02030051r
1_
CI
BUILDINGDIVISIONCONTRACTOR
PERMIT
INFORMATIO
BUILDING ADDRESS:
PERMIT NO.
10380 RIVIERA RD
02030051
_W NER'S NAME:
SILL BLACK & JEAN ZUO
APPLICATION SUB DATE
03/13/2002
HONE:
SANITARY NO. CONTROL NO.
AR�'HI't1;CT/<rNGINEER.. '"
!I
- BUILDING PERMIT INFO
�''
BLDG ELECT PLUMB MECH
! LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
i'with fallSectionme ado(Division3 of the Business and Professions Coda and mylicenae
is in full force end often.
License Class a
STRU
NO
J D C ,
U
ES G D V..
Lic.
" Dale
V
S DE LL or
ARCHITECT'S DECLARATION
I undersand my plans shalt be used as public records
,.
'Licensed Professional
DECLARATION
• Oat
-
I am BUILDER
1 hcrctiy.Stun rant I am exemptsforanan the Contractor's Low for the
followingreason.a Studiedit7031.5, Business and Professions Cade: Any city or county
e: Any c
which requires alae improve, demolish, or repair awment
n e, site marine,
.poor mits issuance, also rcquiiea the applicant for such Permit fleaeigned statement
rine, the ed
..._._..
that beiii licensed pursuant,q the pressor, of the Contractors License Law (Chapter 9
(commencing with Section]000)of Division 3o f,hefludoessartd ProQ/slons Code)
a.._ Sq. -Ft-Floor Area-,
t t, %, •1 ii. t 1:121:'1 I4'
V4.1uation
or that Fa is exempt therefrom and the basis (« me alleged ei ting ibll. Any violation
t 4t. LIE',
4: sa to
of Section 7031.5 by any application fora permit subi the applicanno. Q penalty
rofeet mora ,ham five hundred dci S500h.
umber
.' Occupancye
Type
111, as owner of the prupart , or my employees with wages es (heir sole comparisonn,
-will do 'he work. and the structure is not intended or offered for sale (Sec. 7614,
'Business and Professions Cade: The Contractor's License law does not apply Io an
-
102 -
- -
PIERS Required Inspections
w
oner of property Who builds or improves thereon, and who does such work himself
or throw h his own employees. provided that such improvements are not intended or
:comdd or sale. IChow6veiruilde then or is -sold within one of
10 3 -
.. __. - __..
UFER _ _ _ _ _
.. _ ._ ___-.__ . .__.—___..__ .____ _
—
year
completion, the owner -builder will have the harden of proving that he did not build or
hav t urden of preying
1 04 -
REBAR " fi"' "'
mProveforPurposeofsale.).
105 -
ANCHOR BOLTS
l:asnwnar pmpmyam rlusl an se at c
ont omm
-- 106 -
SEWER & WATER
el the jCcc
tutee Contractor
c4wat plc.y 7to a cowerBirth. and arty who ills or The vas t encs a
Licet ply to an owner otpropeny who bu0da or improve:menton,
'
2O2 —
UNDERFLOOR PLUMBING
.and.in ch projects W' co ors"' )licensed. pamaant.m me
cc .,
.... -. 203- -
UNDERFLOOR --MECHANICAL'
Oraa. in ' `' reason
Our
204 -
UNDERFLOOR FRAME
ate 2'I'B&Pctar,ma
'S
205 -
UNDERFLOOR INSULATION
L(d3sl�—
R COMPENSATIONDEC ATION
301 -
ROUGH PLUMBING
I hereby aSrm and r Malty of perjury one of the following declarations:
302 -
TUB & OR SHOWER
1 has. add wi0'main,'n a Cernficat= of Consent to self -imine for Worker's
303 -
ROUGH MECHANICAL
ompelva,ion, as -p d -for by Section 3700 of the Labor Code, for the
erfomantt of the work for ivnich this permit la issued.
