02070027 TINO
CITYBUILDING DIyVIISIONPERMIT CONTRACTOR INFORMATION:
BylnlLpt3srArkt3DRFSc�EVENS CREEK BLVD HOWARD WRIGHT CONSTRUCTION PIT 070027
IF�'1sFU
x`U &fEE CORPATION (2ND. FL) PIER 9, THE EMBARCADERO #1 A1puCAdGTJIiJSA1112002
PHONE: (206) 447-7672 SANITARY NO. CONTROL NO.
M c z ARCHITECT(ENGINF.ER: BUILDING PERMIT INFO
P w O BLDG ELECT PLUMB MECH
H i. I
1C�'�� 'r�I= L—:I L'.I
h i LICENSE[)LICENSE[)CO\TRACTOR'S DECLARATION
e s c rlptl00 `s• 'l"-itt D
i z—e I hereby arena mW I em reamed awe/�pra,l,mn,of Chapter 9(eammendng TENANT IMPROVEM; 'P
p us h; w,P Sav'is),f70W)af Dl,'I,iaa 3 of the BasiMl and Prnli•>.,ions Code,and no y lic ms,
s x< Littnulls.g(`and of LII.NNN O -5 f- 0C f 0 9 2002
a u Dme 44441111_MMMM ��T Cont ,
t 3 ce y ARCI I ITF.CFS D.' ARATION
n—`O a .n J m ,lane ehnll he n,edhlic rrcoN,
s BUILDING
I 6 0 C Licensed P o esiohnl
=uN. OWN'ER-BUILDER DECLARATION
'at I nearby mean that 1.m exempt from the Canto ,License Law far he $9 9 3 6 8
I following reason.(Section 7031.5.Business and Pmfessions Cade:Any city or county
'a
w hich requires a Permit to construct. her intion,a.cannot ish.or mpuir any swcture
n 3 Ca Ca pmmtn .. Is 9 thef such Peint flsignedstatement 1.
butt licensed prsi ni the p n fan Contractor's License' I (Chapter9 3�(](A ( r Valuation
a ] aValuation(cram . 8 'foSect 71NX)) IU o, 3 ft B dProfession,Code) h k
or that he is esrmpt Sherefrom and the basis far the alleged afem,nion.Any violation
of Section 7031:5 by any applicant fon a permit subjects the applicantto a civil Penalty
of not mote than me hundred dollars(SSM). APN Occupancy Type
M T.as owner al the prr,arly.of my moplayeas m ill,wages as their sale nomsensmina, 102 — PIERS
will do the work.and the structure is not intended or offered for sale(Sec.70L4, —
Baanexs and Pmde:fessions CaThe C°ntmcmr'e Lipase Law does not apply to an Required Inspections
r of property Who builds or improves themnn,and who does such weak himself 104 — REBAU 11 ht'R
orthrough his awn en,pinyccs.p....ded chat such improvement are nal intended or 105 — ANCHOR BOLTS . ... .
'offered far sale.If,however,the building or impfosermto is sold within are year of „
iompletion.the owneo-builder will have the Wader or proving that he did not build or 106 — SEWER & WATER
mprove for purpose of sale.).
202— — UNDERFLOOR PLUMBING .
D 1.as owner of the property,am exclusively contracting wlin licensed contractors m 203 — UNDERFLOOR MECHANICAL '
construct the project(Sec.TA,1.Business and Pmfessions Code:)The Contractor's ,
icensmm
nr , awdoesnonapplytoanownerofpropenywhoWildsorimprovesdameon, 204 — UNDERFLOOR FRAME
I. andwho contracts for such,projects with a concrfs)licensed pursuant no the _
co° acmrsLi«nreuw. 205 — UNDERFLOOR INSULATION
❑I ata exempt under Ser. ,B&P c far this rtes..
301 — ROUGH PLUMBING
owner Data 302 — TUB & OR SHOWER
WORKER'S COMPENSATION DECLARATION
I hereby affirm under.penmiy.1 perjury one fthe following declaraim, 303 — ROUGH MECHANICAL
n�o1 have and wiH ...ionic is Canincrate m Con..ent 1.scv-in=ure for worker. 304 — ROUGH ELECTRICAL
Compensation, a, provided for by section 37W of the Labor cache, for the 305 — FRAME
prrr.rtnanca of the work ear whim this permit is issued.
