02050020OF
CIBUILLDING
CONTRACTOR INFO • ION:
DIVISION PE
BUILDING ADDRESS:
PERMIT NO.
10123 N WOLFE RD
r,'7
02050020
OWNER'S NAME:
APPLICATION SUB DATE
RICHARD E JAGROUP, INC
05/03/2002
PHONE:
SANITARY NO. CONTROL NO.
ZO ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
❑
BLDG ELECT PLUMB MECH
Cid
U1 CJ C� LJ
Z LICENSED CONTRACTOR'S DECLARATION
Job Description
' I hereby oFrm Nat I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business d Professions Code, and my license
s m fol rc nd eHecr
ANTENNA SITE FOR SPRINT PCS
ULittnse C Lic.
Date Can tar
�+
FINALED
HITECT's DE
S ensand my plans shall be used as public records
NOV 2 6 2002
Licensed ProPossionol
OWNER -BUILDER DECLARATION
H I hereby M. [hat 1 am exempt from the Contractor's License law for the
followingreason. (Sectiont703 .5. Business and Professions Cade: cit orcoun
O
$50000
which reuires a permit roe conamct ober, improve, demolish, or repair any srmcmrt
p
$ _. Pnmm LL it w nedsmrcment.
B=tq tmtheappncantf
___._.._..._".. -
pit
- tlut�llalingwghSoctimrlGlhepfDivision3o theflyme.,outPrdaw(Chapter9
eCon toesLicen
(c mmuic i(ht Pon. Cone)
nor
y,xyt�fpor a- [ ,r
,3,1;b1yLUT]...;U UYId.
Valuation
a
ar Inet he m exempi [n from nnC the basis for the alleged pRemPtiuh. Any v'olauon
therenitl(R))ofhe basisthe rimord Any
1
- of section JN I:5 by any applicam torn permit suhjceu the applicam m e civibpenelry-
afn9tmarethanlfvehundredaoil.(S5Bo).
101APNPb�ATION
-�'T": Occupancy Type
❑Las ower ofthe pmpeny, m my employees with wages as their sole mmpcnedon,
will do the Work: ad But sINCNR is bar Intended ar Offered for sale (Sac. -9 ,
'Busineis andToofessions Code: The Contractor's License Law does not apply to an
—"
103 UFER Required Ins ections''r ��'� •:"
owner of property Who builds or improves thereon, and who does such work himself
aN ply provided ad
104 REBAR
d Nomin ngor roimprovementstiro
,uttered r In"however"N willbuildor p _-env la he within one r
iompinion, the owner milder will have the burden of proving that he did not build or
_ -
105 - "ANCHOR BOLTS ;.`''y
mprove for Purpose or Ole.).
106 - SEWER & WATER i
------...__
174 as wen I be.Property, am exclusively contracting with licensed contractors m
-- --- -_._
-
- ERFLOOR PLUMBI
construct
iw i the p sect (Sec W W Business and Professions Cade) The Contractor'
- Low does not apply m e owner of property who bullas te improves thereon,
thereon,
203 - UNDERFLOOR MECHANNG
L, t
'I CAL
(: wh
.-and-who icenstor Lsuch Pmjau wN.a, conwcmrts).0ansce punuantm the
' License La
-__. ___......
_.._._.._. _'204""' -.._UNDERFLOOR. -.FRAME__.- _._-- ..._...-------
01 sure
0
❑Lem exempt antler Sec"", '"(` "',B'.r for this reason
205 - UNDERFLOOR''TNSUL'ATION
owe '"Uarc fe,
301 - ROUGH PLUMBING
'WORKER'S COMPENSATION DECLARATION
302 - TUB & OR SHOWER
hereby efflrn ands, onally of.pe — I one mfthe following eeemrndons.-
303 - ROUGH MECHANICAL
- ❑ 1 b.'Wiand wiil'ro iniain V&nificaie of Couilm to self-insum for worker's
3 04 - ROUGH ELECTRICAL
Com,souro O -m provided -for by Senior 3900 of the Labor Code, -fm Ne
_ 'performance'of the work for which thus pemut_s issued.
