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02100014 CITY OF CUPERTINO f.�q •" =" BUILDING DIVISION PERMIT .CONTRACTOR INFORMATION: '.. Bu1120C7A9JiESSCOFIELD DR WM H FRY CONSTRUCTION COM pisWN102100014 JTV CHAMRAJ 10351 SAN FERNANDO AVE APPLICATI�U1/� I'Y2002 INr:: (408) 996-8173 SANITARY NO.// VV // CONTROL NO. ARC HITECfIENOI NE ER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Poo LICENSED CONTRACTOR'SDECLARATION ��TT��tt,, z�F I hereby affirm that l am licensed under provisions of Chapter 9(commencing INTERIOR REM011E'LDe&scrip[ion with Section 71X0)of Division 3 of Ne Business and Prufeseioes Code,and my license is w O �� y.pw in full home and effeci.9 �Zo78t SHOWER @ M/BATH '�' . INAsl l� Z O S1 Z License Class Lic.X oz-p Datc 0111-/-o7 Co..trsctur iu N Fin? 4as-f7— �� ' ARCI..TECI'S DECLARATION MAY 0 7 403 sSy R (......stand my plans shall M used as public records 11IF11 Co uF1 W O Llccread Pro msional ` y m that DECLARATION �'�VFY�� at a f I hereby.flirat 1 am exempt firm the Contractor's License Law for the ,u p O following reason.(Section 7031.5,Business and Professions Code:Any city nr county, - x$ which acquires to permit to construct,alter,improve,demolish,or repair any structure $30000 w-re Thar o its i.ssuance.al.sre requires the applicant for such permit to the a signed statement �Z< that he is licensed pursuant tu the provismmof the Comrvclms License Law(Chapter 9 Sq. Ft. Floor Area Valuation o (commencing with Section 7(kg)of Division 3 of the Busineas and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of 35912004 . 00 Section 7631.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy e not mom than five hundred dollars(s500). 101 - FOUNDATION P Y Ty YP ❑1,as owner of the property.or my employees with wages as their sole compensation, will do fie work,and the structure is not intended or offered for sale(Sec.7844,Business and Professions Code:The Contractors Lic rose Law drops not apply to an owner of 10 3 - UFER Required Inspections imroves property who builds or pthereon,and who does such work himself orthrough his own employees,provided lhatsuch Improvements are not intended oroRered forsale.If, 104 - REBAR however,the building or improvement is and within one year efcompleion,the owner- lO5 - ANCHOR BOLTS builder will have the burden of proving Nat W did act Mild or improve for purpose of aln.1. 106 - SEWER & WATER ❑1,as owner of the properly,am exclusively contracting with licensed contractors to 2 02 - UNDERFLOOR PLUMBING conswct the project(Sec.locate,Business and Professions Cade:)The Conlracmr's Li" cense Lass does not apply to an comer of property who Milds or improves themnn,and. 203 — UNDERFLOOR MECHANICAL who contracts for such projects with a colarachohn licensed pursuant in the Contractors License Law. 204 - UNDERFLOOR FRAME IamexemptunderSec. B&P C for thisacascn 205 - UNDERFLOOR INSULATION act Dam 301 - ROUGH PLUMBING WORKER'S COMPENSATIONDECLARATION 302 - TUB & OR SHOWER I hereby affum under penalty of perjury one of the following declarations: ,303 - ROUGH MECHANICAL I have and will maintain a Certificam of Consent m self-insure for Worker's Compen- sation,as provided for by Section 3710 of the labor Code,for the performance of the 3 04 - ROUGH ELECTRICAL work for which this peamil is issued. 305 — FRAME c and will maintain Worker's Compensation Insurance,as required by Section 3 06 - HOLDOWNS Blind the Labor Code,for the performance of the work for which this permit is issued. M Workers Cnmpcnsatinn Insurance canicr and Policy number are: 3O7 - INSULATION rtie.: rnrfF.vu� Policy Nn: /s 1t `L 308 SHEETROCK CERTIFICATE COMPENSA7'[ON INSURANCE 309 EXTERIOR LATH (This section need not too,completed it the permit is fornew hundred dollars D Its)) 310 - INTERIOR LATH mless.) 311 - SCRATCH COAT 1 certify Inco in the performance of the work for which this permit is issued.1 shall not 313 - ROOF NAIL employ any person in any manner se as to become subject m the WorkersCompensation Laws of Celifllmla.Dam 501 - FINAL ELECTRICAL ENERGY Applicant NOTICE TO APPLICANT llafter making this Cenilicam of Exemption,you should 502 - FINAL PLUMBING ENERGY become subject trvhe Worker's Compensation provisions of the labor Code,you must 503 - FINAL MECHANICAL ENERGY OO forthwith comply with such provisions in this permit shall lc deemed revoked. CONSTRUCTION LENDING AGENCY 504 - FINAL BUILDING ENERGY �N+ I hereby affirm that there is a cnnstmcticn lending agency lot the performance in 505 - FINAL ELECTRICAL p; D the work In,which this permit isissued(Sec.3097,Civ.C.) 506 - GAS TEST fi7 Q Lentil Name Z Lender's Address 507 - FINAL PLUMBING U O 1 verify that 1 have read this application and stem that the above information is 508 - FINAL MECHANICAL fL (~ comon.Iagrecmcomplywithallcityandcountyordinancesand.starelawsrelatingto 5 FINAL GRADE Q building construction.and herebyauthense representatives of this city to rearupon the W .hove-memienWproperty for inspection purposes. 10 FIN I G (We)agree to save,indemnify and keep harmless the City of Cupertino against ferry, liebilitics,judgments,cask and expenses which may inanyway accrocagainst mid City rj N I WORKS J Z in consequence of the graming of this Permit, APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date elil v SOURC REGU TIO Re-roofs nature of Appfirmd Cnmrm Dire HAZARDOUS MATERIALS DISCLOSURE Type of Roof Askla Will in .pelican,or future building occupant store or handle havaNuus material chard by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety e.Section 25532..3? `' All roofs shall be inspected prior to an roofing material bei.. Installed. E]yo �N P P Y 8 g 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 in hamNeus air emu m cants as defined by the Bay Ama Air Quality Managcmcnt all new materials for inspection. 7d�'mv trict? ❑Ycs No 1 have read the haMous materials requiremcnk under Chapter 6.95 of the Calihn- Health A Safety Code,Sections 25515,25533 and 25534.1 understand died if the building not emrenlly have a terra..,,Thal it is my responsibility In Oily the nmupanl of IM guirc iswhichran"hemetpdertoissuarecefeCertiBcateof(Acyhancy. Signature of Applicant Date neroramhontedagent7 Dam All roof coverings to be Class "B" or better