01050044OF
CITY
I BUILLDINGDIIVISION ° CONTRACTOR INFORMATION:
PERMIT
BUI DINGADDRESS.
10114 VISTA DR -BLD 2
`( nnTINO COMMUNITY SERVICES
PHONE:
O,O ARCHITECT/ENGINEER:
6
U
�a
[ N : LICENSED CONTRACTOR'S DECLARATION
a _ C 1 hereby affirm that 1 n 3licensed wWer provision of ns Code 9 and
mmenrsng
ht
stn Section7").fad of Division3of the Rosiness and Professions Code. and my license
gcas< LiCeFall C'«eadeB Lic.g .2
i Date Sommer
u3. V -n ARCIiITECT'S UECLARATI N
SI ondemmird my plans shall W used as p.hlic records
�Y
pp Licensed Pmfikasional
OWNER-BUILDERDECLARATIONhe RATION
t L' 1 puraw .tion o in., 1 1..Benne from the Convenor's License Law fur the
t Z a following mason. (inion 7031.5, Business andmpr ve. de Potassium Cadc: Any city or county
5 S C which rtymrn n panni, m construct, altar, improve, demolish, or panne any vatic
par
s,. that oslcensed pursuant
applicant for Contras wfileeaigiid smmmem--
is licensed pSecinj m the of Di ma of the he Bu is Urease law fCTap¢r )
. orbuhe(commencing,'with 5ectionlmirt'i ofhe haus o the alleged
sand Professions Code)or Seas lin is ez1 S b thnkfmm .an she basis forthedllgd eah...I to Any l Pendon
of Sat mn 7031 S by a u dred doll for a permit subjects the applicant to a civil penalty
.of not Imre then five hundred dollars IE500).
[11. as owner of the property, or my employees with wages as their sole compensation,
will do he work; ad the-strucame is at intended cor offered for sale (Sec. 7610,
Business and Professions Code: The Contractor'a License Low does not apply to an
-owner of prnpeny Whn builds or improves thereon and who does such work himself
or tbmugh his own employees. provided that such improvements are nor intended or
-ofrcrcd for sale. If, however the building or improvement is sold within one yen of -
completion, the owner -builder will have the burden of proving that he did not build or
improve far purpose of
_ QI'm ownerufthe property, oat exdusiv<ly compacting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's
License law does tet apply to an owner of property who builds or improves thereon,
...and who contractsfor.such projects with.a contractor(s) licensd.purcuant to the.
Contractors License Law,
❑ 1 am exempt under Sec. ; I' ' B & P C far his mason
Date '
c WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury one of the fallowing dednmions:
❑ 1 hive and will maintain a Ceinf¢ate of Consent to self -insure for Worker's
Compensation, as provided far by Section 3700 of the labor Cade, for the
performance of the work for which his Permit is issaee.
01 have cad will maintain Worker's Compemotian Immerse, as usn std by Section
3700 of the Labor Cade, for the perdmor once of the workfor which this permit is
harred, My Workers C mpdsni a Ina/I tt and Pnbcy mbn am:
I If
1l. CEKTI ATION OF EXEMPTION P WOR RZ,'
_ - ;COMPFNSATION INSURANCE .. ,,.:
I . (lits season nod nm he mmPlstd if the permit is for one hundred dollen
(EI(p) nr Icsr.) .
1 certify her in he performonce of he work for which his Permit is ivud, l
shall not employ any Person in any manner so as 16 become subject to he Workers'
Compensation laws of California. Data
.Applicant ' 1 ... --"`
NOTICE TO APPLICANT: If, alter making this Centiliter, of Exemption, you should
becdm, subject to the Wotkbr's Compensation Provisions of he Labor Code, you must
z Q forthwith compor Nbe
rurality with such provisions is permit hall deemed revoked.
of' 'I "CONSTRUCTION LENDING AGENCY
1 hereby atfrm that di con trans n
n t tl'ng agency f the Performance
erfornce
bhhi work for hich this Permitis oared (Sec. 3097 Civ
C 7
LBndairs Name'-.•. •. .._ ..,. ....;
;;I z-, Lentlpr's Address"
1 certify ha, I haw read his city
and co and Bnm that the above information is
- 0 ,F t ovid: 1 agree to comply d he all city and counrysedmi ordinances and sine taws relating
Q''(;;) mbuilding cornmare construction, rtinspecby oon purposes.
