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CITY OF CUPERTINO
CUNTRi�CTOR INFOW TION
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
03050123
gl
PERMIT ISSUE DATE
05/27/2003
SANITARY NO. CONTROL NO.
ARCHITECUENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTORS DECLARATION
Job Description
p
mender provisions Chapter 9 (cmmmeaing
I hereby strip Na 1 am liad uof
with Section 7000) of Division 3 of the Business AM Notation Code, and my limom is
In fell rec L6$oB2
La,�
UNDERPINNING
(7 PIERS) TO GARAGE BEAMS
Dau — _ A CHnSCITSD Conimwr ATION
CONTRACTOR:
SOIL ENGINEERING CONST.
- I understand my plan shill be used As public records
Licensed Professional
OWNER -BUILDER DECLARATION
I herehy aRrm that 1 am exempt from the Contactors License Law for the
reamn. (Section 703 1.5, Business and Profcaions Code: Any city or county
JULfollowing
J U L 1 0 2003
which requiresa Permit to coning, alter, improve, demolish, or reour any structure
prim N In issuance, alm inquire; the oppliWnt formch permit to file a signori anement
Contractor's Lane U. (charm, 9
Sq. Ft. Floor Area
Valuation
that be is licensed pursuant to theprovisiomnf the
(commencing with Section 7000) mDivision 3.1' the Bminunnd Printing ... Code) tar
Nat he Is exempt therefrom and de bast& for the alleged exemption. Any vlol da of
APN Number
'
;; ccupancy Type
Secdon 7031.5 by arty applicant fora permit subjects the applicant 10 A civil penalty of
not more Nen five hundred dollars (SSW).
I, a owner of the pmpany, or my employers with wages, a their sole compensation,
357040(;9
00
Required Inspections
will do the work and the structure Is not intended or offered for AM, (Sea 7044. Business
and Professions Code: The Contractor's License law does not apply to In owner of
property.bbulids m improve thereon, and who doessuch work himself or through his
101 -
FOUNDATION
owmployeca, provided Na such improvement& ere not intended oroRered image. If.
n e
'
however. the building or improvement Is mid within one you of completion, the owner.
102 —
PIERS
builder will new the burden of prating that M did not build or improve for purpose or,
103 —
UFER
ale.).
❑ I, es owner of the properly, am exclusively contracting with licensed cmitina ms 1.
104 -
REBAR
construct the pmject(Sec.7044, Business and professions Cade:) The Contractor's Li.
105 —
ANCHOR BOLTS
cense law does not apply to an owner of property who Wilds or Improves thereon, and
who contracts for such projects with a conuacmKA liansed pursuant o Ne Consume,
106 -
SEWER & WATER
`u .
❑em xempt antler S,Bk PC for this anon
I.exempt
202 -
UNDERFLOOR PLUMBING
203 -
UNDERFLOOR MECHANICAL
m Dam
WORKER'S COMPENSATION DECLARATION
204 -
UNDERFLOOR FRAME
(hereby affon under pealty of perjury one of the following declarations:
205 —
UNDERFLOOR INSULATION
❑ lbw and will maintain•Certifieam of Conmm to self-itnum for Worters Compen-
301 —
ROUGH PLUMBING
inion, As provided for by Section 3700 of the lobar Cede, fm rhe performance of the
302 -
TUB & OR SHOWER
work for which this permit is boea
❑ I haw and will maintain Workers Compensation Insurance, As required by Satin
303 -
ROUGH MECHANICAL
3700.1' the labor Code. for the performutecof the wort for which this permit is banned.
304 —
ROUGH ELECTRICAL
My Workeh Campeuadon I.. g d Policy numbers.:
�NpoliayNo.:IZ4 teal- ar2
305 -
FRAME
CERTIFlCATE OF E% PI ON FROM WORKERS
306 -
HOLDOWNS
COMPENSATION INSURANCE
307 -
,
INSULATION
(This section reed trot he completed if tae permit is for one hundred dollar(SIM)
308 -
SHEETROCK
m Ins.)
I unify Nit in Me performaae of the work for which this permit is kated. l shall am
309 -
EXTERIOR LATH
employ any person many manner an As in become subject o the Workea'Compenution
310 —
INTERIOR LATH
Laws of Calif..!.. Data
311 -
313
SCRATCH COAT
ROOF
Applicant
NOTICE TO APPLICANT: If, after making this Cenificam of Exemption, you should
become subject t. the Worker's Compensation provisions of the labor Cede, you mutt
-
NAIL
forthwith comply with such provisions or this permit hall To deemed invoked.
- 501 —
FINAL ELECTRICAL ENERGY
CONSTRUCTION LENDING AGENCY
502 -
FINAL PLUMBING ENERGY
1 hemhy teff rte that Nert in cmuwninn lending agency for ted perfurmma of
Me work for which this pmmit is issued(Sm. 3097, Co. C.)
503 -
FINAL MECHANICAL ENERGY
Lender's Name
504 -
505 -
FINAL BUILDING ENERGY
FINAL ELECTRICAL
Iemms Add.
j I certify that 1 haw read this Application and tete that the above Information is
cortecL I agree to comply with all city and county ordinances and auto laws relating to
506 -
GAS TEST
building contraction, and hereby mthurixe representatives of this city to enter upon the
FIN PLUMBI G
above-mentioned property far inspection purposes.
(We) agree to saw, indemnify and keep harmless the City of Cupertino against
F I N L
j liabilities, judgmenu, costs and expanses which may in any wry accrue against City
590—
in consequence of the granting of this permit
A PLICANT UN TANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by
-
Date
uaceR u Na Ste` _ ��o�
Re-roofs514 -
Type of Roof
NAL PUBLIC WORKS
curt o Ap im an -.I- Date
HAZARDOUS MATERIALS DISCLOS E
Will me a pliant in future Wilding occupant atm Or handle hassNous maedal
u defined by the Cupertino Municipal Code, Chapter 9.13, and the Health and Safety
Section 25531(07 --�'``
an
All roofs shall be inspected prior to any roofing material being installed.
C] Yea
If a roof is installed
without first obtaining an inspection, I agree to remove
Will the applicant of future building occupant use equipment or devices which
emit heardom air anuminanU a ned by the Bay Arta Air Quality Management
all new materials for inspection.
Dimim7
❑ Ya o
1 hew real the haaNmrsmxurixt& requiremcnu underCbper 6.95.1' tieGlifor-
nt&HatthhSafctyCode,Seeti=u M5.25533au125534.1uMermnddWIftie Wilding
J net chew x tet the it u my responsibility m notify the meting of de
sameurren nm met pdSrmiu....I,Cent f ` pan y.
Signature of Applicant
Date
'IV11
—EC S-03
All roof coverings to be Class "B" or better
caner .r..tn.rim ant Dee