03040082 CITY OFCUPERTINO ss'",� ' ' H�` v °a:
BUILDING DIVISION PERMIT C� .T„ TQ ,��`,�. MA'P(
EYy"?Dt6K8STON DR NICE & RIGHT CONSTRUCTION MrrNo.0307�40082
fNE:
FA'§` L I M 166 EUCALYPTUS DR PERMrrssyu�n7� 1/2003
SANITARY NO. / u CONTROL NO.
(415) 239-2696
IC1'IENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�g ii LICENSEDCONTRACTOR'S DECLARATION O O O O
1 hereby Nlrm that 1 em li d u provisions of chapter 9(commencing Job Description
wiNSact1on70f0)of Divhma3of the Busi and Profcubm Codes mylimmu
infnnrorce ^I � �41C1 REVISION-TRUSS CALS--IN HOUSE USE ONLY
�IIFg--g LD�.nw Cl Can= .2 NO NEW PERMIT ISSUED, ORIG. #02070032
ARCHITEcrs RATION
LuodpraGnd my tans.hal he
h0 Licanud Pw2xionslDl
OWNER-BUILDER DECLARATION
.�a0 I hereby.(Seco o n 1 e1.exempt from circ fessm.mro :Any c law for the
D D following mesa(Sidon 7071.3,Bminesa and Profusions Code:Any city orc musty
$�a which its
•permit re conswn,slug improv.do permit
t or rtpalr ed auucmrt
Ss
poor to itsisauanca aluantto res the
ovisioso for suchmrms's Uoisagaednhumem
< that he(commeeliro withSewmunlhcpwviviomofNeueBuecros,ndPrwLaw(Coute)9 Sq.Ft.Floor Area Valuation
(commencing with Section eand theof osis f r the al B ed exampi ce,My
Code)or
333$ Out he u eacmpt rMn.from and Ik baso for the alleged amnptioa Mr violaUm of
Section
e mole 4431.s.nw nunemd dean fllars r a permit subjects Nc applicant b s civil penalty of APN Number OCcupancy Type
❑I.is owner of the property.or my emplayeu with Wages u their sale compensation, 32611006 . 00
will do the work and the structure is not intended or offered fm rau(Sm.7044,Buanw Required Inspections
uw Protests. Cads: Commissars b The Coissars I was Law acmi apply in owng
owner of 101 — FOUNDATION
p
property who bNao m improv themon,and who doesouch work Mmaelf through ough hu
own employee..provided that such Improvements sae mtinunded oroffertd locusts.If. 102 — PIERS
however.the building or improvement Is sold within aro year ofcompletion,the owner.
Wilder will law the burden of proving that he did not build in improve for purpose of 103 — UFER /J
01. 104 - REBAR \/ \
❑I,a owner of the property.,B sines and contracting with IureoseComaanbm u
eonnwn the protect(Sec.7044,Business and Protwions Code:)The Contr.ebta u- 105 — ANCHOR BOLTS.
who camwdmsnoupplyban ithawner orpropeny whored i or puritan,
themon,and,remes 106 — SEWER & WATER
whoe Law do s not sap projects with a eonuscarty)licensed Wil puruum ro the Canusnoh
License Lt.. 202 — UNDERFLOOR PLUMBING
❑I sen nemptunder Sea .B k P C for this means 203 - UNDERFLOOR MECHANICAL
" Data 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
I hereby arms under penalty of perjury aro of the following declanuons: 205 — UNDERFLOOR INSULATION
I how and will maintain.Certificate of Consent b self-insure for Worker',Cooper. 301 — ROUGH PLUMBING
sation,u provided for by Section 3700 of the labor Code.for the performance of the 302 - TUB & OR SHOWER
soh far which Nu permit u lIIncd.
❑1 haw and will maintain Workers Compensation Insurance,u required by Section 303 - ROUGH MECHANICAL
37U0 of Nc labor Code,for the perfonnanm fthe kfm which Nie permittaisaved. 304 — ROUGH ELECTRICAL
My We
Co emation Insunnco< i_momm.re:� 305 - FRAME
Carel PoII No.: ��
IFICATEFEXEM
P110N ORKERS' 306 - HOEDOWNS
COMPENSATION INS ANCE 307 - INSULATION
(This amount need mi he completed if the permit Is for one hundred dollen(5100) 308 - SHEETROCK
orkst) 309 - EXTERIOR LATH
employ unity Net erthe n any mann of as wart fm which this permit u issued.I shall cot
LA. a Califo on In any manncranubbecome wbjcotto theworten'Cmmpensatim 310 — INTERIOR LATH
Lawn aiCni(omla.Daa 311 - SCRATCH COAT
Applicant
NOTICE STOAPPLICANT.If,Cmmakingthisvisins of the
EaeW Cod youshould
onal 313 — ROOF NAIL
become subject y it Worh pro Comsat thin provisions of the labor Coke you muss
,J`� forthwith comply with such provisions or this permitxhall be dcomrA revoked. . 501 — FINAL ELECTRICAL ENERGY
?O CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
[r.. I hereby Num than dem is amnwuctim linding.genry far the puformarce.1 503 - FINAL MECHANICAL ENERGY
a Newhich h4 permit 13issued(Sc.7N7,Civ.C.)
del'sNurse 504 - FINAL BUILDING ENERGY
Ianaer,
W Q Lmi N
4 Address
Z 505 - FINAL ELECTRICAL
Up Icattily ethat 1law readthis tyandtiunWadmathistheshow IwformNmu 506 - GAS TEST
cortcoL I.gree b comply With all city and cmnty onlinuuss and sou law Mining b
Cune,nconowctlon.end hereby suthonbereoses. tiv crisis city menur open the JIPLUMBI G
W ehovcmenuonetl property for Inspection purposes.
(We).gree b an,indemnify and keep harmlw the City of Cupertino a¢ainst 0 8 L
rjj liabilities,judgments.costs and eapenva which may in any Way accrve against said City 5
V'l in consequence of the granting of Nu permit
C� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 NG Date
SOURCE BEGUI.ATIONS. _
NAII PUBLIC
ce- ' Re-roofs
Sign re b aCo ror D
HAZARDOUS AIS DISCLO E Type Of Roof
11 de applicant or future building acoupanurore or Nndle huallous materia
u de0ncd by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
.S Uan25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu �No
Will the applicant or future building occupant use equipment or device,which If a roof is installed without first obtaining an inspection,I agree t0 remove
I'Mardnuants
s air contaminu defined by the Bay Arca Air Quality Management all new materials for inspection.
Distict? y
Cl Y. d a
I have mad the ha7zolous mautials requirements underChapur 6.95 or the Califor.
nisi Hulthh Safety Coda Sxdmu255U5,25533 and 25534.1 undersand thulftao building
does mi currently haw s tenant that Itis my rtipoml (lily b notify tie attupanl of the
7., mat me arm' o earOccupancy, Signature of Applicant Date
e rD
'Own4gonnd agent Dna All roof coverings to be Class"B"or better