02050054 CITY OF CUPERTINO
BUILDING DIVISION PERMITP CUNTR.ICTOWINFORMATION•
ALJ.' _.CY' .ti.•.
Bu104t7D1R SERRA ST PERMIT 12050054
1'r'AMN GROUP N-Sk'r96§Y
APPLICATIB2002
tHONE: SANITARY NO./ X1/1 JJ//CONTROL NO.
I,
µt00 ARCHITECVENGINEER: BUILDING PERMIT INFO
8�'t BLDG ELECT' PLUMB MECH
` u c-1 L. '1 I
h
Z LICENSED CONTRACTOR'S DECLARATION S 't� p
,i- Ih<rcby afonn shalom licensed under provisions of Chapter9(commencing NEW SINGLE FAMS�tY�LL"iING
It
Section 101)(i Division 3 of the Businessand Professions Code,and my license
:ms is in fail force LIVING SPj 4 S FT. /GARAGE 772 SQ FT
:w5< Licenu Clus Clim -F 1 L
:O U Date Convector r Y
u O t1 ARCHITECT'S DECLARATION
N1
I undersand my plain shall be used es puhlic records FEB 2 6 20 03
o o Licensed Professional
"R E OWNER-BUILDER DECLARATION
-m 1 hereby offish that I am exempt from the Convector's License Law for the 0
Z O following reason.(Senior 7031.5.Business and Professions Code:Any city ormunry - - -
which requires a pumit Inconstnat.alter,imparve.demolish,or repoir any structure
BUILDING
3 .ar shai he a uemynhertfrdm end the basis for she allegcd.eiemgion.Ary wolauan
,
_.... $4 3
9 33.3t u Iorequiresapplicantt such Wrmnm�ess umem,
tpHraomo i I censd p rsuynl ttl hepra 7sJons f she Commcmh License law(Chapter 9
(commencing with5 uniP00)ofD vi Sof she Business and Prof¢ ons Cade) Sq'Ft.,Floor'Area Valuation
'3"4L259618♦f60. _.
'
of
nor than
hundred
ollfor S5W).tmbjms Ne applicam too civil penalty,
idfdotmat<thenr.awnareddaBata(asoB). APN Number Occupancy Type
❑I,d other of the and
the t:ser lu employees with wogcs their sole compensation,
101 - FOUNDATION
willing the l Professi she a iiclute C not miens ListmeoffendLow
our
apply
to an
LUZ _ _
'Buslneei arid'Professions Code:The Comment's License law dos not opply to an 103 – UFER Required Insp'ections�='
oe throuf lihis owns employees.provided Nat such im ro ements art not intended or
WOW Y proves thereon,sod who does such work himul(
m, P .P v
Icompleonfile:IGhowcveeJ Me havngon burden of
proving
what he
oM year of 1.04'__-..._REBAR..____.._._ _.. .__.�,.._._- _.______.....___..._._._._....__... .-.
improve forh<ownefsale.).will have Me buMeno(proving that hedidnot build or 105 - ANCHOR BOLTS 7• '
improve for purpose of sale.).
� - ..._....__ _ ...__..___.__...1.06._ SEWER--&--WATER-_ _ 'tiILIu._•.s-l_s.k_n_b_
o the y,am exclusively 2omrocuiog with licensed nd convenor m
jec 5 70aa,B Illus and Prof..i..,Code:)The Co manor's 202 – UNDERFLOOR PLUMBING -
LLicense la nes to pl loan netofpropcny who builds or improves there ;f, plon. - - L:.,;¢
_andwho far Poo cls.wnh.a rontmcsor(s).licensed pursuant.tu.the. . _._. __-_–_.203._.-=--..UNDERFLOOR--MECHANICAL.--' ._.__..._:.--
c°°°' "" " " 2 04 - UNDERFLOOR -FRAM.E:;;
:. ❑la a "" ,BkPCfo this reason
205 - UNDERFLOOR INSULATION
N Ec RATION 301 - ROUGH PLUMBING
Ihertby affirm undttW of of pedaw'oni;ofthe following dedmmions: 302 – TUB & OR SHOWER
?I, 0 1 heve'und'will'maintail'o Cariocme of Consem'i.self-insure for Worker's 303 _ ROUGH MECHANICAL
5� Compensation, m p—!tied for by Section 37M of the Labor code, for the 304 ROUGH ELECTRICAL
perfonwnee f the work for whi,h this perms is issued,, 305 - FRAME
3700❑I hew-tM iI1 munuJn WOAe s Comperwuon I s mnce ai rtquirrA by genion
of Me labor Code,for the performance of Ne work'for which this permit s 306 HOLDOWNS
teed Myw kcti Compo set on Insurance came end Policy u..... .0.7__. ..INSULATION
tasu
r ei.dtt '...�u1PJ: fLs1 z.... f ..__ _-3 .._.., -..
