02100194 CITY OF CUPERTINO "_ 'oto : _ - -; ;•';^!
BUILDING DIVISION PERMIT CONTRACTORINFORMATION:
BUI DR A .IN CT B . K. DEVELOPMENT PERMIT NO 2100194
! SR'sIfAME:DEVELOPMENT 1072 WALLIN CT APPLICAT113V61BYTY 2002
PIIONE: SANITARY NO.!! CONTROL NO.
ARCHITECHENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECII
0 0 0 0
op LICENSEDCONTRACDOR'S DECLARATION fk(�pp�
rc F I hereby affirm Nm l am licensed under Provisions of Chapter 9 Ri mormcing VISION (SID T�Q�D II'D 1 U C C0
with Section 700(B of Division Sof the Business and Professions Cmc.and my license is
in fall form and effect. IN HOUS USE ONLY, NO NEW PERMIT ISSUED
ZOg$ Lim...Claes Lica
ezFo Date Contractor ORIG. 401100132/REVISION #02100134
F=� ARCHITECTS DECLARATION I
sSy y. 1 understand my plans shall he used as public records
6O6u
ILL Licensed Pmfcssinnal / \
OWNER exempt
front
the RATION
y. a I hereby reason.(Sec that 11. cumpr from the Cusses is :Any c Low lin rhe 'C
4600 whichfollowinguiresaminor
nrn to 703 1.5,Business,atr,immoe.de demolish.
Cr Ne:Any city ar county V
S O which requires a permit re construct,alter,improve.h Permit i file
repair any structure
FZ< prime.its,e..d,,also requites the
o,,ism antxorf for sucCann ma's License,
a,Law statement o
SSxx that he is liccnwJ pursuanuonce provisions of the Conuacmr's Liccnu Law(ChupwrY Sy. Ft. Floor Area V.}+�t100
Cs-Q (commencing with Section 700)of Division 3 of the Business and Professions Code)or
y _ Nat he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects me applicmt 10 a civil penally of -3 bXP4
not mole man rive hundred doll..($500). bC Occupancy Type
0 1.u be,of the property,or my employees with wages as mei, to compenution.
will do the work,and me s0ucture is oat inwnded or offered for sale(Sec.7W.Business 1:191 FE)blf
and Professions Code:The Contractor's License law does not apply to an owner of 102 - PIE S equired Inspections
property who builds or improves thcremor and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If. 103 — UFER
however.me building or improvement is sold within one year of completion.the owner. 104 — REBAR
builder will have the burden of proving that he did not build or improve for purpose of
sale.). 105 - ANCHOR BOLTS
0 1,as owner of the property,am ewhriwly moracting with licensed contractors m 106 — .SEWER & WATER
construct the project(Sec.7044.Business and Professions CwR:)The Contractor's Li-
cerise Law does not apply to an owner of property who Wilda or improves Bomar.and 202 — UNDERFLOOR PLUMBING
who contracts for such projects with a contractually licensed pursuant to me Contractor's 203 - UNDERFLOOR MECHANICAL
License Law.
0 l am exempt under Sec. ,B&PC for this reason 204 - UNDERFLOOR FRAME
ner Date 205 - UNDERFLOOR INSULATION
WORKER'S COM PENSATIONDw"RATION 301 - ROUGH PLUMBING
I reach,ammr under penalty of pe do,one of me following declaration¢ 302 — TUB & OR SHOWER
D l haw and will maintain a Cenmcaw ofComent toself-insum for Weakere Courier-
.it...
ompere 303' - ROUGH MECHANICAL
cation,as pot,ItRd for by Section 3]081 of the Labor Code,for the pe,fmm...c of the
work for which his perm it is issued. 304 - ROUGH ELECTRICAL
0 1 bare and will maintain Workers Compensation Insurance,u required by Section 305 - FRAME
37(1(1 of me labor Came,for me perairm nce of me.,it for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are: 306 — HOLDOWNS
Carrie,: Policy No.: 307 - INSULATION
CERTIFICATE OF EXEmvriomi COMPENSATION INSURANCE CE RK [RS' 308 — SHEETROCK
(Thissectiun neednot becomplctedifthe permit isforone handeaddollam(SIM) 309 - EXTERIOR LATH
.'r ILSs') 310 - INTERIOR LATH
I certify that in the performance of the work for which this permit is issued.I shall nest 311 - SCRATCH COAT
employ any persm in any manner so as to hecome subject o the Workers'Compensation
Laws of California.Date 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT:I1,after making this CeaiGcaw of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Workers Compensation previsions of the labor Code.you must 502 - FINAL PLUMBING ENERGY
OO fnnhwim comply with such provisions or this permit shall M deemed revoked.
Z 503 - FINAL MECHANICAL ENERGY
` CONSTRUCTION LENDING AGENCY
[—� I hereby aoirm that there is a construction lending agency for the performm.or 504 - FINAL BUILDING ENERGY
eK > me work for which mispermit isissued sec.31H7,Civ.C.) 505 - FINAL ELECTRICAL
gkiW Q Lenders Name
Lender's Address 506 - GAS TEST
U O 1 certify But 1 have read this application and state that the above information is 507 - FINAL PLUMBING
W P correct.l agree ro comply with all city and county ordinances and state laws relating to
�U building construction,and hereby ambodm mpresenmtives of this city toenwrugm the 5,0.k FINAL MECHANICAL
W aNmomentioned property for inspection purposes. O9 — FIN GRADE
(We)agree m save,indemnify and keep fumblers the City of Cupertino against
faA liabilities,judgments,costs and expenses which may in any way amme against said City 5 F N N G / Y,,")
V 2 in consequence of the granting of this permit. l/
r APPLICANT UNDERSTANDS AND WILT.COMPLY WITH ALL NON-POINT Issued bys 1 WORKS Date
SOURCE REGULATIONS.
Re-roofs 603 - OF BATTENS
Signature rel AppliwHAZARDOUS MATERIALS DISCLOSURE.noVionfactur Date 'Iypeofl;G30f4 - ROOF IN-PROGRESS
Will the applicant or future building occupant store or handle hazardous material
s defined by the Cupenino Municipal Cate,Chapter 9.12,and the Health and Safety
Section 25532a)?
❑No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or more buildingswcupant use equipment ordevires which If a roof is installed without first obtaining an inspection, I agree to remove
emir fri,mmus or,womminntses defined by the Bay Arca Air Quality Management all new materials for inspection.
DisWct7
❑Yes ON.
I have mud the havallous mumrun.requirements under Chapter 6.95 of thc Culifnr-
or.Ilcabh as Salety Code.Sections 25515,25533.ed25534.I undcrshend Nati(the building
does not currently halm a wnam,that it is my respomihlliry m notify(be aeuPam of me
requirements which mum be awl prior to issuance of acen;feawnfOeaparay. Signature of Applicant Date
Owner or xurhnrlacd agent Date All roof coverings to be Class "B"or better