03040086 CITY OF CUPERTINO 3xk'� , , � :t
BUILDING DIVISION
PERMIT zfi.CONTR"'CTnR I�NFORMATION
BUILDING ADDRESS: ALVAND CONSTRUCTION PERMIT"°03040086
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ER'SNAME: 10413 TORRE AVE. PERMITL%UEDATE
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PHONE: (408) 781-7620 SANITARY N0. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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100 LICENSED CONTRACTOR'S DECLARATION JobDescri tion
Eu 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing p
withSection 7")of Divmon 3 of the Busiwe red Profcasiom Codc.and my licenao is
in(alno C, red arrest. G �tZ�� (0 2-STORY SINGLE FAMILY DWELLING
y i Lbf f Cla Lic.N
;� Dans R fITELTS DECLA cum.cmr � LIVING SPACE 3075 . 25 SQ. FT. /GABA E 432 SQ. FT
ION t
I understand my plans shall he a A used public records
e8
Licensed Pnrfenionel J
c OWNER-BUILDER exempt
DECLARATION
COO 1 harcby.(Erre Na I am exempt s an Ne Contractors e:Any c Law for the
p O following soon.Permit
i 703 1.3,Business and are,do of Code:Any city S county
COO
u` which in ira•Issuance.also a cnnnrvn,pSims.plic Improve,do ermit t air repair any atmcmre (�
-Z i that he its eased etw acquires to he Ile Applicant for such Permit to fileom La(Chapter
poor that he is licensed pursuant to the provisions of the ComnnaM1 lJttnte Law(Chepter9 Sq. Ft. Floor Area Cyael OO
t�$ (commencing with Section 7000)o(Division 3 of she Buainaas and Prafessione Cade)or
.. that he Is exempt dertfrom and de bels for the alleged exemption.Any violation of
Section 7031.5 byanyappliamfor.permluubjecuthe applicant a civil penaltyof 39RJ310ftcr00 Occupancy Type
not more Nan five hundred doll.. - '
0 I,an owner of the property,or my employees with wages u their sole compensation,
will do the work,and de sructum is not Intended or offered for sale 7W.Business e air
and Pnfeaions Cadc:The Convnemr's License Law e not apply a Reaued Inspections
an owner of 101 - FOUNDATIONir
property who builds or improves demon.and who dmsaah work himself or through his
awn employace.provided Nat such improvements are not intended oroRered for ale.If, lO2 - PIERS
however.Ne building or improvement is writ within one year of completion,Ne owner. -
builaer will have the burden of proving do he did not build or improve for purpose of 103 - UFER
0
1,I,as owner of the proany.am clusively contracting with licensed contractors a 104 - REBAR
continuer tax projen(Sec.7044,Baines sea Profuaiom Code:)The Convtewra Li. 105 — ANCHOR BOLTS,
cense law Moan not apply to an owner of property who butles or improve Marron,and 106 - SEWER & WATER
who contracts for such projects with a contramorn)Iterated pursuant to the Contramme.
LtaemaL,w. 202 - UNDERFLOOR 'PLUMBING
am iftp sunder Sec. ,Bits PC fm@Bre an
tyC-\J-) 11 203 - UNDERFLOOR MECHANICAL
`WORKERS COMPENSATP iDECLAR TION / 204 - UNDERFLOOR FRAME
I hereby eRimr under Pen.lty of perjury am of the following declarations: 205 - UNDERFLOOR INSULATION
❑I have and will maintain a Certificate of Content to self-Usure for workers Cartoon. 301 - ROUGH PLUMBING
.tion,as Provided for by Session 3700 of Me Labor Code,for de performance of the 302 - TUB & OR SHOWER
work for which this permit is issued.
❑I ban and will maintain Worker;Compensation Insurance,a required by Section 3 03 - ROUGH MECHANICAL
3700 of Me L.WrCode.fm the Performance of Me work for which this pamrlt is tared. 304 - ROUGH ELECTRICAL
My W.A.e.Cnmpeaatioe Insurance carrier ad Policy numba am: 305 - FRAME
Cartier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS' 306 - HOLDOWNS
COMPENSATION INSURANCE 307 - INSULATION
ma.)Tha
( sea
ctioncdnoWcomplorha pe
ed lftrmltisforomhundredaollars(5100) 308 - SHEETROCK
Ir309 - EXTERIOR LATH
1 certify Met
�ianssodo,performance of the work for which Nis Permit B issued,I shall not '
Lawsoof C.11Tta in Say�Zr—an So In�—oma subjeaiw re Worken'Comprnalon 310 — INTERIOR LATH
am
ApplifFan� t 311 - SCRATCH COAT
NOT16ryf0 APPLICANT.ILAfter making this Certificate of Exemption,you should 313 - ROOF NAIL
burn object to the Worker's Compensation provisions of Ne Labor Cade,you must
=O funhwithcomply with wehprovisinmorthis Permitshallhedaemedmvoked. 501 - FINAL ELECTRICAL ENERGY
CONS rRUCfIONLENDING AGENCY 502 - FINAL PLUMBING ENERGY
Thereby oRvm Nat Nereisaconstruction lenaingagcmy for NC Performance of 503 - FINAL MECHANICAL ENERGY
Yi Ne work for which this permit I.Issued(Sec.NP7,Civ.C.)
4F5 L nae;"eme 504 - FINAL BUILDING ENERGY
Z) Z Lcnaer;Aaamse 505 - FINAL ELECTRICAL
;)Q 1 cenify Na I hen read this application rend satM that than Above information is
7 V correct.I agree to comply with all city dna county ominanaa and sate laws veining to 506 - GAS TEST
building constrction,and hereby sudsorine representatives of this city to enter 0'.Me, PLUMB G
N W abuvcmemioned property(m inspection purposes.Ir tL (We)agree to an,indemnify and kap harmnse,the City of Cupanino agaial O 8 F I L
fn fabllilenjudgments,costs andexpemes which may to any way accrue against said City 5
J7 in consequence of the granting of this Permit.
r7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 ING Date
\ SOU REGULATIONS, 514—tv
—I 3Re-roofs
III
Will
fApplien✓Convenor Dam 6E2 NAL PUBLIC WORKS
OOF PLYWOOD NAIL '
HAZARDOUS MATERIALS DISCLOSURE Type ofR�o 3 - ROOF BATTENS
Will Ne applicant or future building occupant store or handle harodous memrid
a defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety 604 - ROOF IN-PROGRESS
Section255324)?0rc. PNa All roofs shall be inspected prior to any roofing material being
Will the applicant or future building occupant use equipmcntordcvica which If a roof is installed without first obtaining an inspection,I agree to remove
' am0
luxurious air conarahmon as dcfimd by the Bay Area Air Quality Management all new materials for inspection.
Dixuiet?
❑Yes 00
In 11va read the haaadnm materials rtyvircmenu unser Chapter 6.95 of the Cali for.
nit Heal"Safety CoaC,section 25505,25533 and 25534.1 undersand dnlfda building
soca nm cumentiy hen s anm4 Net Il is myrca mlhility a nndl'y Rha mcupal of thp
myimmcn hichmuuhemetpoortoiuu cc fi
aCo. caeofOc cy SignatureofApplicant Date
Owner orauthorindseen, ' D All roof coverings to be Class "B" or better