01100027C:
-CITY OF CUPERTINO
CONTRACTOR][NFORMATJC�T_
II
BU.LDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS:
11850 UPLAND WAY
LARRABEE CONSTRUCTION
01100027
OWNER'S NAME:
3275 STEVENS CREEK BLV,
APPLICATION SUB DATE -
#10210/04/2001
PHONE:
(4 0 8) 985-4121
SANITARY NO. CONTROL NO.
ARCHITECTIENGINERR:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o L= t= LL -i
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
ADD SUPPORT FOOTING.
is in full force and e ffe
It — S,
License Class Lic. #
DateContactor
or
U ARCHITECT DEA -ARA
S
lford!f���
I understand my plans shall be used as public
LRensed Professional
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
v$4 0 0 0
which requires a permit to construct, alter, improve, demolish, or repair any structure
,%prior.to its,issuance,,also re te ment—
.......
n
'Valuation
.gLiires-theapplicant-for4ucl�pern�ttofile,asigned�sta
tliat.b4i9,Ji6h*d t.u?sii1fti i6i the p�bvjsions of the Contactors License Law (Chapter 9
3 Bponest,and
(commencing with Section -7000) of Division of the Professions Code)
li�e exempt iherdioril'ind the basis for the alldged e: tnnptibl Any Violation
is
of Section 7031:5 by any applicant for a permit subjects the applicant to a7civil penalty
of not,more thab five hundred dollars ($500).
10 1APN DAT I ON
Occupancy Type
0 L as owner of theproperty, or my employees with wages as their sole compensation,
102 - P T -F.Rq
will do the work; add the' structure is not intended or offered for sale (Sec. 7044;
Blis'litiess';md Trofessi6ni Code: The Contractor's License Law does not apply to an
103 - UFER Required lnsplectidfis:"'
owner of property Who builds or improves thereon, and who does such work himself
0 4 -
or through his own employees. provided that such improvements are not intended or
gffe.po, wsale. If,_however, the building or improvement is sold within one year of
..REBAR
105 - ANCHOR BOLTS
completion, the owner-builder.will have the burden of proving that he did not build or
improve for purpose of sale.)..' I
106 - SEWER & WATER
ffl,!as pw_ner_o_f t-he,,p, r—ope, n_y,_ an exclusively contracting with licensed contractors to
-
` 202 - *UNDERFLOOR PLUMBING
construct the projecu(Sec. 7044, Business and Professions Code:) The Contractor's
License Law'does not apply to an owner of property who builds or iniprovesthereon,
203 - UNDERFLOOR' MECHANICAL
and wh - contracts for such -projects with a coritractor(s) licensed'puFsuarit to the......
.....
204 -UNDERFLOOR - FRAME
Contractors License Law...,
❑I ..'exennpt under Sec. ,g'&�PC,fordtisre on
205 UNDERFLOOk�'INSULATION
06er'
301 ROUGH ,PLUMB,ING
WORKER'S COMPENSATION DECLARATION
302:- TUB :& OR SHOWER
I hereby affirm under penalty of perjury oge. of. tbeSollowing declarations:
303 - ROUGH MECHANICAL'
0 1 have aad ',will rhathtain;'a Ceriificaie of'-&nstni to self -insure for Worker's
304 - ROUGH ELECTRICAL
Compensation, as provided, for by Section 3700 of -the Labor Code, for the
performance of the work for which this pepnit•is issued.
305 - FRAME
01 have dn_d will main6tin-Workeei Cgmped§aticn;lnsurarice, as-ieqiiiired 6y:Sr: on
ithe
306; - HOLDOWNS
1700 of. the Labor Code, for the perf6imance.6f work foir which this permit is
i' 'W' kqr' C " s�on Insurance carver and Policy number are
307 - INSULATION
'SUEE
Carver. Y.
TRO'CK
_WPR,
-CElZTIFICATIONOF.EXEM7QNF9o9 I S"I .....
-,3.,0'9 --EXT' -tAT1-r,.--
.R.,
COMPENSATION IN _�E .