Policy No !
zCERTIFICAION OF,EXEMPTION FROM WORKERSt ,�1, / "M:, 3s'3s0'8J(4 Is:SHEETROCK'";i, :��,
i. cpMrENsnnory NsuRANCE : '�' eT _._--_--3.0.9—...__EXTERIOR...LATH _. ---
fhamen dt400m 1:2d me 3101 - 1INTERIOR LATH IT : f'' :t; k
` p perms s(mo one hundred dollars t .L� stDf'
(g100)o Tljjjea " " ',,,� 311„_, SCRATCH COAT I
1 s thewoNforwhtcht spa tsissue,
d'1 313 – ROOF NAILiti(:; t '.t,l-'.:tl"i ' '"��
shall no Io t er so vs 1.barn c t the Workers -
Compo e n
r it - """" ""' _ 501_- _FINAL ELECTRICAL ENERGY
aeof Eaem tion ya should 502 - FINAL' PLUMBING ENERGY —
O0 not cmplywithschprovisions0L Permit shall bedeemsdrtvokd 503 - FINAL MECHANICAL ENERGY
e rets om s Ish, of the labor Code ou most
I.ENm"ancE{acY � - --� " 504=FINAL-BUILDING ENERGSSI. u, , c;
i
I hereby ?rm roar th t a dpnswctip led g agency for the pert mi nee 505 - FINAL E LE CTR I CAL ^c• PC' -t
fa] the work rot h ch N s pe t tssueE(see 3097 ave)
y:p Cerate Mame _ - -506 -- - GAS--TEST--- - ._.__
Lend sAddrtss ^ - --
U p ' - ' .''. t �r, - r -r. 507 - FINAL PLUMBING', •i t
,.�;;. Iccnify Thin lhav dNis appliceto ednt roar the ob0 fo atioo is 508 - FINAL MECHANICAL
fsx coneq I agree to comply with all city and codmy ordtoences and acne laws relating
O%�`j to Wildingmn -';andnertny'ere 'ntertpresentesivesdithisoitymmtcrupon 509 - FINAL GRADE
yy (rj 'the eb_ove- wn ' -try for inspc iov purpose}.,..:=
L 11x' cirri-'nity dkeepharMeutheCiryofCpenlndagainst 510 - FINAL PLANNING
FFII W liebili' ts, s set wh ch hey n any w accrue egamt laid 514 - IN WORKS
U,7 Cit tris pertnu ”' m
wwltxA N r5iIssued bp:0 - 0 �' IL Date
OZ
AZA OusMA uLSD,,CL,SU., I. +=i 1 Re-roofs 04 - ROOF IN-PROGRESS
Will the appltaht mfuturc Wil 'ompent Wore or handle bezWous maenel Type Of OOf - -
as defined by,Lha Cupcma,Municipal Code Chapter 9 12 and the Health and Safety
hde Section 25532(sI° 1' •`:'". - .__ `_.I ;
A 73 s s- Ii t .. a ....---,-
in 1 4 _All.roofs shall be inspected poor[o.any roofing.matenal.being installed...
,, Wdl she a heart o fu b Id ng occupem use egeipmem or dotes which f
VP If a roof is `tilledawithout first obtainingan ins ecuon;I a'iee,to•i'emove
'ihazWous sere nti rams defi cd by Ne Bey Arte Art quality Management P g
Dan all ne t fo act n Applicant understands and will comply_with
O Yes _. ...._.._..
all n _ - I b� I ons:,.,,,
I h vat' a haadr ate'i requirclnenu undel Chapter 6'33 bf Ne '
Califd I "s e. ecu' s 25505,25533 and 25534:1 understand Milt,
'iPsh dY mnaltrshat it ii my reaponsibiliry to notify she
se' list net priorm wence" a ' Ere f
0
.-:..
u of
BP_
. . . ._ ate-----•
All roof coverings to be Class ` " or,better