02120053 CITY OF CUPERTINO �,w+ g..« '� °R :xi _
BUILDING DIVISION . PERMIT CONTRACTOR TNFOItVIAIONxh;
BUILDING ADDRESS: INC PERMIT NO.
z
10101 N WOLFE RD 02120053
0.'S NAME: W2 32 S 7530 BIG BEND DR PERMIT ISSUE DATE
'qWSEARS ROEBUCK AND CO 02/26/2003 .
PHONE: - SANITARY NO. CONTROL NO.
ARCHITECV/ GINEER: BUILDING PERMIT INFO
OLDO
LICO EO ATION PLO O
30o rimE ilmilmSED RAunarpCMR.S vision CChap
fly Ihcmbr.rnrtmthatl.mnalwwandarpmvwnKaren.pwrv(eammenana Job Description
with Scction7 )of Dividoa Sof Ne Bu41 and Pmfcuinns Code,and my license is
"'� inronmine err 8 -2-PL - 63 REVISION— —IN HOUSE USE ONLY
?gaor C "a..pf NO NEW PERMIT ISSUED; ORIG. #02090116
Y
ARCHITECTSQWXARATION
Y 1 .and my plans shall he used u public mrnNa �
5 C
Licensed
cnsed Pmfaeinnal
y OWNER-BUILDER DECLARATION
0 0 I mason.
.fflam(Sect on I am exempt Item Ne Camnctofe License law for the AT
—
prior
C following massa.(Section 71D LS,Business end Prafcedam Code:Any city or county
$ which requires a Permit e,also re winds the alar,improw,such pennitt or repair Any structure
FZIvn pdmteits tensed pursuant to the the anions of for Contrator'4uccruste ae Law(ned Chapter
gg o matnmcanadpanumnmthepmviekmmnhcCmrtsinmrwnenseLionsCaper9 Sq.Ft. Floor Area Valuation _
$
(commencing a1' .O pttSerefromction and
the
Division 3 theor al Business exe end on.AProfen viola dc)of $10,0-
mm Section
7 exempt therefrom and or bola for the cis the exemption.to Any l Penalty
of Aq�3y7��T 7y�.TIJIII{y,
.01.0 than by any applicant.(a pannh subjects Ilse applicant to a civil pcndly of 3
00
Dol mon Nan five hundind tloltsn(5300). er C)CCUpaOCy'Type `
❑1,u owner of to property,or my employees with wages As their sok compensation,
will do the work.and the structure is not intended mattered Basalt(Sec.7044,Business
and Profession,Cade:The Commutes Liceme law does not apply to an owner of 101 - FOUNDI"P41619d Inspections
pnpenywho Wildsorimptovea thereon,and who dmuuchwmkhimself orthmugh his
lO2 - PIERS
own employees,provided that such Improvements are not Intended oroaered hostile.If,
however.the building or Improvement l.sold within one year of completion,the Owner- 103 - UFER
builder will have the, u burden of proving Nk did not build or improw for purpose of
ale.). 104 - REBAR
❑1.as owner of It.pmpeng am exclusively contracting with licensed cunmamma in 105 - ANCHOR BOLTS
minimal the project(See.7044,Business sod ROfueom Cade:)The Conuracmr's Li.
emote Law does net apply in an Owner a property who Wilds Or Improm themon,and, 106 — SEWER & WATER
who contracts rot such projects with a conuacmr(s)licensed pursuant rode Committees
License law, _ 202 - UNDERFLOOR PLUMBING
aemptundersee, ,B&PCfurthhreasoa 203 - UNDERFLOOR MECHANICAL
Data 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
Ihereby amtmunder penalty ofperjury amofthe following declarations: 301 - ROUGH PLUMBING
❑Thaw and will maintain a Ccrtifiateaf Consent to self-lmum far WarkeesCompcm 3O2 - TUB & OR SHOWER
salon,u provided for by Sermon 3700 at the labor Code.for the performance of the
Work for which Oiapermhtslaued. 303 - ROUGH MECHANICAL
❑1 haw and will maintain Weakees Compensation Wumcc.u requited by Section 304 - ROUGH ELECTRICAL
3700.r Ne Labor Code.for Ne pedoMwe afthe hichthts permitislaued.
My�es Comp matlon Imurt me abler(a�nd Paltry nu eart: 305 - FRAME
cad Yv rtt'yPoueyNa. N �/dw�o�3 306 - HOEDOWNS
CERTIPICC MPENSATIONINSURANCEON FROM WORKERS' 303 - INSULATION
('ITIS section need not M computed if the permit Is foroan hundred dollan(Sim) 308 - SHEETROCK
or In...) 309 EXTERIOR LATH,
1 certify that in the perfnrmancc of the work fm which thio permit Ie Vaued,l.ball nut - 31 O INTERIOR' LATH
employ any person many manner an sae become subjecua Oe Westar!Cnmpematlon
Laws of California.Date 31.1 SCRATCH COAT
Applicant
NOTICE TO APPLICANT:It.after matin,this Cendicam or Exemption,you should 313 ROOF NAIL
zbecome subject to the Workers Compensation provldons of the labor Code,you mum SO1 — FINAL ELECTRICAL ENERGY
f rmhwith comply with such provisions or Uds month.haR he deemed invoked,
zcoNsraurnoNLervowcnoENCY 502 - FINAL PLUMBING ENERGY
(ti IherebyAM.Nnmemisacontraction lending agency rot the performance of 503 — FINAL MECHANICAL ENERGY '
x > to ookfor which this permit iaiaued(Sec.3097,Ciwc•)
UILemim s Name 504 - FINAL BUILDING ENERGY
Q
a Z IcndersAddree. 505 - FINAL ELECTRICAL
U p l atify thou haw mad w.application and atse that the be.information 1. : 506 - GAS TEST .
aF correctIagrmto comply Wlthallcity and County calloNasand staelaws OtAfingm 7 4— FINAL PLUMBING
pbuilding conswedon.and hereby anlhodm representatim of this city te emu upon OeWshve.metionedpropertyforimpemlonPWPOWL - SO L MEC ICAL
(We)Agree maw,indemnify and keep harrnea.Ilse City car Cupertino against14Oabllitin,judgments,emu and expenm which may In any Way aceme aplmt said City 9 G D
V m consequence of the graining of this permit.
P (CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON!-POINT Issued by: 5 ING Date
RCE RF-,S'iULATIr/''/ :D/O�
��/ J� Re-roofs
Sipeture ofApplieanVComrDO
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
ad yteCupertnont or fotum opal Coe.Chaptamnor handle Health us and aerial -
ed o me Cupertino Municipal Code.Chapter 9.12,and me Health and Safety
Non 2553:(.)7
❑Yes *No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building woupant use cqulpmam or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emh hamNou.Air contaminants As defined by the Day Area Air Quality Management all new materials for inspection.
District?
❑Ye. (No
I haw mad the hazardous materials requirements under Chapter&95 or On Cairor. - -
Ole Health&Safety Com,Sections 25505.25533 and 73534.1 understand that if to building
docs not currently haw a Orem,that it I.my responsibility to notify me occupant of the
mquimmen wa.It Rbemelpd mlauanceoraccofiaeoroccaPancy Signature of Applicant Date
ncr or authorized agent Data All roof coverings to be Class mBn Or better