00040098 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUII.1D}NG1CS:1!ff WOLFE RD PERMIT NO. 00040098
Ow�IVLr�srPtN1NVEY CO. IN C. APP5V7N"7f600
IONS: SANITARY NO. CONTROL NO.
Z ARCHN ECUENGINEER: BUILDING FERMI r INFO
C BLDG ELECT PLUMB MECH
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LICENSED CONeTRACTOR'S DECLAR CUT E IWHLLOn
I hereby alfinn that 1 am licensed under provisions o! apmr Y tco n.Tg
:intro with Sation]lNlt)lof Division3mthe Busin<ss and l'r°rnsi Code.unties tit
is in fall force and effect.
m < License Class Lic.u
'a`a�' Data C- a emr
j 3 c,y ARCHITECTS DECLARATION
.g c 5 I undcmand my plans shall Be area as public recordsPin rM
)
i C O Licensed Professiowl
OWNER-BUILDIiit DECLARATION
w o, I hereby a1Rrm that 1 Bin exempt from the Contractor's License i for the
t 3 a following mason.(Section 7031.5.Business and Professions Code:Any city m munty $3000
2 3 a run requires a permit w construct,alter,improve,demolish.or repair any structure
E ts-a which q
t t also requires
Provisions
r inions o for such permn m(leas sped statement
t
morn .len tip muattthe mo snr me Com usinesandPelaxons Code) ,$q. FL Floor Area - Valuation
(commencing m sen ]oom, 1b' rtion 3 or me Business dna Professions code) . ., , ..
or Shothe is exempt thedhot6 and the breis forme alleged applicant to Any violation
ofSection 7B3Ls lir any applicant for a permit sant«n me applicant to a dsB pemmry
or notmntemanr.enanareaa°narslssoB).
101PNN6®bIDfDATION Occupancy Type
❑I,asowner ofthepmpeny.ormyemployees with wages a their sole compensation, 102 — PIERS '
will do the work,and the amatore is not intended or offered for sine(Sea.lou. 10 — UFER '
Business and Professions Code The Contractor's License Law does not apply to an Required Inspections
owner of p,c,cny Who bmlds o,m nto,c,Rninum and woo dre,such work d o elf 104 — REBAR
Of through his own employeet,provided th t such improvements are But intended oroffered far sale:Ir no a the Ia s prove , sola x ruin one year of �L10 Q5� ANCHOR--BOLTS „I
completion,mowner-builder 'un m burden rap a sin to ea tbuild r `SEWER & WATER
omorpo f t in . f l .).
01; m property, g sur econtractionto
.2�Z — UNDERFLOOR—PLUMBING
construct,the r,,act(Sao.7044,Basin...Bud lmfii Code)The Contractors 203 — UNDERFLOOR MECHANICAL .
f License Law done not apply m an owner of propcny who Wilds or improves thereon,
and who contract:for such projects x'im a eval ations)licensed purnmanutwchm 2 04 -.- UNDERFLOOR- FRAME-- --- —. -- -- -
Contractors License Law.
❑I an,exempt unad Sec. ,B&P C for this r,a.on 205 — UNDERFLOOR INSULATION
os er Date 301 — ROUGH PLUMBING
WORKERS COMPENSATION DECLARATION 302 — TUB & OR SHOWER
I hereby affirm under penalty or perjury one of the following declarations: 303 — ROUGH MECHANICAL
I besa and win ma nein a Cerci of Co°sent mself-ir,am for Workers 3 04 — ROUGH ELECTRICAL
: y Compensation. as pro°iaed for by Semon 37W of the Labor Code. for the 305 — FRAME
_ performance of the work for which this permit is issued,
OLDOWNS
CI have and ,will maintain Workss Compansaron Insamnce,as required by Section 306 — INSULATION
3700 of the Labor Code,for the performance of the work for which this permit is 307 — INSULATION
issueJ.My Worker's Compensation Insumnce carter and Policy number are: r,'
- 3.08: — . SHEETROC-K' -
c.aIr:" Policy No. " 309' =' 'EXTERIOR.-LATH
I CERTIFICATION OF EKEMPTION FROM WORKERS'
COMPENSATION INSURANCE,- - ._._.. ....__3.1-0,,---INTERIOR LATH._.__.
1'• 'fThrs sectio,n need nor be completed if the permit is for one hundred dollars 311' — SCRATCH COAT '
Slw)oriess.) 313 — ROOF .NAIL -
niydial mthe verort,anknm
uexarkrwhimrhisfrontisi,ssued,1 501 — FINAL ELECTRICAL 'ENERGY
• a
shall not employ any person in any manner so as to become subject to the Workers'
U�cant nLaws or cafiromia.Dae 502 — FINAL PLUMBING ENERGY
AOTICEt TO s r - 503 — FINAL MECHANICAL 'ENERGY
APPLICANT IL after Compensation
unix Cemfisofd Exemption, y should
become subject to me Worker's omen,.1 his provisions of the Labor Cade,you mus,
O ZO punct,sire'eomplYwhnsueM1pm.isiomsnnm.pe.it shall IN,eeemearesokea. 504 — FINAL BUILDING ENERGY
.F ^ CONSTRUCTION LENDING AGENCY - " 505 — FINAL ELECTRICAL
1' I hereby M.that there is a<onnmaion lending agency for performance 506 — GAS TEST
r a' u of the work for which this permn is issued(Sce.309],Civ.C.)
yp LemersName . . : .. . - ...-.- .. 507- FINAL PLUMBING._..
a z Lenders Address 508 — FINAL MECHANICAL"
U OI verify mat l have read ads cep leaion and state amt ate abuse information is 5 0 9 — F I NAL GRADE
fL Eta mmeet.I agree m comply with all city rend county mdiaances end nae laws relating
O p ,o wilding construction,and hereq-authorize representatives of city to enter upon 510 — FINAL PLANNING
W me above-mentioned propcny for Imran.purposes.
pray (we)agrca to save.indemnify and keep harmless the City of Caroni against 514 — FINAL PUB IC WORKS
W liabilities,judgments,cos.ora expenses whim may in any way acemc against said
U.Z C'ny in c......ence of the amin,of this permit.
SOURICE REGULATIONSV DS AND WILL COMPLY WITH ALL NON-POINT Issued by: r Date
Date
Signamfthe applicant orfuture building occupant store m handle Wurdow ma Re-roofs
P<' HAZARDOUS MATERIALS DISCLOSURE
Will
enol . Type of Roof
u defined to the 32m)?nn Municipal Code,Chapter 2,and the Health and Safety
�Cndc,Scdion 255?2tu)p - I
❑Yes ON.. q,. �' •, '; __All roofs..shall be inspected prior to any-roofing material being installed.. -_ --..-
Will the applicant or mumboldLngUe"PUTo useequipment ludeviceswhich If a roof is installed without first obtaining an inspection;I agree to remove
mit baurdom airmoumimaia,as defned b)the B y Arca A r Quality Management
tistrictp all new materials for inspection. Applicant understands and will comply with
1St/ 0Yes Orho all non-point source regulations,
\.� 1 have read the hazardous materials requirements under Chapter fi 95 of ma
California Health&Safety Code.Sections 25505.25533 and 25534.1 undernandbut - -
if thc building docs not currently have a tenant,that it is my responsibility to notify the
ivpant of the requirements'which mint be met prior to Issuance M a Certificate of
_ ampancy.
Signature of Applicant Date
owner oreuthonzedagent .
Data All roof coverings to be Class"B" or better
s
OFFICE