02060037 (2) OF
CITY
DII IISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20245 STEVENS CREEK BLVD 02060037
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APPLICATION SUB DA
oyNAIIROPERTIES 06/06/2002
,HONE: SANITARY NO. CONTROL NO.
1
0 Z ARCHITECT/ENGINEER: IL
BUDING PERMIT INFO
O OF k BLDG ELECT ' PLUMB MECH
L.J
LICENSED CONTRACTOR'S DECLARATION Job Description
cz-o herebyeffmthmlamlicensedunderpravisiansofChopte9(commencing H/C PARKING STALL, FACADE REPAIR, NEW CAN
rr,t m is in full faille mal of Divisi°n 3 of the Business and Professions Code,end my license
is in full force and effect.
U
d0 License Class Lic.M
Data Contractor
a .t'i ARCHITECT'S DECLARATION
t rO g 1 understand my plans shall be used as public records
p�
Licensed Professional
as
a, OWNER-BUILDER DECLARATION
at I hereby affirm that I am exempt from the Contractor's License Law for the
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following reason.(Section 70315.Business and Professions Cade Any city or county $25000
O which requires a permit to consimet,alter improve,demolish,or repair any stmctud,
37.3
-pd.,1is issuance.also requires meapphcant for such pent to fleaugnedwate nt -� �
tliaChe ih2enaed pursdmtto theyrov Bions of dm Convacton License Law(Chapter 9' q„ ,,, 31C..2Frt,.Ci +, .A Valuation
(nommeticing with Secu n700p)of Division 3of the Bysjness and Professions Cast t ,j;0 Y 1, `OI,'7V�ES •e VV 0.�0' . \i k N: 1
or that Wit exempt therefrom and the basis for the alleged exemption.Wny violation
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penaltyQCGD
of a.,mare man eve hundred dollars(s5a($50(y. l O lAP`VpJI*MAT I ON Occupancy Type
❑I,as owner of the property,or my employee with wages as their sole compensation.- 102 — PIER '
will do the work;and the structure is not Intended or offered for sale(Sec
.'70,14;' 1 O3 - UFER Re aired Ins actions - T
Business and Professions Code:The Comracmr's License Law does not apply to an tl p
owner of property Who builds or improves thereon,and who does such work himself 104 - REBAR _ ----
ye
_
or through his own employees.provided that such improvements are not intended or
-,-offend for sale'If n tier,the building or improvement is sold within one year of - """"' '- 1 O 5 — ANCHOR BOLTS -
immletionrthewider,builder will have the burden of proving that he did do,wild or 106 - SEWER & WATER -
P purpose
t ______
-202"' =" UNDERFLOOR'-PLUMBING
as - iter ofineP eexclusively i contracting licensed to '
aw<t me pmjeet(sece.7 7014.Basroeas arta Prormamn Came)The contra<tora2 03 - UNDERFLOOR MECHANICAL'!' ' .
License Law does rigsly 10 a owner of property who bit ids or improve,thereon,
. ._.and who comms uch. ens wnhacommnor(a).licensed pursuant an ma. ... ._ _-204_._...UNDERFLOOR--FRAME—
oie`m oat Li` ' „8&P for this reason 205 - UNDERFLOOR'`'LNSULATION
1' 301 - ROUGH PLUMBING
D
• rte ERSCO ATIONDERN 302 - TUB & OR SHOWER
I hereby affirm under penalty of perjury one of the following declarations: 303 - ROUGH MECHANICAL
- ❑ 1 have'and'will maintain a Certificate°fcomma to self-insure far Workers 304 - ROUGH ELECTRICAL
Compensation, as provided for by Section 3700 of the Labor Code, far he 305 - FRAME
'performance of the work f h ch this permit' issued
❑1 have and will maintain Worker xCimptiondima Insurance,as required by Section 306 - HOLDOWNS
700 of My Worker Compensationdth 'rforma race of the work f which this pemut is 307 - INSULATION
p
yhasucance carrier and Poli y number e:
. _ ,
_C".ert er
YIz f4 ,
., ., - ,.. «3.00�89. �.SHEETROCK
ffP hey a fyjE {TRIORL`,A..TH_CERTIFICATION '•FEXEMPTION WORKERS!
COMPENSATION INSURANCE.'`
- ----�----
311 '- ' SCRATCH
-SCTERIOR--LATH- ..-_
(Tit tion need not be completed if the parmn is f ' SCRATCH COAT ( r
e hundred dollars - 313
OF NAIL n
:nn dt`emplohat Pneon in fine if nen s 'tttothe W kdr.I 501 - FINAL ELECTRICAL`�'ENERGY
cmP ' rP 502.. -...FINAL PLUMBING ENERGY-___
. ... ..
ce Ir after making thnl ate of Exemption,you should 503 FINAL MECHANICAL' ENERGY
oma subject to the Winker',Cmd,enswano pro,isicasof the LaborCode,
Q C de,you add
0' forthwith lyw th h p thispermit hell b deemed okea
504FINAL BUILDING _- -
CONSTRUCTION LENDING ncENCY 505 FINAL ELECTRICAL '
a zI nerebyWind
m that pthere is a
mmt' 'construction
t o lending
e tlri agency c if the rf°rm race
506 GAS TEST NLnd Name _ 507 FINAL PLUMBIG
am Address " ..
tiro
°fth w kfo w
U O I certify thin[have read this application and scam that me above information is 5 0 FAL NAL ME CHAN I CAL
W cordect.I agree to comply with all city and county ordinances and state laws relating 5 9 - INAL GRADE
O E to building c°nstroction,and hereby authorize representatives ofthis city to enter upon 510 - INAL NG
the ab a tinned property for inspection purposes.
_
-t C6 (we)agree tos damnify ke phe.[ess the City of Cupertino against 51 - INAL RKS
V1 liabilities,ludgmen t ad ex s which may in any ay wide against said JA
AN
V City into quen th rad to this pe od'
A PL[CAM1T - R \DS WILL COMPLY WITH ALL N+P INTIssued b Date
'S RC. I S,-'' -1%2. 222 yi
ign F plica C tmcmr "" '" Da Re-roofs
HAZARDOUS MATERIALS DISCLOS E
Will the app( a t r future building«cupadu state in handle hiiardoro mammal . Type of Roof, - - ' '-'-'
as deBnW by she Cupertip M i a Chapte9 12and the Health and Safety vP x x;., ,, r
C'on,Section$553 (al x i t a" ` x 1 r CtedG 0101 tOf j
❑Yea NQ �_ All roofsshall be ms e p ..any roofing matenal.being installed..____
Will the app( to future drag
occupant use equipment or devices Hien If a roof Is in without first obtaining an inspection;I'agree to remove
I hazard S air m m def M by the Bay Area A' Quality Management
D am<t an all new materials for Inspection,. ,Applicant understands and will comply With._,
11Yea, ON all non-point source regulations.
t i t
I have%ad the hat"ons materials requirements under Chapter 6.95 of the
"Cxlif°mia Bandl&S y e,See 1 25505,25533 and 25534.1 understand that
m
ifthebuildingdoe, ulynm nuns,mat it is my responsibility to notify the
occppant of the rI e .whit st c met pdor to issnanc of a Cenific a of
o`<opaney Signature of Applicant . . . . .. . ... .. ... .. _ Date,
.w an ot;rcDale
8 . All roof coverings to be Class B or better
' e:_ __... .... ..._
. . ...._: .. ..:.� _. -. . . _• , . . . .. OFFICE. ... _
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