305 - FRAME
❑ 1 h 1W II ma t In work Cp pc s uon immmn s req tred by Seethm
306 - HOLDOWNS
pert n e of the work for I Ir which Yh perm t'is
N" M of Lok isode pfor N Insura aim ens Pol cy numbs
307 - INSULATION
`
I c O�'
�
.... 308 ..-1 SHEE,TROCK _
C.ERTIFl ION OF EM ION FROM
oM w's or,
r s,
) 3309 1-/EXTERIORI'LATH
COMPENSATION MSURANCE ;e _
,.._-. , .__.,
- 31'0 -;: ZNTERIOR'-I ATH i a n d I' ,c
csioo) sx>c)cion'necdnotbeoompldedifthePermitisforonehundreddollarsh
311 - SCRATCH COAT 'r
1 cm f Net, n Ne rfo' a f th rk f w
ad",
d, t i
pe , x ssi1
c
"shill t rap y any person n y a m m become sub3en to In' W h re
-.ROOF°NAIL,.,
501 FINAL ELECTRICAL ENERGY`'
1.
Co Peneat on laws f Cal r ;Dam
i
=--FINAL
?become TOAPPLIb. CANT If, f¢rmakmg thismmapa o,"ousce fExemption,you should
provsions ofe Labereme, youmuit
bccomesobfect to the Workers visions
..PLUMBING --ENERGY __
s, ,,, b.ra SO
503 - FINAL MECHANICAL 'ENERGY
P or his
j fano uhc tywithsuchp --n- ----mit shell bed drevoked._504
-..-FINAL .BUILDING....ENERGY_
CONSTRUCnONLENDINGAGENCY
505 - FINAL ELECTRICAL Irl,;;
the bynfinnOur there t construction lending agencyf nits per! tt
( .0 -
of the k for which N Permit is issued (sea 3097 Cic)
506 - GAS TEST
Lnd Nnm 9+� - I x
L eersAddre
_ .._ ... ..
508 - FINAL PLUMBING
508 - FINAL MECHANI CALF
1 ntfy thatlh rtdthsapplication d tt Ih nth lose nf nnato is
aprtGm I agree I plyy with all city and my rdinances ane tate laws relating
to budding constructio.Sod hemby:amh ze
509 - FINAL GRADE V —
premmatives of this city to?mer upon
the ahove-manionedpropeny for inspection purposes.
510 - FINAL PLANNING
(We) figure idsaGe.'imbaFtify sad Ittep harrnicA the Ciiy of Cupertino"eginst
liabilities, judgments, casts and expe which may in any weysnceme ageinn ssid
514 - FINAL UB C WORKS '
C ry to consequence f Ne tht p<mur
APPI IQAI-r WDPTIO'. DS\ D�b4 LCObIM1L�"NITHALL YON:'F 'VTh
!, '
Issued by: Date �./
so�Ryp �ue nD t";. Z 3�^�
haat re rAppTcwu Camm'or .. r )
HAZARDOUS MATERIALS DISCLOSUREib t
Re -roofs
,
Will the licant or Imre biddinguccupat tore f handle hazardous matenal
T eOf.ROOf^
YP
as def nedb the Cu Ino Mun , Ch pt 913, ad he Health and Safety
n
Code Shit 25532 t..'
r
Tmatenal
❑Y r�
All be an
roofs shall ins ected nor to. xoofin ben
P P Y g ing,installed ...._.._
trailrmicu I c rot o rot rt b Idt g Occup m u cq p t re ices itch'
cm t it m u [sm,em tl W by AreaA
.''
If a roof is installed': Without first obtaimn an!inspection'!, I a res to`rerhCove
g g
co the Bay Quality Management'
D m oYee No_
all new materials for inspection., Applicant understands and will comply with _.
'
or 1, oo
all non-poinFsource'regulations ." _-
I ha a d the hazy do s amn 1. requ rements under Chiller .95 of the
Cahfornm Hmlth & sorely Cafe sections 25505,25533 and 25534' I undemmnd that
'
o--'-
es not or atmly he trot ant't'nismyrcuance of. tonotifythe'
Lear,do, lof, cash
"a4,p m of Ifie require ms Wti ch must be ' a p'ar to issuance of a Ccnifica[e of
-"
'
' •' '^•
..Signature of Applicant Date
All roof coverings to be Class "B" or better
a tnorzed agent
e
r,'7
net
,... .
v
......_..OFFICE- ._ . ..... ... _. _.._ ., ..... _. ___.. __ ......__ .