03070174 (2) CITY OF CUPEWFINO k 'r�
BUILDING DIVISION PERMIT m CONTRACTOR INFORMATION
BUILDING ADDRESS: ALVAND CONSTRUCTION PERMITN003070174
R'S NA MG: 10413 TORRE AVE. PERMIT ISSUE DATE
PHONE: (408) 781-7620 SANITARY N0. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
?Op LICENSED CONTRACTOR'SDECLA TION Job Description
I� 1 hereby affilm that I am licensed under previsions" hapter 9(commencing
with Scetion7aa)of Division 3nfthe Busimessand prufesaiuu edeand my license is
Sp? �otosecl;a;°d effect.
Lic.x REVISION--IN HOUSE USE ONLY
Dow—CeNnn"r NO NEW PERMIT ISSUED ORIG. #02080042
Ie ARCHFTECTS DECLARATION a
t a I understand my plans shall he used as public records
>yU
Licensed PM1IrC3a111n0
cOg OWNER-BUILDER DECLARATION
I 1 hereby affirm that 1 am exempt from IW Comnnoh License Low r the
COO following reason.(Section 7131.5,Business and Pmfevinw Code:Any city or c my
5$� which requires a permit m conslmct,alter,improve,demolish,or repair any struel
-iy prior or its issuance also requires Ne applicant for such formicto NC a signed natemcn
that he is licensed pam.ammthc pmvisiow oftW Comrvmri License lAw(Cllapmr9 Sq.Ft. Floor Area Valuat10A107
r�S (commencing with Section 7000)of Division 3 of the Business and Profesaiew Crnle)w '7
I£E that he is exempt Ncodrom and the basis for the alleged enmp0un.Any vlolmion of
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty,.1 3 rlkAnimnh.w.1.4r0 0 Occupancy Type
not mon than five hundred dollar($300). 3 FJ�Y Int .
❑I,as owner of the pmpcny,or my employees with wags,as thein.lcwmpenmlon,
will do the work and Ne awnun is not intended m.ffered for salt(Sec.7044,cosines
and Professions Code:The Contractors License Law does nor apply to an owner of Required Inspections
property who builds or improves therc.n.amd he dmessuch work himselfmillr.ugh his 01 - FOUNDATION
own employees,provided Nat such improvements arc not Intended oroRered for ale.If, 1 2 - IERS
however,Ne building or improvement is sold within one yev of completion,the owner
builder will have the burden of proving Oilhe did not Wild or improve far puTwo of ].0 — UPFER
.in I.
104 - REBAR
co I,as owner of the Sec.7 y,am exclusively Professions
with licensed rontr¢mrs to
come La the project(Sec.]044,Business roti property
wh i hit C or improve,
Comremors Li LOS — ANCHOR BOLTS.
ces,elawdos,not r such apply man owner ofproun(s who WiIds
namprovs,theteon,and
, 106 — EWER & WATER -
who contracts Toroth prejcca withaconwnor(s)liu dpunwmmthe C.nuactoh
License Law. 202 - kDERFLOOR PLUMBING
am esempt under ,B&PC for Nis n/+yon 203 - UN RFLOOR MECHANICAL
r J Sec. Date 3 s 0
WORKER'S COMPENSATION DEC ATION 204 - UNDERFLOOR FRAME
, 't IhembyamrmundorXultyofMdutyomofthem0owingdeelmilom: -205 - UNDER OOR INSULATION
rQlhave madwill maimdnsCcnificumofCnnen
atloself-inmmmrWm1,m'sCompam 301 — ROUGH UMBNG
cation,as provitled far by Senior 3]00 of the I�Wr Code,for the performance of the 3 02 - TUB & OR SHOWER
work for which this permit is issued.
Q 1 have and will maintain Worker'sCompemallon Insurance,as required by Section
303 - ROUGH MEC I CAL
3700 of the Labor Code,for the performance of the work for which this permit is issued 304 — ROUGH ELEO ICAL
My Workers Compensation Insumum carrier and Policy number an: 305 — FRAME
Carrier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS' 306 — HOLDOWNS
COMPENSATION INSURANCE 307 - INSULATION
(This section need not W completed if the Permit is for one hundred dallan(510B 308 - SHEETROCK
or Icss)
I amory that In the pe,pana mce or the work(or which this permit is issued,1 sh.11 not 309 — EXTERIOR LATH
employ any person nm in any mentor so as enhance subject m the Workers'Compensallon 310 INTERIOR LATH
of
Laws of California.Data
Applicant 311 - SCRATCH COAT
La
NOTICE TO APPLICANT:If,after making this Ccniftcve of Exemption,you should 313 - ROOF NAIL
became subject to the Worker's Condominium provisions of NC Ishnr Code,you mum
.J z forthwith Comply with such provisions orunsPermit aha0the deemed revoked, 501 - FINAL ELECTRICAL EN RGY
Z 0 CONSTRUR[ON LENDINGAGENCY 502 - FINAL PLUMBING ENERGY
(•. 0 IWmbya(lirm0.,thenisac.ommcti"nlending agency car Mperfurmanceo( 503 - FINAL MECHANICAL EN GY
94 the work ter whim this Permit Is issued(Sec.UN7,civ.C.)
W q Lenders Near 504 - FINAL BUILDING EN GY
= z Lender.Address 505 - FINAL ELECTRICAL
U0 I certify that 1 have read this application and sate that he above information is 506 - GAS TEST
W correct I agree to comply with all city and county ordination;and cute taws relating to
OU building construction.and hereby auction reprosomatives of this city to enter upon ft FIN PLUMB I G
W omv.-Temohmed property for iasrchea npuriwxs.
(We)agree t.save,indemnify end keep humlen the City of Cupertino against Q$ FIN' L
h Iiabilitics,judgmcna,cosuanl cspcnvs which mayin anyway accrue agais,tnid City 5
Uz in co gwncc of the gmmingo! /
" APPLICANT UNOERS7 ILL COMPLY RH ALL NON-POINT Issued by:5 NG Date
SD�RCE REG LATIOf3�(`-``\--%' 2S 14 NAL PUBLIC WORKS
�¢ Re-roofs
' "aturcofApplicam/Contractor Date 6 2 OOF PLYWOOD NAIL
HAZARDOUS MATERIALS DISCLOSURE Type ofR3 - ROOF BATTENS
Will site applicant or fawn Wilding occupant stem or landle harucluw material
darned by the Cupertino Municipal Code,Chapter 9,13,and the Health and Safety 604 - ROOF TN-PROGRESS
Senior 235320)7 All roofs shall be inspected prior to any roofing material being installed.
p res jyNo
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
colt h.,x dous all conaminann as claimed by the Bay Ana Air Quality Management all new materials for inspection.
District?
❑Yes AN.
I have mad Ne lmsaid or mat remenaumkr Chapter 695.1'the Calif.,
ria HcaOh&Sefct w35505,25533v 534,1 andenanducatiftice Wilding
dors t comer have a chum.Net it u my resp Ibility m aroly do mc.l.t of the
req me which us norI.inu of.Centre. Signature of Applicant - Date
own uramh mdagcnt D rc All roof coverings to be Class"B"or better