03070019 CITY OFCUPERTINO
BUILDING DIVISION PERMIT CONTRACTORRINjFORMATIONt
BUIL DING ADDRESS: TESCO CONSTRUCTION INC. PE111N003070019
OWNER'S NAME: 380 BEINORIS DR. PaRMlT Issue DnTe
E' (630) 595-2219 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
200 LICENSED CONTRACTOR'S DECLARATION -OR
1
iy 0 1 hereby affirm that 1 am located under provisions of Chapter 9(commencing .
^� with Scctkm7ak) Divlsionlof Ne Busi .M Profesiony Co c.and mylicense is
imm�mree a ]23(7 TI (QQQTa1�E FRONT:).
2 Llcnap Cl L' Le.N �
2 Da c Cu IrR 6ta[-
S ARCHITECT'S A local i
tudcmand my plans shall W use public ranrus
you F- DI
50 Licensed Professional
OW NER-BUILDER DECLARATION
xI hereby affirm Nal lm exempt from the Contractor's License Law for the gQdg�
O O following reason.(Section)(01.5,Business and Professions Coda:Any city or county 'c gI �►7�Jf�
3 m which inquires a Permit In covstrom alar,improve,demolish,Or tepair Any structure
-ai prior m its issuance,aim requires Liao applicant for such Permit to fit.minedmcampt
ggxxD that he is licensed pursuant tothcprovision of LM Contractor's Lienselaw(Chapter 9 Sq. Fl. Floor Area Valuation
yF (commencing with Section 7")or Division of the Business and Profcuinna Cad.)or
y $ that he is exempt therefrom and the basis for the alleged emmpon.Any violation of 31620037 . 00
Section 7031.5 by any applicant fora permit subjects the applicant to a civil Penalty of APN NumberQ�Q Occupancy Type
m
nmom Nn an five hundred dollars(5500). Q
jr
❑I,As owner of the property,or my employees with wages As their sole compensation, 112
will do the walk,and thto.wchoot an.I intended or offered far We(sec.7044,Business 101 -
and Professions Code:The Contoctarl License Law does not apply in an owner of d Inspections
property who builds or improves thereon,and who does such work himself.r through his 102 — PIERS
own employees,provided that such improvements are not intended or oRemd forsele.If. 103 - UFER
however.the building or improvement is old within oro year of completion,the owner
builder will Mve the burden of proving that h.did not Wild or improve for purpose of 104 - REBAR
Aale'l' 105 - ANCHOR BOLTS
01.a owner of the pmpm,,am exclusively contracting with licensed contractors to 106 - SEWER & WATER
convect the project(Sec.7014,Business And Profcssioaa racror'
Cade:)The Com .Lt
Came taw does not apply to an owner of intersect,who Wilda or Minnows,lhemon.and, 202 - UNDERFLOOR PLUMBING
who contracts for such pmjec%with a condrsu
ano*d licensed purant to the Contruclors
Licnve Law. 203 - UNDERFLOOR MECHANICAL
01 am exempt under Sec. B k P C for Otis Moon 204 - UNDERFLOOR 'FRAME
III
Data 205 - UNDERFLOOR INSULATION
WORKERS COMPENSATION DECLARATION
Ihereby afnrmunder penalty ofperjur,amofthe following deditudimel: 301 - ROUGH PLUMBING
hawandwillmaintain.CertificateofConsentasell.insureforWorker'scmnpan. 302 - TUB & OR SHOWER
,o provided fm by Section 3700 of the labor Cade,far dw performance of the 303 - ROUGH MECHANICAL
for which this permit is issued.
have And will m.isln Worker's Compensation Insursnc,u required by Section 304 - ROUGH ELECTRICAL
of the Labor Code.far the perfmmmce of the walk for which this permit is issued. 305 - FRAME
oheM1 CmmPe uonl trona artier PolicynumWr-A^�tufAf. Pn° 306 - HOEDOWNS
C RTS IPICA �PIOIN NO ORKERS307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
(This section need not W completed if LW Permit is for one hundred dollars($10(h) 309 - EXTERIOR LATH
or less.) 310 - INTERIOR LATH
employ coif,that ter the in any manse of IW work for which Nis permit rk tomo,1 shall nm
Law,OfC.peruninanymmmr».sue Wmme wbjatrothe wolken'Compewtlan 311 — SCRATCH COAT
laws of C.lifomis Data
Applicant 313 — ROOF NAIL
NOTICE TO APPLICANT:IL after making this Certificate of Excannion.you should 501 - FINAL ELECTRICAL ENERGY
become subject to the WolkeM1 Compensation previsions of the labor Code,you must
�,z forthwith comply with such provisions or this permit shall W doomed revoked. 502 - FINAL PLUMBING ENERGY
z0 CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
f~ 1heabyaRrmOat there isaconstruction lending agency for LIN perfurmmceof 504 - FINAL BUILDING EDMR Y a
(Y, t7 the work for which this permit isissued(See.J(N7,Civ.C.) 505 FINAL ELECTRICAL
. la
W nder':Name
z <nd;anedeu 506 - GAS TEST
U 0 I certify that 1 have Mad this application and slaw that the abow information is 507 - FINAL PLUMBING
(-' conea7.I Agrte to comply with all city and county ordinances and sate laws staling 10
DU building cootmnion.and hereby mthorire representatives of Nis city to corer upon thc FIN MECjVNG'�
CL
W .h vmmentionod property for inspection pugwsea
(We).gone to save.indemnify and kap hu mess One City of Cupenino against 0 9 F I
y
liabilities,judgments,costs and expenses which may in any way accaw.gainst mid City 5 V 7 in conuyuence of the gamigLhispermit.APPLICANT UNDERSTA AND WILL COMPLY WITH ALL N N OINT Issued by:5 WRKS Date
;It
E ON
tb, A L Re-roofs
e of A icon o cror Data of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
ill dw applicant ter future Wilding Occupant stere ter handl.hanmdous material
d by�a Contorts.Municipal Code,Clupar 9.13,and the HcalN and Safety
Cut. tiion-25532(a)7 Na All roofs shall be inspected prior to any roofing material being installed.
itt NC Applicant m lure ilding Occupant use equipment at devices which If a roof is installed without first obtaining an inspection, I agree to remove
.Mm,air common u ss dcrood by the Bay AM.Air Quality ManAgcment all new materials for inspection.
❑Yes
I have mad the haaard us materials requimments under Chapter 6.95 of the Califor•
Its Health@ Safety Code,Seed N)5,35537 and 35574.1 undersand awif the Wil ing
Jnea not curten0y bow a an 11 is my resPon.1.1. m nodi',them ,ant the
ustW i' or0nodule,a .ccni' a° ` `' Signature of Applicant Date
owlerar.athre .nL ,a All roof coverings to be Class "B" or better