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02070170POC_ &Ut, a rFnaa O Z y- C P!2 �aaQ n`.pat; t�3c,,y H N aoC aX ce �zQ SSC � z a3- CITY OF CUPERTINO BURMING DIVISION PE' "IT CONTRACTOR WOR"TION-. n BUILDING ADDRESS: PERMIT NO. 10585 FLORA VISTA AVE. 02070170 07/26/2002 PHONE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH L= L=J 1_ _I LICENSED CONTRACTOR'S DECLARATION Sob Description 1 hereby affirm that I am licensed under rovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busin and *e�ns C anmy license ADD 175 S Q . FT . �e, is in full o e and elle LI L 6 L[ s � Li Date _ ConuuwaqoQr ARCHITECI"S DEGiARATION 1 understand my plans shall be used as public records Licensed Pro(essibnal OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county $18756 which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement +`ea Valuation that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9o,+p (commencing with Section 7000) of Division 3 of the Business and Professions Code) 32 O �' O LLS U U or 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 penalty1�,}, of not more than rive hundred dollars (3500). 101 `kPNN CNN ffAT I ON Occupancy Type ❑ I, 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 Contractor's License Law does not apply to an 103 - UFER Required Inspections owner of property Who buil&s or improves thereon, and who does such work himself or through his own employees. provided that such improvements are not intended or 104 — REBAR 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 10 5 — ANCHOR BOLTS improve for purpose of sale.). 106 — SEWER & WATER ❑ 1, as owner of the property, am exclusivEiy cent rac ng. ith lice contractors to 202 — UNDERFLOOR PLUMBING construct the project (Se.,. 7044, Busin and P to stuns oil a Contractor's License Law does not apply to an ow r of mproves thereon, 203 — UNDERFLOOR MECHANICAL a who contracts for such projec w' or tor(s) want to the Ctractor's Li 204 UNDERFLOOR FRAME I exem a for this reason 9-2b-02— _ 205 UNDERFLOOR INSULATION " ' 301 — ROUGH PLUMBING L ARRATION KG ON DECLARATION 302 - TUB & OR SHOWER I reby affirm under penalty of perjury one of the following declarations: 303 — ROUGH MECHANICAL ❑ I have and will maintain a Certificate of Consent to self -insure for Worker'? 3 04 — ROUGH ELECTRICAL Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 305 - FRAME ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 306 — HOLDOWNS 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number are: 307 - INSULATION Cartier. Policy No.: 308 — SHEETROCK CERTIFICATION OF EXEMPTION FROM WORKERS' 309 — EXTERIOR LATH COMPENSATION INSURANCE 310 — INTERIOR LATH (This section need not be colleted if the pennit is for one hundred dollars cs100) or less.) - 311 — SCRATCH COAT shall not Cdfifficate of Exemption, you should come sub' t to the Worker's Compensation provisions of the Labor Code, you must 503 — F I NAL ME CHAN I CAL ENERGY forthwith c ply with such provisions or this permit shall be deemed revoked. 504 - F I NAL BUILDING ENERGY CONSTRUCTION LENDING AGENCY 505 — FINAL ELECTRICAL I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) 506 — GAS TEST Lenders Name Lender's Address 507 — F I NAL PLUMBING I certify that I have read this application and state that the above information is 508 — F I NAL MECHANICAL correct. I agree to comply with all city and county ordinances and state laws relating 509 — FINAL GRADE to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. 51 0 - FINAL PLANNING (We) agree to. save, indemnify and keep harmless the City of Cupertino against liabilities,; nts, ems nil expTn hich may in any way accrue against said 514 — F I NAL U WORKS City m con u f t ntin Qertnii T L\`�O/-0 MPLYWITH AL N PO�� Issued by: % Date f A ica a tractor Date SiIdined Re -roofs ' HAZARDOUS M IALS DISCLOSURE ill the applicantoc4atn [ ding occupant store or handle hazardous material Type Of Roof as by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Cction 25532(a)? ❑Yes G No All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? all new materials for inspection. Applicant understands and will comply with ❑ Yes El No all non -point soufce re ions. I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Saf Code, Sections 2550 7-5533 and 25534. 1 understand that {� i([he building does no u a-aatenult t it is my responsibility to notify the c� occupant of the requi m is us[_ ni2r to issuance of a Certificate of Occupancy. h� _ U gnat re o pp ' Date All roof coverings to be Class "B" or better Owner or authm iz d agent Vale OFFICE