02090025CITY OF CUPEWI'INO
BUILDING DIVISION PERMIT
CONTRACTOR
INFORMATION:,'
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RU
MAULDIN DORFMEIER CONSTRUC
TISTFND'
10050 N WOLFE RD
02090025
NER'S NAME:
3240 N. MILLBROOK AVE
APPLICATION SUB DATE
MENLO EQUITIES
09/04/2002
HONE:
SS9 252-4600
SANITARY NO, CONTROL NO.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
L ELECT P M MSCI
j LICENSED CONTRACTOR'S DECLARATION
I he thm 1 licensed Chapter 9
lob Description
affirm am under pmwisi ms, of (commencing
with S• nWNMp of DivisinnJof the lhesincssand Rnfermps Code.'end my license is
Hume and eff 'L (aY—t6L/(/�/G�y2i
Icon
.se Class i'S-f � Lic.If"SatO
SPRINT PCS/NSA WIRELESS
q Conthatio,ALED
9 ARCHITECTS DECLARATION
5 M�
e I understand my plans anal[ be used as public records
e
F" E B 2 7 2003
3 Licenced professional
OWNER -BUILDER DECLARATION
from
g 1 hereby .(limo that 11. exempt from the fesnuectC's License taw for Nr
WIS. BusinessandProfessions Core: Any city or musty
C
whluwingricesa(Sectionhito
which) r. silos improve, demolish, or repair any structure
ho s a permit u, consumer.
do
' pdnnnirs issuance, also "Ores the applicant lir such perminn file axigneJ nmemem
its
that he is licensed pursuant the procedures of lice Comment's Lim m, aw(Chapter 9
Sq. Ft. Floor Area
t
(commencing with Section 7000) of Division 3 of the Busimm, and Professions Code) ur
- that he is exempt therefrom and the basis for the alleged exemption, Any violation of
bC
Occupancy Type
Section ]031.5 by any applicant for is p .I, suhjecu 0e applicant o it civil penalty of
nut more than Eve hundred dollars ($51)(E.
D I, as emon, of ft property, or my employees with wages is their m1. compensatio,
will do Ne work, and Ne souclum is not intended or offered for sale (See. 7W, Business—
Professions Code: The Connector's License taw does to
eq f quire Inspections
and not apply an owner of
10 2 -
PIER S
property who builds or improves thereon, end who doessuch work himself., through his
own employees, provided that such improvements ase not intended or offered for sale. If,
103 —
UFER
however, the building or improvement is aoW within one year of completion, Ne owner -
104
REBAR
Wilder will have the burden of proving that N did not Wild or improve for purpose of
-
sale.).
105 -
ANCHOR BOLTS
C] 1, as Owner of the property, am exclusively contracting with licensed convents to
106 -
SEWER & WATER
construct the project (Sec. 7W, Business and Ruminations Code:) The C.ntranora Li-
ccn,eLaw does not apply to an owner ofpmpenywho Wilds orimproweathrenn.and ,
202 -
UNDERFLOOR PLUMBING
who contracts for such projects with acmnoumr(s)licensed pursuant to the u
ContrmrS
License Nw.
203 -
UNDERFLOOR MECHANICAL
I em cxcmpt unde, Sec. ,B&P C fee this ..on
204 -
UNDERFLOOR FRAME
her Dam
205 -
UNDERFLOOR INSULATION
WORKER'S COMPENSATIONDECLARATION
301 -
ROUGH PLUMBING
I hereby affirm under pe.slryof Mdo, one of the following declarations:
302 —
TUB & OR SHOWER
IEI
I have and will maintain a Cenificam of Consent to self-insum for Workers Compen-
mi. u provided for by Section 3700 of the labor Code, for the peromermee of the
3 03 -
ROUGH MECHANICAL
k for which this Permit is turned.
304 -
ROUGH ELECTRICAL
I have and will maintain Workers Compensation Insurance, as required by seems
305 -
FRAME
0 of she tabor Code, for Ne performance of the work for which this permit is issued.
r lnsumncecomerenJ Policy numMrare:
306 —
HOLDOWNS
�mpmmasati-mn
ounce G� Polac,
Nro"n.:/'1l
307 -
INSULATION
CF.RTIEICCOMPENSATION INSURANCE O KER
308 -
SHEETROCK
obiameion need makcomplctedifthe pelmilisfornne hundred dollars IS Half
309 -
EXTERIOR LATH
less)
310 -
INTERIOR LATH
1 wr ify that in the performance Office work for which this permit is issued, l moll not
311 -
SCRATCH COAT
employ any person in any manner sit as m n
become subject the Workeri Compensation
lawsof Califomta. Dale
Applicant
313 -
501 -
ROOF NAIL
FINAL ELECTRICAL ENERGY
NOTICE TO APPLICANT. II; after making this Ceni little of Exemption. you should
NCm.e suhjccno the Worker's Compensation provisions of the labor Code, you mus
502 -
FINAL PLUMBING ENERGY
forthwith comply with such provisions or this prom it shall be deemed revoked.
503 -
FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
I hcrchy affirm Nal Neon tsacomsuuctinn lending agency her the performance of
504 -
FINAL BUILDING ENERGY
'he work for Which this permit is issued (See. 3(197. Civ. C.)
.dedra Name
505'-
506 -
FINAL ELECTRICAL
GAS TEST
I.. cr's Address
j 1 eerify Nal 1 have read this application multimedia, the above information is
507 -
FINAL PLUMBING
I comer. l agree m comply with all city and county orelinences and more laws relating to
building construction, and hereby audience representatives of his citym ch mr upon lbe
abeve-(We)aee 1. ertysave for indmnify an loci, es.
(We) agree to rove, indemnify and kip harmless the City of Cupertino egainsl
5 -
SO9 —
FINAL MECHANICAL
FIN
j liahIII 's,judgments,cusuinnJcxpcnseswhtchmayinenywayaccmcegainslsaiJCity
5
N G
set L CAN ceof ER(ynt'ng.uS AND WILL COMPLY WITH ALL NON POINT
Issued b)F 1 -
WORKS Date
Re -roofs
Type of Roof
i plicanUConitactor Dale
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant (tritium buildin occupant some, or handle harandous mmerial
s donned by the Cupertino Muni Crede. Chapter 9.12. and the Health and Safety
e. Section 25532(a)?
❑Yea No
All roofs shall be inspected prior to an roofing materir n installed.
P P Y g g
If a roof is installed without first obtaining an i ction, I agree to remove
Will the applicant or future bulletin pant use equipment or devices which
mit haeaNnux air cmnmmi.ams as the by the Bay Arca Air Quality Management
all new materials for inspection.
Disuict7
❑Yet
Ihavcmalthc1d. mama�lg�r alsreyuiremenu under Chapmr6.95oftheCalifor-
ni lealth&Sm fie Can, Ii�bv 505,25533 and 255M. l understand thmiUbe Wilding
cs not comm ' �Leben Noon is my res,rem bila, to ramify IN occupant of thc
if ryamuNmet t;.rminumccefacenmcamofQcuupancy.
Signature pplicant
Date
All roof coverings to be Class "B" or better
.ser a.tFmrreed ascot Dare