01070076 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10860 VIA SORRENTO CT. TROJAN CONSTRUCTION 01070076
OW ER' NAME APPLIC TION,UB DATE
S�LAZAR MARILYN 681 ELDEN DR 0717 2001
PHONE: (408) 371-9179 SANITARY NO. CONTROL NO.
C rc z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w— BLDG ELECT PLUMB MECH
F i UJ L_:_I 1_I CI
as
N z LICENSED CONTRACTOR'S DECLARA'T'ION Job Description
oz—o ction700)of "i'Is.licensedusinessandPronsnion,Cicr9(commeceing
se REPLACE TUB SHOWER & 'TOILET.
me_w with Semion]OWlof Divieion3 oRhe Business and Profensionn Cmle,end my license<' is in full force and a ec_p 1.
z J is in full
corse_[3 sect.» 74,1
a<o a
t' I understand m
y plAanRsCsHM1aITll ECT'SComm
of
O DEnR
ATtore
.Wap Licensed Professional
a esa OWNER-BUILDER DECLARATION
1 hereby HWIM that 1 am exempt from the Contractor's License Law for the
�z< Winning mason.(Section 703 s,Bnsmex.and I'ro&xxmns CW11 Any city ser county 70 0
i 2 which re9uirex a permit to eeMVuct,altar,imprm'e,Jcmulish,ser repair any nrvaure
a, 11im.toI.isomme..also re9uims Neapplicant fmsuch permit 19 flenalgrsed uatement.
that he ispmnjea porwam m Ne provisions or Ne Contractors License Law(Chapter 9 31�IOFlt2@1�f;6CFa;a, r x, Valuation
(commencing with Section 700 of Division 3 of the Business and Professions Cade) _, •A, t.� moi y),
ser that he is exempt therefrom and the basis for the alleged eaemplon.Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty �ef�x.,�.ak,�
ofnot..or town 0vc hundred dollars($500). 101AR-N' N1011 YY'DAT ION 1'.' ' cupancy Type
C1 1,as owner of the property,or my employees with wages as their sole compensation, 102 - PIERS
wilydo Ne work;and the a ire os,is ma,rimcnded'er offered for sale(see.70u; 10 3 - UFER Required Ins ections `
Business and Professions Code:The Contractor's License Law docs not apply to an q p '
caner of progeny Who builds or improves thereon,and who does such work himamf 10 4 - REBAR
or through his own employees,provided that such improvements meals within
not intended or _ __ __ ___ __ .. _._
-,,,completion,
ompllefor stile.IC however.the buildingor etavenocmemissold hedidone
otyam:est ' "- 105- ANCHOR BOLTS r
cetio.'e on,Ne owner-builder will have the Wrden of proving Net he did not build or o
improv<tor purpose or sale.). 106 - SEWER & WATER I
7i:a:o nil o7
he prop a ulnsi lreoniF tine w6 rad d ens roam -202 - UNDERFLOOR -PLUMBING. .....
construct the project(Sec.7004.Business and Professions Code:)The Contractors 203 - UNDERFLOOR MECHANICAL
License Law does not apply m an Wooer of prop<try who builds or improves Nercon.
_and.who contractor for sem proie<ts with a comia,mn(s)licensed pursuant to Ne204 --- 'UNDERFLOOR
..FRAMEContractor's _
❑1 amnemL'i<under 5e. ,B&PC heirs reason 205 - UNDERFLOOR -INSULATION
owner ` ' Date 301 - ROUGH PLUMBING
- WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
-_� 1hereby airocardirpeoallyofperiurynne,af,Nefollowing deelo-comm: 303 _ ROUGH MECHANICAL
❑ I have and will maintain a Certificate of Consent 10 self insure for Workers 304 ROUGH ELECTRICAL
Compensation, as provided for by section 3700 of the Labor Cmlr, for the 305 - FRAME
perfor acre of tAc work for which this permit Is issued. -
O I hive and will maintain Worker's Compensation In>umiice,us required by Section 306 - HOLDOWNS
3700 of the Ichor Code.for the performance or he work for whim this permit is 307 - INSULATION
Its dMy WmkcreC pas nlnaura a ierunJ Pol cy numbers¢ _ ,�" �.,
308 -' ;SHEETROCK. . . _._. .
