03070176 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATIQN
BUILDING ADDRESS: CHARVEZ CONSTRUCTION PERMITNo03070176
ER'S NAME: 360 W 8TH ST PERMIT ISSUE DATE
PHONE: (408) 893-7693 SANITARY 0. CONTROL NO.
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
y o O LICENSED CON-MACTOR'S DECLARATION
u I hereby affirm that I.m licensed under provisions of Chapter 9(commencing Job Description
^�
full
lYfuce ondeffec tD.Liccaivisions of the Duainexs end Pmfcasinnx Code.and mylicense is
Ur.# REVISION--BEAMS/CRICKET
Data Contractor
r
ARCHITECTS DECNO NEW PERMIT ISSUED ORIG. #03040092
I undcrtund my plans shall he used as public records
Licensed Professional
OWNER-BUILDER DECLARATION
iZ 1 hereby off that I em exempt from the Contractors License law for the
i poo following mason.(Sudan ND 1.5,Business and Pmfrsaods Code.Any city or county
9 which requires a Permit to construct,alter,improve,demolish,or repair any structure
prior m its issuance.Riau reyvires the applicant for such Permit to rile a signed statement
that he is licensed pursuant to the provisions of the Contractor's License fsw(Chapter 9 Sq. Ft. Floor Area Valuation $o
$ (commencing with Section 700)of Division 3 of the B uinass and Professions Code)or 9
—
Out he IS evemPt therefrom and the basis far Ne alleged exemption.Any violuion of
Second 7031.5 by airy applicant far mountaubj.,u the applicant to a civil penalty of 351��I 1pTperpo Occupancy Type
nor mom than fin hundred dollar(9500).
❑I,as owner of the pmpeny,or my employers with wages as their cold compensation,
will do the work,and the sent is not intended or offered for sale(Sec.7W,Business Rid I
and Professions Code:The Crummu rt mRequired Inspections
p License law does not apply
an owner of
propeny who builds or improves thereon,and who does such work himself or through his 101 - FOUNDATION
Own employees,provided that such Improvements are not intended or offend for cale.It. 10.2 — PIERS
however,the building or improvement is sold within m¢year of completion.Ne owoer-
WBear will haw the burden of pausing that he did nor Wild or improve for purpose of 103 — UFER ( \
F1,as comer of the progeny,am exclusively contracting with licensed contractors to 104 — REBAR
nswct the project(Sec.7044,Business and Professions Code:)The C°mnctori Li 105 — ANCHOR BOLTS. ^ate
whocoawd°unotapplyman Owner ofpropeny who huildaarimprovu themnbuand, 106 — SEWER & WATER \\
who contracts for such pauto a W N e eof property licensed puna acro the Cemod.and KV\
License Law. 202 - UNDERFLOOR PLUMBING
❑lam examet oydet Sec. .B&P C fm this....
1 IUU4 d,-Q pea -712-303 203 - UNDERFLOOR MECHANICAL
WORKER'S COMPENSATION DEC TION 204 - UNDERFLOOR FRAME
I hereby affirm under penalty of perjury one of du fallowing declarations: 205 — UNDERFLOOR INSULATION
Ihawandwillmaimudii.Cmifuteof Co...to,calf-insure for Worker's Compere 301 — ROUGH PLUMBING
..tion,as provided for by section 37W of the lane Cade,sur the pertmmence of the 302 - TUB & OR SHOWER
work for which Ibis permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section 3 03 - ROUGH MECHANICAL
3700 of the Labor Code,for the performance ofthe work for which Nis Permit is issued 304 — ROUGH ELECTRICAL
My Worker.Commissions lneunna aoim and Policy mortar a m: 305 — FRAME
Cartier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS' 306 — HOLDOWNS
COMPENSATION INSURANCE 307 — INSULATION .
(This scome need nm W completed if the permit is for one hundred dollars(S 10o) 308 - SHEETROCK
car leu)
I unify that in the Performance of the work for which this Permit is issued.1 shall not 309 - EXTERIOR LATH
employ any Person in any manner an as m become subject o thewofken'Compensiumn 310 — INTERIOR LATH
Laws of California.Doc
Applicant 311 - SCRATCH COAT
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should 313 - ROOF NAIL
become Object to the Worlan.Compctuation provisions of the labor Code,ynu muss
Z forthwith comply with such provisions or Ibis peornii shall W dammul revoked. 501 - FINAL ELECTRICAL ENERGY
z0 CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
F Iherchy.RomNathereisomnstrocOnnlentlingagencyl'nnhePerformanceof 503 - FINAL MECHANICAL ENERGY
the work for which Nis permit is issued(See.YM,Civ.C.I
2 Ga Lenders Name 504 - FINAL BUILDING ENERGY
=z UndersAddress 505 - FINAL ELECTRICAL
U O 1 canify that I haw .it this applirnion and state that the.bon information is 506 — GAS TEST
U. to .1 agree to comply with all city and county ordinances and suite laws relating to
C Vrenbuilding construction.and hereby euthorim mlimscrmives of this City to enter upon theFIN PLUMB G
4 shove-mentioned property for inspection purposes.
(We)egos to urs,indemnify and keep harmleas the City of Cupertino against %IF
F IL
liabilities,judgments,costs and expenses which may In any way accrue against aidCityZ in eMoser,mme of the granting mf this Permit. ��APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON,POINT Issued by: ING Date
/5
SOURCE E ULATIONS, self
3 Re-roofs 514 NAL PUBLIC WORKS
turd of ApplicanUComnctor Data
HAZARDOUS MATERIALS DISCLOSURE) Type of Roof _
\ Will the applicant or future building aceupanumre or handle hatsudaus material
as dcfred by the CuMnum Municipal Code.Chapter 9.12,and the Health and Safety
c,Section 35532(.)?
UYcs It�Nu All roofs shall be inspected prior to any roofing material being installed.
'
Will he applicant or future bmWingoccupanl use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit M.-mous air contaminants M defined by the Bay Area Air Quality Management all new materials for inspection.
District?
71 Yet �Jo
I have mad the hazardous materials requirements under Chapter 6.95 of the Califor.
.in Hcelth&Safety Coale,Sections 25505,25533 and 25534.1 unta"and hat if the building
does not eurmotly have a unapt,Out it is my resonant hility to MMI ceupent of the
rquimmdnswhich must be act prior at issuance I.Certificate of Oublvey. Signature of Applicant Date
103
Owner or authorised agent Dat
y?Date All roof coverings to be Class"B" or better