Loading...
02020063-DPCITY OF CUPERTINO BUILDING DMSION PERMIT BUILDING ADDRESS:, 20910 ELENDA DR PHONE: 0 c0 Zo ARCHITECTIENGINEER: AUL, ?ZLL) nab Z` LICENSED CONTRACTOR'S DECLARATION Z = — { I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing rn F � i with Section 700D) of Division 3 of the Bu 'nys and Professions Code. and my license ,2 , is in full fo d effect Li . F�(� O ce r ¢ �Li¢¢nse Cla a v Q(re Contra r CHITECT'S DECL TI t I understand my plans shall be used as public records p O Licensed Professional xF ` OWNER -BUILDER DECLARATION = ro I hereby affirm that I am exempt from the Contractor's License Law for the F' Z < following reason. (Section 70315, Business and Professions Code: Any. city or county n< which requires a permit to construct. alter, improve, demolish. or repair any structure to F m prior to its issuance. also -requires the applicant for such petit to file a signed statement a 3 — that he is ficemied puisuani to the pfovisions of die Contractors License Law (Chapter 9 (commencing witli-Section 7M) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 703 1.5 byany applicant�for a permit subjects the applicant to a civil penalty' of not more than five hundred dollars ($500). ❑ 1, as owner of die property, ar my employees with wages as their sole compensation, will do the work. and the structure is not intended or offered for sale -(Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property Who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to _ construct the project (Sec. 7044, Business and Professions Code:) The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts.for such projects with a contractor(s) licensed -pursuant to the _ Contractor's License Law. ❑ I am exempt under Sec. , B & P C for this reason - Owner Date - WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations; 5� ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation,' as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the labor Code, for the performance of the work for which this permit is issued. May Worker's Worker s Compensation Insurance er and Policy number are: erg/ / a'�e /tell j Polic 4,R �nl t CERTIFICATION OP EXEAd� FROM WORKERS' COMPENSATION INSURANCE - (This section need not be completed if the permit is for one hundred dollars ($100) or less.) G 1 -certify That in the performance of the work far which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TOAPPLICANT: If, after making this Certificate of Exemption, you should Z become subject to the Worker's Compensation provisions of the Labor Code, you must ZO : forthwith comply with such provisions or this permit shall be deemed revoked. N rte. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Ci`. C.) . A fender's Name' - Lender's`Address V C I certify that I have read this application and slate that the above information is correct. I agree to comply with all city And county ordinances and state laws relating (, to building conswction, and hereby authorize representatives of this city to enter upon >� the above-mentioned property for inspection purposes.., . [.i ':r (NVe) agree to save, indemnify and keep harmless the City of Cupertino against Uto liabilities, judgments, costs and expenses which may in any way accrue against said V rZ.i City in consequence of the granting of this permit_ APPLICA2Na U_' �STANDS AND WILL COMPLY WITH ALL \ON-P„QLNT chtaarFbEM /.tnoar:�--i __ r r� �L _,erg HAZARbO' US MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertinq Municipal Code, Chapter 9.12. and the Health and Safety Code. Section 25532(a)7 - - — ❑ Yes,No Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management District? 11 Yes `ICN. I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505.25533 and 25534. 1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the iccupant of th - Date CONTRACTOR INFORMATION: IO CTM CONSTRUCTION 2308 WALNUT GROVE AVE (408) 554-0198 ADDITION 3 §9A fiP2r.40a 10 iRMIT NO. 02020063 PPLIC TIONS B DATE 02%19 2002 \NITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH U E__I L . 1 �] Job Description TION $125000 Valuation 103 - UFER Required Inspections 104 - REBAR 105 - ANCHOR BOLTS 106 - SEWER & WATER 202 = UNDERFLOOR PLUMBING 203 - UNDERFLOOR MECHANICAL 204 - UNDERFLOOR FRAME - 205 - UNDERFLOOR INSULATION 301 - ROUGH PLUMBING 302 - TUB & OR SHOWER 303 - ROUGH MECHANICAL 304 - ROUGH ELECTRICAL 305 - FRAME 306 - HOLDOWNS 307 - INSULATION 308 - SHEETROCK 309 - EXTERIOR LATH 310. - 'INTERIOR LATH 311 - SCRATCH COAT 313 --ROOF NAIL 501 - FINAL ELECTRICAL'ENERGY 502 - FINAL PLUMBING ENERGY 503 - FINAL MECHANICAL ENERGY 504 - FINAL BUILDING ENERGX, 505 - FINAL ELECTRICAL 506 - GAS TEST 507 - FINAL PLUMBING 508 - FINAL MECHANICAL 509 - FINAL GRADE 510 - FINAL PLANNING 514 - FINAL PUBLIC WORKS Issued by: Date Re -roofs Type of Roof 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 all new materials for inspection. Applicant understands and will comply with all non -point source regulations. Signature of Applicant Date All roof coverings to be Class `B" or better OFFICE