03070052 CITY OF CUPERTINO 's; °� _�• a
BUILDING DIVISION PERMIT B CONTRACTOR�INFORMATION
BUILDING ADDRESS: SYL-MAR CONSTRUCTION PERMIT NO 03070052
OWNER' -N TANTAU AV
NAME: 1310 TULLY RD. # 114 . PERMI77L59UEDA'IE
E: (408) 293-7969 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LOO LICENSED CONTRACTOR'SDECI1,,,,AARATION Job Description O
_ 1 hereby affirm that 1 em licensed under prmvyt(3hs of Chapter 9(commencing
I Secion7 Bef Division Sof the lluaims.lUa s ms Call my license s '0 �
in full fnrc deffen. 6�' 6✓ OCT
j z License CI Lie.
7 TENANT IMPROVEMENT 2003
net- Dam Cuntthe <—MISQ
ARCHITECTS D ATION p.,
I undennnd mu aorda
F[�
At,n.m.hall he used public re
W11 �',v�1G
u LL/
30t; Licensed Pmfessinnal
5 OWNER-BUILDER DECLARATION
i y 1 hereby aRum that I em exempt from the Control License Law for the
—00 following mason.(Section 7031.5.Business and Profcssiom Cock:Any city or county
m which mutual a Permit to convect,Mur,improve,demolish.or mpair any structum
Fiy primmi4 iuuence.alsu mquimstM appliamfm such permiuo fileealgned nemmem
F licensed puction7 )orivado of the cmm�ns:nd ProflswfChapmr9 Sq. Ft. Floor Area Va allOn
ERR
(commencingathe
wit thectior.And df Diissis far
she
alleghe ed
Business iom CMe)or
.. Net Ae is uemp Nemfrom And de buH for the alleged cnmptlon.Any vinhtion of
Section 7031.5byAny applicant for a permit subjects Um applicant to a civil penalty Of APN Number Occupancy Type
oat more Nen Ove handled dollars(55007.
❑I,umvner of Ne propcnY•Or mY cmployua with wegu uNelnOle mmpeue0nn, pT
will do due work.and the swoon is not intended oroReretl for sale(Sec.7044,Bulinus - - 101 — FOUNDAq@Nd Inspections
and Professions Cal The Clinical License law decs not apply m an owner of
property who builds or improves benon.end who doessuch work himselfor through his 102 — PIERS
own employees,provided thin Such improvemcnel not intended or offered for sale.If, lO3 — UFER
however,the building or improvement is auld within one year Areal the Owner
builder will have the burden of proving Nat M did not build or improve for purpose of 104 — REBAR
Aide.).
I,as Owner of Ne initis .em exclusively convecting with licensed eonwcron to 105 — ANCHOR BOLTS
nnntronthe projaet(Sec.70i4,Business end ora nnsCol Title Coattail Li. 106 - SEWER & WATER
come law does not apply to an Owner of property,who Wilds or Improves demon,and, ZO2 — UNDERFLOOR PLUMBING
who comunI
mis!or such projects with a contrail licensed pursuant the COc roe
License LIsco. 203 - UNDERFLOOR MECHANICAL
❑1 am aempt under Sec. .B&P C for this mason
204 - UNDERFLOOR FRAME
Owner ata
137WWORKER'S COMPENSATIONDECLARATION205 - UNDERFLOOR INSULATION
I hereby&Man under penalty of pal oro of lie following dailar.dnm: 301 — ROUGH PLUMBING
have and will maintun A cmincneofCement ro salr.inaum ter Walker'.Compen 302 — TUB & OR SHOWER
n,u provided for by Section 37M of Ne Labor Code,for the Performance of the 303 - ROUGH MECHANICAL
for which this permit is issued.
have and will maintain Worker's Compensation Insurance,u retailed by Section 304 - ROUGH ELECTRICAL
of"e Labor Code,for Ne performance of the work for which this perming issued. 305 — FRAME
C9rnkcr'g4 namsin�lnaml camicnnyP]icy number am 306 — HOEDOWNS
eY/yO MI PryRyNO.: WOLo79,0yt/// CERTIFICATE OP EXEM ON FROM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
(This Ail need not he completed lithe Permit is foram hundred dollars(SIM) 309 - EXTERIOR LATH
it,lCs4.)
1 certify that in the performance of the work fm which Nis Permit is issued,I men not 310 INTERIOR LATH
employ any parson in any manner an u to become subject to the Workeri Compensation 311 — SCRATCH COAT
Lew,of Cl Data
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT:If.after making Uds Cenificne of Demotion.you mould - 5O1 — FINAL ELECTRICAL ENERGY
become mbjut to the Wal a Compensation provitions of she Ishm Cede,you must
ZO forthwith comply with such provisions ordusPermit shall Wdeemed mvnkad. 502 — FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
Ihemhy aRvmNet"ereits coastal lending agency for the performance of 504 - FINAL BUILDING ENERGY
C'Y the work for whichthie permit is issued(Sale3097.Civ.C.)
a 0 Lenders theme 505 - FINAL ELECTRICAL
O Z cmaer'aAeem:: 506 - GAS TEST 'l
J0 I unify Net 1 ban read this application and suite that the above information is 507 - FINAL PLUMBING
fL coned 1 wane to comply with all city and county ordinances and state laws mlatimg m
O V building convection,and hereby amhurim representatives of this city to emer upon the FIN aMEICAL
W ahmvc (We). .pmpcny fotlnpacti keepha.
(We)came ro 4eve,ar!.A ify tl keep harmless the City Of Cupcninn against O 9 F I
p3 Iiabllitieb Judgmen cost,mdeape whichmay in any way accrue against aria City
mcnnsequcn of c r 1 guf thi noir 5 NG
"^ APPLICAN U D T NO WILL COMPLYgH AL NO POINT Issued by:5 C WORKS Date
URCE :G 1 N .r,is6
Re-roofs
AignJuriforApplicaVCO
mncmr Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
ill Ne applicant or future building OOcupam atorc or handle havatdou,material
As need by the Cupertino Municipal Code,Chapter 9.1 i,and the Hetlthand safety
Cod.Section 35531(a)?
❑YuNo All roofs shall be inspected prior to any roofing material being installed.
Will the Rol Or future building occupant use cquipmem Or devices which If a roof is installed without first obtaining an inspection, I agree to remove
1 hanrdnus air aromainanu As defined by the Bay Arca Air Quality Management - all new materials for Inspection.
ixtrict?
❑Yag Nu
Ihove maJ"e msNous mamri myuiremens under Chapter 6.95 of be Cl
nie liculb S ety n ,Sec' ,25511 5533.,115534.1undersmnJNmif Na ilding
dlxerico nmly roe et a "m' my responsibility ul' them p ofthc
uimmen wh' b net Iprin issuance nnCanircl a a Signature of Applicant Date
�
Dole All roof coverings to be Class "B" or better
cone am orived afenl