02040021 CITY OF CUPERTINO ^
BUILDING DIVISION PERMIT olO TRACTORYNFORRATION:^�
BUILDWGADDRESS: PERMITN .
�j200955p6p1 HOMESTEAD RD 82040021
"OdA l a I NST I TUTE APPLICAT51sl&D 72 O O 2
SANITARYVN'OO./ lJ-S/ CONTROL NO
ONE: - .
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O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
raj Fj BLDG ELECT PLUMB MECH
Li C=1 L:7 I
Myi LICENSED CONTRACTOR'S DECLARATION nescrL@f$tltt� /� �L�
hinny am en thus1am lif,ha Bsunderppd P.fsofns Code9(commencing TENANT IMPRI VEI !!n. {'r` VF1 Ei
,2- w,infllforI03d)O(Di1'I,lOn3 ofthe Businessand Professions Cale and my license
'Y E J is in full fart,and ellen.
06u putle Glasa corn JAN 2 4 2003
LL O g ARCHITECTS DECLARATION
]understand my plans shall W used as public records
i&n
aapo Licensed Pmfesnonal
u�Ti LL OWNER-BUILDER DECLARATION BUILDING
11 1 hereby affirm that 1 am exempt from the Commnor's License Law for the $60000
h?Q following reason.(Secumn 7031.5.Business and Professions Code:Any city or county
4 a which rcquirts v permit to mnnruct,anal,improve,demolish,m repair any structure
v13Q ..Echam t,issum¢e,glw,nquirtnhe aPplicam for such permino file asigtrcdnWarneda. - m�cc11 [[tt _ _ _ _ __....—.....__ _ _
that he'islicensed PUrsuammthe pronsiom of the Conwcmh Liccnu Law lChvpur9 J_,,.,.1,...(,r3$ W'WWL C!6
(commencing with Satma 9Q003a(Division3of the Bysipess and Pryleasionx Codel is, s, y;T "°t w't r ` srl\ Valuation
or thvi he is
exempt
ero ithert(rom add the bust,tonne aIle-rd exam rod.An cirri ±.\; - s2':i*.: hg\.
P B P Y rialetion
of
Section 70315 byany vpplicam for v permit subjects the vpplicam m v civil penalry-
'ot/not.roore than five hundred sonars(S5D0). 10]APN rEldW&D T �:=p`•., .n Occupancy Type
, II,,son'nor of the property,army employees with wages smah sole compensvrion, lO2 - PIERS
t I do thEwbrana the awnure is nisi imendeJ-orbOcrBJ'for stile(Sec:)046;-' _
Boniness and Pro&ssmure Codc:Thc Comncror'a Littnx Law dos no,apply to an UFEF Required Inspections''._ '`•- - •
owner of gopeny Who Wilds ar improv,theuon,and who does such work himulf 104 - REBAR
or thmueh his own emplayas,provided then xuch improvements vrc not intended or
(fciad for sale.If,however,the buildic "'"_""-' -- '---- --- -------- -- -.-------_-___.
gar improv,mem is aald within one Year of
completion.she owner-builder will have the burden of proving that he atonal Wild or
imPmv,rorPurPar,af,al,.3. 106 - SEWER & WATER
.1 as c -, _ _—._.202---- UNDERFLOOR- PLUMBING ---.
El 1-a 10.f je p(Sec.7 a Bus vela c mrvn i with 1 cenud nwracts to n..l U' C . t - -construct theprola,(S 7044 Business d Pror„ a tae,)ThContractor 2 0 3 - UNDERFLOOR MECHANI CALi,
Uttnse Law doe eat apply m vn awns of pmpenY who builtls or Improves thereon, ,'..
und.who conwna..for.mch.projau with.a.cantneta(s)license] ant.m the. _2 04- - UNDERFLOOR_FRAME._ -
ORKER S O Er ATION DE R ION
r. Convut Li ens,la Pursu _ -. _______.. _ -----------
_.—_._ --------
01
-_
❑I anee,sr' - ' B pCforthisrtason 205 - UNDERFLOOR INSULATION
301 - ROUGH PLUMBING
�� 302 - TUB & OR SHOWER
the by rtmunder rultyofperjuryonearthefollowingdeclwtiam: " 303 — ROUGH MECHANICAL
I neve end will'maintain a Certificate a(Consent to"If-insure for worker', 304 - ROUGH ELECTRICAL
,. Compensation,-as-provided for'by"Section 37W of the labor Code, for the 305 - FRAME
performance (the work harwhiclathi.psorit is asood..,
r ❑IhvveonEsvill•mainnmwoke{compensuionlnsurance srequiredhy,Section 306 - HOLDOWNS
3700 of the Labor Code,for the Performance of the work'for which this Frauds is 307 — INSULATION
issued My Workei's Compensation Inane tuner and Polity tuber m. .308 — -SHEETROCK
darner• I. re td.i?�a9Policy No .-';,;.i a s'. t ve�.,.. .-n
F CERTIFICATION'OF,EXEMPTIONMom WORKElSSt, k,t}'''q •3O9k ..,•,EXTERIOR.\,LATH
.—. t Co1,-,`.,_ MPENSATION WSURANCE,, ." ..._._.......