cpm
_NR ic T cr Nn.. 2t. yq y� r ! " ' 309 `- ' EXTBRI�OR:LATHr:
TIFICATION OF XEMPr10N rB M W RKERS'(
_ COMPENSATIONINSURANCE ---- ----310 INTERIOR--LATH---,-s - --'- ---
1 Mis section need not be considered if the Permit is for one hundred dollars 311 - SCRATCH COAT
csioolor fete.) r . . 313 - - ROOF NAI-L
.i unify that in the performance of the work for which this permit is issued,1
shall not employ any person in any manner so as to became subjen to the Workers 501 - FINAL ELECTRI CAli`'tENERGY'
CmnpensatmnLawemfC.,lifomia:Dme 502 FINAL PLUMBING ENERGY
.Applicant
:NOTICEIOAPPUCANT:It,after making this Certificate of Exemption.you should 503 - FINAL MECHANICAL ENERGY
become eubjen hr the Worker's Compensation proviximm mf Ne W Wr Ceme,you mast
O Bmhwilh rnmplywiN each prcvisitins or Nis permit shall he deemed rtvokeQ 504 FINAL BUILDING ENERGY
z - - -
'W s^• '• " 'CONSTRUCTIONLEND]NOAGENCY SOS — FINAL ELECTRICAL -
I hcrcby affirm Nut there is a,Worsotion lending agency for the,perfonimnce
a > 506 - GAS TEST
y p -LrnJer'eNante•" '- ;:.. _. .. ;t .:_... - 5'07 --- FINAL PLUMBING - .. . .
or the work for which this pennil is Issued(Sec.309],Cis.C.
O Z Lender's Address' "ll
1 sena Nat 1 have read this application and state Nat Ne above information is 508 - FINAL MECHANICAL—'
-Q correct.1 agree to comply with all city and county ordinances and state laws mlzting 509 - FINAL GRADE
O-U outbuilding construction.and hereby amheriie mprexenmtivesof ohiscoym ctncrupmn 510 - FINAL PLANNING
} W otic abuvcmemioned prop<nv for inspection pmpous.
F y (Welagreemsem,indemnifyandkttph mlesethcCityofCupninmagamst 514 - FINAL PUBLIC WORKS
_ fA liabilni<s.' d m u penses w 1 may in oby way creme again,,said
[1.Z City ins a ceof the gmmu or this permit. '
APPLY A.'
t' NDS D WILL COMPLY WrrH ALL .ON- L ISSUed b Date
SOUR ERE ATIONS.� —�� y'
Signata 'Alpha ontracmr oat Re-roofs
AZARDOUS MATERLxLS DISCLOS E
' W' cappac t rm Wilding occupaat same ar Ile haardous mmai:d Type of Roof - - 7r . "
as deo d by the Cupe i n M Acipol Come Chapter 9 12.and the Moulin and Safety _
Code Seaton 35532(al- ' ` x1 - ',a ' ` ..•' t
oyes 1 ❑No'' s Allroofs shall be inspected prior to-any roofing.material being.installed—
Will heappiicr000riuturebuiwNgoccupant yscetloipmrmorJeviceswhich If a roof is installed without first obtaining an inspection', Iidgree to remove
emit hammoux air contaminants as defined by the(lay Arca Air Quality Muoafk mere
District" all new IT for inspection. Applicant understands and will comply with
oYa' ono - all non-coins rce regulations.
1 hay t J the'hiztNous,materials requirements under Chapter 6.95 of the
California cal &Safety Coda Sections 25505.25533 and 253.34.1 understand that
if Ne Wil ing ties not cumcndy have a tenant.that it is my responsibility to notify the
cupan of ems whie rosea be met prior to iswarce mf a enificate of
kcup .. .. . . _ .
Signet r of Applicant Date
o aarmeri> em' ate All roof coverings to be Class "B" or better
OFFICE -
.,