02060167 (2) CITY
ofDISNO
c DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
19055 PRUNERIDGE AV 02060167
OWNER'S NAME: APPLICATION SUB DATE
1MES AVENUE ASSOCIATES 06/25/2002
/ PHONE: SANITARY NO. CONTROL NO.
COO ARCHITEC(ENGINEER: BUILDING PERMIT INFO
m C BLDG ELECT PLUMB MECH
ac 1_7 U CJ LJ
fs.. LICENSED CONTRACTOR'S DECLARATION
O ? 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
„tw with T 7arD;viawn3anh<Beai naProfeaaron.,cede.anamyn«n INSTALL CEILING/LIGHTING/
as ayy� iammn line Jeftea' �'Q REGISTERS F�IiIAI„ED
re0 i 6 LQice�nse cla. Li�tRx��
F u3.O I-n •Jf ARCHITECT'S DFQCARATION J#%I x cl
N
I I understand my plans shall be used as public records V AY 2 2003
se se i O O Licensed Pmfessionm
a.a OWNER"BUILDER DECLARATION
vl I hereby affirm that 1 um exempt from the Contractor's License Law for the BUILDING
t?< following«sson.(Section 7031.5.Business and Professions Cade:Any city or county
ESC which requires a permit m construct.aRec improve,demolish.or repair any structure,
de
re `prior.mitiutmace.aBorequves Ne applicant forsuch pemutmfilealigned statement.
that he islicensed puRultn mrhe paovisimi ofthe Comractms License Law(CWper9 S Ft FloorAreaaluation
(commencing with Simon(/()(I)Iof Division 3of,he Business and Profi ions Corel C'Oh�-j j.'.:,.a9't r:>r, Tlei-t rF:":17:1i 1.i3''.; '
or that he ii exempt Merefrom and the basis for the alogW ei<arjstdh,Any violation
of Section 70313 by any applicant our.permit subjects the appheum m u civil penalty-
of rat more than five hundred Milk..,(s58)1. 3 um err 'n,.,.. ',t, Occupancy Type
Q I,as owner of Ute ampcny,to my employees with wages as their sole compensator, 101 =INT
wilpdo therid Prof and ssions odestruTh C net intended e e Lawered roe coot appl too. - - - - Required Inspections' t l
Busineis and Professions Code:The Contractor's License law d«s not apply m an 10 2 - PIERS '
r through
owner of property Who builds or improves thereon,and who does such work himself
oneough his own employees.provided that suchnPo improvements arc not intended or 103 - UFER
,
affeieS rofsale:IChowever,the building " - its salt within otic-'- �f - "' ---`�--'- �
urdrnofpro aa° 104 - REBAR
iomple,ion,the owner-builder will have the burden of proving that he did not mild or '
mpm,vorpnrpwc.17mle.). 105 - ANCHOR BOLTS
pmpcn>.am exaati.�ly=entmeting,.en r�e�aen eonna<tna to I06...-- SEWER -"& -WATER_.._._._. ..._..------ -----------.
onswct the project(Sec.7(3l Business and Professions Codc:)The cnntraemrs 2 0 2 - UNDERFLOOR PLUMBING
License law does not apply to an owner of property who builds or improves thereon, -'
and.who contracts for.suchprojects-with.a.contracrar(s)licensed.pursuan m.Ma- _ -_ ._.203 _ UNDERFLOOR MECHANICAL-
El I a.esc d Liter,,Law.
❑lamgxempiapaerSer. a'&�Pcfar this mason 204 - UNDERFLOOR'`FRAME'''''''
owe, ^' ' Date 205 - UNDERFLOOR INSULATION
_ WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
I hereby affirm under penal ty,ofp<rjuryon<of the following declarations: - 302 - TUB & OR SHOWER
❑ I nave and win rtcidie.b cent utute of Covent to self-insure for Worker's 3 03 - ROUGH MECHANICAL
m
ii; '7. Compensation, as,provided for by Section 3700 of the Labor Code, for the
perferarice of the work tar wmm
<n this pe ,it is issued. „ 304 - ROUGH ELECTRICAL
❑1 have and will maintain W'orker's CompensationIn inumes,as redound by Section 305 - FRAME
3700 of the labor Codefair he ff.ismunoe of the weak far which this perms is 306 - HOLDOWNS
iss ea MyW kelsC t Incur and Pol cy number are "
cul 4re1 y /YJ(�9S/U �.. .