: __. -..�
ERI OR..LATH_._
ffhu xenon neem.bemmpleied if the pc.it s for one hundred dollen 3111'- 'SCRATCH COAT Ss r r f,
slop) l / 313...7--ROOF, NAIL__.,,....
Irnfy tAat�' m perrarm ae b'the ok r non Perm, la uedl 501 - FINAL ELECTRPCALiiENERGY'
ihall pot pl o pe n in a s�7 b�c ul � (e�\'orken
Com eat / 502 - FINAL PLUMBING ENERGY _
p c t .. .. .. . _ .. -_. .._ _
C o 1 A I g, Eam1Ic0Ca1Eemplo you should 503 - FINAL MECHANICAL <ENERGY
o blecu the ka C status.,
at an ra mons of the LabsCod,you mut '
nh Mcompl wit ubhprovso rthispermtanonbedeemed revoker. 504 - FINAL BUILDING ENERGY
O p ro
j CONSTRUCTION LENDING AGENCY 505" = FINAL ELECTRI CAL t -
a�La I hereby affrm Chet the 's e co burn n le a g agency(r the pert tmance`
506 — GAS TEST 1
W bfthe ok(r"hch Inti pe tst ed(Sec 3091'0 CJ - "
y;q Letitia aNme '�: ..�•: ._ . ...'-507---.--FINA-L--PLUMBING -- - .__ _
D a ,Adan 508 - FINAL MECHANICAL
U-0
1\. ;' : .._ ..:,., t u ^ars-:�� -
�,,,� - ;,1 certify shot 1 hove reed(hrs applicnion ana uvm that the above information is 509 - FINAL GRADE
IT+'[r cortccL Inpee m,camP1Y with ell city eM coumy o(dinences ana sun laws rclning
O:V to Wildingmnvmmion.endheiebyeuthorizertprcsemetivuofthiscirymennrapon 510 - FINAL PLANNING
;ypW the abovcmentioned property for inspection purposes.
F
,U)
„ -
' ' stat
514 - FINAL PUBLIC WORKS
Uim mI aid
/
SPeEUR7 G. .EIX. SUDS AAD 7PLY'M7TH ALI.LO'9- INT' Uedb LY Date
rte f ofAppl t/C n act r at Re-roofsAZA DOUS MATERI DIS OSURE -
.. Will the
an Icant Tum Wilding nc panutort o nandl,horardovs renal Type Of.Roof _..
as defined by the upem o Mu tPal Cod Chapt 9 12 and the Health nd Safety ”' - -
coo,oY s usll(•1 'r Na ' c• •a I ` If a roof is all I ' r y-t
}
All roofs shall be nspected.pnor_to.any roofing.matenal being installed..,
Wdl the PPticent of fm buildingoccupant use equipment d vices wh'ch • ' t _..... .
nil hatod con wnna u' defined by the Bay Arta Air Quality Management tilled without firs obtaining an irispecnon; removeI-agiee.tol
stns+ . inspection.
t( a uvea Na all new materials for ms action Applicant understands no., comply,with_w _•.
4 all non-point source reguplattons
ll.r11havariced,he hagerdous mauriils gmrements'J der Chapter 695 of the
Cali Health'&Sef. Code,Sections 75505,25533 and 25534-1 undersand Chet
ird, bGlltling doesodt rreally have a(maraflot tismymIums' ilitym.mi(ythe
u
odim t 1 Ne re nimenwhich 'h Met p ,o� - iacau of
_ Signature of A_pplicant_.
Date.
r.iha ads t All roof coverings to be Class `B 'oretter " '
.. gar., .:are •.' t '•;c' , ;C'i� .. .i -..
. .-'.OFFICE-