03050020CITY OF CUPERTINO
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UC,TORINFORMATION:
BUILDING DIVISION PERMIT
CONT
.
BUILDING ADDRESS:
10102 FTRwoon ng
DOBASHI ARLEEN A
PERMIT"°03050020
SANITARY N0. CONTROL NO.
ARCHITECDENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
I tereby affirm Nal 1 am licensed under provisions of Chapter 9 (Commencing
P
with Section ]flip) of Division 3 offt Business and Profession Code, and my license is
inform fullerceae
PATIO DOOR/LIGHT FIXTURE
License Clan Lic.N
Dam Contractor
CHANGE WINDOW TO PATIO DOOR/I1IT FIXTURE
ARCHITECTS DECLARATION
E
p —e1� y0
I understand my plans Mall used a public records
�9
MAY 2 0 2003
Licensed Professional
DECLARATION
O.11
am GUILDER
I hereby +Irian Nal 1 exempt from the CrnhrenCe License law for sW
C J
1. o Code: Any city m county
mama. (Section ]fD L5, Business and Pn.
de or sig any su clum
which a •permit m cnvvect, port improve. demolish.
which mqus
nnit
h pe t a. mm.t
Poor in itsissuance.me.almmquima preapplinof for Coin Pcrmi'mices Law(tatamcnh
u
ivions dic
Sq. Ft. Floor Area
Buftaumillfw
nuumsandPro smansCaPmr9
n3 of the Business and Code) or
(commhe esccgwithSrsuammmcofDivision3offt
(eat
basis Any
Net rte u sump, hWrefrom and the base for IW alleged exemption. Any violation of$2000
In, 4exampt funSectctions and
APN Number
Occupancy Type
Section ]m1.5 by any applicant for a permit subjects the applicant to a civil Penalty of
not mom Nan fin hundred dollen (SSW).
34233035.00
0 1. a owner of the Property, m my employees with wages a Neu sale Compensation.
RR Inspections
will do the work end Ne machine u not iemnded or offered fm sale (Ser. IDN, Business
and Professions Code: The Contractor's License law dose not apply W an owner of
property who builds or i mpmva thereon, and who does such work himself or duuugh his
101 - FOUNDATd
own employ=. provided that such improwmenu are not intended oroffered for We. If,
102 — PIERS
however, due Wilding or improvement is mid within ane year of Completion, the ower -
builder will haw the Wrden of proving that he did not Wild m improve for purpose of
103 - UFER
ale'1.
104 - REBAR
0 1, u Owner of Ne property. am exclusively contracting with licensed contractors to
comment the project (Sce. 7W Business and Professions Code:) The Conincmrt Li.
105 — ANCHOR BOLTS
cone law does not apply to an owner of property who Wilds or impmves Ntmon.and,
106 — SEWER & WATER
who contracts for such projects with a eonuaemr(s) licensed penman, m she Cuntrssmes
Li me law.
202 - UNDERFLOOR PLUMBING
em ,under Sec., B d: PC forth
203 - UNDERFLOOR MECHANICAL
`
204 - UNDERFLOOR FRAME
205 - UNDERFLOOR INSULATION
Ihereby amrmunder pnaltyofPedoryonanfthofollowing dcclantom:
and win mainuina G[WfiCota of Consenlmself-insure for Workeh Compen,
301 — ROUGH PLUMBING
saran, a provided for by Semnn 37W of the Labor craft. Tor thc pcdormanm of the
3 02 - TUB & OR SHOWER
1Thaw
work far whim di, permit isiarad.
303 - ROUGH MECHANICAL
0 1 ban and will maintain Workeri Compensation Insunmet, a required by Seedon
311 of the labor Code, fm sM performance of me work fm which this Permit u issued.
- 304 — ROUGH ELECTRICAL
My Workers Compensation Insurance carrier and Policy number am:
305 — FRAME
c"" Polity
3 06 - HOLDOWNS
FROM
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
307 - INSULATION
(Thu section need not W completed if the gait is for one hundred collars (SIM)
308 - SHEETROCK
mkt)
309 - EXTERIOR LATH
1 certify Net'
ion, you Mould
We in previsions ilbac
boe m object m the Worker's Compensation prevision of the fab" Code, you muse
Comply with mmpmaiyonorthis Permit shauxafctmedranked.
501 - FINAL ELECTRICAL ENERGY
CONSTRUCTION LENDING AGENCY
502 - FINAL PLUMBING ENERGY
Ihereh affirm
Y+ g agency I'm Nc performance ser
503 - FINAL MECHANICAL ENERGY
thework frwmmth pmmh amd(s«.3W].civ.c.)
hander's Namc
504 - FINAL BUILDING ENERGY
Iamcier'sAdd.
505 - FINAL ELECTRICAL
1Codify That1ban madhis application andstatethethe eWnbronatuotis
506 - GAS TEST
comm I agree m comply with all city and county ordinances and sem laws Clang m
Wilding Construction, and hereby OrWrire mpmantadves of this city to enter upon the
FINA PLUMBI G
move -immuno property far impaction Puryoxs
(We) agree to saws, indemnify keeP hamlless the City COFcmino
Q$ FIN N L
and err against
liabilities, judgments. costs and expenses which may in any way aeman against said City
5
in consequence of to granting of this permit,
jWNG
APPLI NT UNDERSTA DS D WILL COMPLY.WITH ALL NON -PO NT
Issued by:5 Date
SOU LATION
Re -roofs
Type of Roof
store of Applican✓Comrumr
HAZARDOUS MATERIALS DISCLOSURE
Will Io applicant or future Wilding occupant score"handle haardons maurial
u defined by the Cupertino Municipal Code. Chapter 9.13. and the Hcalm and Safety
Code, Section 35333(a)?
❑Yv No
�]
All roofs shall be inspected prior to any roofing material being installed.
Will net appfican, or alum Wilding occupant use equipm vel or devien whim
If a roof is installed without first obtaining an inspection, I agree to remove
is havardous air contamiaanu a afcriincd by Ne Bay Area Air Quality Management
all new materials for inspection.
Diauion
D Yes L.yno
I ban mad a hvardous muenalsmquimments under Chapter6.95 of Ne Calier.
Z Healthy, etyCodc, Sec om3M5,35533wd35534.lun&mwdthuifthc Wilding
me of n
Signature of Applicant Date
All roof coverings to be Class 'B" or better
'r as horind agent Dare