01030069 CITY OF CUPERTINO -
BUILDING DIVISION pN R CONTRACTOR INFO WON;
BUILDING ADDRESS: PERMIT NO.
10123 N WOLFE RD nin nnFa
OWNER'S NAME: APPLICATION SUB DATE -
WESTLAND PROJECTS
PHONE: SANITARY NO. CONTROL NO.
i
elO i , ARCHITECT/ENGINEER: - ,- BUILDING PERMIT INFO
LDG LE LT LUMB E
yi. e - - '
Z y i LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Fmhc with Section 7000)of Division 3 ofahe Business and Professions Code.ond my license
Y force ane ermct. 6 II SPRINKLER. �"�ry�p I6nt��d7
z J L'm ma Class Lic.# �d
e'O a ate GDECLA e��r
3 u ARCHITECT'S DECLARATION Imo. IT BENIHANA.
IE:O I code rsmnd my plans shall heated as Public records
or i o O Licensed Professional
OCTM so
ce
2 5 2002
oLL OWNER-BUILDER DECLARATION
ti =' 1 hereby alarm that 1 am exempt from the Contructor's License Law for the
u
C?a- following (Section]0t 1 S.Business and Professions Cade.Any city or county
ztz-Oc which requires a permit t t t Iter,improve demolish or repair any structure BUILDING.
n:__,p t a 9 t pp t pe a a.y e mm t r Valuation
,I ne I 'ad ' vI d 9.r r
p t' a. 'If � r I I d,thim 9 S Ft Moor-Area ,1,
or , eeingwms tnoah todtDigsnoonna Business rdlrvf�.�on Code) t:'f'y . ,tat ,._. . _ 4a �,±-R
or that Section
is 31.5 b therefrom anE the basis for the alleged exemption.Any violation 1
of not o re than
5 iv any applicant Into permit subjec¢the opplicam ro a civil penaby
of not more man rve hundred ammra($som. APN Number i.:.r.'t'-'•,, ccupancy Type
❑1,as owner of the property,or my employees with wages as their sole compensation,
-
will'do the work,and the structure is not intended or offered for sale-(Sec.]044, Required Inspections,''
Bus s and Professions Code:The Contractor's License Law does not apply to an tl
owner property Who builds or improves thereon,and who docs such work himself
orthrough his own employees,provided that h'improvements t' tended or 101- -FOUNDATION -- - ----
off retl for >le omer the bmave t em' Id within one y ar of
c mpl[ n mr,osee sale.)rwillhavetheburdenofprovngthatM1etldnotbuddor 102 — PIERS
improve for purpose of sale.).
_. _. . . - -1.03,,- UFER ...._-.-.
❑1 a.o er Lthe PmpenY am exclu Ely mnvecI ng w th I cursed ronuucmn ma ---_., .__ - _ - .
= construct the project(See 7014,Business and Professions Code)The Contractor's 104 - REBAR
'-
Licensewho
Law does not apply moan owner of progeny who builds or seimproves thereon,
.and who.commetse I sucRprojecu with-o cantrunorts)licensed pursmm to the. ._. ___.....10 Cj.. - .ANCHOR- BOLTS
Contractors pitaffi I.
❑lam exunpt undersec: _ ,e&Pefor miareason
- 106 — SEWER & WATER ' '"'
0 6t" 202 - UNDERFLOOR PLUMBING
'WORKER'S COMPENSATION DECLARATION 203 - UNDERFLOOR MECHANICAL
• by fiffirm orderpcostly fanjry emine Following aecmratm : 204 - UNDERFLOOR FRAME
❑ 1 have and will maintiliri a Certificate of C nsem'to self insure for Worker's
Cons,...timu asp ded III Section 37W of me Labor Code, f -me'' 205 - UNDERFLOOR INSULATION
performance of thew permitkfrwhienthisr 'sum..,, 301 - ROUGH PLUMBING
❑Ihav aadwill m t w krsCop t Insurance,'askgo-edbySection 302 — TUB & OR SHOWER
: 37M h Labor Cad for hetpefdr f m work f which this pe t
,iso d,My koe C i unaware v r d Poly number an:
. 303 • - .ROUGH MECHANICAL- _-._,-.. ., .... .._.