, this city toenter upon
'the elov c) itg oc cm ooeC property for inspersion purposes.,
eWel agree ts save; and a ify and keep harmless an City of Caperii ai against
^.tn I liabilities, jutlgmenu, costs end expenses which may in any way aecme against said
. C] "lnfrhi�rr.mrl," - "• - "" '
toga nurdor nppucuauw:nmcm: ,. .-. io."...I
LS �.
HAZARDOUS MATERIADISCLOSURE
i't kill the applicant or future building occupant store or handle hazvdms material
as dcfnd by, the Cupertino Municipal Code. Chapin 9.12 and the Health and Safety
Code. Section 25532(x) P
I e
a-
: eWJI the applicant or future building occupant use equipment or devices which
emit hawdommin
us ear a{de6nd rea by the Bey AAir Quality ManagementD tinct ..
r 11 M1ave�rtd Ne iiauido/, matenels mqu rcmcau'under Chapter 6.95 of the
California Health & Safety Cde S ction 25505 25533 and 25534 1 understand that
-ifthe buildingdneant currently have at t" that it is my responsibility to notify the
m a pogoyy hitch mu i W n poor to i.... of Cer ifcam of
Occu /
V 01050044
)P5Gf03/2001
3NITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Job Descri tion
BLDG 2/ 6 UNITS: 4 UN TS (A) 557 SQ.FT. E
2 UNITS (B) AT 609 SQ.F���CHH LE®
MAR 2 4 2003
,or Area., • •, .- ,
i.,1t t, ,-AS.b.1 : r.7.
102 - PIERS Required Inspections
103 - UFER
._ - _.___.._ —. __. __ _ _—.__
105 - ANCHOR BOLTS
_.106 - SEWER &'WATER q-
202 - UNDERFLOOR PLUMBING
203 -- UNDERFLOOR- MECHANICAL ----- -'----
204 - UNDERFLOOR')FRAMEI.:
205 - UNDERFLOOR INSULATION
301 - ROUGH PLUMBING
302 - TUB & OR SHOWER
303 - ROUGH MECHANICAL
304 - ROUGH ELECTRICAL
305 - FRAME
306 - HOLDOWNS
307 INSULATION '
A 308 `r SHEETROCK i s
-"- 309: ,EXTERIOR' -LATH' —
310 INTERIOR LATH
311...,-,.. SCRATCH COAT-_
313 - ROOF NAIL',I"'. 1 i,, tt:.•,,, ..: ..
501 _-_. FINAL. ELECTRICAL _ENERGY _.,...--.
502 - FINAL PLUMBING ENERGY
503--.FINAL_MECHANICAL... ENERGY.-.
504 - FINAL BUILDING ENERGY "
505 - FINAL ELECTRICAL
GAS TEST ,
507 - FINAL PLUMBING
508 - FINAL MECHANICAL
509 - FINAL GRADE
510 - FINAL PL ING
51"FN 1 WORKS
IssuedODn t T. Date
. TYPe o �of,ROOF IN-PROGRE.S. .S. .,.__- ---.
...meq.. ......:..;... ._
.-All roofs, shall be inspected,pnor to -any roofing. material being installed..__
If a roof is installed without first obtaining an inspection; I agree'to remove
all new materials for inspection.. Applicant understands and will comply with _
all tiofi=point source`iregulations'
Signature of Applicant Date _
All roof coverings to be Class "B" or better
•;qa'::=. _. ...._ .:. - ._..OFFICE'