03050135 CITY OF CUPERTINO1411`1111'"**"",
7m
BUILDING DIVISION PERMIT ,'� o TIZACTWIONFORMATI ,
BUILDING ADDRESS: TUCKER JAMES D JR AND MARIffth"003050135
1 01 1 1 PT-TAR TAP nT?
ERs '19A/TL 8/2 0 0 3
CKER JAMES D JR AND MARIETIT
PHONE: SANITARY NO. CONTROL NO.
ARCHrrECTIENGINEER: BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
C=
LICENSED CONTRACTOR'S DECURA71ON
I thereby affirm that I not licensed under provision of Chapter 9(commencing Job Description
irtfulforaccaut ffm
License a. Lie. REMODEL 2 BATHS/REWIRE GARAGE
Dais_C.m., TERMITE REPAIR
ARCHITECTS DECLARATION
I understand anypizessimiltcomalp.blieraccent;
Licensed Professional
OWNER-BUILDER DECLARATION
I h.. .(hero that I am exempt re the Contractors License Law for the
0 (.timing....(Section 7031.5,Business and Ponfessions Code:Any city ce County
Fa which retinues a Permit to construct.shce improve,demolish,or repair any someone
4j
Nat be is licensed pursuant to the prevision of the Commerce's Liccause Law(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business and Prolesdons Code)Or
e N§ that M is attempt therefrom and five basis far the alleged exemption,Any violation of
00
at '
Section 70315 by any applicant for a permit subjects the applicant to a Civil Penalty Of APN Number c.A cupllTypeTypen
.or..than five hundred dollars(M), al-�
32618013 . 00
C]l,w�offtpropmy.mmymploymwiffiwgesuftUwle�pemdon,
will do the sona,and thestruchure ism,intended oraffiecd formation(Sec.7044,Business
d Profession,Code:The Conuscuter's License Law does an[apply in an maower of d Inspections
an
property who builds orimpromans ancomen.soul whodmasimch work hinnumtror though his
101 - FOUNDAY218K
cover employees,provided that such improvements not notimmudeall or offered(or sads,If. 102 - PIERS
however,the building or Improvement is sold within one year of completion,the Owner.
Wilder Mill haw the burden of paving do&,he did mat Wild or improve four purpose of 103 - UFER
,sm.' 104 - REBAR
b1.as Owner of the property,mrs exclusively contracting with licensed Continuator no
consumer man project(Sec.7W.Business and Professions Code)The Conlemon's Li- 105 - ANCHOR BOLTS
.Law does not apply to..of Property who Itudhistur lonprovent therven.and, 106 - SEWER & WATER
who Comeaces;for such projects with.comotacu(s)Hummed Cam se the commissars
{.deme Itionex, 202 - UNDERFLOOR PLUMBING
❑ law. 202 See. a a P C for thi 203 - UNDERFLOOR MECHANICAL
1 11111116 nm. 204 - UNDERFLOOR FRAME
WORKMA4ZOMPERSATIOND N
Kh/layaffirrounderpernalayofixerfuryounco t conving dedammatV 205 - UNDERFLOOR INSULATION
0 1 haw and will maintain a Certificaut ofConsunt to ulf-imum fmWorkesConsiant. 301 - ROUGH PLUMBING
sation,as provided for by Section 3700 of the Labor Code,fear um performanceof the 302 - TUB & OR SHOWER
work for which this permit is issued. 303 - ROUGH MECHANICAL
0 1 haw and will anutimain Workers Compermentim Insurance,as mainland by Section
37M of the Labor Code,for the performance of the were forwhich this Permit is issued. 304 - ROUGH ELECTRICAL
pe
My W.alser's C.mpCmU.O Imausenot carrier and Poll,moolve,me: 305 - FRAME
Carrier. Policy No.: 306 - HOLDOWNS
CERTIFICATE OF F-XEMFnON FROM WORKERS'
COMPENSATION INSURANCE 307 - INSULATION
(This scedco mad not k completed lithe permit isforom,hundreaddollars($1 ) 308 - SHEETROCK
Or bass.)
I C:fy th.t I c,rurnmen. am, C IN t 309 - EXTERIOR LATH
otymamner. 5 310 - INTERIOR LATH
employ any PC
,,w,ver r,i;riiprt :a 311 - SCRATCH COAT
APPlivnt44fZr-"a 44 (4 4�1 4VA— 4
NO
"grC ricam of Esemption.you should 313 - ROOF NAIL
uy'PLICANT".after rhakIng this C
I .to the Worker's Compensation pro xill ns of thou LaWr Codc,you mum
or 'I.
JZ mply with such provisions or this pomnii shall x docamed revoked.
r, 501 FINAL ELECTRICAL ENERGY
z 0 CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
E4 Itherebyfifirmtharthereit....truCtfim 1crefi.S.gc.cy I.,theperformanox.f 503 - FINAL MECHANICAL ENE
> ft souls for which this permit Is iscond(Sec.3M.Civ.CA
WE Led.
jName
504 - FINAL BUILDING ENER
LZeeels Add=Z 505 - FINAL ELECTRICAL
U C I certify that I haw head this application and main that the&be"inform aflun is 506 - GAS TEST
Comm I agree to Comply with all city and County ordinances and sum laws miming to
OU building Construction,and hereby audamice capneseentafives of this city to enmr upon the rc-13-� I- FINAL PLUM
W 11now-mandorax!property rce insixch..purpose. 40 A 4FI M Tf- L
06 (We)agree o an,immune y and p lasurnhes,the City of Cupertino against
"I al
'
C4 11 hilit] Judi Used. Ich vs.an y secret,against aid City
ra .casts
' 'm mg
U a= the
1/- COWITH ALL NON-PQM sued by: Date
SOURCENDEZROS-TA C, IS kWING
GULATION Re-roofs
GU
S of Da
K Type of Roof
;,roz;MATER11 &DIS G�4 E
future to.
7. finme Wilding uporrumoneorhandicimmuMmmormorml
oadeflnedbythi&perthm m pal Codc.Chapccr9.12.and the Health and Safety
Seem.255324)?
M yea All roofs shall be inspected prior to any roofing material being installed.
Will tive.pplicant o future ilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
colt haeardous,air concern ants as defined by the Bay Arca Air Quality Management all new materials for inspection.
Disvicq
Ihavc
re
the olousmauen rcq n torch r6.95oflhcCalifor.
niaHC t, my ctaas 25
25
dm not currently wn 4 res Ihllity notify the mcupwt of Ne
require on mum cip nun ofoc Bn.aarOcmpanty. Signature of Applicant Date
I s to be Class"B"or better
2wnjX4jr6oHrcd agent I 1-sa 11 All roof covering