"; Palny"° .304 i-?=ROUGHei'EL'ECTRICAL
CERTIFICATIONOF EXEMPfION MWOR S's - � '
. COMPENfAT10N'INSURANCE"
-305- -.FRAME -. . . .. .,- .. ._ ------
306
�_..._
_.._ _.
"' (Th fon need not be complemd Jme permim is for oto hundred dollars 3 0 6 HOLDOWNS
(5100)1 cnls m l
p r• yPhe m 307 - 'INSULATION '.
-h fy 'an n he P in any m f the k f which ul p 't is
issued, n! . . .
i
shot[II not em to �n on nun a as to beco b)ect 16 the workers 3 0 8 - SHEETROCK -
C aen.aton Laws fC f Date '
Applicant ; .. - .. 309 - EXTERIOR LATH j
_.
1; 'NOTICE TO APPLICANT ion sCert nsof f2 Code.
youhmule +
'beom ',omptom Workers Compe wn P onsole Labor Code you muni 310 - INTERIOR LATH r
Q O forthwith e mplywthsuch provisions histPermitshallh d mdrewked.
311 - SCRATCH_ COAT
y ` CONSTRUCTION LENDING AGENCY " ' "
In orwhic,tnttneee cP boa 1 dngag yfarmeperro 313 — ROOF NAIL
r •
-E q
of one kmrwhichm petmt siss d(s 3097Civ C) 1
q -Lee Name- � � -'� - '' � r -- --- -501 - -FINAL- ELECTRICAL--ENERGY------
Z --
a'
502 - FINAL PLUMBING 'ENERGY
I mfymminae dthsaty. i estate dinancs aboveinformation503 - FINAL MECHANICAL ENERGY
-FT' ['Ii co ct 1 ere to,comply lh II city nd county ordinances and state laws relating
-0'l,
the
above
-ounione dh byaumh inspection pe' mtivx fth. lymemu pon
y w ,meanp�e agree , p tdefyandpurposes, � 504 - FINAL BUILDING ENERGY
(We)d,orto dmni,a,,whep ich
in wayrenpe.,Front
Fongmm 505 — FINAL ELECTRICAL
U] 1 city
t j figment t d expense h h y in a y ay r_ue ago n.t said
C7 Z ,C tyi, i.equence of theg nline of th pe t _
APP I(:ANT'UNDEkSTANDSAND WILLC(MPLY'WITHA' -N)N-POI lT' ISsued 06 Date
s I ATIUN O '
mea Appnca Cn turn •Date' r Re-ro,908 - FINAL MECHANICAL
.HA I ATERIALS DISCLOSURE
:Wilthe appl t r f m b dd pant store o n d1 humna ami nal' -TYPe(969of—.. FINAL GRADE' ..... .. ......... _ . -._ ... . . .. _.
la d0 dby mheC pn M "p lCe Chpt 9.12 dtheHealth adSfmy _
C de se t nn zss3zu c n All ro f hall b
❑Y. . . c :pN 'I e- 510`. '',FINAL't,91;ANNING
' g p 9 p l - all non- is i sour p�gGted first o}�Dy inspection,
being installed
� . - y tt 66
we ih<applicant r r t building a If a too is Instal a 'wit out vst o taming an mspectlofi;-I'agree to'remove
emit h and r c W t theB Area Air Quality Management
D t m,' ' o N' yall new materials for,inspection Applicant understands and will comply with
trey
- r•, '.. , • p source regulations", I
I I ve,rcae'tn haeno I ms msec uh,requvementy under.Chopmer 6.95mf the `
rCahfomin Health&Safety Code.Sections 25505:35533and 25534.Lundersmndmhot
t m £mere u n m hcM1m t e that
smY 'Po 4b'Ityt notify the
if b Id ngd esu tc rte dy hnvear m rhm t '
p q p nos f a cnrfc m f
pn j f
�6 /2)I p I) ' Signature of Applicant ._ - Date, .-
, nernmarkerl`rgf ` Date All roof coverings to be'Class `B" or better
OFFICE