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03010136CITY OF CUPERTINO BUILDING DIVISION PERMIlk-w CONTRACTOR INFORMATb0i: BUILDING ADDRESS: ROWE CONSTRUCTION CO INC PERMITNO. 19985 PRICE AV OWNER'S NAME: 980 SMITH RD APPLICATION SUB DATE 01/23/2003 PHONE: (83 1) 722 - 12 04 SANITARY NO. CONTROL NO. WOO ceUU aZ vF,aa uJ a aO,U uu, t -=0a a�p0 Xm� w..y FZa ce 4 uJ ARCHITECTIENGINEER: LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with S__ectio99��7000) of Division 3 of the Business nd ofessionsCode, and my license is n fuand effect. (t (+� Zs� haw Contrt. ARCHITECTS DEL ATION 1 understand my plans shall be used as pu tic records -icensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the 'ollowing reason. (Section 703 1.5, Business and Professions Code: Any city or county ,which requires a permit to construct, alter, improve, demolish, or repair any structure mor to its issuance, also requires the applicant for such permit to file a signed statement .bathe is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 ;commencing with Section 7000) of Division 3 of the Business and Professions Code) or ,at 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 five hundred dollars (S500). 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 sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Conu ictoes Li- cense 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. E31 am exempt under See. , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain aCertificate of Consent to self -insure for Worker'sCompen- sation, 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 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 Insurancecarrierand Policy number are: C3KjerlySNlerV- — krPolicy No.: 0 0 0 i CERTIFICATE OF EXEMPTION FROM WOR S' COMPENSATION INSURANCE (Ibis section need not he completed if the permit is for one hundred dollars IS 100) or less.) 1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workcrs' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the worker's Compensation provisions of the labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 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.) Lender's Name Lender's Address I certify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS ILL COMPLY WITH ALL NON -POINT Q Sign f Applican Contact ate HAZARD S MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑ Yes itf" 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? ❑ Yes 1,1115 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a tenant, djal'riis my responsibility to notify the occupant of the or Date BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description BATHRM REMODEL/UPGRADE ELECT, PANEL & WIRING Sq. Ft. Floor Area 102 - PIERS Required Inspections 41 Occupancy Type 103 - UFER 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 ENERGY 505 - FINAL ELECTRICAL 506 - GAS TEST 507 - FINAL PLUMBING 5 MECHANICAL 09 E 5 4FINAL G Issued by51 WORKS Date l 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. Signature of Applicant Date All roof coverings to be Class "B" or better CITY OF CUPERTINO BUILDING DIVISION PERMIT CQNTRAGTUR INFQRMA . 01 BTV�glRpkjCE AV ROWE CONSTRUCTION CO INC PERMIT NO. 03030163 980 SMITH RD PERMIT ISSUE a /V2 4/ 2 0 0 3 PHONE: (831)722-1204 SANITARY NO.CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lie.# REVISION TO UNDERFL. --IN HOUSE USE ONLY Dale Contractor NO NEW PERMIT ISSUED, ORIG. #03010136 ARCHITECTS DECLARATION 1 understand my plans shall be used as public records ADD B PLANCKRE P FEE $111.00 --PER POH Y.04/24/03 Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county 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 that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he it exempt therefrom and the basis for the alleged exemption. Any violation of APN Number 9qqug4IQy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 0 I, as owner of the property, or my employees with wages as their sole compensation, 3 6 9 0 5 0 41 . 0 0 Required Inspections 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, 101 — FOUNDATION 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 102 — PIERS sale.). 10 3 — UFER ❑ 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 Li- 104 — REBAR cense Law does not apply to an owner of property who builds or improves thereon, and 10 5 — ANCHOR BOLTS who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. 106 — SEWER & WATER I am exempt under Sec. . B & P C for this reason 202 — UNDERFLOOR PLUMBING Owner ate WORKER'S COMPENSATION DECLARATION 203 — UNDERFLOOR MECHANICAL I hereby affirm under penalty of perjury one of the following declarations: 204 — UNDERFLOOR FRAME �Ihave and will maintain a Certificate of Consent to self -insure for Worker's Compen. 205 — UNDERFLOOR INSULATION salion, as provided for by Section 3700 of the Labor Code, for the performance of the 301 — ROUGH PLUMBING work for which this permit is issued. O 1 have and will maintain Workers Compensation Insurance, as required by Section 302 — TUB & OR SHOWER 3700 of the Labor Code, for the performance of the work for which this permit is issued. 303 — ROUGH ME CHAN I CAL My Worker's Compensation Insurance carrier and Policy number are: 304 — ROUGH ELECTRICAL Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 305 — FRAME COMPENSATION INSURANCE 306 — HOLDOWNS (this section need not be completed if the permit is for one hundred dollars (S 100) 307 — INSULATION or less.) 1 certify that in the performance of the work for which this permit is issued, I shall not 3 08 — SHEETROCK employ any person in any manner so as to become subject to the Workcrs' Compensation 309 — EXTERIOR LATH Laws of California. Date Applicant 310 311 — INTERIOR LATH — SCRATCH COAT NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you muss forthwith comply with such provisions or this permit shall be deemed revoked. 313 — ROOF NAIL CONSTRUCTION LENDING AGENCY 501 — FINAL ELECTRICAL ENERGY 1 hereby affirm that there is a construction lending agency for the performance of 502 — FINAL PLUMBING ENERGY the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name 503 504 — FINAL MECHANICAL ENERGY — FINAL BUILDING ENERGY L.cnder's Address 1 certify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to 505 — FINAL ELECTRICAL building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. — GAS TES T (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City 5 I CAL in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: _ Date SOURCE REGULATIONS. Re -roofs 510 Type of Ro �f 4 INAL PLANNING — FINAL PUBLIC WORKS Signature of Applicant/ContractorDam HAZARDODOUS MATERIALS DISCLOSURE HAZA Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? All roofs shall be inspected to any roofing material being installed. C]Yes ❑No C] Yes prior If a roof is installed without first obtaining an inspection, I agree to remove 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 all new materials for inspection. District? C] Yes C] No I have mad the bazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building docs not currently have a tenant that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a certificate of occupancy. Signature of Applicant Date All roof coverings to be Class "B" or better Owner or authorized agent Date