02110143 CITY OF CUPERTINO " _.- -`t?ra
BUILDING DIVISION PERMIT NTRACT
CO „OR INFORMATIONN
BWL1x VI EsW LKINSON AV GIORGI ALAN P AND EILEEN PERMIFN(0211O143
I(Bt 43I ALAN P AND EILEEN T APPLICATI?NlStffY 2002
PIIONE: SANITARY NO. 7 / CONTROL NO.
ARCHITEC IENGINFER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEC11
ng
TOO LICENSED CONTRACTOR'SDECLARATION Job De 711 �®
a U I M1crcM1y allirm that I am licensed under provisions of Chapter Y(commencing IN-GROUND SPA
1y with Section 70(k)of Division 3 norm Business and Profnsslons Codc.and my license is
Fly In full fame and effect.
LicrrMGlaas e"
DJUL 0 3 2003
OZ— aft Conctor tra
ARCHITECTS DECLARATION
Ow< 1 understand my plans shall Na used as public records I�a{��� � w�■ •.q
LL p�is
Licensed Professional S/RMIN G
y OWNER-BUILDER DECLARATION MM
fa<Y I hereby allirm that 1 am exempt from the Contractor's License Law for the $10000
C O following reason.(Section 7031.5,Business and Professions Code:Any city nr county
n$(L which requires a Perrot at construct.alter,improve,demolish,or repair any structure
FZ< prior to its iswanuc,also requires the applicant for such Permit to life asigred statement
x that he is licensed pursuant to Ne prookions(if the Contractor's License Law(Chapter 9 3�T 617t.ff�'bBA10A Valuation
o�aFO (commencing with Section 70100)of Division 3 of Ne Business and Professions Cook)Or
i $ that he is exempt therefrom and the basis for Ne alleged exemption.Any violation Of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of i UpN'N Occupancy
not mom than five hundred dollars(s5(n). 102 - PIERS p y Type
❑I,as owner of the pmrerty,or my employees with wages as their side compensation,
will do the wells,and the structure is not intended or offered for sale(Sec.7044,Business ±e3 UFRR
and Professions Code:The Conraanri License law does not apply to an owner of 104 - REBAR Required Inspections
pmpeny who builds or improves thereon,and who doessuch work himself or through his
soon employees,provided that such improvements are not intended orolfered for We.Ir. 105 — ANCHOR BOLTS
however,Ne building or improvement is sold within one year o(completion,Ne owner.
builder will have the burden of proving that he did not hand or improve for pumps,or 106 — SEWER & WATER
sale') 202 - UNDERFLOOR PLUMBING
r] 1,as Owner of the pro,st am esebusively contracting with licensed contractors 203 - UNDERFLOOR MECHANICAL
construct Ne project(Sec.704,4,Business and Professions Cale:)The Conoactor's Li-
comm Law does not apply toanowner ofpropenywho builds orimproves fromma.and 204 - UNDERFLOOR FRAME
Useless,LLaa""�rnr such pmiecu with acomranor(q licensed pursuant to the contnnori' 205 — UNDERFLOOR INSULATION
Ism eaemP.un cr ,B&PC for is reason 301 - ROUGH PLUMBING
Date 302 - TUB & OR SHOWER
WORKER' COMPEN. ON DECLARATION 303 - ROUGH -MECHANICAL
Ihercby elBrm under Penalty of I br one of the following decimations:
304 — ROUGH ELECTRICAL
I have and will mainuiea Cenificatrof Consent tosel6insutefor Worker's Compen. 3O5 — FRAME
section,as provided for by Section 37W of the labor Code.for the performance of the
work for which this Ismail is issued. 306 — HOLDOWNS
C 1 have and will maintain Worker's Compensation Insurance,as required by Section 307 - INSULATION
374)of the Labor Code,for the pmformance Of the work for which this Permit is!Wood.
My Worker's Compensation Insurance earlier and Policy number am: 308 - SHEETROCK
Carrier: Policy No, 309 - EXTERIOR LATH
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 310 - INTERIOR LATH
This section need nut he completed ifthe permit is for one hundred dollars(S 103) 311 - SCRATCH COAT
to,icss.) 313 - ROOF NAIL
I trimly that in the perbmmamce of the work for which this permit is issued,l shall net 5 01 - FINAL ELECTRICAL ENERGY
employ any person in anymamne naem Madmes bean the Workers Compensation
Laws of California.Data 502 - FINAL PLUMBING ENERGY
�® Applicant r.
NOTICE TO APPLICAI : f.after making this Ce d m of Exemption,you should 503 - FINAL MECHANICAL ENERGY
Ecmme suhjemmthe WOrkeri Compensation Provo ora d the talon cafe,you moa 504 - FINAL BUILDING ENERGY
OO fonhwith comply with such pmvisiore ler this permit s IM deemed atvnked.
CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
(-. .N. I hereby affirm that there iso construction lendingagcrt'y lir the"furmencc of 506 — GAS TEST
a > the work for which this permit isissued(See 31197,Civ.C.)
land507 - FINAL PLUMBING
W Q er§Name
1 Lit ar'sAddrtss 508 - FINAL MECHANICAL
Uo oily Nat 1 have read Nis application ends Nat he ado info matin is 509 - FINAL GRADE /
W (.. correct.l agree to comply with all city and county ordinances and state laws relating to
Obuildingconstruction.and hereby authorimrcprcsentativesnf5thiscitytoenterUponthe FINAL PLANNING
above mentinned property for inspection purposes.
� d (We)agree ln.wva indemnify and keep humlecs the City of Cuperinoagainu 14 FIN I W RKS
H(A liabilities,judgments,cons and expenses which may in any way Items against said City
U z in consequence of the granting of this permit / (//1
•+ APPLICANT UNDERSTA AND WILL PLY WITiI ALL N N-PIssued by: Date
SOURCE RF.GULATI N
It Re-roofs
Signature ill Applic V d t ctnr ' Da
HAZARDOUS MATERIAL D CLOSURE Type of Roof
Will ythe Cicanton(Mune buildinge.Ch st 9,12,handle Health
smatfely
do al
fined by the Cupcninn Municipal Gds.Chapter 9.13,and the Ileahh and Safety
le.section 25532a)7 All roofs shall be inspected prior to an roofing material beim Installed.
❑Yes E]No
P P Y g g
Will the applicant or antra building(occupant Bt A ea Air Qu ler devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit heaarduua stir contaminants as ddinN by the Bay Arca Air Quality Management all new materials for inspection.
Diaricfl
-7 Yes ❑No
I have mail the hxmrdous materials mquiremen s under Chapter fi 95 of the Cali for.
ilial lca"'Safety ,Sections 25505,M533 and 25SW.1 Understand dw if the building
tiros not currently a tenant.th \my responsibility to notify the Mompmn of the
Qrcyuimmem wanceorfaCenificamrfIXc arty. Signature of Applicant Date
Ownermauthorived age t me
All roof coverings to be Class "B" or better