03060135 (3) CITY OF CUPERTINO
N
BUILDING DIVISION PERMIT �CONTRACTnRINEORMATIO
a. _w _ti via 4. ORMATI
BUILDING ADDRESS: PERMIT NO.03060135 3060135
R'S NAME: PERMIT LSSUEDATE
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
JOO LICENSED CONTRACTOR'S DECLARATION
I I hcrtby affirm that]am licensed umkr provisions of Chepur 9(commencing lob Description
eLlwith Section affect. aion3of to BusineM end Prufcssinns Cele.end mylicenceb
N iiceufnae and.rtes 7 ' FENCE
t q Data Class Lie Contract., JUN 2 6 2003
�-� Data DaelDECL 1
p As Mail
DECLARATION
WU I understand my plans Mall W used as public rtcnNs p�
5oG
Licensed Pmfcau...I BUILDING
3 OW NER.BUILDER DECLARATION
-I f 1 hereby affirm that 1 am exempt from the Conlncloh License Law for the
COO following mason:(Section 71313,Business and Professions Code:Any oily or county
which requires a permit to construct,aper,improve,demolish,nor repair any structure -
5"zi
prior mits issuanre.elsu myuiresxhc applicant(orsuch pontine file uigneJ moment
pp < that he is licensed pursuant Inlbeprevision orMe,Contractor's LicenmLaw(Chapter 9 Sq.Ft. Floor Area Valuation
2€'$ (commencing with Section 7")of Division Sof the Business and Professions Cock)at
—
that k u exempt thcmfrom and to basis for Ins alleged exemption.Any violation of 36219026 . 00
Section 9031.5 by any applicant for a permit subjects to appficanno a civil penalty of APN Number Occupancy Type
net more ten Rw hundred doll...(S500).
❑1.as nor of the property,or my employee.with wage.as their auto compenntion,
will dote work,and to suuclum is not intended or offered for sale(Sm.7044,Business —
and Professions Code:The Connector's License Law dura not apply to an owner of ],O 2 — PIERS I ERS d Inspections
progenyhim
who Wildsor improves thercon,and who does work wlf ortrough his
ownempioycc.,provided that such improvements art not intended oInfrared forme.IL - 103 — UFER
however.to Wilding or Improvement is to within one year of completion.this owner. . .
Wilder will have dca burden of proving tat he did not build or improve for purpose of 104 — REBAR
u1`')' 105 — ANCHOR BOLTS
I,a Owner of tc progeny.am exclusively contracting with licensed contractors m o 10 6 — SEWER & WATER
onstons the pmjcct(Sec.7W:Business and Professions mnct
sions Code:)The Coor.Lt
come Law doss not apply to an owner of property who Wilda or improves Lemon,end, 202 — UNDERFLOOR 'PLUMBING
who contncu for ouch ojectswith acennenarp)licenxd puraventolW Comncmr'a .
Liven 203 — UNDERFLOOR MECHANICAL
❑1 a p\ r see. ,B&PCmr is 204 — UNDERFLOOR FRAME
P w D mann 205 — UNDERFLOOR INSULATION
'ikmb aRm uncle penaty f rjurya o(tt meowing lantiom: 301 — ROUGH PLUMBING
I have and will meincaina C.nificate Co I to selamure for Woluce,Compen. 302 — TUB & OR SHOWER
ration,as,provided for by Section 37110 of to labor Code,for to Performance of the 303 — ROUGH MECHANICAL
work for which this permit is issued.
I have and will maintain Worker'.Compensation Insurance,as required by Section 304 — ROUGH ELECTRICAL
3900 of is labor Coca.for dw performance of Me work for which this permit is issued, 305 — FRAME
My Winkel.Compensation instincts carrier and Policy number am: 306 — HOLDOWNS
Carrier. Policy No.:
CERTIFICATE OFEXEMPTON FROM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 — SHEETROCK
('fhb senim need not W completed it the permit is for one hundred dollars n fro) 309 — EXTERIOR LATH
I,Icerfif) 310 - INTERIOR LATH
e certify tet in tc p any mann of the work for which this permit is issued.1 shall not
employ any person in any mannermumbecome subjwu.IW workcri Campcnaaden 311 — SCRATCH COAT
ApplicanCelifomia.Dem 313 — ROOF NAIL
NOTICE TO APPLICANT:If.after making ti.CcniOcau of Exemption.you should 501 — FINAL ELECTRICAL ENERGY
become
�z Bromwichcomply with such mo
itn,mnproaCboimmmpetorurattibonpporiit Mall
okf Iseemed
rrevoked.
you mum
502 — ' FINAL PLUMBING ENERGY
z O CONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY
=� Ikmhyaffirm that then isaconstruction binding agency for lbe Performance of 504 — FINAL BUILDING ENERGY
Under',Name
a tower,for which this psnnit la issued(Sec:7097,Civ.CJ 505 — FINAL ELECTRICAL
W Q
az LcadefiAdd` . 506 — GAS TEST
U O 1«nify Lal l have read his applimaion and scam that tk above information is 507 — FINAL PLUMBING
correct,l tgre.he comply with all city and county on insanes and sou laws rotating to
Vbottom&eanmuclmn,and hereby autorim mpleseoalivcs of this city to cnur.pnn to — FIN MEC CAL
151 aleve-mention.d progeny for be,cnion purpose..
Q. Wall ague m save,indemnify and keep harmless the City of Cup rtino gains) O F I
y liabilities.' .n ,cos and expcnmI which 'n any way accrue asainat acid City NG
U 4
AP CAcnc.oNDc n' g (Aa pc W L L MPLY WITH ALL NON I
Issued by: 5 C WORKSDate
i.eS R
Re-roofs
.of p nV on rola au
AZARD $$,MA IALS DISCLOSURE Type of Roof
Wi tcappf mt." buildi mcupanumre m handl.hvardousmaudal
define by to C nine al C .Chapter 9.12.and to Health and Safety
Sccden 25532 a)? All roofs shall be inspected prior to any roofing material being installed.
(.cYw
Will the applicant or future building«mpa n use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardoua air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑YesN
I have a hualdtus materials reyvirem un der Chspur 6.95 oIlk Giif
nix Hralt alet ode, item s. SJJ SN.I undcrsund Nazi( Wil ng
Jmsn cu haws an t' ihilitymnndf dr upant ftc
req ' me hicnan nncconfusion Signature of Applicant Date
woe ramm�rP da tBrute All roof coverings to be Class "B" or better