02060120TY OF CU PiEi(tTENO
BUILDING DIVISION
BUILDING ADDRESS:
20570 SCOFIELD DR
OWNER'S NAME:
PHONE:
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ARCHITECUENGINEER:
LICENSED CONTRACTOR'S DECLARATION
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 - Lit. #
Date Contractor
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following 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,
...prior.to.its issuance, alsorcquires the applicant for such permit to file a signed statement
that fit its lioauted p supttltq the prop isions of the Contractors License Law (Chapter 9
(commenting withSection,iiMO) of Division 3 of the Business aqd P55o(gssions Code)
or that he is ezeripf theiefroin and the basis for the alleggd ekemptioh. Any violation
of Section -7031.5 -by any applicant for a pemdt subjects -the applicant to a civil -penalty
:of not more than five hundred dollars ($500).
a—
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will dv the work. ant) the structure is not intended or offered for, sate -(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
'.offcredTor sale. If, hbwevee thebuilding or improvement is sold withiri orie year o(*
completion, the owner -builder will have the burden of proving that he did not build or
improve for purpose of sale.).
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-wbq conUticti.for such.projects.with.a cootractor(s) licensed pursuant.to.the
Co tractors License Law.
,[ a for this reason
iZ 'ION DEC ARATION
ereby affirm undar penalty of perjury Ope o(the following declarations:
❑ I have and will maintain a Certificaie o('Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the -Labor Code. -(or -the
performance of the work for which this permit is.issued.
❑ I 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. My Workers Compensation Insurance -carrier and Policy number are:
'Cai�ier.� '' i• t.'", Polity No.: _.. -
CERTIFTCATION,OFEXEMPTION FRO14 WORKEPS', -
° COMPENSATION INSURANCE `••
(This section need not be completed if the permit is for one hundred dollars
($100) or less.)
' I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in a manner -;o as j/bceme subject to the Workers
Cambensatib
Certificate of Exemption, you should
' beco s I t to the Worker's' Compensation provisions of the Liibor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
'CONSTRUCTION LENDING'AGENCY -
"i hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issded (Sec. 3097; Civ. C)
Lender's Name
Lender's Address
I certify that I have read this application and Mate that the above information is
correct. I -agree to comply with all city and, county ordinances and state laws relating
to building construction, and hereby iuthorize representatives of this city to enter upon
the above-mentioned property for inspection purposes.
(We) igree to save, indemnity 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.. '
ICANT UNDE,RST NDS WILL COMPLY WITH ALL NO -POINT
ate
HAtARDOUS MATERIALS DISCLOSURE
Wrll the applicant or future building occupani stort or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code; Section 25,5340" ,
- ❑ Yes ' ' ' VN. ..
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
❑ Yes -No .
I
have read'the hazardous materials requirements under Chapter 6.95 of the
Califomia Health & Safety Code. Sections 25505, 25533 and 25534. 1 understand that
if t6 building does 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
or
(CONTRACTOR
JAMES LEPETICH
PERMIT NO.
02060120
APPLICATION SUB DATE
06/19/2002
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LJ
Job Description
ADDITION/REMODEL
REPLACES PERMIT #21652 (OLD)
OTHER FEES PD ON OLD PERMIT.
3 5 9 TLVO ETTM .•. •, 11
101
- FOUNDATI9lKuired InspectioriS"' > = "•
102
- PIERS_
103
- UFER
104
- REBAR
10-5
-' 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
3.07
'- - 1NS'ULATION
-''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
508
9
- FINAL MECHANICAL
- ANAL
5510
Issue d�w A
gF
G T7n Date
Re -roofs 0
Type of Roof .... - ... . .
All roofs shall be insper.ted prigr.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 -
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINOAPPLICATITTA
INSPECTION DIVISION - JOB INSPECTION RECORD
JOB ADDRESS. C-P - { C( UNIT # LOT #
OWNER z�- � CONTRACTOR '� � - �
E,IT Nc;
A
CATEGORY
CONTROL a
BUILDING BERMIY ENFO
INSPECTIONDATE INSPECTOR
INSPECTION RECORD
NOTE: ALL GRADING AND DRAINAGE
SHALL BEINSTALLED TO COMPLY WITH
THE APPROVED PLANS AND CITY OF�
CLJI'ERTINO STANDARDS.
F32�1
FOUNDATION/PIERS
UFER GROUND .`
JOB DESCRIPTION
41 (2
PAD SET BACK-CERT
GARAGE SLABS/PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEAr SIGNED
INSPECTION
DATE
INSPECTOR
UNDERGROUND/SLAB
PLUMBING
ir 1-G)
ELECTRICAL
MECHANICAL
.,- - l/�
I
J
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
WOOD FLOOR
PLUMBING
ay"
MECHANICAL
ELECTRICAL
FRAMING/VENTS/CLEAR
INSULATION a ,•�) /,
PLACE NO SUBFLOOR UNTIL ABOV6�HAS BEEN SIGNED
ROUGH
PLUMBING
TUBS & SHOWER PAN
MECHANICAL
ELECTRICAL/JACUZZI BOND pf L/-7-
INSULATION/VENTILATION
G
'. EGRESS
SEWER
e l
NO WO N UNTIL ABOVE HAS E SI £
EXTERIOR SHEAR/HOLD DOWN . p.- e , -
INTERIOR SHEAR/HOLD DOWN Z07
SHEETROCK/SHEETROCK SHEAR
EXTERIOR LATH/W-SCREEN,1i.
SHOWER LATH
SCRATCH COAT
NO TARE OR PLASTE =UNTIL ABOVE: HAS BEEN SIGNED
NOTE: NO FINAL INSPECTION SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
FINALS DATE INSPECTOR O
SAN.#
ELECT. ENERGY
PLUMBING ENERGY
MECH. ENERGY.
BUILDING ENERGY
ELECT. FINAL TEST
PLUMBING
GAS TEST
MECHANICAL
HEATING �4 :eJ�
ELECTRICAL RELEASE
FIREDEPT. ,�
GRADE
OCCUPANCY
TEMPORARY APPROVALS
ELECTRIC t
GAS
BUILDING
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY, 24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT # ARE NEEDED WHEN PHONING.
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION
ISSUANCE DATE
ISSUED BY: _