02070035 (2) CITY OF CUPERTINOna
BUILDING DIVISION PERMIT 'CONT RACTOR INFORMATION
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�Y STANLEY C AND STEPHAN E APPLICAT61 SN"TE2002
PHONE: SANITARY NO./ / CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
�00 LICENSED CONTRACTOR'S DECLARATION Job Description
�-
y V I hereby affirm that I am IiccmcJ under provisions of Chapter 9(commencing ADD 400 SQ. FT . p
< wilt Section 7010.)of Division 3 of die Business and Professions Cade,and my license is
a in full force and effect.
Licauseclasa 1.ic.g ALED
c i r Uam Conuacmr
ARCH TECrS DECLARATION
Q 1 understand my pilots shall W used as public."d, mAy
MO' scoff,
Licensee Professional L l�
OW NBR-BUILDER DECLARATION
`v� f 1 hereby allied that 1 am exempt 0nm the Cnmractnr's License Law for '�'�� $65000
w—0O following reason,(Section 7031.5,Business and Professions Coale:Any city car eau
e K a which requires a permit to coavuct,alit,,improve,denoollsh,car repair any tract
w poor in its issuance,also maludes the applicant for such prom,in file a signed statement
that he is licensed pursuant to the provisions of NC Commetor's License Law(Chapter 9 3S:j5Ht5I0a2A&'0 Valuation
y�a (commencing with Section 70(k)of Division 3 of the Busi nes,and Professions Code)ser
�.. that he is exempt thcmfrom..it the basis for the alleged cxcmption.Any vialmion of
Section 7031.5 by any applicant(or a permit subjects the applicant to a civil penalty of NFQPPATi UN Occupancy Type
not more than rive hundred dollars($500). 102 — PIERS
p y p
O I,as owner of Ne property,or my employees with wages as their sole compensation.
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business 183 UPER
and Professions Code:The Contractors License Use does not apply to an owner of 104 - REBAR Required Inspections
property who builds or improves themon,and who doessuch work himself or through his
own employers,provided that such improvements are net intended or offered for sale.It, 105 — ANCHOR BOLTS
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden Of proving that he em not nand or improve for purpose of 106 - SEWER & WATER
"It). 202 - UNDERFLOOR PLUMBING
01,as owner of the properly.am exclusively contracting with licensed contractors to 203 - UNDERFLOOR MECHANICAL
construct the project(See.7044,Business and Professions Code:)The Contractor's Li-
conse Law does not apply to an Owner of property who Wilds or improves themon.and 204 — UNDERFLOOR FRAME
who contacts for such projects with a contomter(s)licensed puaantto the Contractor's
License Low. 205 — UNDERFLOOR INSULATION
I am exempt under Sec. Bdi P C fm Nis arson 301 - ROUGH PLUMBING
Data 302 - TUB & OR SHOWER
WORKER'S COMPENSATIONDKA RATION 303 - ROUGH MECHANICAL
I herebyifftm under penally or perjury one or the following declarations: 304 — ROUGH ELECTRICAL
❑ I have and will maintain a Contrition of Consent to self-iaum for Worker's Compete
cation,as provided Tor by Section 37R)of the Iannr Code,for the Performance of the 3 05 - FRAME
workforwhichhispermitisissued, 306 - HOLDOWNS•
O 1 have and wit]maintain Workers Compensation Insurance,res required by Section 307 - INSULATION
3701 of We Labor Cade,for Joe perfmmanm of dre work far which this permit is issued.
Workers Compensuina lnsuanet our,, ad Policy number ate: 308 — SHEETROCK
aria,: friEcyNo.: 309 - EXTERIOR LATH
CERTIFI COMPENSATIONIINSURA CE•.ORKERS' 310 — INTERIOR LATH
(This section bond nut becampleme iftbe permit],future hundred out[.. 00) 311 - SCRATCH COAT
,it 313 - ROOF NAIL
I codify than in the Pcrfomtance of the work for which this Pcrmin is issued,1 shall bat 501 - FINAL ELECTRICAL ENERGY—
mpiny any pets tonanym. e . too 5yhjcct In the Worlone Compcnsotion
LawsnfCalifnrni . u� s L� 502 FINAL PLUMBING ENERGY
pplicam
NOTICETO C ll.after making this Cenitieafc ill cxcmption,you should 503 - FINAL MECHANICAL ENERGY
become soh'ct to the Workers Compensation provisions of the Labor Cade.you must 504 - FINAL BUILDING ENERGY
OO forthwith comply with such provisions or this Permit shall M deemed revoked.
z CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
rte. Ihereh affirm agency tonne rformonceof 506 - GAS TEST
F Ya s ,) cY Ire
ai the work far which his permit is issued(See.ltyl7,Co,C.) 5 0 7' - FINAL PLUMBING
LeaLeader'sAAthedns,
¢7O Lr's d . 508 - FINAL MECHANICAL
ts�
VO 1 certify that I have read this application and stoic that the above information is 509 - F I NAL GRADE
(—' correct.I agree to comply with all city and county onfinances and sate laws rearing to
building construction,and hereby autbonrz representatives of this city to enter upmtbe 5 - FINAL PLANNING
WahovemenfioncJ property for inspection purposes. S 4 — FIN=RKS
(We)agree it save,indemnify and keep harmless the City of Cupertino against
F-t N Iiabi lilies,judgments,costs and expenses which may in any way accme against said City
U Z in consequence of the grrrmlinjufods permit
APPLICANT UNDE NDS AND WILL COMPLY WITH ALL NON OINT Issued by: Date
RCE RE ONS.
Re-roofs
Sigaar Appbcant/Contractor D
HAZARDOUS MATERIALS DISCLOSURE Typo of Roof
Will Ne applicant or future building occupant more or handle hazardous material
s defined by the Copernican Municipal Code,Chapter 9.12,and the Health and Safety
e.Section 253321a17
❑Yes ON. 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 hazaNaus air contaminants as del]ned by the Bay Arca Air Quality Management all new materials for inspection.
DinoicV
Oyes ON.
1 have realv
the hinhous mown, requirtments under Chapter 6.95ofeve Cali for-
ms Healtha Safety Code Srcdons 25515,25533 and 25534.1 a&-rid that if dr building
does not cannot,have a team.Nat it is my responsibility In badly the acceptt of
a to metpdonoissuanceofaCeniricam ,02_ofOccupan SI ureofA Kant Date
arms nI ,m All Too yerings to be Class "B"or better