03030004 (2) CITY OF CUPERTINO ('�'"�*,y'�°`y"�pk^�w� �"'�7'�°f',Np � '`
BUILDING DIVISION PERMIT � ,;,� �'" Iy�yl�"+a ATIO ^'.
BUILDINO ADDRESS: CONSTRUCTION INC PERMITNO.
20355 STEVENS CREEK BLVD 03030004
'S NAME: 3360 DE LA CRUZ BLVD PERMIT ISSUE DATE
FINANCIAL TITLE CO. 03/03/2003
E; —4 4 2 2 SANITARY NO, CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
DIDO ELECT PLUMD MICH
0 t�
atop LICENSED CONTRACTOR'S DECLARATION JobDescri tion
1 hereby affirm Our I am licensed u' r pmvulons of Chapter 9(commencing P
with Section 7006,ofDiviAon 3 of 60 Bug,' and pretenium Code,andmylicenseis
P��a in mnro a effect.
z�J� Dia. M , Conti 5 '3
0 �r ARCHITECTS RATIO fd✓/�
I u%n)05Nnd my plam shall be used as public records
j Licensed Professional D
OWNER-BUILDER DECLARATION YV
1 hereby affirm that 1 am exempt from the Coutractoei License Law for the
p o following name.(Section 7031.5Basincess W Professions Code:Any city ar county
$ which requires a Permit to conwwI,alcor.Impmw,demolish.or repair any strunune _----+ ,—
Fzs' prim to its iaswnco.tlw requires the applicant fortuch permit to rile a signed statement ..
dm11�� I�IOn
ggFF< heiiii.m puuuentmththe
epmvisiomofCuecone.ummelAw(Chaptor9 Sq. Ft.Floor Area
a $ (commencing with Section7000)of Division 3 of the Busnassand Profeasimu Cade)or
�s that be is exempt ulemfrom and the basis for the alleged exemption.Any viclaeon of `
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty or r Occupancy Type
Int more Nan five hundred dollars(S5o0).
oI,as Owner of do property,a my employees with wages as theh sole compewtion. / \
will do the wark.andW structure is Act intended maQered fat Ask(Sec.70th,Budneas lred inspections
and Prefeaaloru Cade:The Contnin
mor's Lime Law does rem owner
Act apply an or 102 - P I ERS a9uP
propenywho buudsorimpro estbumn,and w'hodoasswh work himselforlhmoN hu _ __
ownemploym,provlded Nmmahimpnm'amenu=wtintwedmaauWfmule_IL Y03 — UFER'--- -
hawem,the building at improvement is sold within oro)ear of completion,she owner- 104 — REBAR
builder will law the buNen of proving that he did not build or improve far purpose of
9�+ba). 105 — ANCHOR BOLTS
1,As owner or she property,am exelualw)y contracting with limased contractor,to 106 — SEWER & WATER
mmtnect the project(Sec.7044.Bminasa and Professions Cade:)The Con cie ce&U•
esmeLawdoesnotapplytoanownerofpmpenywhoWild,orimpmmtMrem.and, 202 - UNDERFLOOR PLUMBING
who corm,eat for such pmjcm with aconuactm(s)licensed porevant to NeCenuanors 203 - UNDERFLOOR MECHANICAL
License Law.
exemptander Sec. .Bk PCforthamasnn 204 - UNDERFLOOR FRAME
205 - UNDERFLOOR INSULATION
WORKERS COMPENSATION DEC M 301 — ROUGH PLUMBING
I herby afrbm under iamlty or perjury one of she fa11ow1iImwom: 302 — TUB & OR SHOWER
IluwaMwillmaintiaCeNOauofComentm.if.i mrmW.,k e$Compem 303 — ROUGH MECHANICAL
urian,as provided for by=.3700 of tie Labor Code,for the Performance Of Ne
work for which this permit is Issued. 304 - ROUGH ELECTRICAL
❑1 haw and will maintain Workan compemation Wassong,a required by Section 305 - FRAME
3700 of de IAborcoda,for tie performance oftin wan forwmcb Nu permit u Imwd.
My Worker ea pemPaI lmm.y Iv�ydp�Iry num an/: 306 — HOLDOWNS
1 esrt hiley-na TRS, 307 - INSULATION
ceRnFlaT OFE%FMP170NFR RKEas 308 — SHEETROCK
COMPENSATION INSURANCE
trials serum need notWoompleled if the ranch Is foranc hundrldollan(5100) 309 — EXTERIOR LATH
mwa) 310 - INTERIOR LATH
1 unify that in the perfomance of de work for which this permit is Issued,l Nati not 311 — SCRATCH COAT
employ any person in any mannerso as to become subject to the Worker'Cmapemation
Law of CaRromia.Dam 313 - ROOF NAIL
NPOlican
TICEtTO APPUCANT.IL after making this Certificate of Exemption.you should 501 - FINAL ELECTRICAL ENERGY.
become subject to the Workers Compemation provisions of the Lahor Codc,you muss 502 - FINAL PLUMBING ENERGY
Z forthwith comply with such Provisions Or this permll shall M memcd mated.
�0 503 - FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
J--i thereby affirm that there is a mmtnetion lending agency for the perfomame of 504 - FINAL BUILDING ENERGY
fYr�„ thewank for which this Permit a Issued(Sm.3097,Civ.C.) 505 - FINAL ELECTRICAL
W Lender's Namc
az LendersAddreas 506 - GAS TEST
Uo Icertifythat Ihaw mad this application sadmtothat the show InformWmb 507 - FINAL PLUMBING
O U mrmct.l agre N comply with all city and county ordinances and auto law relating to FINAL MECHANI CAL
building construction,and hereby authorize representatives of this city m enter upon tic
W above-mentioned property for impemion purposes 0 FIN DE
(We)agree m tow,indemnify and keep harmless the City of Cupertino against `
L.tq Ilabilitics Judgments,costs and exposes which may In any way acome apinatseld city I
U In consequence of the Stenting of this permit.
APPLICANT UNDERSTANDS AND ILL COMPLY WITH AL NON-POINT Issued by:5 WORKS Date
SOUR ULATI S. Q� ,
Re-roofs
3gindurt,of ApplicaZ mr ate 'Type of Roof
H DOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant nom or handle haeardous material
nod by the Cupertino Munid I Code,Chapter 9.12,and the Heald and Safety
$1,
Section 35532(an All roofs shall be inspected prior to any roofing material being installed.
❑Yea oWill the applicant or future building occupant use mulpment or devises which If a roof is installed without first obtaining an inspection,I agree to remove
ayardaus ser conuminmu m defined by the Day Arca Air Quality Management all new materials for inspection.
m7
❑Yes
I haw mW the hazardous materials mqullemenu under Chapter 6.95 of the Califon-
me Health&SalmyCade,Seen om25505.355 end 25534.1 understand that If to Wilding
docs not tonally have a ant.Net It Is upon slily Io mN'y Illi mxupent o Na
rcyulr mnmait met dorNi a a f enilicaneofOm Signature of Applicant .... Date
Owner or auarired agent U m All roof coverings to be Class"B"or better