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02060126 (2) CITY OF CUPEKI'INO "" 4v •" �' BUILDING DIVISION PERMIT CON - CTORaINF,ORMATION:_ BU ILLAU(i/At)HOUSU OHN SON AVE . PERMIT N®2060126 .PAT9,Iyr:SON LIN APPLICAT©bS'1 .xQ�2OO2 ONE: SANITARY NO. II__�� CONTROL NO. ARCIi1TECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 <OOp LICENSED CONTRACTOR'S DECLARATION u affirm'hat 1 am licensed under provisions of Chapter 9(commencing NEW SINGLE FAMIAI?esfffftt I NG JJ In<i with Section 3lXX)of Division 3m the Business and Rofessionx C,de.end my license nis ��„ 'nluernrceande««,. LIVING SPACE 2158 SQ. FT. _qn uanseclaxx Come GARAGE 438 SQ. FT. Far Dam QS DEC( As shall W use DECLARATION I understand my plans shall W used as public records U, 2: Licensed Professional OWNER-BUILDER DECLARATION w a i 1 hereby affirm that 1 am exempt from the CnnmucmLs License Law for A 00 following reason.(Sec'Ibn 7031.5.Business and Professions Cwle:Any city or county at 'm which requires a permit In construct.alter,improve,demolish,or repair any struemm te Prior pr as istarric,also requires the applicant for such permit to file a signed statement ZiGthat he is licensed pumoanttothe provisions offacContractor'sLicense Law(Chapmr9 Sq. Ft. Floor Area $35OVMiLtion ,' n (commencing with Scaion7kXB of Division 3 of the Business and Professions Cade)9r -w — that Im is exempt dea from and the basis for the alleged exemption.Any violation of Swum 7031.5 by any applicant for a pemmin subjects the applicant to a civil penalty Of not more than five hundred dollars(S500), e Occupancy Type 01,ex owner of the property,or my employees with wages as their sole compensation. will Jo the work,and Ne structure is not intended proffered hostile(See.7B1d.Business and Pmfcsions Code:The Cmuseme,License Law does not apply m an owner or 10 2 - PIERS equtred Inspections property who builds or improves themon,and who does such work himself or through his own employers.provided That uch improvements arc not intended or offered for sale.If, 103 — UFER however,the building or improvement is sold within one year of completion.Ne owner- 104 — REBAR builder will have the burden of pausing that he did not build or improve for pur ma of 105 — ANCHOR BOLTS I,as owner ofthe pmprny,am exclusively contracting with licensed commensal to 106 — SEWER & WATER comwm the project(Sec.3044,Businccs and Professions Code:)The Contomtiux Li- nsetawJcesnolapoly toanowner fpropertywho Wilds orimprosixthercon.and. 202 — UNDERFLOOR PLUMBING who cora or such projects with a conmamor(s)licensed pumuanrao the Common's LicemrL 203 — UNDERFLOOR MECHANICAL ❑ lame ptandrrsec. B&/PCr�dysr 204 — UNDERFLOOR FRAME nr ore&'— I 205 — UNDERFLOOR INSULATION / < OMPENSATION DELL ATI 301 — ROUGH PLUMBING Ihcrcby irundcrpcnallyofperjuryoncofthc mgd«Iaradnns: 302 - TUB & OR SHOWER ❑I have and will maintain a Certificate of Consent to ulf-insum for Worker's Comte pe station,as provided for by Section 3701)of the labor Code,for the performance of the 303 — ROUGH MECHANICAL work for which this permit is issued. 304 — ROUGH ELECTRICAL 0 1 have and will maintain Worker's Compensation Insurance,as required by Section 305 — FRAME 37(X1 of the UWr Code,for the performance of the work for which This Fermi'is issued. My Worker:eCon,taxaa^n Insurance carrier and Policy number are: 306 - HOLDOWNS Camief: Policy No: 307 - INSULATION CERTIPICCOMPEN A1 E OF ATIONION INSURANEORKF.RS' 308 — SHEETROCK (This section Decd notWcomplemJifrhe permitfnronc hundred Jollars(SI00) 309 — EXTERIOR LATH arlcts') 310 - INTERIOR LATH 1 certify 0.1 In the perhmnure. 'the work for w�'jrh Nix t is Issued.[shall not 311 — SCRATCH COAT employ any pe n (any man drAu itulreTo�srhjeQ)a, aWonwas Ciarfam dam ws`"cal' ria Da' "Yffft VV 313 — ROOF NAIL Ap is CE is ng this CenificateofExemption,y^uxhould 501 — FINAL ELECTRICAL ENERGY Come v wufmr';epmpen,atinn pmxixium nnnr UNIT Cone.YOU mum 502 — FINAL PLUMBING ENERGY Qz forthwith comply w h such provisions or this Fermi'shall W deemed revoked. Z 0 CONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY [-. = Ihereby affirm thalpace is aeonnmcomlending agency bethe perFormancror 504 - FINAL BUILDING ENERGY the work lin which this permit is issurd(Sec.30it Civ.CJ w 3 Lemrr'sName 505 - FINAL ELECTRICAL 5 z Under,Address 506 - GAS TEST J0 I certify wt 1 have read this application and state that the above mfm,nation is 507 — FINAL NAL PLUMBING Iy ,r corf«l.I agree m comply with all city and county ominances and saute laws relating 10 U building construction,and hereby antawn,atprcsanotivcsofNixcity menter upon the %3 — INAL MECHANICAL W ahovcmcmioncd property for inspection purp9acs. F y (We)agree In save,indemnify and keep harmless the City of Cupertino.gains' IN DE h liabildics,judgments,costs and expenses which may in any way accmc against said City N G A ) V z APPLIC u `UNDERSTAN SAND WILL COMPLY WITH ALL NON.POINT Q L./ 5 ;G ,ATIONS. v0 Issued byWORKS Date o Re-roofs gn r f It Ito cp rte Date OF BATTENS IIAL RDOUSMATERIALSDISCLOSU TypeOf%()f4 - ROOF IN-PROGRESS will a applicant fracture building Occupant mfre orhanele ha amiss,aimed.) er de0ned by the Cupertino Municipal Code.Chapter of 2.and the Health and Safety %ha/aydous n 25532(a)7 s )�wp All roofs shall be inspected prior to any roofing material being installed. Willthe applicant of/future building Occupantuse equipment If a roof is installed without first obtaining an inspection, I agree to remove qui or devices which g p ux ter contaminant,rev Je(ineJ by the Bay Area Air Quality Management all new materials for inspection. s mad the hvardous materials mquircmcmv under Chapter 6,95 or Ne Califur ufefy Gdr.Sccdom2 cnOY haw:a timet, a it ix my rcapmxibiliiy m notify'M,x'cupa'nl Nc re r ,1 W me Pro 1 ix,uan«^faCrmUr�o cepatm Signature of Applicant Dale orwil agrnl Date All roof coverings to be Class "B" or better