02020007CITY OF CUPERTII
BUILDING DIVISION
CONTRACTOR ` 14®RIMA
BUILDING ADDRESS:
7774 OROGRANDE PL
OWNER'S NAME:
PHONE:
0 Q Z� ARCHITECTIENGINEER:
LD
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f— LICENSED CONTRACTOR'S DECLARATION
Z _ 1 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 to nd effe .
s 4 Lse CI ic. A
a v Contra to
i O h ' AR TECT'S DE ATION
H ; I understand my plans shall be used as public records
i p O Licensed Professional
o W OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
C ? < following reason. (Section 7031.5. Business and Professions Code: Any city or county
i 0 which requires a permit to construct, alter, improve, demolish, or repair any structure
2 prior to its issuance, also requires the applicant for such permit to file a signed statement
a 3 — that bit ii; licerts�d pursuanieo the provisions of the Contractors License Law (Chapter 9
(commencing. wi(h Section 7006),6f Division 3 of the Businespp'and Pmfessions Code)
or that he is exempt therefrom and the basis for the allig'ed efbmu?ubn. Any violation
of Section 7031.5'by any -applicant fora permit subjects the applicant to acivil penalty
of not more than five 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 sale.).
❑ 1, as ovrner,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 who, contracts for such projecm with a contractor(s) licensed pursuant to the
Contractors License Law.
❑ I arn,exempt under Sec. , B'& P C for this reason
Owner' Date '
"WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
{. ] ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's
�J( Compensation, as provided 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 Worker,'s Compensation Insurance, as required by Section
370Q of the Labor Code, for the performance of the *"rk for which this permit is
issued. My Worker's Compensation Insurance tamer and Policy number are:
Policy No.:'
CERTIFICATION OF EXEMPTION FRAM WORKERS'
COMPENSATION INSURANCE' � 1.6'
(This section need not be completed if the permit is for one hundred dollars
($100) or less.)
I certify that in the performantx o the work for which Uii's pemut is issued, I
shall n t employ'ang person, m y m r so as o comd subject to the Waricers'
cation Laws o(Califb a '
CE TO
Labor Code,you must
forthwith Comply w' su provisions or this permit shall be deemed revoked.
rn "CONSTRUC nON LENDING AGENCY '
I beeby affirm that there is a construction lending agency for the performance
of the work for which this permit is Issued (Sec. 3097, Chi.'C.) '
I•enderri Name'
�. z Under Address
® I certify that I have read this application and state that the above information is
Rt- E.4 correct I agree to comply with all.city and county,ofdiaances and state laws relating
0_ U to building consutiction, and hereby authorize represemHuves of this city to enter upon
�- the above -mentioned property for inspection purposes.,
�y Qy i (We)'egree to save,' indemnify and keep haimles3'the Ciry of Cupertino against
l=- rnf liabilities, judgments, costs and expenses which may in any way accrue against said
�.044I C rye in��. ��mmcofeanlutgmf thispecini�. ni v i, r�. r r"
-_,1®
V' � 11ALJUtVUUJ D7A1 EK1ALS ll1SGLVSUILtr. — ,
' Will the appGlant orfuture building oocapant stoic orh'andle hazardous material
of defined 4y the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code; Section 2$532(a)?
Oyes.
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Mariage'ment
District?
❑Yes N9,
i{ I' have read the hazardous materials requirements under Chapter 6.95 of the
Califprdia Health & Safety Code, Sections 25505; 25533 and 25534, 1 understand that
if the building does not c ntly have a tenant, that it is my responsibility to notify the
oceu alit of the rcquue en wh-,h mess[ be met prior to issuance of a Certificate of
an
—''- Owper or au - - Date C -,
ROCKWOOD CONSTRUCTION
248 BELDEN DR.
(408)227-7999
PERMIT NO.
ZP. 02020007
APPLICATION SUB DATE
02/04/2002
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
y I— I IJ =3
ADD 711 SQ.FT. Job Description
i -3
$120000
Valuation
101"--N i91bAT I ON I 1 Occupancy
L nTFRS
103
- UFER Required Inspections
104
- REBAR
105
- ANCHOR BOLTS
106
- SEWER & WATER
202
- UNDERFLOOR PLUMBING
203
- UNDERFLOOR MECHANICAL'
204-
- UNDERFLOOR FRAME
205
- UNDERFLOOIR' INSULATION
301
- ROUGH PLUMBING
302
- TUB & OR SHOWER
303
- ROUGH MECHANICAL
304
- ROUGH ELECTRICAL
305
- FRAME
306
- HOLDOWNS
307
- INSULATION
308 " r SHEEROCK„
3 0'9 • 'EXTERIOR t',LATH
3-10- .-= INTgR-IOR -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 - FINAL MECHANICAL
509 - FINAL GRADE `
510 - FINAL PLANNING
514 - FINAL_PUBLIC WORKS
Issued by: ''( Date V7
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. 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