03030163 CITY OF CUPERTINO �> :- R«.�eg *a,t`9' o': .W� a - m•«,� •d'
BUILDING DIVISION PERMICONTRt1CTORNTORIVIA�ION
BYIMVOICE AV ROWE CONSTRUCTION CO INC PERMIT NO.03030163
° U'�T MONK 980 SMITH RD P®`M '3%At"24/2003
E:
(831) 722-1204 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BO ELO
�z
PLUMB
ass OMn
is LICENSED DECLARATION
imbyafm Nn I am tunder provision of Chapter 9(commencing Job Description
with Section of Division Sofhe Business and Rr(esaiOu Coe,end my lice=Is
I.fullrmaeM.rte
Lim.Class
Lk.Is REVISION TO UNDERFL: —.—IN 'HOUSE USE ONLY
t• °ae ARCHITEC, DECLARATION
440 NEW PERMIT ISSUED, ORIG. #03010136
I uoresaunB my plan shall he used u public records ADD BPLANCKREP FEE $111 . 00--PER POH Y. 04/24/03
7
f6
�C G Licensed Professional
-m3 OWNER-BUILDER DECLARATION
I i hereby•?rm the I em exempt fmm the Contractor's License law far the
D o following moon.(Section 703 1.5,Busince,and Profession Code:Any city or mumy
5 which require a permit to conuuc,eller,improve,demrlih.at repair any m,wo.
2iy
PH.,it,its Isaunee,o.0 mochas lMapplicam racwrh Permit b Ne.sigwdstaemcmt
2 � thnheislicsedpum
rutmNeProvisionofUteCurvature.Licenm(aw(Chapur9 Sq.Ft. Floor Area Valuation
u a ( enommencinS with Section 7000)of Division 3 of the B udn.s and Profeainm Gnde)ar
That he Is exempt Utemfrom and tie bub for oro alleged exemption.Any=r
of
Section 7031.5 by any applicant for a permit ubjero the applicant to a civil penes of
not mart than 0w hundred dollars(M). y AFN Number 94cli9dP9y Type
❑1,u Ownm of the propa y,or my employees with wages as Nei able compensation.
will do the work,and the structure is not intended or offered for sale 7044,Bmious 36905041 . 00
and proproperty
he
Code:The connector.thun,Limns talo dab rot apply lf an hough is Required Inspections
propertylona Wildswed Oat s thereomaorwho are act in', hlmsalfor for
his
.om owner,the Wilding
or i Wtswblmprowmwuart inam you of cmaferta fab Owner, 101 — FOUNDATION
however,the W e ox a improvement ll ants Whin arc rev of completion,Ne plorcr.
Wilder tum Mw tie Wrdcn a1 paving Oat Wdid oat Wild aimprowf«parpoO of
ale) 102 — PIERS \
103 — UFER
co L u t ft p of live property..m exclusively and Pommeling with'lashed mnvaewn m
cmuwn the project(Sec.n an Business nor Profession Core:)The Coniaemea and. 104 — REBAR
who contrcmraapplreanwwnesorpmperty wnawua.or(mpmton Neman.,ra. 105 — ANCHOR BOLTS
who mmncu for wen projects weds a eonuatmr(q Teamed punuanl m Ne Contnctars
01arnexe 106 — SEWER & WATER
❑lam exempt unser Sm, ,Bk PCfar Ni.recon
Date 202 — UNDERFLOOR PLUMBING
Owner WORKER'S COMPENSATION DECLARATION 203. — UNDERFLOOR MECHANICAL
I hemhy affirm under penalty or perjury ane ofthe fallowing dnlantioxce 204 — UNDERFLOOR FRAME
Ism and will maintain a CenmOnu ortomeni to salf-iasum forworkees Camper. 205 — UNDERFLOOR INSULATION
sa ic..u provided for by Section 3700 of the Inbar Code.fm thnce o
e performaf the
work for which thea Permit b issued. 301 — ROUGH PLUMBING
❑I luw.or will maintain Worker.Cmmpeamom Imurance,as requital by&,ue 302 — TUB & OR SHOWER
37M of Ne labor Core,far the peRormance of the wart fns which this Permit it faced. 303 — ROUGH MECHANICAL
My WoAce.Crmlenadoe 1.amine and Pone,nambcrata: 304 — ROUGH ELECTRICAL
Gaolers CERTIFICATE OFEXEMPrIOPallNROM WORKERS' 305 - FRAME
COMPENSATION INSURANCE 306 — HOLDOWNS
or lcsa)nhb section need not be ampleua jr be permit Is for one hundred dollars(SIB°) 307 — INSULATION
I certify the,In the pcHemtance,of the work fab which this Permit b Issued.I abet ma 308 — SHEETROCK
employ any person In any manwran as to bcamdwbject in Ute Work",Compeme,irn 309 — EXTERIOR LATH
Laws of California Data
Applicant 310 — INTERIOR LATH
NOTICE TO APPLICANT:If..Mr making this Certince,of Exemption.You owed
bccomesubject to IN Wboar'a Cmmpcnalan pwvialons or the,Lour Core,you mm 311 — SCRATCH COAT
�O fianowith amply with such Provision or this Permit she]W deemed revoked. 313 — ROOF NAIL
z� CONS"MUCTION LENDING AOENCY 501 — FINAL ELECTRICAL ENERGY
IWtaby aRthi wrthembsed(Sec.30 l7.CimgaOwy tar tie perftumuax of 502 — FINAL PLUMBING ENERGY
Y r�i the der,for which 444 permit b fovea(See.]091,Civ.C.)
s7O Lenders Name 503 — FINAL MECHANICAL ENERGY
:Z1z lender,Adams
JO IcertifyOat 1haw Had this applicationand sum Oat theabove informnowwa 504 — FINAL BUILDING .ENERGY
Y t~
correct.lgmemcomply wioall city and County onlnaweand low law,miming On 505 — FINAL ELECTRICAL
7 V building construction,and hereby authorize rcpmxntatiws of Nb city a enter upon the — GAS
4 above-memtrwd property for impaction PurPasaa
(We)agree to ave,indemnify and kap har alae om City of Cupertino paint
h 11.bllltin,judgments,costs and expenaa which may In any awywcme gain,,Old Cityin �50gUFIN07AL
AcPLICANce ofD RSTAN of this Permit.APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON•POINTIssued by: Date
SOURCE REGULATIONS.
Re-roofs 510 NAL PLANNING
Signature of ApplicanUConRDO Dae �f14 — FINAL PUBLIC WORKS
HAZARDOUS MATERIALS DISCLOSURE Type of Ro
WilltheftC.Isentm,future Municipal
Coe.Chantm9remNd thh eaAond Safety '
u ak.Sed . the Cupertino Municipal Cade.Chapter 9.12. ad tit HUIN and Safety
code.SeNen 25552(.)7
❑Yes 0N All roofs shall be inspected prior to any roofing material being installed.
Will the. Brant of future building Occupant use If a roof is installed without first obtainingan inspection,I agree to remove
PP g p ea Air
Mara which P g
mricaTamom ewe mntaminanu u dcfinc0 by the Bq Area Air Quality Managamem all new materials for inspection. -
C]Yea r]No
I haw mad the Weems materials requirements under Chapter 6.95 of the Califor-
HisHealth,k Safety Code,Sectors 25505,25533 and 25534.1 understand the If the Wilding
does not arwady haw a unanr.Net it is my remsen twity in notify the oaupant of Ute
requirements which mum W me,poor to issuance of a Ccrancau or Occupancy. Signature Of Applicant Date
ower rt.wthoriva gem Data All roof coverings to be Class"B" or better