03070226 (2) CITY OF CUPERTINO ssh�a
BUILDING DIVISION P> RMIT CONTRAGTOR INFORMATION R
. �e. .,x 3 .]4°..:� a�
111.1ILo1NGADDRESS: SPECTRUM FINE HOMES, INC. PERMITN1Q3070226
1944 TERRA BETLA DIR
-R'S NAME: 1734 EL CAMINO REAL PERMIT ISUEDATE
PHONE' (650) 960-2449 SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INTO
BLDGELECT
PLUMB MECH
0 E t� o
:oa LICENSED CONTRACTOR'S DECLARATION
rf F I hereby affirm that 1 em licensed under provisions of Chepmr 9(commencing .lob Description
sur wi,hSc tion] ))ref Dwison3adr.Busines Pmfcasinns Code.coat my license is
+Za REVISION--IN HOUSE USE ONLY
Dat= aeor 7NO NEW PERMIT ISSUED/ORIG. #03020122
ARCHI CTS DE N �l(y/34
1 unmrsunJ my plata¢hall W used m public records
JU
= Licensed Pmfcminnel
p 0
�1 OWNER-BUILDER DECLARATION _ (w
2<0 I hereby.(Sere ober 1 1. exempt fere Ne Comraeoo License Lew for the
5 p O followwhich ac reason.(Section]1131.5,Business and ve.fdemolli h,or Any tiny m county
$ poor t its issuance,
a panto to cnnsthe atter,improve,h Naftin,fi repair any Structustatement Mono its i ensed pursuant
entrance to he tW visiappon of for sucContractors
rmLice se signed summcm
x
< thatbe ending wit pSesuent 7")of Di¢inns of theeBusinsand Prseluw(Chapmf9 Sq. FI. FloorArea Valuation $Q
that he Is
(commencingwith Section]Ino h summit
r the
the Business and on.Any vi Codd of
��$ Nn W u exempt therefrom and the Eau for the alicgcd exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 39fM2tiBffger00 Occupancy Type
not mom than circ hundred delta.(S500). -" '
1,as owner of the propcny,or my employees with wages a their sale compensation,
will do the work,and the swcwrt is not intended or offered far male(Sec.7044,Business RR d Inspections
and PTofemion,Col The Contractor's Laterite Law it=not apply to an owner of 101 — FOUNDAT�� p
property who build,m re
improves thereon,and who dos such work himself or through his
own employ=,provided that such improvements are not intended or offered formic.if, 102 — PIERS
h.Cm,.the building or improvement is Said within one yea of completion,the owner.
builder will have the burden of proving that he did not Wild or improve for purpose of 1 03 — UFER
mlcJ, 104 — REBAR
C3 1,as owner of the property,em exclusively contracting with licensed contractors to 10 5 — ANCHOR BOLTS
consmact the project(Sec.7044,Businw and Professions Cotler)The ConVutori Li-
cemeLawdocsnotapplytoanownerofpropertywhoWild&or improves themon.ad, 106 — SEWER & WATER
who contracts for such projects wit a contractor(+l limmed pursuant m the Conmactoes ,
Llcenseiaw. 202 — UNDERFLOOR PLUMBING
I an exempt under See. .B k P C for Nave
is maven 203 — UNDERFLOOR MECHANICAL
r Dow 204 — UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
I hereby 41rmt under penalty of perjury one of ren fallowing declarations: 205 — UNDERFLOOR INSULATION
❑ 1how and will notouinaCerdfntc.fConuntmulGinsumforWorkchCampcn- 301 — ROUGH PLUMBING
,tion,a provided for by Section 3700 of the Labor Code,fm the pafformtt anof the 302 — TUB & OR SHOWER
work for which this Permit is issued. 303 — ROUGH MECHANICAL
❑1 have and will maintain Worker's Compensation resonance,me required by Section
37M ofthe"bar Coate.ler um performance of work ler which this p=rmn measured. 304 — ROUGH ELECTRICAL
My Workers Compensation lmurance camicnnd Pc5:Z ny�.a '^ 305 — FRAME
Ca r. 9 — PolicyNa�Rp' _d 306 — HOLDOWNS
CERTIFICA OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 307 — INSULATION
This section need not he completed if the permit is for one hundred dollar(511111) 30B — SHEETROCK
or 309 — EXTERIOR LATH
employ certify that er thein any mean of the work fm which this perm It is issued,l shell nm
Law'oanypcman in any mmncrsoam Wromc mbjectmthe Workeri Cnmpematian 310. — INTERIOR LATH
Laws of California.Oa` 311 — SCRATCH COAT
ACmCEt
NOTICETD APPLICANT.If.afor,makingthis Certificate
,of of Memptioe adShould313 - ROOF NAIL
become subject w the Wohero Compensation provision,Shat of the m Wr Coated you must
�z forthwith comply with men provisions or this permiuhallMd=ee=d revoked. 501 — FINAL ELECTRICAL ENERGY
� C CONSTRUCTION LENDING AGENCY SO2 — FINAL PLUMBING ENERGY
I hammy oMo.thatthere ice.eamu elon lending agency lot porfarmarac of 503 — FINAL MECHANICAL ENERGY
x ► work fur entmapmni¢issaad(sec.3w7.cm.c.) 504 — FINAL BUILDING ENERGY
Sl Lender's Name
L IsnderiAddrcm
DZ 505 — FINAL ELECTRICAL
J O I certify Net 1 Mrs read this application and aura Net the minim l Informationrelng is 506 — GAS TEST
Ftorten.l agree m comply with all city and county ordinances and sum laws relating m
�U building construction.and hereby amhorim representatives of this city to enter upon the FIN PLUMLT zBI G
G ahovc-mentioned properly for inspection purposes.
(Wu)agree to Save,indemnify and keep Nameless the City of Cupertino against O B FIN L
h liabilities,judgmunu,costa and expemm which may in any wry accrue against mid City 5
;Jz to consequence of the gmnei ng of this permit.
^ APPLICANT UN S AND WILL COMPLY WITH ALL NON-POINT Issued by:5 NG Date
SOURCE LATIO
Re-roofs
Sig t cofA IicanV .rUmxIm au
` HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant m future builJin6 acupanl amrc or handle haous material
a dcfrned by the Cupenina Municipal Code,Chapmr 9.12,enJ the Health and Safety
Cl Y.25533(x)7No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazaNnus air contaminants m defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes No
I ham reel Ne hvm nem eats mquiumenu under Ch.pmr695 of the Calif.,
nim Health&Safety Coate,section.25505,25533 asu125534.I understmd that;(the Wilding t
does not euertnil hes a torten,Nat it u my rmpomihility m ruddy dM oeeupmr of the
mqui must Wmee prior m issuance of a Camficam of Occupancy.
w _ Signature of Applicant Date
wee manzedagent Da� , All roof coverings to be Class "B"or better