city o for the O o following rhes a (Saton RO 13.Swims,and us,dcuow Cade:Any<hy or county 5$ri which requires a permit re corwrocL ellen.Wprate,de Permit t w repair any fir«tutu -zt:^ primmits luxuriate.ensedpalso man,in Me the Applicants roc,mchpermit mfdeadgmdwumcm E GNathis li«widSd .7WO)ofDiali.ofthf Contracmr'suawnt,w(Cnapmr9 Sq.Ft.Floor Area RVaa t $ (mmhmcuing with Saton70W)of DivuionJar the Bwimss and Rofruiow Code). 0 - the Wits exempt thmefmm and the hue for the alleged wempdnm My WOIA14m of Seeder 7031.5 by any appii«mfor a perms Objects dR applicant to,civil peony of APN Number Occupancy Type mol more than fixe hundred dollars($SM. ❑1.n owner mrtm pmpeny.mmy mnplaym,wire wage,roe fto wie ampewwmr. 31609037 . 00 will&thework,And the museum Meet intended woRered ren Wn(Sec.7066.Business gt�I(�d Inspections And Pmfwdaw Code:The ContractorD s aee me LAW does l apply m en oe �p��y counter or 101 - FOUNDA 1 1 VN p property who Wild,wimprom mumbon,and who doessuch work himself orthrough his own employees.provided that such improwmenu as not Intended oroRered for sola.16 102 - PIERS however.the Wilding or improvement is mid within one year of completion.the Owner. Wilder will hme the WNrnt of proving that W did ort Wild or improve fm purpose of 103 - UFER sale')' 104 - REBAR 01.As comer of to property,am emlwively contracting with licensed«nvacmnm en105 - ANCHOR BOLTS wmret the recantsu(Sec.70/6,Brs.and Prof carver Code:)The Cmu mQuel U. awe U.does mt.pply in m ower of popery who WHOM or Lope.terem.and, 106 - SEWER & WATER wed onuacv fstsuch proje«s with a canuamodO licensed punwnt to the Contractor, License Law. 202 - UNDERFLOOR PLUMBING ❑Ism e.miumerSee. ,BAPCfardbiruon 203 - UNDERFLOOR MECHANICAL Owner Dao 204 - UNDERFLOOR FRAME WORKER'S COMPENSATION DECLARATION I hcmby affmm under penalty of perjury one of the fallowing declantiow: 205 - UNDERFLOOR INSULATION ve and will maintain a Cenifi«mafCOmmt w self-Mme for WorkeelCompcn. 301 - ROUGH PLUMBING n,As provided for by Satan 3700 of the I.Wr Cade,for ten pe f"Abea of the 302 - TUB & OR SHOWER Work for which this permh is imsed. 303 - ROUGH MECHANICAL 37OIOo And will Cmaintain de teem pin`atmtn Compensation "ftthewolrk"`mw i h 1e9ape�nbi,Section 304 - ROUGH ELECTRICAL My Werk ompe do n end Policy n ram: 305 - FRAME CA Poli�OEKERX 306 - HOLDOWNS CERTIFICATE OPEXEMPI7O OM WORKERS' D R Gpp� ma COMPENSATION INSURANCE 307 - INSULATION (ThMaoOo hl de'e� eomPlet�tt4 permit M for one hundred dollan(SIM) 308 - SHEETROCK ]CIA) 309 - EXTERIOR LATH I arify that In the perfumer«of the Work for which this permit Is Vuued.I shall not 310 - INTERIOR LATH employ any person in any manormw an u to become subject to the Worker,'Compeadon Laws or California.Dees 311 - SCRATCH COAT Applicant NOTICE TO APPLICANT:IL after making this Ccnincae of Exemption,you should 313 - ROOF NAIL become subject to the Worker's Compensation pmvidotn of the Lahr Code,you mvn 7zth fanhwicomplywithmetprovisionsorthispermit511. be 5111111 the 501 - FINAL ELECTRICAL ENERGY zo502 - FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY I Wroby ArErm that Nero h A construction lendingagency l'nr the perfurmanauf 503 - FINAL MECHANICAL ENERGY Z> the Work for which this permitisiewd(Sec.3097.CN.C.) 504 - FINAL BUILDING ENERGY Lender,Ne iI Q am jy LcmdehAM= 505 - FINAL ELECTRICAL o Icertify duiIAxon=it this applicadonand sum that the aWninformation h 506 - GAS TEST coma 1 Agra to comply with all city and county On inns,Ind sum laws relating to wJ SV' building cowwemn,and hemby suburban mpmsenudves or this city In emm upon Be FINAL PLUM BIPG aWvo-mendoned popery for inspection purpama N 4 (Wit)Agra to eve,indemnify and keep harmless the City of Cuperti 1996 st M08 FI L rA liabilities.judgments.costs and expenses which may In my way seem against said City in APPLIICCANTOof me UNDE STANDS Aof IND WIL OMPLY WITH ALL NON-POINT' Issued by: NG Date SO _ 4 Re-roofs alum of ppliandconuactor HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding sec«pmt Mom or handle haurdaw material As defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety Code.Section 255320)? All roofs shall be inspected prior to any roofing material being installed. ❑Yw Will the applicant or future Wilding occupant use equipment AT deviw Which If a roof is installed without first obtaining an inspection,I agree to remove ararme,air comemin5nu As dcOned by the Bay Are Air Quality Management all new materials for inspection. m? ❑Yea /�Syr I haw tonattuhuudnu msmriahrounder Chapter We Cali n nMHnith&Safety Code,SeNm33Andt25534.i nderundma, if the Wadithng does.Out currently Its.Amnane.dist Itis my responsibility in eeti(y on ox"uant o roqurtmcnuw dem �d•17 mmWertirn.maracupmcy. Signature of Applicant Date Dan:DAll roof coverings to be Class"B"or better O r mthowsd egenl C Dem