03070066CITY OF CUPERTINO
A
BUILDING DIVISION PERMIT
INTORMATION
BUILDING ADDRESS:
C 332 VA11C.0 PARTWAY
PARAGON MECHANICAL, INC.
PERM.TN*03070066
OWNER'S NAME:
2460 DE LA
CRUE BLVD.
PERMIT ISSUE DATE
E: '
(408)727-7303
SANTTARYNO. CONTROLNO. .
ARCHITECryENGWEER;
BUILDING PERMIT INFO
BO ELECT PLUMB MECH
O
LICENSED CONTRACTOR'S DECLARATION
Job Description
op
1 ksehy affi m that I am licensed u ovisionr Of Chapter 9 (commencing
with Sccti n ))of0ivisio 3ofLWBusi ..end rufeninna Codc a ilin,I nancis
is foN p 2
Liceme Lie. N
REPLACE 2
AIR HANDLER UNITS
Date Gamin 0 il hj&A
R 1 CD 1
1 understand my plana shall k used a public records
P'4 •w �w vs 4
AUG 2 1 2003
Licensed Professional
OWNER -BUILDER DECLARATION
affirm the I ore, from Rte Contractors Law for my
1 hereby mexempt
eLicense Ac
maso situ end Cade: Any tiny ar county
reason. (Section 8171.5, Business
'
ve. dioiona
which rcyuins in permit het construct. improve, or repair any strutatemure
Whicfolloh re
g
miesthealter,
priann its issmnce, alio requires applicant for such Permiuu Olcesigned matement
h prolan
that he is licensed purmam to the provisions or the contractors Liccnm Law (Chapter 9
Sq. Ft.
Floor Area
g
!. Valo'a[i6,
(comm)caning with Section 70110B of Division 3 of the Business and Proreuions Code) or
..
Nan he Is exempt Neefrom and the buts for On alleged exemption. Any violation Of
31620075.0
0
APN
Number
Occupancy Type
'Section 707:.5 by a try applicant for a permit subjects the applicanto a civil Penalty of
not mon Nan five hundred dolhrs
❑ 1, u owner of Ne pmpemy, or my creployau with wages u Heir rate compensation,
_
d Inspections
will do Newark, and Ne structure is not intended or offend formic (Sec. 70m, Business
and Profen).. Coda: no Cortisone,'.Lt..law does not apply u an owner of
10 2
PIERS
wa Hereon, and who doesch work himselfar through his
mortality who Wilds or improHeu
-
own employees, provided that such improwmems are not intended or offered formic. If.
103
— UFER
however, the building or improvement Is sold within can year of completion, the owner.
builder will hove On. burden of proving than IN did not Wild or improve for purpose of
104
- REBAR
sale.).
105
- ANCHOR BOLTS
❑1,aOwner ofthe properly,.Bsineexclusively ndcomraciinsCmd:iceneCconuectonna
construct the protect (Sec. 7014, Business and Professions Coda) The Contractor's Li.
106
- SEWER & WATER
more law des not apply to an owner of progeny, who Wilds or improv themon,and.
202
— UNDERFLOOR PLUMBING
who contractsfor such projects with a conmctor(s) licensed pursuant to she Conwnar's
Line. Law.
203
- UNDERFLOOR MECHANICAL
0 l an exempt under Sec. .B&P C for this reuon
204
- UNDERFLOOR FRAME -
Data205
- UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
Ihereby alrum ander penalty or perjury ane Of the fouarring deelmaOans:
301
- ROUGH PLUMBING
have and will methods, a CeniGcare of Cannot to self -insure for Workers Compel-
302
— TUB & OR SHOWER
than, u provided for by Section 3700 of Ne labor Code, for the Performance of the
303
- ROUGH MECHANICAL
.,it for which this permit is issued.
304
- ROUGH ELECTRICAL
El I ban and will maintain Workers Compensation Insurance, u required by Section
3700 of IN labor code, for We performance of Ne work far which this Motor is issued.
305
— FRAME
My Worker Compensation Insunme carrier and Policy nom k am:
3 06
— HOLDOWNB
Co Policy Na: 0
ERT FICA TE OF EXEMPTION 1W BK� S'
307
— INSULATION
COMPENSATION INSURANCE
308
- SHEETROCK
f ibiareetwo need nmkcomNctcd Hine fcrmiinforonahundmddonm(SIOtO
309
— EXTERIOR LATH
or In".)
31 O
— INTERIOR LATH
T ccnify that in the performance erforance of the work for which His permit u issued, 1 anlreao
employ any Pension any manmr ra as to Wetur esobject to the Work,,'COnfermlime
311
— SCRATCH COAT
Lava of Califaria. DensAppi
am
313
501
- ROOF NAIL
- FINAL ELECTRICAL ENERGY
NOTICETOAPPLICANT:r'. after this Girton. of of Excerption, you Mould
NC71
become subject m the Workers Compensation provisem of the Labor Cndc, you mum
Compensation
forthwith comply with such provisions or permiunall kdmmcd rcwkca.
SO2
— FINAL PLUMBING ENERGY '
CONSTRUCTION LENDING AGENCY
503
- FINAL MECHANICAL ENERGY
I hereby affirm that there is a construction lending agency for the performance of
504
- FINAL BUILDING ENERGY
the work for which this permit is issued (Sec. 3097, Civ. C.)
Unit Name
505
506
- FINAL ELECTRICAL
- GAS TEST
Lenaerm
'a
1 certify that I haw =it this application and state than the akw information is
507
— FINAL PLUMBING
cement. I agree to comply with all city and county ordinances and soon laws elating to
building construction, and hereby euthorim mpreematiws of this city to enter upon nhc
FIN MEC CAL
abovomemiunc0 property for inspection purposes.
(We) ague m cave, indemnify and keep hmmless the City of Cepcmino against
O 9
F I
tabilkim,judgments. costs and expenses which may in any way accrue against send City
5
NG
in cnnuyuencco cgnnbng uhhia permit.
APPLICANT STANDS Al. WILL COMPLY WITH ALL NON -POINT
Issued by:5
C WORKS Date
SOsU[��CE RE
Re -roofs
Type of Roof
G7
�
Signature ofheron/or
HAZARDOUS'MATERIALS DISCLOSURE
Will the applicant ser future building mcupant marc or handle brimni,mr, material
.
u dented by sic Cupertino Municipal Code. Chapter 9.11, and the Health and Safety
coda
X.N., ezss3255320)?All
0 Yes
roofs shall be
inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future buildingoccupon use equipment or devices which
W.Nous air contaminants as defined by the Bay Area Air Oualiny Management
- all new materials
for inspection.
nlflCl7
❑Ycs AN.
1 have cad Ne harandon materials requirements under Chepar 6.95 of the Ca:ifor.
Health & Safety Cade, Sections 25%5.25533 arta 15534.1 undersund Nm if the building
dm�p cu dy how n , Nat a u my rtaponsibilit natif Ihe mcupant of the
eymmmcn sa1fbtecns
paorininaanmaracan,r=a m =y
Signature of Applicant
Date
ry
All roof coverings to be Class „Bs, or better
Owner
ar Nnri'rnd agent