03090067 t CITY OF CUPEWHNO
BUILDING DIVISION PERMIT ,CON TRACTnR'INTORMATIQN ;
BuaDING ADDRESS: PACIFIC AUTO EXPORT (VALLC R�RMrr"03090067
OW ER'S AME: /PERMIT ISSUE DATE
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MF.CII
foo LICENSED CONTRACTOR'S DECLARATION lob Description
I u 1 hereby affirm that I am licensed under provisions or Chapter 9(commencing - p
wi ih Section 96Vllp or Division 3 o(quc Business and Professions Code,and my license is
�iCm.0 andeffect.
Lic.g GENATOR (USED CAR SALES)
FI ISLE
Date Contractor
M
ARCHITECTS DECLARATION y M
i l understand my plans mall he used as public records 7. 2003
e
y0 Licensed Professional
Oat NEm exempt
DECLARATION
COO hereby maso affirm that 1. exempt tram Ne Conine Con :Any c Law for the dUI DING
COO following mason.(Sadao]Construct,
Business and improve.
de um Calc:Any city or county L, �\
Y! which requires a permit re construe.alter,improve,h promah,or e a sig ed awment
ZY that hor nslicenedpossuasuance.als ,tothrtW applicant for.such Law(Chapter
pp <
that me cccnud pSecumuolhc provision nrthe ofthe Business
LicenseLion,Copmr9 Sq. F[. Floor Area Valuation
2�m
0 $ (commencing Section 1 and axis n 3for th al eged exe and on.Any i CMc)of
Net he is exempt themfmm and the bssiz for me alleged exemption.Any violafian of $500
Section]831.5 by any applicant for a permit subjects the applicant to a civil penalty of . Type
not mom than five hundred dollars($500). '- ^--'--- -- -APN Number Occupancy ---El 1,m owner of the pmpery,or my employ=with wants u Meir aole compcmation, 31620037 . 00
will do the work,and the stmeun is not intended or offered(orsale(Sec.7044,Business
and Pmfessiom Code:The Contractor.License Law docs Out apply to an owner of Required Inspections
'property whobullds or improves thereon,and who does such work himsel(or through his
Own employee,pmvidcd that such improvements ere not intended orcffered for sale.If. 101 — FOUNDATION
however,the building or improvement is mid within one year of compinion,the owner. -
builder will have the burden or proving that he did not Wild or improve for puspou of 10 2 — PIERS
sale.).
❑1,as owner of the property,am excl.mvely contracting with licensed convenors to 103 — UFER
combvct the project(Sec.7014,Business and Prate cions Code:)The ConvaemS Li. 104 — REBAR
me Law does ant apply to an owner of property who builds or improves ocmon.and, lOS — ANCHOR BOLTS
who contracts for such projects with a mntnetor(s)licensed pursuant to the Contractor's
m mow. 106 — SEWER & WATER
Cie
t M .Bet PC fur are nn 202 - UNDERFLOOR PLUMBING
Owner dD.MRKER'SC P. SATIOI DECy, TION 203 — UNDERFLOOR MECHANICAL
I hemb nderpcnat[ rjory one or din,rotheving dalmniom: 204 -- UNDERFLOOR FRAME
+ have and will maintain aCemficmeofConsanftoselGinmmmrWorkers Compen. 205 UNDERFLOOR INSULATION
Conn.u provided for by Section floe of the labor Code,or the performmin of the 3 01 — ROUGH PLUMBING
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insunna,u required by Section 3 O2 — TUB & OR SHOWER
3]03ofthe Labor Code,for the performance of the work for which this permit is Issued. 303 — ROUGH MECHANICAL
My Worker,Cnmpemation].a..ere carrier and Policy number,are: 3O4 — ROUGH ELECTRICAL j
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS' 305 — FRAME
COMPENSATION INSURANCE 306 — HOLDOWNS
(ams all.need notWCompleted itthe Terrnitisforenchundred dollars($IM) 307 — INSULATION
or last
I Carl fy Oat in the Performance of the work rot which this Permit is vaned,I mall not 308 — SHEETROCK
employ any paten in any marmran as to become subject mhe Workers'Compeesation 309 — EXTERIOR LATH
Laws of California.Data
Applicant 310 — INTERIOR LATH
NOTICE TO APPLICANT.IL after making this Cchricatc of Exemption,you should 311 - SCRATCH COAT
Weems subject o the Worker's Compensation provisions of the labor Code,you muss
D forthwith comply with such provisions or this Permit shall W domed revoked. 313 — ROOF NAIL
z'O CONSTRUCnONLENDING AGENCY 501 — FINAL ELECTRICAL ENERGY
I hereby aMrmthat there is a construction lending agency for the performance or 502 — FINAL PLUMBING ENERGY
k 7 the work for which quiz permit Is issued(gee.J09],Civ.C.1
Leaders Name 503 — FINAL MECHANICAL ENERGY
jL Lcroars Addresmmfys 504 — FINAL BUILDING ENERGY
p1 certify that 1 have rad this application and zine that the above information is 505 — FINAL ELE CTR I CAL �f
y building I agree to comply with all city and county ordinances and Cute lawsws relatingng to
La movengcansncel construction,andforebyamhorisrtose&. etives Of Los City menmr upon me GAS EST
� G ahovcmcntioncd property fnrimpcction purpeuz.
(Wer)agree to save,indemnify and keep harmless fee City of Cupertino against 0 7 F I
r�
liabilities.judgment,casts and expenses which may in my way accrue against said City
J 7 inconsequence he t of mh permit. Issued b 5%07
ICJ
Date
rr77 APPI.I N STA S AND WILL COMPLY WITH LL N N-POINT Y;C,
SOU ERE UL ON
Re-roofs 10 NAL PLANNING
'I Igne App'am/ContraaorUS Date 5114 — INAL PUBLIC WORKS
AZARDOM RIALS DISCLOSURE Type of Roo - -.
Will the rotor future Wilding cupmt nom or handle huallousmatrial
u defined by the Cupertino Municipal Cotler,Chapter 9.12,and the Health and Safety
Code Section 35532(a)?
❑Yea PN All roofs shall be inspected prior to any roofing material being Installed.
Will the applicant or future building arupant axc equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
.- havardous air contaminants as defined by the Bay Ana Air Quality Management all new materials for inspection.
I trim?
❑Yes
I have rand the havalloyy na rah requimmennstoner Chapter 6.95erthe Calif.,.
ma H.rIM&SN ICs ry"cyduas 505,25533 and5534.1 undersan
d that if On Wilding
dans not cu fly a Ilfnent at it I'
my rummos,hilay n run Iy me uccouse o9he
m4uimmcn wh' s lar prior to issuance ofa Ccnifc ofQ pan/.
Signature of Applicant Date
o eramh •,� ascot Dat All roof coverings to be Class "B"or better