03080172CITY OP CUPEWI'INO�-
BUILDING DIVISION PERMIT
CONTRACTanR INFORMATION
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BUILDING ADDRESS:
"07Aq UP,1LEY
SOUTH BAY CONSTRUCTION CO PNCITN 03080172
GREEN DR
AME: nm�UTEIZ (BLDG 46)
PERMIT LSSUE DATE
511 DIVISION STREET
PHONE:
SANITARY 0. C NTROL NO.
(408)379-0400
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELER PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
]ob Description
I hereby affirm that Ism licensed under provisions of Chap e, 9 (commencing
I3
3oe Businui and Professions ode. or my license is
L
winsSectionIMMBaf DivkA71!1!1rnCTS
in full forte and effect.
Llbcnx Cfas Llc.a
REVISION--ATRIUM STAIRS
Dale Co.
DECLA A N
NO NEW, PERMIT ISSUED/ORIG. #03080172
that[m
1 understand my plain shall M used as public records
Licensed Professional
OWNER-BUILDER DECLARATION
0 1 hereby afErm that I am exempt from the Conu elarb License Law far the
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folio ling notion. (Section 7131.5, Business and Professions Code: Any city our county
which requires a permit to construct, alter, improve, demolish, our repair any structure
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poor to its issuance, also require the applicant (or such Permit to rile a signed statement
that he is licensed pursuant to the provisions Or Common's Littnx Law (Chapter 9
- Sq. Ft. Floor Area
V7�ilx"000
(commencing with Sanction 7IXMB of Division J of the Business and Professions Cook) or
that he Is exempt therefrom and the basis for the alleged exemption. Any violation of
3216TGNCO0
_OCCUpanCy Type__
"-'
Section3011.5 by any applicant for a permit subjects the applicant to a civil penalty of
notmom than Bvc hundred dollen(S500).
❑ 1. n owner of the progeny, or my employced with wages as their sole compensation,
Required Ins ect10US
er, q p
will do the won. and meswcmm is not intended oroftead far .1.(Ses. 7044, Business
License Law does
Contractor, Cade: TheContractor,m
and not apply in owner of
property who builds or improves thereon, and who doessuch work himseforthraugh his
101 - FOUNDATION
own employees. provided that such improvements are not intended oroRered for can. If,
lO2 - PIERS,
however, me building or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that h , did not build or Improve for purpose of
10 3 - UFER
sal..)
104 - REBAR
1, as owner of the propany, em exclusively contracting with licensed contractors to
comarml the pmjcet(Sec.7W4, Business and Professions Cade:) The Contractor's Li-
105 - ANCHOR BOLTS
cense Law docs not pply to an owner of property who Wilds or improves thereon, and
who contracts for such projects with a conuator(s) licensed pursuant to the Contractor's
106 - SEWER & WATER
License tan.
202 - UNDERFLOOR PLUMBING
❑lameaempt under Sa. ,B9PCfar this ..a
203 - UNDERFLOOR MECHANICAL
s are-
204 -;;UNDERFLOOR' FRAME,
WORKER'S COMPENSATIONDECLARADTION
I hereby afrirn under penalty of perjury ane of the following doclarmions:
205 --UNDERFLOOR INSULATION -
❑Ihaw and will meinuinaCeniOmm ofCansamto self--insert far Workers Compcn-
301 - ROUGH-PLUMBING
motion, u pmvided for by Section 37W of the Labor Code, (m are Performance of the
3 0 2' -- TUBOR SHOWER.
work for which this permit is issued.
,&
❑ 1 have and will maintain Worker's Compensation Insurance, u required by Section
3 03 - ROUGH MECHANICAL
5700 Of the labor, Cade, to, the Penmmance of the work (a, hi,h iris Permit is luded.
304 - ROUGH ELECTRICAL
My Work 'a Cn met. In ounceca 'e and Policy numbers
305 - FRAME
Gamier Polity No:
CERTIFICATE OF EXI
,
306 - HOLDOWNS
COMPENs ION INSURANCE
307 - INSULATION
(Tdsuction need not be completed if the Permit Is for one hundred dollars(SIWI
308 - SHEETROCK
our lava)
I sanity that in the performance of the work for which this Permit is issued. I shall not
3 09 - EXTERIOR LATH
employ any Person in any thitherto astoBecome subject tothe Workers'COmpensation
310 - INTERIOR LATH
L.w.Or California. Data
Applicant
311 - SCRATCH COAT
313 -.ROOF NAIL
NOTICE TO APPLICANT: IC after making this Cenifmate of Exemption, you should
meanie subject m the Workers Compensation previsions of the labor Code. you moral
,
foruwiu comply withsuch provisions or this permit shall x deemed revoked.
501 - FINAL ELECTRICAL ENERGY
CONSTRUCTION LENDING AGENCY
502 - .FINAL PLUMBING ENERGY
I hereby thatthereI issed(Suninnknding agency to the performance of
dm work for which this permit is issued (Sec. ion le Civ, C.)
503 - FINAL MECHANICAL ENERGY
Lender's Name
504 - FINAL BUILDING ENERGY
505 - FINAL ELECTRICAL
lender's Address
and application and ore that the above information mulling 10
1 century that I have mad this city
building 1 agree m comply with all city and county and state lana mauling td
5 0 6 - GAS TEST
ntun cs of t
building ronmm�imn. and hereby authorim reprcscnnsiws of this city to enter upon the
FIN&gfL
shave-mentioned property for impecdon purposes
(We) agree to cave, indemnify and teal, harmless the City of Cupertino against
0 8 - FIN
liabilidu,judgmenu.cosuand exPnueswhich may'n any way accrue against said Cityin
SAPPLICANT
consequence of ue grating of this perm'
UNDERSTANDS AND PLY WITH ALL NON-POINT
Issued by:5 Date
SOURCE REGULATIONS.
Re-roofs 514 NAL PUBLIC WORKS
Type of Roof
'
Signature o(ApplicanV ver Data
ARDOUS MATERIALS DISCLOSURE
Will are applicant or future building occupant store or handle havardous material
defined by the Cupertino Municipal Code. Chapkr 9.12. and the Health and Safety
Setian 255328)'`�
❑Yu �°
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant r future building occupant use equipment or devices which
emit haamous air conuminanIs defined by ire Bay Area Air Quality Management
all new materials for inspection.
DistrictP '
❑ Yes Y,/. C/
I have mad the Weamnus matannia requirements under Chapter 6.95 of are Califor.
,
nial3ealthgrs.fetyCode, 505.25553 am125534, 1 understood that irde, building
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n
does not currently haw at' my responsihility In notify ftoccupant of the
myuiremcnu which t / t p' issuance of a Cerufiyq¢ of OCcu
re O
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner
res Onlcd agent I /'> Date