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03010148C 0F0 i n= c 26U CLLj 05 Ey�5$t�—`O Lig � O Z � > s, G �z JO �F F0. Uz CITY OF CUPERTINO n- tit��sea x 4 !''��z rx € >n CO rRAC'Y'OR IN�`ORMA' -1 5: BUILDING DIVISION PERMIT BGILDINCADDaFSS; ADMIRAL CONSTRUCTION PERMITNO.03010148 ER'S NAME: 1711 BLOSSOM HILL RD, '""69'7b6 /2003 NE: (408)309 -5981 SANITARY 440, CONTROL NO. ARCHITECDENGINEER: BUILDING PERMIT INFO BLDO ELECT' PLUMB MECH O t� O O LICENSED CONTRACTOR'S DECLARATION ,1 Wreby affrm tint 1 am Ilemsed under prevision] of Chapter 9 (commencing Job Descri tlon P with Sleypn 70(10) of Division 3 of the Business and Profession] Code, and my ][correct] TI pBgpep ecnm Cla p— 4 =.• T /^7,_ m Contractor ARCHITECTS DECLAKZIOP I understand my shall be used ss records JUL ©r 2003 plans public Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that I am exempt (rem the Contnnofs License Law for the BUILDING following roman. (Section 70313, Butiaas and PmmsGO" Code: Any city or county which requires a permit to construct, almr. improve, comn kir. or minor any amtum prior to its issuance. elan requites the applicant for such permit to rile a signed summem that he is licensed pursuant m the Previsions of the Commewes Lmcme law (Chapter 9 Sq. Ft. Floor Area ���� ion (ecarom of with$eCtlan 7000)of Division 3o1' de Business Nd Profixodmo Code)er Nat be is exempt therefrom and a basis far the alleged exemption. Any vloladan of 3 %filth NOMtkr O O Occupancy e P Y GYP Section 7031.5 by any sppliant for a permit ubjects the applicant to a civil Knotty of not more than Bw hundred dollars (1500). 0 I, u awmr of the pmperty, m my employes with wega u timkwie mmpenudon, iui — d Inspections will do the ..h and theswclum Is not intended oroQemd (Dream (Sec. 7044, Business And Pmfessmn Code: Th. Contractor's LI"ne Law doer oat apply te an owner of 10 2 - PIERS property who buims or improves thereon, and who does such work himself or thmugh his awn employees, provided thatsuch improvements art notintended moBemd formle.If. 103 — UFER however, the building or Improvement Ismld within on year of completion, the owner. builder will hove the burden of proving Net he did oat Wild or improve for purpose of 104 -. RE BAR sale')' 105 - ANCHOR BOLTS 0 1, as owner of IW property, am exclusively eankacdng with licensed eonaumrs to construct the project(Sec.70". Business and Profession Code) The Conlncmr's Li. 106 — SEWER & WATER ecnm law sou not apply to an owner of property who Wilda or lmprova thcmon ,and, ZOZ — UNDERFLOOR PLUMBING who contracts for such projects with aconaalor(O Boned puwanl to the Comractoes ' Licenmlaw. 203 - UNDERFLOOR MECHANICAL O l am exempt undo See .B k PC for this mesa 204 - UNDERFLOOR FRAME Dam 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION IWrtby affirm under penalty of perjury arc of die following declaration: 301 — ROUGH PLUMBING _ Thaw and will maintsin• Ccrsificamtuf Consent to self -iuum fm Worker, Compere 302 — TUB & OR SHOWER aetim, u provided for by Section 3700 of the labor Cade. for The performance of the 303 - ROUGH MECHANICAL work for which this Permit is leaned. 304 - ROUGH ELECTRICAL 0 I have end will maintain Wuhe /s Compensation Insunna, u rtyulrtd by Section - Ind of theL.aWf Cadc, for the performance of the work fn which this permit is Issued. 305 — FRAME my War Co mnutlon lnumnc carrier ud Pygry numbnnm: �/3 3O6 rOOS7B0307 — HOEDOWNS mar. PoIIryNO.: - CERTIdCA r F EXEMPTION FROM WORKERS' - INSULATION COMPENSATION INSURANCE 308 - SHEETROCK (Oilsa- inmoeed let W completed if the permit is Fortune hundred dollars ($1pan 309 - EXTERIOR LATH or mere) 310 - INTERIOR LATH unify than in the performance of Ne work for which this permit rk issued, 1 NJI ram employ tieWOrkeriComps "ation 311 — SCRATCH COAT Lawso CalifosoninanymennoruutoWSOmeubjectto Iawscf6lifomim Dam Applicant 313 501 - ROOF NAIL - FINAL ELECTRICAL ENERGY NOTICE TO APPLICAW.it. after making this certificate of Exemption, you should become subject to the WoAces Comp ms,amm provisions of the Lahr Code. you must forthwith comply with such previsions Or this rwmiuhall W demand revoked. 502 — FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby affirm that them is ""auction lending agency for the performance of 504 - FINAL BUILDING ENERGY the look for which this permit is issues (see 3097. Civ. C.) the look Nurse 505 506 - FINAL ELECTRICAL - GAS TEST La.m,'sAddmee 1 certify that I have read this application and sum that um above information Is 507 - FINAL PLUMBING correct. I agme to comply with all city and county on inmens and ends laws mlating to Wilding convection, and hereby suthedxe representatives of this city to corer upon the — FIN L MECHA11ICAL shove - mentioned property for Inspection purposes. 0 F I (We) agree to arc, indcmnif and keep h ell the City of Cupertino against — Ilabilities.judgmenu, costs and ichm nay way seems against said City of me �d APPLICANTeUNDEgunl AND COMPLY WITH ALL NON.POINT Issued by: 5 C KSDat SO EREGU roofs -roofs Type of Roof Signuumo pliantrCon r Dam H O S MATERIALS DISCLOSURE III the apPlia fulom building Occupant farm or handle husNou material as defunct by the Cupertino Municipal Code. Chapter 9. 12. and tie H"Ith and Safety . Seen" 25532(.)7 p Yea All roofs shall be inspected prior to any roofing material being installed. If a roof IS Installed WItl10u first ob fining an inspection, I agree to remove Will the applicant or future Wildingmcupanl use equipment or devices which It haurdnu air contaminants u dcfncd Try the Bay Area Air Quality Management all new materials for i hors ISIrIC11 10 Yea ono Ihawmadth,leemdoug'25� 'lirequi menmundmr Chapwr6.95ofthe Califor- nie Hcolth &Safety Cade. Sccti and 25334.1 undemund thulfNC Wilding iN due of ctmoull ho y responsib ility at notify the Occupant arts, immuntssi issuemcar a C0ni mamofoccupury' Signet Of App' ant Date °i —/D- All roof coverings to be Class "B" or better owner ultorized 9SK Dam