J' 30,7___ INSUliATION,_ ._ -.
._.. ,.w..,. ..._...._..,. 1_,..,__,...._...___.__.
)1, RTIFCATIONOFEXEM N4AONWORKER$' 1-�-1y' t 3'0'g`. L .•BH-EETROCKIS l: 't:v]
'COMPENSATION INSURANCE -' "'
_-_:..- _� - - . . ..----- ---. . :_.. ..._,. -_ ___ 309"--EXTERIOR-_LATH---�-------...--.- --
-,
.."(This seciion'iwdJ a.,be complemd d the permit is for one hundred dollars _ l I^^
(s 1001m1esn) . _ 310 - INTERIOR LATH
-.... ._. . . 31`1 "--SCRATCH-- COAT
I - - _ - —
certify,that in the rm
e Pedoance of the work far which thi-s pemsit is issmd,1 L-
'.:6PF�1 ly any person anyman < to become subject mmew kra 501 FINAL ELECTRICAL-
ce . rpl,w�mcrf p,Dae 313 - ROOF NAIL'
.A leant -.....-. .. -_. .ENERGY- _ . ....__. --
NOrICE"f0APPLICANT:If.after making this CenificaleofExempom,you should 502 - FINAL PLUMBING ENERGY
O pbecome subject to the Workers Compensation pmtisions of the Labor Cale,you must
mnhwithcomply with such provieinnvorthis pnmitshallbedeemedmvnked. _50.3 - _FINAL. MECHANICAL_ENERGY._ _ -.
Z r. 'I hereby affirm mann gage Y'. �. ._. . ._._
CONSerekacONLENDINGAGENCY " - � � 504 - FINAL BUILDING ENERGY.;, '
as ya 'rel sau,ued(S to lending agency rnr the perfom,anee -
ofeworkNamrwmmmia pemltfaisadm(see3897.civ.cd 505 FINAL ELECTRICAL
LDC "
Under',oda 506 - GAS TEST .._.
V O - 507 - FINAL PLUMBING
1 c n fy that 1 have read this applmat ed or tam that the abo a ndu m tion s U
:csrrtcr. agreet complywith all city and countyped' c d.tt laws relating 508 - FINAL MECHANICAL
to U building t fan and M1cri soth 'z' p „ of,ti scty m<mvrngsn
mean( mm,etositpenyh,a spatkephorml 509 _ FINAL GRADE
tAl e'.p ngrc mil.site,and a ify,and keep htmnless any wa a Cupertino st onat
%rid
'A liabilities,judgments,costs end expenses which may in any way accede again(sore 510 FINAL ING
U,Z ehyiICAN'T ND12RSthe gmntANDWthis p<m,R. . 14 r.' F A WORKS
APPLICANT UNDERSTA"7$AND WILL COSIPLY WITH ALL S(V-P VT
ostir- r ,,. Issued T Date
va .'�.Ca ` s�
,gr.,um MApplicandCrmmda'. - atm Re-roofs
HAZARDOUS MATERIALS DISCLOSURE '
�- winn ' ,�pce nrcbimmg pma, enrhandle'hazNucmaterial .. Type..ofRoof_ ._. _..-'--.._. _.,. . ....._ ... . ., -. . ..._._._-..
as efncd by the Cupertino Manic pal Code Chvpmr 912,vnd the Ilcalth and Safety _ _ • ; : , :
Code.Section 2551?la)7 �: ;'i.'s S j: .I v. iii 4 •' ,' :.ry 's .
Qr. �" ""° All,roofs shall be-inspected prior,to.any roofingmaterial being installed. -
wum ppr t r t.<bmuam8oce�pam,iaceq r t- d . n n If a roof is installed without first obtaining an inspection;-I'agree to'remove
.runit ma,aulo at, ordammou;>pforied by the Bay%ja&ir Quality Management
D,am err _ all new materials for inspection. Applicant_understands and will comply with
-,❑Yes -...-.. . 0Nn .....
all non-point source regulations:
1 hose read the hazardous materials requirement under Chapter 695 of the
California Heahh&Safety Codo,Scnions 25505:25533 and 25534,1 understand that
ifine building does not currently have a renam.thu it is my responsibility to notify the
oc"pant of the requirements which must be met prior to issuance of a Cer fie.of
'"`y' ✓ ! Gignature_ofApplicant _ Date
own authorized Date All roof coverings to be Class "B" or better
OFFICE-