03010119-DPCITY OF CUPERTINO
BUILDING DIVISION PERMIT"` CONTRACTOR INFORMANT..
BUILDING ADDRESS: R &Zt DEVELOPMENT PERMIT NO.
21353 VAI AVE 03010119
OWNER'S NAME: 21771 STEVENS CRK BL #100 APPLICATION SUB DATE
VAI AVE. L.P. 01/22/2003
PHONE: (408) 252-1101
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB x4Fru
Q O p LICENSED CONTRACTOR'S DECLARATION
C V t— 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
F Z with Section 7000) of Division 3 of the Business and Professions Code, and my license is
F y in full force and effect. FENCE
Z License Class Lic. A
2Z—, Date Contractor
P = t; ARCHITECTS DECLARATION
a C a
X01 understand my plans shall be used as public records
,U
LU 3 u, I— Licensed Professional
y ; OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
H O O following reason. (Section 7031.5, Business and Professions Code: Any city or county
a X g � which requires a permit to construct, alter, improve, demolish, or repair any structure
ul prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
F(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
a 3 $ that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than rive hundred dollars ($500).
❑ 1, as owner of the property, or 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 Contractors 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
as owner of the property, am exclusively contracting with licensed contractors to
,uct the project (Sec. 7044, Business an Professions Code:) The Contractor's Li -
Law does norj
m r of pro rty who builds or improves thereon, and
a /qon is for swit a cor(s) licensed pursuant to the Contractor's
e un , B & P i for this Mason
�:nebwyraR7s�dt�dtr penalty of perjury one of the following"declarations:
I hd ill maintain a Certificate of Consent to self -insure for Worker's Compen-
sationprovided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hun red dollars (SI00)
or Icss.� y�orfr
S�
I certif th n rfw rmr rssucd, I shall not
employ a / ryf an c ompensation
N�1jICgA .al�azc n. You should
I c e c er' nsati of the r Codc, you must
O Z fortitw' coin y with suc isio s or this permit shall be d erred revoked.
Z O CONSTRUCTION LENDING AGENCY
(--r ►-r 1 her y allirm that there is a construction lending agency for the performance of
is the work for which this permit is issued (Sec. 3097, Civ. CJ
W ALend er's Name
0Z
Lender's Address
U 0 1 certify that I have read this application and state that the above information is
LL, r --r correct. 1 agree to comply with all city and county ordinances and state laws relating to
0 V building construction, and hereby authorize representatives of this city to enter upon the
W ahove-mentioned property for inspection purposes.
LLAeo save, inti d keep h less the ity of Cupertino against
,costsexpense whichmyinanyyaccmeagainstsaidCity
AT]
U Z egran g of is mit.ERSTAND A WILCOMPLYITHALL PO TOp(S. y
Wif the applicant M re ilding occupant store or handIcAarardous material
as dcftne y the Cupertino u ' al Codc, Chapter 9.12, and the Health and Safety
Code, tion 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Ycs
Will the applicant or f lure building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air contamma defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes kNJ,
Sq. Ft. Floor Area
102
103
104
105
106
202
203
204
205
301
302
303
304
305
306
307
308
309
310
311
313
501
502
503
504
505
506
507
5
Issued by515
Re -roofs
Type of Roof
Job Description
PIERS Kequlred Inspections
F1
Occupancy Type
- UFER
- REBAR
- ANCHOR BOLTS
- SEWER & WATER
- UNDERFLOOR PLUMBING
- UNDERFLOOR MECHANICAL
- UNDERFLOOR FRAME
- UNDERFLOOR INSULATION
- ROUGH PLUMBING
- TUB & OR SHOWER
- ROUGH MECHANICAL
- ROUGH ELECTRICAL
- FRAME
- HOLDOWNS
- INSULATION
- SHEETROCK
- EXTERIOR LATH
- INTERIOR LATH
- SCRATCH COAT
- ROOF NAIL
- FINAL ELECTRICAL ENERGY
- FINAL PLUMBING ENERGY
- FINAL MECHANICAL ENERGY
- FINAL BUILDING ENERGY
- FINAL ELECTRICAL
- GAS TEST
- FINAL PLUMBING
FINAL
L MECHANICA
L
FINN - OR
KS Date
r�
rircments under Chapter 6.95 of the Califor-
3 and 25534. I u crstand than building
responsibility t notify the ura, t f the
rice of a Ccrtif alc of Occu
Date
Signature of Applicant Date
All roof coverings to be Class "B" or better