02040060 (4) CITY OF CUPERTINO -
BUILDINGDIVISION PERMIT CONTRACTOWINFQRMATIOM
I UILDOJO ADDRESS: PERMIT NO.
M&CADAM LN MACKEY CONSTRUCTION 02040060
OWNER'S NAME: APPLICATION SUB DATE
7URAJ PAVLOVIC 2593 HEBRON AVE 04/15/2002
iiONE: SANITARY NO. CONTROL NO.
(408) 274-6799
LOOARCHITEC7/ENGINEER: BUILDING PERMIT INFO
& BLDG ELECT PLUMB MECH
y2
reLICENSED CONTRACTOR'S DECLARATION
i=S 1 heby arm R ,he,I ren licensed under of Chapter 9(commencing Description
ommencing � P '
ryt� with full
tI00)ofDivisfon3 ottha Baamess and Professions Cove.wd my license INTERIOR LOFT & ENCLOSE ENTRY.
rs in full f an ea.
ne L;a it S O 3
cmmnn� is-
H.
O G ARCHITECT'S DEC ON
,5 1 understand as,plans shall heated as public reoores
rc o O Licensed Professional
R�y of
O\VNER-BUILDER DECLARATION FIN
A ��
I hereby .the mr
1 ore euempt from the Cononc 's License Law for,he C��p.N"pA
It i afollowing rtewn.(Sasion]0313.Business and Profcuiom Codc:Any city m county
o which requires a permi to commuct.alter,improve.demolish.or repair any strunum OO $15000
634-pn«souses ne atw q ' th applicant for such prov0o Mea u
ugneds ,e o - . . -
tfat he Kl ansid 0....11.this pro,sronnorth,Comranors License Law ICheq 9 5., t 3 Sra�2•' '{jTpary,r (A S. t.s. Valuation
(commenting wish Sen 9000)of D Won 3 of she Buyiness end Profaim ons Cod) e''� p t. 69 .L -tN ` S s,
ar that be a acmpnherefrom and,he basis for the alleged akempuon.Any violation -
-arSecdon]0315 by airy applicant fm a permissubjecu the applinnt to a ciNl pnphy
rarnormoamaeRwna,aaeanahg5w). 10Y4PNON ^'` T`O Occupancy Type
pe
as owner of the property,Or my employees whh wages in their sole corm pnsmion, _
will'do the work;and the uruEture L not ihHhde9 or-dRdcd'far'sale'152cf]niA,-'
'BasineisindProfessions Code:The Conoac t is License La.dom ria apply w w 103 - UFER Required Inspections iP
owner of pmpny Wtio builds or improves thereon,and who docs such work himself
or mrou h his own empluycm.provided thin such imprgremema ore nor Wended or 1 O�I - RSBAR
-.. . . - _ ._ car ar ._._...-.____ .-...__._ __._—__..__...___._.;_-I.__._..--___-_._.___..-._._
,aRnN or tile.l(however,then hav t or improvement n that
be did one y ,,.-,uY:G ;�...`C,.`y- '-------
'c6mpinion.,hcowner-builderwill have the burden of provingshashedidOut Wild or 105 - ANCHOR BOLTS
im«ovc ror paryow arnle.J. 106 - SEWER & WATER _
- ----__.. ..........--------------._.. __ ._.. _ . .... - ._..._..-- - -... - - - - --
OLast owneroftheProperty,amexclusivelvcontracting with hcenmdcontractors i. 202 - UNDERFLOOR PLUMBING -
comwn the Project(Sec.7044,B.1i•.and Profen ons Cade)Tbc contractor's f:i:.': - )•7
apply property 203 - UNDERFLOOR MECHANICAL. . '�" •"�f`
License Ines does not I to a ow of ron who builds r mpmvaa memo,
_Co who comncu.fm ouch po,au.wW ontrac,ar(s)bcetued.purauaorw this..-.,........___
contranora Ltcerue La _._ ra 204_.___.UNDERFLOOR.... ''RAMS.._. ._......_.
