02080167z
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CITY OF CUPERTINO
CONTRACTOR INFO ®N.:
BUELDING DIVISION
..PER -D
BUILDING ADDRESS:.
'PERMIT ism -
18971 PENDERGAST AVE.
:02080167 .'
08/29/20012
PHONE:.
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.Ch. apter 9 (commepcing
ADD 262 SQ.FT.
with Section 7000) of Division 3 of the Business and Professions Code, and my license
is in full force and effect.
License Class Lic. #
Date Contractor-
ARCHITECT's DECLARATION
undmia -be used as.public records
Nccioscid Profsiollal
UILDER 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 of county
$28081
which requires apermit to construct, alter, improve, demolish, or repair any structure
prior. to its issuatice,also requiresthe applicant for.such. permit to file a signed statement-
tKat1ic"N lice. IM �iqvjsions of the Contractors License Law (Chapter -9
. I
7090) 6f Division 3 of the Businessand Professions Code)
3V4 71
Valuation
(c"o'mij!�,'nc,i'p�g..�p'!h•S�qgI
n S'z[it'd
the basis for the lleg'M.ek6mpliion. Any violation or that'hels'exempi thl&lfr'o .
-the
of Section 7031-5 by any,applica t -fora -permit subjects: applicant to wcivil penalty
-ofinot more than,five,hundred dol ark ($500).
)�l
10 iAP-N ft*DA T I ON'
Occupancy Type
El I, as owner of the property, or in . y employees with wages as their sole compensation,
102 PIERS
--will-do th-e'wotk;,aisdilre:'gLructuff'isi'nbt iritendeVor'offebed fdrsald-(Sbc:'7044
f-Builfiesisak-Pi6fessions Code: The Contractor's License Law -does not apply to an
103 :UFER Required Inspectibri§:"'
owner of property. Wh6 builds or improves thereon, and who does such work himielf
104 REBAR
or through his own employees. provided that'such improvements are not intended br
`p'--
--SOLT-9,
iFdfoirsalc�. If.'K Qr,'iWb4ildinj-6r! iiri6vimiiitis`i6ld withini
ANCHOR
6orniiietion, thc.o'wner-builder will.have the burdenof proving that he didnotbuild or t
improve -for purpose of sale,).
106 SEWER & WATER
U.J.,asiowncr,of.the.property, am exclusively -contracting with li6ensed contractors to
2-(Y2-- ---.UNDERFLO`O`R—PLUMB1NG--WC. P.r'R,!!'f !NFO
consa;act the project ('Sec. 7044, Business and Professions Code:) The Contmclor*s .
License Law does not apply to an owner of property who builds or improves thereon,
. 1, .1',
203 UNDERFLOOR MECHANICAL'' i W! %,I
And -who. j:ontrActs for such-projem-with.'a contractor(s"censed-pursuaut -to,:thc..'
Contractors License Low_.
0 1 aM exempt ufider Sec. ii P C for this reason
205 UND E R F L 0 0 IZ-1- IN S dhAT I ON
V2 ON DECLARATION
301 ROUGH PLUMBING
302 TUB & OR SHOWER
- -"Thereby affirrin under pepalty.of 0ij6ry:ooe,of-the
...,followingdeclarations:
303 ROUGH MECHANICAL
0 1 b'f' 'C'onseht'to self -insure for Worker's
304 - ROUGH ELECTRICAL
,C-ompeqsation,- as -provided -for b -Section 3700 of the Labor Code, for the
,Compensation,- . y
-perecirm.ance of the work forwhichthis ,pe it is issuecL,,,,..
.305 - FRAME
El I haveand'widrriai4din �Vciikerl Compensation . lasurati'c'e,`a�-requirecl by Section.
