03070194 (2) CITY OF CUPERTINO ' t
BUILDING DIVISION PERMIT CONh1RACTOR INFORMATION
��n�-,r✓pa's _�x s .a.,�"m� to .• s�����
au11.DING ADDRESS: GREG FAROTTE CONSTRUCTION "ND03070194
ERS NAME: 8545 MONTEREY STREET FERMITLSUEDATE
'T. JOSEPH OF CUPERTINO PAR SH 071gs/ 003
NE: (408) 848-9993 SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i00 LICENSED CONTRACTOR'SDECLARATION IobDescrip[ion
U I hereby affirm that I am I camacd under previsions of Chapter 9(comnti
meng
!�E withSeorceandcrec'.vlxion3ofhcOmin"aanJProfcasinmCntic,andmylicenmlm
7,�
in fall REVISION--FOOTINGS @ SEWER LINE
�8 Dtow Clam Conractor
e� ARCHITECTS DECLARATION NO NEW PERMIT ISSUED/ ORIG. #02040044
` � m m I a l d u public Tec rds
>yV
�o dProfessiorial
OWNER-BUILDER DECLARATION a�-�
if 1 hereby affirm that I am exempt from Contractors Conors License Law for the V
00 following mason.(Section 11131.3.Business and Professions Code:Any city rr county
$ which require a .it h+ennnract.alter,improve,demoliah,nr repair any structure
-`�
pour,,out issuance.also require the applicant for each pcnniuo file a signedsutement
�0 that he is licensed IF un
ursuano the provisions of the Common's Liacm Law(Chapter 9 Sq.Ft. Floor Area 1 _ I}lat*on $O
E5 $ (cnmmcncing with Section 7000)of Division 3 time Business and Pr,,rcaions Cartel or
e .. that use Is exempt therefrom and to India for tine alleged exemption.Any vinladnn of
Section 7031.5 by any applicant for a permit subjects the applicant to.civil penalty of 3]A IH41®nTe100 Occupancy Type
not more Nan five hundred end...(5500). 3
I,a owner of the property,or my employees with wages u their rale compensation,
will do the work and Immiucture is not intended or offend formic(Sec.70U,Business ]R� qg
Add Profession Codc:The Canuactoes Liam Law does not apply to an owner of 101 — FOUNDAT I VN d Inspections
propenywho builds or improves Hereon,and wbodoes such work himself or through his
own employees,provided that such improvements see not intended or offered for ale,If, 102 — PIERS
however,the building or improweent is veld within ane year of completion,the owner.
builder will have she burden of proving that he did not build or improve for purpose of 103 — UFER
m1c,1, 104 - REBAR
1,as owner of the property,am"elusively contracting with licensed contractors to 1 O5 — ANCHOR BOLTS
eonsmact the pmjeet(Sec.70",Business and Professions Code:)The Contractor's Lt
cause law docs not apply to an owner of progeny who builds or improves domed,and 106 - SEWER & WATER
who contracts for such projects with a contracoads)licensed purmanno the Contractor's
Lkmmm Law' 202 - UNDERFLOOR PLUMBING
Ism emmptunder W. ,B A P C for this moon 203 - UNDERFLOOR MECHANICAL
Dem 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION RATION
I hereby affirm under penalty of perjury one of the following declarations: 203 — UNDERFLOOR INSULATION
I haw and win maintain a Certificate of Consent to saf-insum for Worker.Compen. 301 — ROUGH PLUMBING
atlan,u provided far by Section 3700 of the Labor Code,for me perrommana of the 3 02 — TUB Sc OR SHOWER
work for which his remelt is issued.
❑I ban end will maintain Worker's Compensation Wudina,as mcuimd by Section 3 03 - ROUGH MECHANICAL
3700 drum labor Code.far the performance of the work for which mis Pepin I,Wind. 3O4 — ROUGH ELECTRICAL
My Worker's Compensation Insurance caller and Policy number art: 305 — FRAME
Cartier. Policy No.:
CERTIFICATE OF EKEM PION FROM WORKERS' 306 — HOLDOWNS
COMPENSATION INSURANCE 307 - INSULATION
(rhlsac,I.need not Mcomplmed if the permit is for one hundred dollars(5100) 308 - SHEETROCK
Ilea) 309 - EXTERIOR LATH
e certify that in the performance mann of Nc vera for which this permit is iaucd,10.11 not
employ any person in anymanncrmait)become subject to warkdri Compensation 31O — INTERIOR LATH
Laws vpitco^blifornie.Date 311 - SCRATCH COAT
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should 313 - ROOF NAIL
become Subject to the Worker's Compensation poor of me labor Code,you must
�,Z fonhwi th comply with such provisions or this Permiuball be decided revoked. 501 — FINAL ELECTRICAL ENERGY
?C CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
I hereby aRrmthat mcrc iucouaunion lending agency for the perrormana of 503 - FINAL MECHANICAL ENERGY
~Y'> hewoh fur which thls permit is issuca(Sec.3097.Civ.C.1
nd504 - FINAL BUILDING ENERGY
U
31 Q Address Isnaer'sri Aadrou
:)Z 505 - FINAL ELECTRICAL
:J O I certify hat 1 haw read all
application and state that the above information miming is 506 - GAS TEST
bonding l agree to comply with HI city and county ordinances of end sum laws relating to
�U
building endonedtiogand hereby Suthon p representatives of his city memo upon the FIN PLUMBI G
about-mentioned property for Inspection purposes.
(We)agree to sew,indemnify and keep harmlcu me City of Cupertino against O B FIN4#6L
h liabilities,j)grento...andomity andkee hird.Onmay in my City of CtiainnuiOCity 5
Jz in can nonce of the granting of this permit.
APP ICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued bye NG Datzv?<,Vb�
RC REGULATIONS. ^�� —
7 2r UBLIC WORKS
Re-roofs
Si re of ApplicaHAZA DO Date 6 2 - OOF PLYWOOD NAIL
HAZARDOUS MATERIALS DISCLOSURE Type of 3 - ROOF BATTENS
Will the applicant or furore building occupant store or handle havudous material
as Mined by he Cupenino Municipal Code,Chapter 9.12.and he Health and Safety 604 - ROOF IN-PROGRESS
m.So lion 25 _� All roofs shall be inspected prior to any roofing material being installed.
❑Ycr
Will the applicant or future building occupant a=equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It bombards airbonimidants u defined by the Day Arca Air Quality Management all new materials for inspection.
isidet9
❑Yes l
I hoe read he huardrua materials reyvin menu under Chirac,6.95 of he Califon
nit Health A Safety Cwd Suctions 25505,25533 and 25534.1 understand hat if the building
does net eared,have a tenant.hat it is my responsibility notify the cupaet of the
decal c which c do,1.!Monaof.cardlc ora ancy. Sitw_ gnature of Applicant Date
Zia All roof coverings to be Class"B"or better
Owne uthorirstl"gat Da¢