71NTER1 CYR 'LATH-
Cmis section need noi be completed if the permit is for one hundred dollars
311 SCRATCH COAT
($100)or.!ess.)
�bik for witch
I certify:ihai ii�'& pi�ffornriaricehf'the, w c is per7nit is issue,
manner, - s . o I as to b�lc b'
shall'nol emplqy-.apX1person,Jm.an , oTe supiect to Wpikers'
•ROOF AIL
501 FINAL ELECTRICAL`' 'ENERGY'
.any —, .. i' I , I ,
CorppensationLAwsofCalifomia.Daie' .
Applichfit� I . -, �.-. I . . 1.. :1 . I.. " __
-502, FINAL PLUMBING ENERGY --
NOTICE TO.APPLICANT: If, ffter making this'Certificatei of Exemption, you'should
liccoirni'subjeLt to the'Worl�er'&C)m'pe'nsati'o'n'prov'isi'o'n's of the Labor Code, you in ust
503 FINAL MECHANICAL 'ENERGY
is
forthwith comply with su�h prov! ions or this permit shall be deemed revoked.
FINAL BUILDING, ENERG)',_._._
'tONSTRUCT16MLENDING AGENCY' I "''t'
_50-4,7.
— : 1, , " 'I
505 FINAL ELECTRICAL
I hi�reby'affirrfi that thtire'is'a construction lending agencyfhr the pedmiance
Permit is igs4ed:(Sec,.;3097, cixl. C.
bf,the work for which this506
GAS TEST
Lkdwsi Nhine-
Leadcr'"ildress'
507 F I &AL PLUMBING.
508 FINAL MECHANICAL
I certifithatJ have read this application and state that theabove information is
,Cuhrect' I agree to-comply.I with all city iuid.county ordinances state laws relating
50 9 - FINAL GRADE
to building ccmstrucd&i,land lier6� inith6irize representatives S:city to enter upon
tke,above-mentibried property for insp,ecfion purposes.
510 - FINAL PLANNING
(We) agrde toisavi,(indenrinify . keep liahrltis� ihebty o Cupertino against
aria
514�� - FINAL PUB IC WORKS
liabilities, judo.ents, costs and expenses which -may - in any way accrue against said
City inconsequence 6f-ihii granting of ihis'piiroL
- . �t)P'WrTHALL NbN-PO; & T
ANDMqLL COM
P U I hl�;ST -
Issued by: Date
dZj�ANDS
NS, •
Si rii/C0b&dtm • 'j" Date
re,ofA'p'Plica
fs
Re -roofs
WARDOU&�.4ATERIALS DIS C
fumire.buildiiig'occupant stoi� hazandolismatefial,•
-Type-of Roof,- -
as defined by,the Ciipertino MqhjcipaliCode, Chapier 9.12� and the Walth an"d Safety
•:C
Oyes 0,
Altroofs sliall.be-inspected.prior to any, roofing. material,beinginstall d.
Will the applicant or future building occupant use equipment or devices which
'cciniamltiami - -
of is ifts6114 Without first obtaining an inspecti " I- " A
If a roof on,, agree. o. remove
emit haiakdoui'air asd6finid byilie�Bay Area Air Qu'alityManajt! inent
all new materials for inspection. Appk�afit understands and will cornply..with
❑Yes. •
all non -point: sou-r-ce"regulations�,.,,,,,.,,.!
'Ihave re 0 6:bi"dous matehaJs requirements under'*C-hapfer'g.i5�)o'f.-t'h'e
'Secfioas 25505�25533 and 25534.1 understand,that
bal�fo a�Heal� Safety Code,Sections
d rig.doesnot currently,have.a.,tenant,, that it is my -responsibility to notify the'
'� il6ifthe.requiri
%
occkipant men hi h b e rior to issuance df a Cer&i0tei of
o
Signature of Applicant = Date
All roof coverings to be Class "B" or'beiie'r`
pKr authorized Date
OFFICrE