03020043TY OF CUPERTINO
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BUILDINGDIVISION PERMIT
F
,C YVWAA
RINA1'IONDI
NO ADDRESS:
J. M. O'NEILL, INC
PERMIT NO.
N DE ANZA BLVD
R's NAME:
5880 W. LAS POSITAS BLV, #
I.gmirr's"UDA"
1NEI10275
DI VITTORIO GAETANO S AND MARY
.
2003
:
9 2 S 2 2 5_ 12 O O
SANITARY NO. CONTROL NO.
ARCHITBCf/BNOINEER:
BUILDING PERMIT INFO
1
BO O PLO 0'.
LICENSED COMitACfOR'S DECLARATION
lob Description
P
1 hereby arm that I ate licensed under provisions or Chapter 9 (commencing
with Section 7000) of Division 3 of shell And Pro(eWom Code, and my license is
`
mBlntrme And a
�,�u `�
REVISION. IN-HOUSE PERMIT ONLY
o"n"�La" Com' r'
ORIGINAL PERMIT #02120052
ARC FF=Sf Pj�. RATION
I understand my plans shall be used an public mcnrch
Licensed Prorenional
OWNER -BUILDER DECLARATION
I hereby affirm NAI I am exempt form Ne Contractors License Law rot the
following mason. (Section 703 1.5, Business and Professions Code: Any city at caumy
which toqulms a Permit to construct, alcor. Improw, demolish, or repair any swetum
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poor to Its issuance• also requires the applicant fnroch permit to rile a signed statement
that be Is licensed punuunt 10 the Forwhiomsur the Contractor', License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 70M) or Division 3 of the Business And Professions Cede) At
that he is exempt therefrom and the basis far the Alleged exemption. Any violation of
APN Number
Occupancy Type
Soca an 7031.5 by Any applicant far A permit objects the applicant 10 a civil penalty of
not mom than five hundred dollars (55007.
32633103.00
❑I,uowner o(the progeny,mmy employes with ngexu thehnkeompemdon,
'
d Ins eCt10Ds
n p
will do to work.and thethuctme Is ml lmended m offered err Aala(Scc. 704/, Business
and Portman Cade: TM Commerce, Limits law does not apply m an owns of
work Wtot Waugh his
101 — FOUNDA 1
-PIERS
OwIntenenywhe yces, pds idodt at such improvements Amts norhounded or
iorI that swhimpmwm sads. If.mu,aa-
however,
however,
- 102 —
of cmpledn.err
the bull thebrlmprowmanntsmt he did not WeldArImproeforNeoweM-
due wtinmt year
builderwillnavetheburdcne(ptming that he not Wild Ar for purpose of
� � 103 — UFER
nit.). - -
104 - REBAR -
❑ 1, As owner of the property am exelualwly Cont acting with licensed contractors in
10S - ' ANCHOR BOLTS
construct the pmjcM (See. 7044• Business and Profusions Code:) The Contractor's U.
'.
came law does not apply to an owner or property who bund. at improve, thereon,and,
106 — SEWER. & WATER-
who contractsfm such projects with a cam actor(.) licensed pursuant the Contractor.
ucenselaw.
202 - UNDERFLOOR PLUMBING
m exempt under Sec. . B Be P C for this mason
203 .- UNDERFLOOR MECHANICAL
Dam
204 - UNDERFLOOR FRAME
205 — UNDERFLOOR INSULATION
WORKERS COMPENSATION DECLARATION
I hereby aim under Penalty of perjury ane of dte following dmlaratmm:
301 — ROUGH PLUMBING
ave and win matnhain a Certificate ofComent to self-imum forwoker.Compna-
, u provided for by Section 37M a( the Labor Code. for the performance of the
Imy
� 3O2 — TUB & OR SHOWER
err which mf. pemws issued'303
- ROUGH MECHANICAL
ove and will reaittem Wmiers Compensation Insurance, u required by Section3Ola
— ROUGH ELECTRICAL
-
or the labor Code. for the perfarmance of d n weak for which thla permit is issued.orkerSCampenntlon
Insurance carrier and Policy number am:
305 — FRAME
ekEep%l� p pPaneWNr..' �1=�'02
3.06 - HOEDOWNS
4J ceRTIFICOMPENSATI TION CBDRlcEies•
307 - INSULATION -
(Thla section need not becompleted if flit 7cm0 la(mune hundreddollan(SIM)
308 — .SHEETROCK
oi1Ps67.._._ .- - ----- _'_ ---
-----309---EXTERIOR LATH
1 certify that in the pc,in mance of the wok for which thl. permit is Issued. I slWl nm
cmplq any person In any man terse u m become subject to the Wokcrs'Compewtion
310 - INTERIOR LATH
L.w..fCalifornia. Dam
311 - SCRATCH COAT
Applicant
313 - ROOF NAIL
NOTICE TO APPLICANT: Ir. After making this Certificate of Exemption, you should
become object to the Weker's Compeondon pmvlalona of the LAW, Code. you must
fordwith Comply with such Provkinm Or this pemiuhall be deemed revoked,
501 — FINAL ELECTRICAL ENERGY
502 - FINAL PLUMBING
CONSTRUCTION LENDING AGENCY
' I hereby Afron that them is a construction lending agency far the pnrumnance of
.ENERGY
503 — FINAL 'MECHANICAL ENER
the work for which this permit issued (See. 3097, CIN. C.)
Leader', Name
504 - FINAL BUILDING ENERGY
Lender's Address
505 - FINAL ELECTRICAL
I canify that 1 haw mad this application and sham that the thaw information B
506 - GAS TEST
COMM. I Agra m comply with all city and county ordinances and sue laws mining to
building construction, and hereby authorise mpmxnu0ws of Nis City m enter upon One
FINAL PLUMBtNG
Above-mentioned Plenty for WAPCM on Pupwet
(We) agree to saw, indemnify and keep humlen the City of Cupertino AgaWt
nabilideaduegmenm emu and expenses which may in Anyway Accrue agalnsuaid Oly
In this
0 8 FIN L
5 A ,7
Al
consequcme of the Senting of pcmih.,
APjjrjjjLLLLLIQAf4T UNDERSTAND" AND WIL COMPLY WITH LL N OINT
Issued by:51 Date
ShRQ,RQGULAT �'�j �(�,
CCApplian
Re -roofs
Slgnatumu mraMAr Dam
HAZARDOUS MATERIALS ISCIDSURE
Type of Roof
Will the applicant or future building Occupant nom arhandle haurdous material
Med by the Cupertino Municipal Code. Chapter 9.13, and the Health and Safety
Section 35533(a)7
':�No
All roofs shall be inspected prior to any roofing material being installed.
❑Yes
devices
If a roof is installed without first obtaining an inspection, I agree to remove
Will the Applicant or ffuu rum building Occupant me Aqulp ncm or which
.'
it hataninus Air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yea �No
I haw read the hnaoduus material. requirements under Ch.PuM 6.95 ofde Califon,
lined,k SifmyCrde,Senimts 25505.35533MW253 .I umkr Uoulfthe building
Z'
oma of cA ntly haw. tCoant; the li Is my poi IMIi o do omupant of do
n
rear enuwmm�m It. '-m' of con race
Signature of Applicant Date
� �
All roof coverings to be Class "B" or better
Ow car ode col Date