❑Iamnemp,undgr Sec "'f sB 9Pc fm thureawn 205 - UNDERFLOOR' I'NS�'JL'ATION
r•t'Date
WORKER SCOMPENSATION DECLARATION 301 - ROUGH PLUMBING
302 - TUB & OR SHOWER
Ihcrtby Minn M,p Iry at pe0ury once ttic:roRowiny aaeamdnns 303 - ROUGH MECHANICAL
fl01hiveond 'lid,. Ceniren fc 7loadf-mumarenwmke.a 304 - ROUGH ELECTRICAL
A Z f Compemation:;m;prov;dad-for by Section 3]o0 of tire-IuborCods,-for One
Perforvunee of the work fm whi�lt,his permit is issued.. -. 305 - FRAME
❑i 111 will'mLipu n Woh.1 Comp sat an Ins ide rry red by section 306 - HOLDOWN S
,OD of tM'Lebor Cnk f the perfpnun.of,his work far which N pmui is
awed My Wo kern Com weo 1 nncC cam '�M QRau s 307 - INSULATION
] pe cY
`S7cmrT?I+o'Ex oN5FR7lo0 X ) SHEE'FROCK ._..f
I ' h 30'9 - 'LATH d. •.,
COMPENSATION.EJSURANCE,
EXTERIOR"
frhers- 31"O�jNJ_-e.•_:n._
tr7tlio3anobeadmpieie,nph;s for one hundred doll
��,n..�.-�;.�..W.....,
;;+yc'"
alao)aneas.)•,,_„ la 311 - SCRATCH COAT
in ;. r ....__. ._-
i cert
if N t in tie pr. a c of Ne rk f hrch th s perm t seed,i 't•l.wu
Shan
on
employ any,puon m,ay nrwmbhec rets b, 1, 1, 501 - FINAL ELECTRICAL"'ENERGY
brompnnat o V sof Cel To'Ii.D
Zlewt 502 --FINAL -PLUMBING--
Co.
NOTICE tD APPLICANT If Nte mold g N Cenif t of E at yd khould I W i
Z bfn sub)cat theWorke sCo pen t prov o rtheiebo code you must 503 - FINAL MECHAN CA�ER¢�
O hwthcomply MsuMpro : rthspnntahtlbeeecmea kd 504 _ -FINAL-BUIL G GYI(UJ
__... _
tn {"1 r rn.(t 'CONSTRUCilON LENDING AGEN�1' ”'
505 FINAL ELEC C
F' ='' Ihrtbyatfmithnthenbadosoucto I engeyncyfmaeprformenn-
W '� floe ink fo hch NYpermt is ueelsec 309]'Cv C7rj06GAS TEST _
o p t<e rName 07 - FINAL PLUM N
r1. 5
G.I
Z Islam Add s,
U!0
" . .. ,, 508 - FINAL MEC CAL
fin 1 cenlfY th t 1 h ve reN tins vpphcavon aM stam,hn Ne above m(omnauon is
w'.Ft wired 1 agree m comply with dl.chy end coumy,«dioarwas sed sine laws relating 5 0 9 - FINAL GRAD
O..fJ tobuildin{mnstr,i2lion:andNeretiyauthoi{TareprcsenutiveibfUtiscitytoenterupon 510 - FINAL PLANN G
yy L] the abo a me s nedproprry for mspa0ov purposes.
L.S IW) g toe mdeMd fyandk pharmless NeCryof Cupn no e`atnu -
LLL'Vl liebttt dgmenu:cress ane p scs hch y n wy y ccwe egunst sad 514 FINAL PUB
V Z Gtyy'' n s of sh sperm a
APP1. ANT '\DERBY ISA iL4C \ LY'3xTiH.LLL\0\i' R' r U
S L RE r, -�� of Issued by: Date
Si ,u&bl'Appl cantlContrusim 1 i, t ,
b,4 HAZARDOUS MATERIALS DISC OSURE I'- °°I�� Re-roofs
C7. r Will the kppbcmtorhessebuld gocnpntiso -o handleharardats t d .Type of.Roof. ._ -'--
m Eefi ed by,he Cupertino Municipal Cade Chapter 912 and the Na1N and Safety r f.'t f 7:•+ I s, .o
.ode ❑Section n 25532WIi%Thltt^ a Oft I Is L it A 1 ).i. . 'L . . .
All roofs sMI.be inspected prior.to.any.roofing.material.being installed. .,.._..._....
FA'!
r WII Ne eppl nn,or buil ding Occupant equipment wni h If a roof is installed'without first obtaining an in'spection;=I'agreeto'remove
mit haagrdosair entemmnt;m hefnedby Ne Bey AreaArQiluyM {ec
Dhmn ,t , all new materials,for,tn5pection._Apphcant understands,and will comply with.,,_
°Vel . i i '. all non-point source regulations:,: t t, .,.
' w
rf 1 ha x as Ae haxW,sus mamriils regmrtmenis'iter Chipser 695'of the
Cobfomian:211L Satcry Code.Secdom 33505.25533ind 25534:1uMe.und that _,- -_ ._-, ,, ,,-_.... .-_.... .........__ ..... .- _ .._. ..._.. ... .. ...,..__..-. _
-Jibe bi,ildin8 doesn� cnty hai�' Tenant.tut hism9 responsibility so nmifythe
st M me oar to lu a of a Ce
m pmaehama tore n ' S ZSignature.ofApplicant..._ _._.. . ._.... ._. _ Date ----_-
of"h .eq
r
« ,. All roof coverings to be Class B or better
.. ._. . _. ..-OFFICE.. .. _ ------
IL
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