03090045 (2) CITY OF CUPERTINO > �
BUILDING DIVISION PERMIT ��k �6Td ,TRACTOWINF,ORMATION
RUILDING ADDRESS: WEGNER CONSTRUCTION PERMIT No 03090045
289 KRIS92A 27
ER'SNAME: 1069 CRAIG DRIVE PERMrTLSUEDATE
NE: (408) 252-2345 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
X00 LICENSED CONTRACTOR'S DECLARATION
�u+ 1 hereby affirm that 1 am licensed under pmvisiur of Chapmn 9(commencing Job Description
iT wiNSeeli.rag IR)ofDivision3ofN Busine nd Profcssian CO1,and my license is
,« imm�m star _ '�Gcd�g REVISION/IN-HOUSE ONLY
j�Z License Class Lia.M t b\
;mac Dam cpmmdT�/ ORIGINAL PERMIT #01110029 '
ARCHITECTSDECIATATION
fWa IundersuTidmyplans shall heu.Jupublic reemik, REPEAT PLAN CHECK FEES ONLY \SS
a M Licensed Professional C�
S OWNER-BUILDER DECLARATION
i<x I hereby affirm that I am exempt from car Contractor's License Law for the
o O following reason.(Section 1031.5.Business and Professions Cmle:Any city or county
3 m which requira pennim to Construct,alter,improve,demolish,or repair any structure
-iy poor to is issuance.also requires the applicant for such permit to file a signed statement
�a0 that hpursuant e is licensed pursuano the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
12-0 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
u`<— that he is exempt dpmfrom and Be basis for the alleged exemption.Any violation of 80
Section 1031.5 by any applicant for a permit subjects the applicant to a civil penalty of .APN Number Occupancy Type
am mme than five hundred dollars(1500). - -
0 h as owner of the pmperdy,or my employees with wages as macir solta compensation. 34245003 . 00
will domitawank,ands: he Cumisnots Laces Lawdofor salt(Sec. owner
and artywh limitations Code:The ws theeton. nd who Law aces not apply m an owner of Required Inspections
property who builds or improves ch improvements
ve who does such work himself orthmugh his
down however.the
that ortmwniimpsnwmwuantane you of completion,
fon awns. 101 — FOUNDATION
M1owevcr,me building or improvement is sold within rota ycv of compinion,Ne owneo-
builder will have the burden of proving that he did not build or improve for purpose of 10 2 - PIERS
sale.).
❑1.as owner of the propeny,am exclusively contracting with licensed coronations to 10 3 - UFER
construct the project(.Sec.7064,Business and Professions Code:)The Contractor's Li. 1 04 — REBAR
came Law dam net apply In an owner of property who builds or improves daemon,and
who contracts for such projacs with a conuantons)licensed pursuant to Be Contractor's 105 - ANCHOR BOLTS
License
❑ se Law.
under Sec. ,B h P C for his mason 106 - SEWER & WATER
Date 202 - UNDERFLOOR PLUMBING
r
WORKER'SCOMPENSATION—DECLARATION 203 - UNDERFLOOR MECHANICAL
I hereby arfmt under penalty of perjury on of me following declarations: 204 - UNDERFLOOR FRAME
--./#IawandwillmaintainaCeniBcamofComenttoselr-insure forWerkaracnmpen. 205 - UNDERFLOOR INSULATION
cation,as provided for by Section 37W of the Labor Cmm.for the pmf...ties of the 301 - ROUGH PLUMBING
work for which this permit is issued.
❑1 have and will maintain Worker's CrmpensWna lnaurance,as required by Section 3 02 — TUB & OR SHOWER
37W of the labor Code,for the performance of the work for which this permit is issued. 303 - ROUGH MECHANICAL
My Worker's Compensation In n.cameo and Policy number am:VUEM304 - ROUGH ELECTRICAL
`1 / ,.k F /�dv �_
V,.
StCERTIFICATE OF �No.: l3 -7
MOM WORKERS' 305 — FRAME
COMPENSATION INSURANCE 306 - HOLDOWNS
or less.)(fail sectione
n ed not k ComPlemd iDbe permit is for one hundred dollars(SHad) 307 - INSULATION
I certify that in the performance of the work for which this Permit is issued.I shall out 308 - SHEETROCK
employ any person in any manner an az or Mcome subject lin the workerSCompemamion 309 — EXTERIOR LATH
Laws of California.Date
Applicant 310 - INTERIOR LATH
NOTICE TO APPLICANT:If.after making oris Ccnificam or Exemptioi you should 311 - SCRATCH COAT
become subject 10 the Worker's Compensation previsions of the Lehr Code,you must
�O forthwith comply with such provlsmor or this permit shall be accmW revoked. 313 — ROOF NAIL
CONSTRUCTION LENDING AGENCY 501 - FINAL ELECTRICAL ENERGY
IWoody r which thi Neat mticre iaaed(Sec.30lending agency for the perfurmanm of 502 - FINAL PLUMBING ENERGY
y
the work fur which this permit is issued(Sec.J 91,Civ.C.)
n q snticr'sNamc 503 - FINAL MECHANICAL ENERGY
Z L naer'sAddmas 504 - FINAL BUILDING ENERGY
I ttnify this ve I haw read this application and sum that the sham information is
yF carcalagree recemplywith at]city and county oninanceaaadsent laws mlamingto 505 - FINAL ELECTRICAL
�U building construction,and hereby amhorim representatives Of this City to enter upon me GAS EST
ahovcmentionad pmpeny for impeecon purposes.
ti LL (We)agree to save,indemnify and keep handless the City¢(Cupertino against O 7 FI
N
liabilities.judgments.costs and expenses which may in any way accrue against said City 5 w-1
z in consequence c M� PPIJ�nl
randing o min permit. I CAL 5
APPN AN WILL COMPLY WITH ALL NON-POINT Issued by:5 Date
SOU
y'3 Re-roofs 510 NAL PLANNING
ncmr Dam 54 - INAL PUBLIC WORKS
DO S MATERIALS DISCLOSURE Type of Roo
future building occupant storeor handle hanardems mandrel
az defined by the Cupertino Municipal Ctx1e,Chapter 9.12,end Cita Health and Sa(edy
.Se❑c yes 25532(6)? [tLNo All roofs shall be inspected prior to any roofing material being installed.
Will to applicant or future building Occupant use equipment lir devices which -If a roof is installed without first obtaining an inspection,I agree to remove
tit hazardous air comaminanu as defined by the Bay Arca Air Quality Management
.rico all new materials for inspection.
t]yes MN.
IIt reW dhehava s materials requirements under Chapter 6.95ofmcCaliler-
niaHeeldhdCSufemy ,Scc, 25505.25533 and 25534.1 undersand thvif the building
does Out eurRnt my ms'nsibllhy m niZ me occupant of the
reyuimmen wit It i sono Realtor cupancy.
Signature of Applicant Dale
Ow a will , Dap All roof coverings to be Class "B"or better