306 - HOLDOWNS
3`70061"thi I2ib6itC6deJbri6e peffornfailtb 6f iheii�k fo��wfiich -this pery"itis
- , ;... .. . q
307 - INSULATION
I I 1. 18 .
ksudd:TAyWokMr'gCoffipensati'wliisUian6etaffier�ifd'P6ric�l�4�iti6r'ar�:
.4 ",'.1
Y'lit"I_.-.'s"—-'0--8---
V ; i k r I
I Poficy go.:
-s-Tl� OCK
.1 .1
�,EfT
T N.PF'EXEMMON-FRD?kW.ORPRS-;-'':.•
PENSA1ION.IN90RA-XCE-,1
J309. L' ft"Tq.0R1,`AE-ATHC
:Tu
Uc'6rnoeied'if the permit is for one hundred dollars i
3 12: 'SCRATCH COAT
(SI00) or less.)
'iC -
-�i -pe�
1-1-3 -
that in the p9 1sf
jk;�ViiW eoi ii2e
`ikllf-abt emp'ldy'a*,9y-p6so,qWi& I e��, p of bit "onne s�`bJect,t , o theWbAdrs'
aw f m Z
501 FINAL
H6 nr
S:0Tlt8 TO'APPLICA,�T� It-'d&'r hinkiHS.'this Certirkate'df Fxemptioh,,ybu� sh6uld,
.50.2 ..-=...FINAL--PLTJME31N-G-..ENERG-Y-.------.. ...........
S03 - FINAL ME CHAN I CAt " t�42RGY
�6'6m6'�'ubjec�'tb'tfi6Wr�6'r';Corii�eng�tib�n ovi�l6�softhe'LAb6rcodq,'yo�'misE.,
66,
fofthWith'c'or661�`Mtl� ii�cfi provisions or this permit shall be deemed revoked.
504 - FINAL BUILDING ENERGY,.-_
C6NSTiU(JIOR LENIJI
505 - FINAL ELECTRICAL \V:
I�hereby'a irmthat there is:i construction lend ng gen'�yjftir,
a )Jhe pe.oftahce
ifilgiie'rnilt ';�iv.
506 GAS TEST
of the".w'cirk Idir which is'liiued (9,��'J07 C)'
Li&nder'i Na
Address
..... . ......
YI NAI; PLW'B'ING'�
�epd,qr'�
: !
that LhAveaepd this that the information is
50 AL
FINAL MECHANICAL
I certify application and state above
iagrce;R,9omft,-wjdh �ll-city,itnd.cpunt.y,-oidinances, and state laws relating
herebq'Ltfidtike44r�nii6i,s bf i9iscity to enter,
5 - INA E
A L
-to'biaildiliniconsthidtion, ad upon
-tlie.abcniemefificned pro6qidrt�i for,inspection S*
_ I NAL NG
5 0 - INAL NG
ifMd
(W44riP"oS5if -J�de6ni e CA, ific� eirj6f &]�� r'd n- o- against
Date
'
Re -r oofs
HAZARD ATERIALS DISCLOSURE t';
f uilciihi
f.I�pe.of,Roof,--.
111. 0.4pp c ;A. occupant store of material,.,
�Wlll. 0
',Qhapter,9:12;
.
.Jas,clefiftedb �the h and the,Health'Qnd$afdty,
ins. �of ng material-being.installed
-..All.,r.o.ofs..shalLbe inspected-priorAo. y.�, ., 1
i t e,
e RR future budding occupant use equipment or devices which,
.
If a roofis installed without first obtaining J agfevlo r
installed . . . "' "' 6thove
pg an inspec, ion
emit. ha2drMtk a ma ts erliiaed bith.Vay Aic.'Air .Quality Ma4gdmem.
bigtrkt7
Yes -/"0.
all new materials" for inspection. Aolic'ant understands and will .co y Ny
-
-ou-irce
all non-poin-Csr-e-gu anon
I. ha�- ;�4uircmuii der'Ch-p'tcr,'��.,9;5'of the
Sietions.2551)5.-23533 anud"25334.. 1 -.understand that
hzv,,fA OhMit:
.. ifin building uflding does,noi aii -that itisinyins ibility.to7notify ille,
& I t
gintly
-&�pant �rdbi 6quitith iiiii %Vfiich`ffidk'.,b� met.prior. tb'issu 41
.1 , • t. . . .- 1�
, .
.Ll- ..
. - I
I
Wniture ppheant-) Date.
of A
• 84�n /Vi.
Dite
All. roof coverings to be Class, "137 or .better
Accu
ccul�i
A
ibira4b
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