04060204 (2) CITY OF CUPERTINOyy�� h��a. ° T�$yy
BUILDING DIVISION PERMIT 4.�NTkA, TQ1R 1��I fJ `i1�A'1r
BUILDING ADDRESS: J.D.GUINEY & CO. PERMIT N0.04060204
102 nOMAT Air
OWNER'S NAME: PERMIT L55UE DATE
JAMES GUTHRIE
ONE: SANITARY N0. CONTROL NO.
650 355-30
ARCHITECfIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a 0 0 0
�op LICENSED CONTRACTOR'S DECLARATION
y� FF 1 hereby affirm that 1 am limmed under provision.of Chapter 9(commencing Job Description rr�.�
noes wire Sermon 00o)of Division 3o Its Businuaan>LProfcsreons Cedc.andmylicensela ,.6���aaI�® Q( p q
REPIPE/REPLACE WATER HEAT1=i3C 0`�J n(•aa 'a4/
S License ^Cast"
Date . Gamtac JUN 2r 2004
elg- ARCHITECTS OECLA ATION•
y a I understand my plans shall be used as public accords
3�u
d:e,� Licensed Professional
h OWNER-BUILDER DECLARATION BUILDING
<2 1 hereby alum Nat I am exempt from the Comracles License Law for the
00 following meson.(Section 703 1.5,Business and Prefessione Cade:Any city or county
$tai which requires a Permit to consent,alter,improve,demolish.or repair any svuctum
riy prior us its issuance..1.rquires the applicant formed;permit to file a aignedsutement
FF < that he is licensed pursuant mthe Provisions ofthe Contractors License Law(Chapter 9 Sq.Ft.Floor Area Valuation
N as-� an with Section 7")of Division 3 mfthe Businessand Professions Code)ser
that he u therefrom and therefroand the bass for the alleged exemption.Any violation of
Section 7031,5 by my applicant for a permit aUbjecss the applicant a a civil Penalty of 3 6liM24W)i8er0 0 Occupancy e
not mom than five hundred delta.($50)). P Y TYP
❑I.as ower of the propuly,or my employee with wegu u their sole eampenution,
will do thewoda and the tenure is not intended oraaered formic(Sm.7064,Business Required Inspections
and Pmfuaions Code:The Contractors License nsse Law does not apply to an owner of q P
property who bu ilda or i mproves thereon,and who does such work himself or through his
own eroployeu,provided that such improvement;are not intended ora@red forsede.If.
however,Ne building or improvement is sold within one you of completion,the owner.
builder will hive the burden of proving that he did not build or improve for purpose of
.in.).
❑1.as owner of the property,am exclusively contracting with limnsed convectors to
construct the project(Sec.7041,Business and Profusions Cade:)The Contractors U.
Cense law does not apply to an owner of property,who Wilds or improves demon,and
who contracts for such projects with a comintor(s)licensed purmam m the Contractors
License law.
❑I am exempt under Sec, B As P C for this means
Owner Data
730�7WORKER'S COMPENSATION DECLARATION
1 hereby aRrm under Penalty of perjury one of Ne following decluations:
I hove and will maintain aCertlfieem of Consent mself-inaum far .WorkeesCompen-
1]10
ion,as provided for by Section 3700 of the labor Code.for the performance of the
rk for which this permit is issued
I have and will maintain Worker's Compensation Imuran, m acquired by Section
of the labor Code,for Ne parfar sof thewark far Lit this Permit isiemed.
y Workers CnmP.e�n�sa-tiayp.Iraunnm ertmr end�PCbZ number am: r�Q
CERTIFICATEOFE%EMPf10FFROMWORK S'
COMPENSATION INSURANCE �L
(Thlswction necd notlrecampined if them mit s foron hon and dollva fSlIXp
or lCm.)
I certify that in the performance of the work for which this permit is issued.I shall oat
employ any person in any manner so m to become subject a the Workers'Compensation .
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subjest m the Worker's Compensation previsions of the labor Code,you must
0 mdeemed
forthwith comply with such provis et or this Permit shall W revoked.
r
CONSTRUCTION LENDING AGENCY
(hereby afmn that there is a conswctinn lending agency for the perfnnource of
!Yi> the work for which this Permit is issued(Sec.3097,Civ.C.)
W� G Lenders Name
0.z Lender's Address
U Q 1 certify but I have tend this application and sure met the be.information is
w F CnweL 1 agree 10 Comply with all city and County ordinances and auto mals relating m
�O building construction.and hereby authorize representatives of this city to enter upon the
w shove-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
y liab'iues,judgmenls.casts and expenses which may in any way accrue against mid City
U ZIno queue _tbwggnnting of this permit.
PL I DEpSTANDS AND WILL COMPLY W4TY@LL NON POINT Issued by: Dat
S E T
^� Re-roofs
gnaturc AppliuMConmactor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wit)theapplicantmfuture building occupant store or handle lueudou material
u doll ed by the Cupertino Municipal Code.Chapter 9.12.cad the Health and Safety
Code.Section 25532(.)+ All roofs shall be inspected prior to any roofing material being Installed.❑Yea Ha
Will the applicant or future building occupant use equipmem or device.which If a roof is installed without first obtaining an inspection,I agree to remove
mit ha'r.mous air contaminants u defined by tW Bay Area Air Quality Management all new materials for inspection.
District?
❑YCs
I they witheh materials
to
under Chapter 6.95 Cline Califor.
nia He dik SaY lyC trio 255U5,2553J end 25534.1undcrsmnd muifmc building
d menton, he am duchserymsparruN�ity@ notifymcn:cummofthe
re immenc h h t normissuseccofaCedffielteofOccupancy, igpatureofApplicant Date
ascot Dean
All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPERTINO
itI
Buildin De artment
JOB ADDR /� ..{._ PERMIT #
OWNER'S N v i e IPHONE #
GENERAL CONTIZACTOW FAX #
I am not using any subcontraic"
Signature Date
Please check applicable subcontractors and com lete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
/Contractor Signature Date
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE J ��
CUPERTINO PERMIT APPLICATION FORM
APN# 0 o �7 Date: 2�
Building Addresss•Q
i o 2 {� s o �� L. �--
Owner's N e,> � )) Phone#:
CJS v1il. � C.t V t`¢
Contractor hone* License#:
c -
Contact: Phone: Cupertino Business License#:
LE f
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑
Job Descriptio :
fX
ripv /( �� �� ,- ,�/� e
Residential ❑ Commercial ❑
Cost of Project-
Qty. if
licable Fee ID Fee Description Fee Group
PPERMTI'FEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPERMFEE Bldg. Permit Fees BUILDING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
\ USLIC Bus•ness License KIUILDING