04030033CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
04030033
WE NAME:
FRANK RTTiRAQ
PERMIT ISSUE DATE
ONE:
SANITARY N 0 T GL NO.
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby afmm Nal I am licensed under provisions of Chapter 9 (commencing
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with Secdon 7008) of Division 3.1' Ne Business and Profestianx Code. and my license is
Lifull coma and affect.
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TI--INFILL STAIRS OPENING NA LES]
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Dam Contrwur
ARCHITECTS DECLARATION
I understand my plans shall he used as public mo
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3. 12004 MAR 2000
Licensed Professional
OWNER-BUILDER DECLARATION
1 hemlry affirm Thal I am exempt from the Contractor's License Law for the
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following mason. (Section 7031.5, Business and Prons fessioCode: Any city or county
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which requires a permit In construct, alms. Improve, demolish. or repair any concern
prior it) its issuance. also requires the applicant for such permit to file a signed abutment
Ft. Floor Area
Valuate
that W is licensed pursuant m the provisions of the Common's License law(Chapter 9
Sq.
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(commencing with Section 7000) of Division 3 of the Business and Professions Code) at
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that he u exempt themlrom and the basis for the alleged morapdon. Any vlus0an of
3 � Sby9�er p p
Occupancy Type
Seddon 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of
not more Wen Jim hundred dollars (5500).
bL m owner of the properly, or my employees with wages as timirsole compensation,
e ns
Required Inspections
will do the work. and the structurals not intended m offered for sale(Sec. 7044. Business
and Profem seiuCode: The Contractors Lt.. Law tltas not apply m an owner of
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property who builds or improves theroon, and who does such work himael f ser through his
own employees. provided that such improvements an, not intended oroffamd formic. if.
however. We building or improvement is sold within one yew of compledem. the onsom,
builder will have the burden of proving that he did not Wild or improve for purpose of
cam"1.
as owner of the property, am exclusively eontmeting with licensed contractors so
sen wet the project (Sec. 7(06, Business and Professions Cade:) The Contractors Li
cense Law docs not apply m an owner of property who Wilds or improves Wemon, and
who contras for such projects with a comacmr(s) licensed pursuant to the Convectors
License Law.
❑ i exempt under Sec. B & P C for this reason
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WORKER'S COMP NSA ON DECLAilATION
1 hereby a10rm under penalty of perjury one of the fah0=1 deelwstums:
I have and will maintain a CedRcern ulcerations to selhiroum for Worker's Compen.
more, as provided for by Section 3700 of the Labor Code, fm the performance of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation lasurance, as required by Section
3700 of the Labor Code, for the perfmmenen of the work for which this Forret is Issued.
My Workers Compensation Insurance carie and Policy number am:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
_
(Irks section need not W completed if the runit Is for.. hundred dollars ($10i
or Icm.)
1 certify that in the performance of the work for which this Permit is issued. I shall not
employ any person in any manner an u an becom,eubjeat to the Workers' Comperemon
Laws of Califomla. Date
Applicant
NOTICE TO APPLICANT: If, efmr making this Certificate of Exemption, you should
beemme subject m the Worker& Conerammtion previsions of the Later Gude, you mum
forthwith comply with such provisions or this Permit Mall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hemhy air. that une 1. • construction lending agency to, We peritoneums, of
the work for which this pewit is issued (Sec. 3097. Cin Q
Lenders Name
Lenders Address
I certify that 1 have mad this application and mute that We a om information is
'
correct. l agree m comply with all city and county ordinances and sus laws relating to
building construction, and hereby autumn repmxnulives of this city m enter upon the
above-mentioned property for inspection purposes.
(W,) acme m ave. indemnify and keep harmless the City of Cupertino againstliabilities,judgm,nts,
cuss and expenses which may in any way acerae againstaid City
inconsequenceofshe granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: D3e/
SOUR E LATIONS.
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Re-roofs
Type of Roof
nates a ams/Coneactor
HAZARDOUS MATERIAL DISCLOSURE
Will the applicant or future building occupant stare orhandleha urdous material
defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safely
Section 25532m)?
E] bNo
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building =open[ use equipment or devices which
it hand... air cmnurrim s as dc0ned by the Bay Area Air Quality Management
all new materials for inspection.
istrict7
(JYcs I (No
I have mad the hmad..e rmimel. mquimne,nts under Chapter 6.95 of the Califor.
nim Heal" SafelyCodc, Sccfims25505,25533 and 25534.1 undoomed Nasifte, building
does not currently haw a tenant, that II s my resporembility in notify the occupml of the
requiumimma whichmost be my4Titrm' sell ser c,mfiestetrOccupancy.
-5 P. W
Signature of Applicant Date
All roof coverings to be Class "B" or better
mer or.. mry<d agent Dam