306 — HOLDOWNS
❑I have and will maintain Worker i Compensation if t boom work f as acquired by Trout in 3 0 7 — INSULATION
.. 3]00 of she tabor Code,for the Performance of the work for which this permit is
issued.My Workers Compcnsanippn I are carrier a ad P.neY number are: 308 — SHEETROCK
cdmienY IRYn Id/ Pary�. 309 EXTERIOR. ,LATH:.
CERTIFI ATION OF EKE N FROM WORKERS'
caMPerysnrio. wsuftn"ce _310-_.c .INTER I OR._LATH_.__.. _
fThia.csfm, aid not the completed inhepermitisfor one hundred dollars SCRATCH COAT
311 ' '-
($10o°rl"`) 313 — ROOF_,NAIL
1 certify What in the psaf.munce of the work for which his permit is issued.1 501 — FINAL ELECTR I CAL.ENERGY
shall apt employ any person in ity manner m as no become subject no the Workers'
Compen,atitim aw,ofCalil ria.Dme 502 — FINAL PLUMBING ENERGY
.Applicant - -
NOTICETOAPPLICANT.If.after makingthkCcrtifcateofEmnation,yen should 503 — FINAL MECHANICAL ENERGY
Z become subject to the Worker's Compensation pmvisionsofthe Labor Code.you must 504 — FINAL BUILDING ENERGY
Q Q fonhwith comply With such pmvisimu or this pertain shall be deemed revoked.
CONSTRUCTION
505 — FINAL ELECTRICAL
�nei<nr arena nam inertm is
Fi i e
,aons a construction llendingalendingLENDINGAGENCY g agency for the pm
err.runa 506 —
GAS TEST
ohne work for which this Pcm,it is issued sec.3097,Civ.C.1 507 — FINAL PLUMBING - -
A' iamu� ,Ad
7 z '' dm,,.
508 — FINAL MECHANICAL
U OI ccnify that I have mad this application and state that the above information is 509 — FINAL GRADE
:*+ H carted.1 agree to comply with all city and county ordinances and state laws mining
O U no building comrmclion,and hereby annornerepresentatives othis cityI.enter upon 510 — FINAL PLANNING
p m mea,ove.acntonedpfopntyforia,pertioapprpo,a,. 514 — FINAL PUBLIC WORKS
t„t
A. (We)agree to save,indemnify and kap humless the City of Cupertino against
W liabilities,judgments costs and expenses which may in any way acerve against mid U z City in consequence of the granting of this permit.,UNDERSTANDS AN'D WILL COMPLY WITH AL DINT, ISSUedb Dater� kl
(U :ERE Jl'ATIONS. `ase y, y'
'74mture of APPlic
HAZARDOUS
ma Re-roofs
HAZARDOUS MATERIALS DISCLOSURE "
Will y e Cent no Mure building acJlapt seam lir Handle Health ad Safety Type Of Roof r .. ..
.. as def net io be Cupertino Municipal Cotic,Chapter 9.13.and she Health and Safay .
Codd Saiion 255J21a17 � .. � * '" '' t ° ..
0Y°' ' ' No _ All roofs shall be inspected,prior to any.roofing material_being.installed.
Will the appbe:hal err ,tar<hundirs.crapam a,aaquipmam or daWces which If a roof is installed without first obtaining an inspection, I agree to remove
MIL hazardous air conmin'�1°``ned Area by the Bay AAir Qualityanage
Management
on
iamm] all new materials for inspection.. Applicant,understands and'will comply with
1 0Yet, O'• � 0" - all non-point source-regulations.'
1..� 1 have read the haeaNaus materials acquirements under Chapter 695 of the
California Health h Safety Code,Sections 25505,25537 and 25534.1 understand that
if Hated ing does not currently have a savant,that in is my responsibility tonotify the
a in consonants which must be men prior to issuance of a Cmifirme of
°""p°" Signature of Applicant Date
,0
own orinnadredagent Date All roof coverings to be Class"B"or better
'OFFICE '