01100046 (2) CI BUILDING
UoFN DN
UPERTNO
IPERMIT CONTRACTOR INFORMATION:
IIJUTg REsPsERALTA CT. PERMIT NO. 01100046
O3ffnfqNAtfE:PAZ BILHEY Arr1'l"�n718`�9(ja{3OT�1
PHONE: SANITARY NO. CONTROL NO.
z z ARCHITECTIENGINEER: BUILDING PERMIT INFO
w C BLDG ELECT PLUMB MECH
�v
z
LICENSED CONTRS DECLARATION Job Description
z
z=� I hereby aRem that 1 am licencedd ander under proviauns of Chap¢r 9lcommeneing ADD 248 SQ. FT.
vJ t,u whh tall moseara)of Division Sof rhe Business and frofosioro Code.and mylicensr
ism Class na<rrec,. (UNCONDITIONED SPACE,
U Licence cress Lie.a GAME RM ADDITION)
?`c r- Date S DECLARATION
n
O tr ARCHITECT'S DECLARATION �Y r��®
< I understand my Dlaro>hall be used as Public records
i$Y
i z cep ne Licensed Prolnsinml NOV 2 7 2002
OWNER-BUILDGR DECLARATION
u�= 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
C?a following reason(Section 7031.5,Bmuress and Professions Cede Any city or county
F O ,lith requires a Permil or construct,alter,improve,did Fish,or clop,any structure
d
3- prior to its Issuance,also requires the applicant for such permit to file a.signed smrmom -
that heislicensed pursuant othe Provisions°fine Contractors License Law(Chapter 9 S Ft. Floor Area . s n
(commencing with Section 70018 of Division 3 of the Business and Professions Code) q', , r . .
or that he is exempt therefrom and the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally'
°fn°Imorethanfive hundred dollars(s5cs). 34A(PN 3Rlb6}0 Occupancy Type
❑1,as owner of the prop any,or my employees with wages as their sole compensation.
will do the work,and the structure is not intended or offered for sale(See.701x, 101 _
Business and Professions Codc'.The Contractor's License Law does not apply to an fired Inspections' '
owner or property Who builds or improves thereon.and who does such work himself 102 - PIERS
or through his own employers provided that such improvements are not intended or .._ _.offered for sale.If.however,the Wildingt,s sold within one f .. - 103- - UFER .... .. .- - . . .' ..
orimen of proving
yearo
improve the owner-,alae,win have the burden nrprovmg m.,he did rent band or 104 - REBAR
improve m,paBnse of,ale.)
105 - ANCHOR-,BOLTS BOLTS -- - -
)KI,as owner of the property.am exclusively contracting with licensed contractors,. ...
construct the project rsen.70,14,Business and Professions Coded The Contractor s 10 6 - SEWER & WATER
License Law does not apply to an owner of property who builds o,improves thereon.
and who contracts for seen pmjects with a eomme ur(s)licensed pursuant to the 2 02. - UNDERFLOOR PLUMBING__
_
Conuacmr's License Law.
of..ex< tender Se<. B&P C fbrmis reran 203 - UNDERFLOOR MECHANICAL
Owner 1 /y/ p`(e„ate /Z /p O / 204 - UNDERFLOOR FRAME
'WORKF,R'S COhiF[NSATIONDEC RATION 205 - UNDERFLOOR INSULATION
Ibrobya(rrmnnder,perdu'mrpe,jury nbennheron°wingdeclardamm. 301 - ROUGH PLUMBING
t•0 1 have dad will maintain.Cerifieme of Consent ,o seer-..sora far Wmkrbx 302 - TUB & OR SHOWER
.� Cm„pensaaen, as pr...ded I., by section 37M of the Labor Code. for the 303 - ROUGH MECHANICAL
s f f the work for which this ,is ,,art.
'per mmanao fermi' 304 - ROUGH ELECTRICAL
❑1 have and will maintain Worker's Compeosatlna Inmranm,m required by Section
moo of he labor Cede,for the perfmmaare of he work for which this Perna is 305 - FRAME
usucd.My C, sapeosai ° ; ecarlorandPolicy number
one: ... '..306: - .HOLDOWNS
camEr: IPM
CERTIFICATION OF EXEMPTION TIO NORKERs' .3 07' -' INSULATI
ON
COMPENSATION INSURANCE,. . 30$._--SHEETROGK_—
-_ -...--- -
!This - ---_-.
satire need not he completed if the permit is for one hundred colors 3 0 9 ` - EXTERIOR LATH
a1001m1"'.' 310 INTERIOR .LATH-- -. .. .
1 certify that in the performance of the work for which this permit is issued,1 3 11 - SCRATCH -COAT
shall not employ any person in any manner m as to become subject to me Workers'
Compensmion Laws of Califurmr.Date 313 - ROOF NAIL
Applicant . . _ .. .. . . .. ...
NOTICE TO APPLICANT.If.oftermekin,this Certificate of Eaemption.you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oz0 forthwith comply with such pmi,i...orthis Permit,rnanbetire.adresulted. 502 - FINAL PLUMBING ENERGY
FCONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
Ihereby affm,that their is a constrawmn lending agency for the performance 504 - FINAL BUILDING ENERGY
W of the work for which,his permit is issued(Sec.3097.Civ.C.)
y p
Under',Name 505` -
FINAL ELECTRICAL
z Lender'sAddren 506 - GAS" TEST '
U O 1 certify mat I have read this application and state that the above infermati°n is 507 - FINAL PLUMBING
I'. F., correct.1 agree to comply with all city and county ordinances and state laws relating f4 '
�.V tto he abdingcomlibrod construction,andbyamhomcmposematives of this city to enter upon 508 - FINAL MECHANICAL G2
y �] theabove-mcns°ned property hereby
authon7purposes.
F„ tS (We)it feet.nml.indemnifyaadkeepharmlesstheCityofCupe,tino.,.n,, 509 - FINAL GRADE
Z) liabilities,judgments,costs and expenses which may in any way sector against said
V z City in comsegaener Orme german,of his .it. 510 lis- N NG
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL''NON-POINT Issued 1 Dale
SOIIIjrJ:REGU S��raa /S'//� / e /
s—igii.ma, AP v mn.r., y o Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occmpmn store or handle hazardous ma,eeal Type of Roof,
as defined by the Cupertino Municipal Code,Chapter 913,and the Health and Safety
Code,Section 25532ta)7
°Yes ` .Je”"° I,': __All roofs shall be inspected prior to_any-roofing material being installed. - _. .-
will the applicant orfuture building cerupantuse equipment ordes ices which If a roof is installed without first obtaining an inspection, Iagree to remove
emit hazardous air contaminants as defined by,he Bay Area Air Quality Management
Dimmer? all new materials for inspection._ Applicant understands.and will,comply.with
0 oyes - all non-point source regulations.
`..� 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code.S&,ions 25505,25533 and 35534.1 understand that -
it,he building dues not currently have a tenant,that it is my respousibill y to noti fv the
occupant of the requirements which mus,W met prior to issuance of a Certificate of
Occu ncy.
. /X Al/0/ Signature of Applicant Dale
. . :e'. own and ,raps ase. . . , - D.te, All roof coverings to be Class"B" or better
-- - - OFFICE - -