03030019 (2) CITY OF CUPERTINO " `"+'s'"'c� r' - �
BUILDING DIVISION PERMIT CONT 0TORANFORMA�T.ION
BUILDING ADDRESS: - PERMIT NO.
21421 MILFORD DR
OWNER'S NAME: PERMIT I SUE DATE
MURAI TOM AND ROBERTA 03/05/2603
NE:
SANITARY NO. CONTROL NO.
ARCHITECf/ENOINEER: - BUILDINO PERMIT INFO
BLDOO O PLUMB MECH
O t�
300 LICENSED CONTRACTOWS DECLARATION JbDescri [ion
I hereby&limn ba 1 am boomed,under Inconstant of Chapter 9(commencing P
whhsection?,odmaf Divi lon3ofdm Bu,inw Profeaalaa Coda,mdmyloonsch,
'1 infmlmacmdercam. REPLACE 8 ,WINDOW5/2 .SLIDING DOORS
� g ueana i s Lle.R —CONTRACTOR: JACK MYERS' CO 8 C I N
R1 D.te Conuator _ N TRU.WCE®
ARCHITECTS DECLAR N li'�Ail�„IU
1 understand my plan hall he ased u public arch -
so Licenced PmleWnnat AUG 1 9 2003
OWNER-BUILDER DECLARATION
gm I hereby effort that I em exempt form the Contactor,License Law for the '
0 o following reason.(Sudan 7031.3,Business and Profednn$Code:Any city or County
''$�i which requires a permit to construct,alar,Improve,demolish,or repair any structure " mew
prior to its iuuance.0so neimm,the applicant forsuch Permit o file ilgred statemente� t
that w is licensed pmemt to the pornhinaanf the COntrecar'fU..Law(Chapaf 9 Sq.Ft.Floor Area Vau tion
t$ (commencing with Section 700M of Division 3 of the Businessand Parwimts Code)at $7000
B that he a exempt IAcatrom and the bub to the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penury of APN Number Occupancy e
at mom than Rw hundred dollars - 32641106 . 00 - P yTyp,
❑I,as owner of the property,army employees with waget ss thntraole eompemation,
will do the wort,and Ne Iumuen isnotlntendedoraReadfo...k(SaAON,Busiws ggr�a� dInspections
and Professions Code:The Consulates Lt.=Law dm ret apply a an owner or 101 - FOUNDA'i'P
porperty who builds or improves thmoun.and who dectsuch week himself ordrough his
Own employes,provided that such improvements are not intended eeaRewl fm tela B. 102 - PIERS
however,the building or Improwmmt is aid within on year of ccmpledon.the owner-
' builder will haw de,burden of proving that he did act bund or improve for purpose of 103 - UFE R
"'9)• - 104 REBAR
01,as Owner of the propeny,am exclusively contracting with licensed contractors to 105 '— ANCHOR BOLTS
construct the project(Sec.70th,Business and Pufaselons Cade:)The Coman ar's Lt.
moss,Law does not apply in inwant ofproperty who wildsorImprove,thereon,ane, 106 - SEWER & WATER
who concocts for such projects with a eanuaetor(,)licensed pursuant to the CminclN,
Licm,se ave. 202 - UNDERFLOOR PLUMBING
❑T am exempt under Sen. :B A P C to this reaan 203 - UNDERFLOOR MECHANICAL.
Owner Dare 204UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 �- UNDERFLOOR INSULATION
I hereby aflion under penalty of perjury on of the following declaration s:. 301 — ROUGH PLUMBING -
I haw and will mainuln a CeNOaa ofConanta.1r.lu m fes WorkersCompen-
satin,as provided fm by Soden 3700 at tee Labor Code.ire the perfoonaxC of tw 302 - TUB & OR SHOWER
wedc for which this permit is issued. 303 - ROUGH MECHANICAL
❑T haw and will maintain Workers compensation Insuranw,as at doom!by section 304 'ROUGH ELECTRICAL
3700 of tee Labor Code,for the pada ream,of the work for which this permit Issued.
My worker,Compensation Insurance miler and Policy numheram: 305- i- FRAME -
canicn - Policy No.; 306 - HOLDOWNS -
CERTIFICATE aMPENSATIONINS R NCE WORKERS' 307 - INSULATION
(TMs summon need not w completed iflhe lemdt lsfaroa hundreddollartnIIX) 308 - SHEETROCK
-•_._309.-----EXTERIOR---LATH-- --`—=
I certify Net in the performance of the wort far which thb permit is Issued,I shall not '310 — INTERIOR LATH
employ anyppaonlnaoymrnme, heApp cpma uathe Wtoln'Compowtlon .
Tawe orcgOBtmfe.`O.te ��r 12� 311 - SCRATCH COAT
NOTICE (CANT:1f,sMr maklqq W.Canircateor Eampdaa yo t ahoZ 313 * - ROOF NAIL .
become sub' the Woher,Compcnafl an Orovlatom of the laver Cade,you muss
oforthwith iywithsuchprnvisionaorthispeonh,naBbedemandrevoked. 501: - FINAL ELECTRICAL ENERGY
CONSTRUCTION LENDING AGENCY502 - FINAL. PLUMBING ENERGY
F� 1hereby&Man that there is a construction lending agency for the performance of 503 -- FINAL MECHANICAL ENERGY
fk;> thewmkrmwhich this peonubissued(scc.3097,cb.c.)
t e ork504 - FINAL BUILDING ENERGY
W p Nese
a7 Z Lender,Addw 505 - FINAL ELECTRICAL
U o 1 certify that I hew aur this pplication and sea that the awes Information is 506 - 'GAS TEST
ly F comm.I agree to comply with all city and county ordinances and sate laws relating to
0 U building convection,and hereby mthoda miamentatiwa of this city to enter upon Inc FINAL PLUMBI G'
W above-mentioned property for impemion purposes. OS .FIN L
(We)agree to caw,Indemnify and kap harmless the City of Cupertino agates
y Ilabilitles,judgments,cuts and expenses which may In my way accrue against old City
U In camequence of the granting or Nb permit.
APPLICANT UNDER ANDS AN WILL COMPLY WITH ALL NON-POINT Issued by:51 NG Date.
s0 REOULA
Re-roofs
Si t cof Appilcan conractor Dn
/Bp HALARDOU§ 1ATERIAIS DISCLOSURE Type of Roof
/ Will themplicanturfuturg alldag occupant Pare arhandle hanrdous materi,l
defined by the Cupertino Municipal Code,Chapter 9.11,and tw Health and safety
ode.Section Z3531(a)7 All roofs shall be inspected prior to any roofing material being installed.-
Oyes
ON.
Will the appllcam or future building occupant use equipmentor dcviaa which If a roof is installed without first'obtaining an inspection,I agree to remove_
roll 1a4,7Cvt air contaminants as defined by the Bey Area Air Quality Management all new materials for inspection.
Ditlrict7
GYas ONO
I hove mad the hvirdma material,requirements under Chapter 6.95 of tee Caliror-
nie Health&Safety Code,Smilow 75505,13533 and 15530.1 undcaand thatifthe building
docs not currently now a anent.Nn It is my ruponildlity a notify the occupant of the
regntmmentswhfeh be t aiuummor.ce r.1tworoccaz Signature ofApplicant Date
O ror ulhorbcd4cm ,a All roof coverings to be Class"B"or better