03030145 (4) CITY OF CUPERTINO
BUILDING DIVISIONPERMIT ' CONTRA, IN 'UIZM TION gM.
BUILDING ADDRESS: VOROS CONSTRUCTION PERMIT NO.
11 92 CRES2LINE T)P
-R'S NAME: 1192 CRESTLINE DRLIT�
VOROS DAVID
PHONE: (408) 253-9332 SANITARY N OL N0.
ARCHITEC(ENGINEER: _ BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
00 LICENSED CONTRACTOR'S DECLARATION
� I hereby affirm that I am licensed under provisions of Clop er 9(commencing Job Description
with Section 70fll)of Division 3 of the B%07,s end Pnefe.mm,Coo,end my license is
�„ in full ftstb end cr yt (C g e TERMITE REPAIR/W/BATH TUB
q= Lteenm I FII �t LIBE
Date Cymrattor O/fl
ARC ATION
u rstan Y Plans ublic records SEP
u z n 9 03
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,aro L¢cnttdP csnanal
5 OWNER-BUILDER DECLARATION
ContrON
1 tachy a(0rm tint 11. exempt from the Canons Cod :Any c Law county
0 o following reason. omen n](131.5,Business end Rofeuinns Code:Any city or county BUILDINGS
$ which requires•permit to.co tans".elmq Improve,demolish,or¢pair any[woes,
iprior in its issuance.also reeuims the applicant for such Permit to file a signed statement
� loiMislicenudpursuamtoshcpmvisions Mthe Contracmist.kenmlaw(Chapmr9 Sq.Ft. Floor Area $
L Tj(vJ vU
xBlllBtlOn
(commencing with Section 70W)of Dvuion 3 of the Business and PmfessinnsCode)or
? $ Nes W is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by anyeppliuntfor•pemtltsubjecu the applicant ma civil penalty of 3RSPde$pli�s�r pp Occupancy Type
not mom Nan fisc hundred dollars(SSW).
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the sticture is net intended or offered for We(Sec.7044.Business 101 — FOUND�r.
and Profusions Code The Contsaemra License Law does not apply to an owner of Aff4 jNd Inspections
propenywhubuildsorimpruvevthememandwho doessuchworkhimmiforthrough his 102 - PIERS
own employees,pmvided that such improvements are notin¢Med margined for ash,If, 103 — UFER
however,the building or improvement is sold within one year of completion,the owner
builder will have toe burden of proving that he did not Wild or improve for purpose of 104 — REBAR
.1,.).
❑I,as owner of the property,am exclusively connecting with licensed contract.to lOS — ANCHOR BOLTS
conswm the project(Sec.7tW,Business and Prefsmons Cade:)The Contractor's Li 106 — SEWER & WATER
rue Law does not apply no an owner of property who Wilds or improves thereon,and, 2O2 — UNDERFLOOR PLUMBING
who contracts for such projects with a conoacmthe r(s)banned pursuant no Conuaclor's
Law.
203 - UNDERFLOOR MECHANICAL
lam acmpt orders .B&P C for this meson
Z&f (�D Dam _69 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATIONOB RATION 205 — UNDERFLOOR INSULATION
I hereby alarm under penalty of perjury ones following declarations: 301 — ROUGH PLUMBING
p l have and will mdnuie.CanifieamofCmaent to self-insum for Wmker'acompen- 302 — TUB & OR SHOWER'
union,u provided for by Section 3]W of Ne IaWr Code.far Ne pcRonnana o(tW
303 - ROUGH MECHANICAL
work for which this permit is issued.
❑I have and will maintain Workers Compensation Insunnce,as required by Section 304 — ROUGH ELECTRICAL
37W of tw tabor Code,for the Four.once of the work for which this permit is issued. 305 — FRAME
My Wrukefa Caon,momod instars..emicr end Polity numWr am: 3O6 — HOEDOWNS
Canner. Polity No.:
CERTIFICATE OF EKEMMON FROM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
less.)(This<This sanon Weempieted lrNe Permit is forms,hundred hundred do (SIM) 309 — EXTERIOR LATH
or
t ceniry titin Nc rmmanec or the work for which this permit is issued.I shall not 310 — INTERIOR LATH
employ any pc ny mn�rsp Asmtgome subject to the workers Compcnaation 311 — SCRATCH COAT
L.ws trees_ .. Dam_ 313 - ROOF NAIL
A II I�
CE APPWeWorke'sComIf.after mamgNirvisiosoftheExemption,de.yshould
must 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation provisions of the labor GMC.you mush
Z forthwith comply with such provisions or Nu Permit mall W deemed revoked.
' Q 502 - FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I bereby affirm that Nen iso construction lending agency for the Pcrfurmena of
x 504 - FINAL BUILDING ENERGY
� Ne work for which this Permit is issued(Sec.3097.Civ,C.)
q 4ndceaNamc 505 — FINAL ELECTRICAL
�Z Lembo. ddress 506 — GAS TEST
Q 1 certify Nan 1 have read this application and sum that the above Infmat tim is
F correct.I agree to comply with all city and county ordinances and sum laws misting to 507 — FINAL PLUMBING
DU building construction,and hembyauNmny npresematoos of this city to enter upon the — ;INJjWNW
CAL
above-mentioned properly for inspection purposes.
r W (We)agree m U.,indemnify and keep harmless the City of Cupertino against 0 9 F'I
Iq liabilities,judgments,costs and expenses which may In any way same Us ran said City 5 Z inconsequenceof the granting of this Permit.SOULICAREG LAT( AND WILL COMPLY WITH ALL NOWPOINT Issued by:5 ORKS Date
Re-roofs
Sig roof Appli m/Contactor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
rWill the applicant or future building occupant a.or handle harudous mamriai
as dcftnod by the CupenNo Municipal Code.Chapter 9.12,and the Health and Safety
Section❑y.25532p)1 'CLNn - All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hanrdous air contaminants as defined by to Bay Area Air Quality Management
Disoict7 all new materials for inspection.
❑Ycs /j No
I have mad the harekous materials mquirtmcros under Chapter 695 of the Califon
nia Hcal"Safety Coo,Seedons 25505,25533 and 25534.1 understand tut if the Wilding
dors not< tly hese a rental Nat it u my responsibility m notify the occupant of the
myui rets an an a dnrmissnenyenr.cenine raman_yd6� Signature of Applicant Date
Dov.e mthndxcdagent .Dy„y� All roof coverings to be Class "B”or better