304 -
ROUGH ELECTRICAL
° I have and will mainairi Workers Compensation Insurance, es iequirtd by Section
3 0 5 -
FRAME
3701 of the Labor Code, for the pffonom of the work Fe, which this permit is
tasued Mr workers Compensation ton Insurance tamer and Policynumber306
-
HOEDOWNS
comer.; ; ,,, Paecyrla _-,
-
-- 3.0,7,',-,IINSULATION ....
i. CERTIFICATION OF EXEMPTIONFROMWFRKEBS���'SHBETROCKv'"°'
COMPENSATIONINSURANCE-
309 =
;EXTERIOR"liATH ".._ __._ ..__...
(Ths section need not W completed d Permit pent is for one hundred n dolle
anless.)
310 -
INTERIOR LATH
cetly that in thea f the work for which this Fermi, is issued.I
F _...' y x rio Yana manner
shull'nol employ an Person in an to become subject to ,he Workers'
-3"11' -
313 -
SCRATCH --COAT
i,� t,,•,_.!{„ „ .. '_.
ROOF NAIL'
Laws ar California. D.m�
-. Applicnsa
Applicant,
501 -
FINAL -ELECTRICAL ENERGY.-.-.--------_--
NUI lUb rO APPLICANr: If, after making this Certificate of Esemp,ion, yen should
become subject o the Workds Comp=nmtion President of the Labor Code, you must
502 -
• �
FINAL PLUMBING ENERGY
fen it aamply with each pmviainna or this permit anau be deemed revokes:
503 _ -
FINAL ME CHAN I CAL. :_ENERGY-,-_., ....
CONSTRUCTION LENDING AGENCY " -
' thereby aSrm that there is is conswethm Icndinyy agency for iW performance
ofmo for issued(Sce. "�
504 -
FINAL BUILDING ENERGY '
.. "
work which this permit is 3097, Cia.C.)
ode a Name ..... .."., - I .:.. .. ,
Lend Address
505 -
... _ _
506 -
FINAL ELECTRICAL
GAS TEST',
I <CM1 Iy Ictal I M1YVe read tnla plication t d stale that the above information is
507 -
FINAL PLUMBING
coirta. l a¢ree m comply with ell ciry.and county ardinentts and vara laws ralving
508 -
FINAL MECHANI CAL
to Wilding conawnio.and hereby amh'onze rtprtumativex of this ciiy,o emerupon
,he above-numioncd pony for inspenian puryosea,. ,
(We)agrte 'e, indemnify and keep harmless the City of Cupenlno against
509 -
FINAL GRADE
liebili!I ,jpdgmcts ss,endexpenuswhich.mayinanyweyaccmeagvas( said
510 -
FINA PL ING
City in nseq a "granting of this Fermi,.
'APPLIC T'L IFS NDS AND WILL COMPLY Wtf}i ALL NON -POINT
s it L c-
S1 -
Issued by:
I C WORKS
Date w
0
Re -roofs
�t
atai'
' " G, HAZA DOUS MATERIALS DISCLOSURE' ' ' '
' Willihe applicont or orate building «cupinl tore or handle heiardous melena)
Type of Roof
..
u earned br.me Cupertino unicipa Coda Chapur9.13. and the Health and safety
Code 5 otos 85J71a1 - •-
❑Yes No
All roofs shall be
-
inspected pnor to.any roofing,material,being installed.
- Will theepplic. _future building occupant useequipmentordeviceswhich
,it Ismansku air contaminate; ss dallied by m Boy Area Air Quality Management
If a roof is installed without first obtaining an inspectiod;'I agree`to remove
imr
all new materials
for inspection. Applicant understands and will comply with
°Y . • .. / "°
all non -point source regulations.
C ld I btavilic read m h iardaus mals requ der255 Chaplet 6.95 of the
Sections
ctio 5533 a d
the Time du& CodC lyhaveioname,th 8577 and 255J4.lity1. understand that
the ilding does t .ratty haveeunant, that it is my rcaponsihiliry ,o notify ,he
oceupa , of e'rc which must be mei prior m Issuance of a Cmiri an, of
"
y'' ILS
Signature of Applicant
Date
All roof coverings to be Class "B" or better'
ow rapt , en - Dale
.. OFFICE