02080042 CTTY OF CUPERTINO
BUILDING DIVISION PERMIT ONTRACTOR'INF`URMA. Tq. s ;
BUILDING ADDRESS: REPUBLIC PROPERTIES INC PERMIT NO.02080042
R'S NAME: PERMIT ISSI%70
6/2003
NE: SANITARY NO. CONTROL NO.
ARCHIT S=rISNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�o6 LICENSED CONTRACTOR'S DECLARATION lob Description
1 hucby draw that 1 w licensed under pravisiou of Chapter 9(cgmmencing
MN Section 7010)of Division 7 ofsh.Business sod Profaadam Code,sod my Iiceme is
n� L e..ClasndeBen LIVING SPACE 3 , 139 SQ FT
j t�-� Once Class comm
allDau ARCHITECTS DECLARATION GARAGE 461 SQ FT
p6�5a 1 understand my pians sIWI he used as rytNic rtads
Z ted Licensed Professional
OatNEm BUILDER DECLARATION
a� 1 hereby a1Ron that 1 un ucmpt from the Cssions Co License law for she
"
GO following won.Permit
t 7031J,Business sod w.de Professions Code:MY city or county
1-$E which requires•eeamit re connrmL alter,improv.demolish, file
repair and stwol ul
ESQ poor at its issuance,also mquiresthe walrusof the Com hones toiense LawJso¢menl
F�
that he is licensed Pnnaam m the Providom of the Contrseora License law(Chapter Sq. Ft.Floor Area Valu
of (commencing with Section 7000)of Division 3 of the Business and Profeulon Cade)or
that he is exempt therefrom and to basis for the alleged!exemption.My violation of
Section 7071.3 by any applicant for a permit subjects the applicant to a civil penalty of APN Number liMey Type
not mom than firs hundred dolian(S504
❑I,u owner of to property,m my MPloyrra wW cages u Wei ell CMPeudm,
willdothewmk..ndshesbuc7um b niton¢nddoraRersd forasle(Sec.7044.1hudrcae Required Inspections
and Profession-Cade:The Commences Liam.Law does nut apply u sn comm,Of
q P
P.P..,who builds m)mprows thereon.and wha does such work himself or through his
own employees,provided that mh lmpmwmum an not imendedaro@mamraae.1f. 101 - FOUNDATION
however,the building or Improvement Issuld within am year of compiedon.the owner-
builder will have the Inwm ong N
f Proving he did not m rove Mid Impfea Purpose of 102 - PIERS
Aske')' 103 - UFER
❑1,as owner of she property am uelmively contracting wish licensed contractors to
comuuct the pmjca(Sec.70",Business and Profusion Cade:)The Continences U. 104 - REBAR
come Law dean ml Apply An an owner or property whe bdW,or hmgoves ft.. 105 — ANCHOR BOLTS
who contracts for such pmjecu with A conuactarts)licensed Pursuant u the Camnctm's
A.a law. 106 - SEWER & WATER
Sam:Iar�tapt under Sec. --�BBfPefor I-won 202 - UNDERFLOOR PLUMBING
---TA•e _" f - ' "A"� 203 - UNDERFLOOR MECHANICAL
WORKERS 5 DECLA DECLARATION
I hereby Anon underpcnalty of perjury one of the following declarations: 204 - UNDERFLOOR FRAME
Iw mon
and will malman.CeNlieate ofconant u self-insure fm Workers Compcn- 205 - UNDERFLOOR INSULATION
ssdon,as provided fm by Section 3700 of the Labor Code.for the peRmmsece of ft301 - ROUGH PLUMBING
work for whim this Permit is Wood. 302 — TUB & OR SHOWER
El haw and will maintain Worker's Compensation Insurance,u required by Section
3700 of the labor Code,for shat performance or to wart for which this permlt o blued. 303 - ROUGH MECHANICAL
My Work.ts Compenution lmm�nce carder and Policy number Am: 304 — ROUGH ELECTRICAL
Carrier: Policy No.: 3 0 5 - FRAME
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 306 - HOLDOWNS
(rhb spire need mtbecompletd ifte permit isfm onehundmAdoOva(5100 307 - INSULATION
roles..) 308 - SHEETROCK
1 o nify that In the perfnmmhha.��e0 of We work fm which this permit p lured,I shall not 3 0 9 - EXTERIOR LATH
employ any pe In ymihTerwu ubec`om subjattt�t�e arken'Con�aton -
U.OfCar-.i tkYYws��� �' 310 INTERIOR LATH
A loot
N IC APPLICANT:If, making nla visions of of ft amption,you de.YouMum 311 - SCRATCH COAT
bac' hsubject Morp nc it Workers ishms or thi. previsions of ton Iahm Cnsk,you mull
.,z foMwithcomply with such pmvidommNn permit shell he deemed rooked. 313 - ROOF NAIL
?y CONSTRUCTION LENDING AGENCY 501 - FINAL ELECTRICAL ENERGY
Er Ihereby afron lit them iurnnstruNnnlending agenryfortheperformanceof 502 - FINAL PLUMBING ENERGY
IQ; : shcwork for which shlapermit Is issued(Sec.3097,Cv,C.) 503 - FINAL MECHANICAL ENERGY
W Mai L eadars Name
z lamer-Addtna' 504 - FINAL BUILDING ENERGY
U O I certify that I hale mad this applicdan and sum,that the-bow Information is 505 - FINAL ELECTRICAL
I,,;'! correct.I&I=to comply with all city and county on inances and sole laws minting to
0 building consuuctmn,and herebyauthade reposenutiws of this city to enter upon the - GAS TEST
y{i7 aMw.mentmed propeny fm inspection pulposes.
L�, (We)agree to aw,indemnify and keep harmless the City of Cupanina agdmt O - F I
�y jj liabilities,judgments,casts and expenses which may in my way acme against said City ICAL
U in ormll
APPLICANT STANDS
consequence
Eof the Rranting of IANhis D WILL COMPLY WITH ALL NON-POINT Issued by: 5 Dat
S CE REGULATIONS. -
( , Re-roofs
gnetu.. Applicu ontrmu D1A3514 INAL PUBLIC WORKS
HAZARDOUS MATERIALS DISCLOSURE Type of Ro@f02 - ROOF PLYWOOD NAIL
WIII she applicant or futum building occupant More on handle autonomous moundRoad
Road byte Cupemno Mumep.l code.Chapur 9.1].and We Health and Safety 603 - ROOF BATTENS
Section 25532(x)7 All roofs st&U 4e iesp$�FpriMo-W00fdrogaterial being installed.
0 Yu
Will the Applicant or fuhum building occupant use equipmut or deviw which If a roof is installed without first obtaining an inspection,I agree to remove
I
hnamom air cmummiumts u defined by the Bay Arta Air Quality Management all new materials for inspection.
ict
❑Yet dJNR
I have mad ton huudms material-requlmments under Chapter 6.95 orale Califor.
ealth A,Safety Cask,ScNmu 25505.25577 stv125334.l understand shM if do Willing
not currently new•moot,Net it u my responsibility m notify she occupant of she
`menu(�uh must be met prior nc issuance of,Ccnipca araenpen Signature of Applicant Date
•-5—�\ Y l e All roof coverings to be Class"B"or better
�zrar.--mrd. ant —� D te —r 3 g