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03010146 CITY OF CUPERTINO BUILDING DIVISION PERMIT .CONTRACTOR INFORMATION: .'' BUILDING ADDRESS: CAROL OZAKI/BARRY WHALL PERMITNO. 10115 CONGRESS �IR'S NAME: APPLICATION SUB DATE AROL OZAKI BARRY WHALL 01/24/2003 PHONE: SANITARY NO. CONTROL NO. ARCHITEC IE-NGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 Op LICENSED CONTRACnderp DECLARATION lob Description I hereby affirm that 1 am Of the a under ndPrinona of Chapter 9(commencingsis p with Section]tkk)of Division 1 of the Business and Pn4casinns Codc,and my license is hsm0¢trceanderfe,t. MASTER BATHRM UPGRADE/REMOVE PARTI-WALLS ar License Class Lic.Y yF❑ Dale Contractor 4 ARCf11'I-C*S DECLARATION 1unJcrswnJ my Pianists llWumJ as Public rcaxds �'�� Oo4ZoZyU ix Licensed Professional EyreOWNER-BUILDER DECLARATION x i I hereby effort that 1 am exempt from Ne Conlraclot's License Low An the DEC 152003 1Ep0 following mason.(Section 7031.5.Business and Professions Cale:Any cityorcoumy a.x$ which requires a Permit to construct,alter,improve,demolish.or mpair any arecom, _Zi prior mots iauaave.also requires the applicant for such permit to file a signed statement n P C Nm W is licensed pursuant to the provisions of to Connector's License Law(Chapter 9 Sq. Ft. Floor Area w11 ' ww.■ 7gly111i On al- (commencing with Section 7000)of Division 3of the Business and Professions Cale)or BY'YY' f� y $ that he u exempt therefrom and the bun for the alleged exemption.Any violation of YYYY Yi/ \A Secdon 7031.5 by any applicant for a permit subjects the splattered to a civil penalty ofOeeH Occupancy not more then five hundred delta.(6500). P y Type ❑1,as owner of the property.or my employees with wages as their sole compensation, will do the work,and fee structure is not intended or offered for sale(Sec.7099,Business .it Profession.Code:The Committees License Law does not apply to an owner of 102 - PIERS equlred Inspections property who builds or improves thereon,and who does such work himself or Borough his own employees,provided that such improvememB are not intended uroBered forsale.If, 103 — UFER however,the building or improvement is sold within one year of compation,the owner builder will hove the burden of proving that he did not Wild or improve for purpose of 104 - REBAR sale). 105 - ANCHOR BOLTS ❑l,as Owner of the property,am exclusively contracting with licensed contractors to 106 - SEWER & WATER construct the project(Sec.70,14,Business and Professions Cotler)The Contractor's Li cense law doss not apply to an owner of property who WnGa or improves themon,and, 202 - UNDERFLOOR PLUMBING Lwho icense Loturnouts for such Pmjecu with aconvacmr(s)licenxd pursuem to the Connector's 203 - UNDERFLOOR MECHANICAL ❑lam exempt m. ,B&P C for this reason 204 - UNDERFLOOR FRAME r �''- 1 2 03 205 - UNDERFLOOR INSULATION Ir WO KER'S MPENSATIONDECLA 301 - ROUGH PLUMBING (hereby aRrm under enalty of perjury,one of Be,following dedaraliom: 302 — TUB & OR SHOWER ❑(have and will for by a Cion 37 te ofCovem m selde,for ie Per(ker ice ofen- ution,u provided for by Section 3]011 of the IaWr Code,fnr the Performance of the 303 - ROUGH MECHANICAL work for which this Permit is issued. 304 - ROUGH ELECTRICAL ❑1 have and will maintain Workoh Compensation Insumnes.es required by Section 305 - FRAME 37M of the Labor Cale,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: 306 — HOLDOWNS Carrier: Policy No.: 307 - INSULATION CERTIFI COMPENSATOTE OF N7ON FROMINSURAANCEORKERS' 308 — SHEETROCK (Thisacetion neednot WcomplercdiftW permilisfornnc hundroddollaraDIM) 309 - EXTERIOR LATH press.) 310 - INTERIOR LATH 1 certify that in the per rico"'the work for which his permit is issued I shall nm 311 - SCRATCH COAT ereplayed,pe rum in a anners gg u+ "y subject to he Workers'Cnmpenaali in Laws nr c.hformsy ¢ - 313 - ROOF NAIL APPS NOTIC APPLICANT:ILafletans igthisCcnires.orExemption,youahnulJ 501 - FINAL ELECTRICAL ENERGY Wen nhjttunlheWorkcr'aCompcnsationpmvisionssfnc�LaWrCOJ0,"monet OO forthwith comply with such provisions or this Permit shall W deemed revoked. 502 - FINAL PLUMBING ENERGY z CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY rmdied there isaconstruction lending agency for amPerformance of 504 - FINAL BUILDING ENERGY C dework for which this Permit isissued(Sec.3lN],Civ.CJ Lender's Name 505 - FINAL ELECTRICAL 00 Z.D "dr;Aaama 506 - GAS TEST U p 1 cenay BOB 1 have read this application and state that the aWvc information is 507 - FINAL PLUMBING D. H come[.l agree to comply with all city and county ordinances and state laws relatinga. OU building conswction,and hereby aothodmrcprcsenutivesofthis city toenter upon the 5 FINAL MECHANICAL D7 show mentioned pmperiyfor inspection purposes. AnR O9 FIN 0. WO agree to save,indemnify and keep harmless the City of Cupertino against 7 rA liabilities, coats and expenses which may in any way accrue against said City 5 YN G 4 V inconsequence"(the grand ngit."f this Permf •7 APPLICANT UN ERSTANDS AND W COMPLY WITH ALL NON-POINT Issued by5 1 WORKS Date SOURCE REG A NQS^ �/� �I&I"' Re-roofs 'Were of ApplicunB nmrnctn o Doc HAZARDDU MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle maadous material Ave it by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety . Section 35s3zlayr All roofs shall be inspected prior to any roofing material being installed. ❑tea RN. Will the applicant or future building Occupant use equipment orAeviccs which If a roof is installed without first obtaining an inspection, I agree to remove emit baiallom air contaminants as defncul by the Bay Area Air Quality Management all new materials for inspection. Distnel? C]Yea ern l havereethe Waarthmns 2550alercquimment534.1u CbaPterfi95 side Wilding Dias no, umentSafety�pChle.Sections 35577 and 15579.1 to unify .P Willing Jas not current a tenant.der it ix m responsibility m notify da:rccuPanr of dm myviremenu /t(b l nP nni ancenreCcnificamnfoccapan Signature of Applicant Date t crnnudnrkmJ agent Date All roof coverings to be Class "B" or better