02110164 CITY OF CUPERTINO ^ '• •' "%
BUILDING DIVISION PERMIT 4t"*13,0M .CT0R N'V�U WT N
BUILDINGADDRESS: PERMIT NO.
8731 TILSON AVE PHIL BOYLE 02110164
OWNER'S NAME: 1PERM"65UB DATBQ//- p ��
) PHIL BOYLE 18731 TILSON AVEAdkk T
SANITARY NO. CONTROLNO.
ARCHITECT/BrOM BER: BUILDING PERM"INFO
BLDG ELECT PLUMB MECH
uoo LICENSED CONTRACTOR'S DECLARATION lob Description
1 hereby sfRrm the,I am licensed under provisions of Chapter 9(commencing P
;Z with Section 70M)of Division 3 oflhe Busineesml Profcations Cade.and my licenseis
N in full forte and effect.
SMS LimeacClaa Lt.N REVISION--IN HOUSE USE ONLY
Dem Comment,
ARCHnRCrS DECLARATION ORIG. #01120098, NO NEW PERMIT ISSUED
I understand my plans shall W used as public records PLANCHKREP .FEE DUE
O
5W Licensed Pmfcesinnel l
C OWNER-BUILDER mDECLARATION \mss
1 hereby afibm that 1 1. ,Business
from the ComrenCo License Lew for the
cfollowing hoes.(Section RI3s5,Business and Professions Cale:Any city or manly
_ which requires a Issuance.ai re e.r es the altee Wpmrc,de ermit t or hast any awmah
priorh itscenedpduan In me the applicant O theforCo permit Lfileasignedmmmenl
Not me cing wit pursuantInO)of Division
of the ComsinesWcenseLaw sCme)9 Sq.Ft. Floor Area VaIU
(comy Meths lndngwim Murine. ndth Di W6 for
of Neege remton.An,omcdk)of
� Jut M1e 4 exempt mertfrom and the bu4 for Ne alleged exemptim.Any violallcan of
Sermon]031.5 by any applicant far a permltUbjece,me applicant m Acivil pelully Of APN Number $98cd8,'6y Type
not muse Nm live hundred dollen(SSW).
0 i.as owner of Ne property.or my employers with"gas as main arm rompeliatim,
will do rhe work,and memscuh is not intended or offered for sale(Sm.7W.Business Required Inspections.
and Profession,Code:The Canuacmra License Law does ant apply m an owner of 3 7 518 0 4 9 . 0 0 q P
propenywW Wilds or improves mereon,and who doesembwank himselfortmough his
ownemployeea,provided that such Improvements art untm ended uroffered for sale.If.
however,the building or improvement is sold within one year ofmmpletion.the owner. 101 - FOUNDATION
builder will nave dm burden of proving that rte did not Wild or improve for purpose of
am.). 102 - PIERS
I.as owner of the proper.am exclusively conuacling with licensed mnuacmn to 103 — UFER
mnsuucnhe project(Sec.T04r,Business and Prommlons Code:)The Conuacm's LI- 104 - REBAR
cense Law docs not Apply to an owner of proper who Wilds or improves d¢mon,ad
who contracts for such pmjcc%with a conuselor(s)licensed pursuant mthe Comnc,ors 105 - ANCHOR BOLTS
License Law.
or sok exempt under Sec. B&P C for this moan 106 - SEWER & WATER
Gane, G {�I m,�f 202 - UNDERFLOOR PLUMBING
Low
WOR ER'S COMPfWATIOND TION 203 - UNDERFLOOR MECHANICAL
I hereby M.under penalty of perjury one of me following declarations: 204 - UNDERFLOOR FRAME
an
end will maintain A CWHicale arc...art m teff-Insure far workers Compen- 205 - UNDERFLOOR INSULATION
alio.,as provided for by Section 3]W of me Labor Code,for du performance of me
wodr for which this parish is issued. 301 - ROUGH PLUMBING
❑1 have and will maintain Worker's Compefuellon Insurance.as mquirad by Semon 302 - TUB & OR SHOWER
37W of Ju labor Codc.for the pcRormance of the work for which this permit la issued. 303 - ROUGH MECHANICAL
My Workers Compensation Insurance carrier and Policy number Art:
Carrier. Policy NO: 304 - ROUGH ELECTRICAL
CERTIFICATE OF EXEMPTION FROM WORKERS' 3055 - FRAME
COMPENSATION INSURANCE
Ohis=I.need not becompimed lithe permit is foromhundseddollan(gIW) 306 - HOLDOWNS
nr meq 307 - INSULATION
I ecnify the'In Performance of me work an which this Permit is looked,1 shall rad 308 - SHE ETROCK
employ snp Omany ran obccomcabjmr lolbe workere'compensadon
Lawsof Cal omIn.Dam - 309 - EXTERIOR LATH
Appplicant- C(,• 310 - INTERIOR LATH
NQT,IQe TOAPPLICANT.r'af. fu mak\g hsea IRcamof Excmpuon,youshould
W subject mthe WorkComperseGnprovisionsofthe Labor Cour,you must 311 - SCRATCH COAT
,J ZO forthwith comply with such provisions or this permit shall be deemed hooked. 313 - ROOF NAIL
CONSTRUCTION LENDING AGENCY 501 - FINAL ELECTRICAL ENERGY
,4 rN-t I hemhy alfirm that More Is a construction lending Agency for the Performance of
C ?,r the work for which this permit Is issued(Sm.3W],Ch,C.) 502 - FINAL PLUMBING ENERGY
W j z Lelwerendahe
Lender's Name 503 - FINAL MECHANICAL ENERGY Z
U O 1 eerily that I here read this application fold sum that the shove Informed..le 504 - FINAL BUILDING :ENERG
L,,P connect.I agree to comply with all city and county ordinances and sum laws misting to5 5 - FINAL ELECTR I CAL
OU building convection.and hereby Aulhorisa representatives of this city to enter upon Me
W aWvemcnlioacd property for Inspection purposes. O 5l I- GAS/?TEST
(We)acme Ice save,indemnify and keep harmless me City of Cupertino against 7 FI
liabllitiea,judgments,cosu and expenses which may In any way&=me against said City
U In consequence of the granting of this Knott.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 5 I CAL Date
SOURCEREGULATIDNS. , r-^ Re-roofs 510 INAL PLANNING
a.m..ofAppli. Conuacmr Dam
H RDOUSMA AIS DISCLOSURE Type ofRo5tl4 - FINAL PUBLIC WORKS
Will tits applicant or fuiurt buildingamupentalort or handle hawdons memrial 602 - ROOF PLYWOOD NAIL
as dedned by the Cupertino Municipal Cade,Chapter 9.12,mul the Health and Safety
Code,Secdun 25532(.) All All roofs s e insp�f�3riW �fn material being installed.
❑You No
Will the applicant or future building occupant use equlpmenl or devices which If a roof is Ilea kk�itR�if frsTt�6tEi mgGmection,I agree to remove
haardnus air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
n.rin7
❑Yes No
1 have mad the huallous materials rcquim rants underChapbn 6.95 of the Califnr-
am Health&Safety Coda,Sections 25515,15533 and 25534.1 undem and that]film building
docs not currently hew a cent,mei it is my responsibility In until ,ho mcupanl M the
requirements which must W mel pdorin amok onemuhcamd Signature of Applicant Date
0car authorircJ agent All roof coverings to be Class"B"or better
Dob