02120014 CITY OF CUPERTINO' r" z:>•` - a
BUILDING DIVISION PERMIT CONTRACTORINFORMATION
teas.,, taxx«„e�as•✓v.
BU I&E+9aP4RESSTEVENS CREEK BLVD SARATOGA CONSTRUCTION PERMITN02120014
R.MAM1,N0R0UZI 12201 SARATOGA—SUNNYVALE �r1.ICATT'2"J"T22002
ONE: (408) 996-1711 SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
Op LICENSED CONTRACTOR'S DECLARATION -
1 hmch affirm that I am licensed under provisions of Chapter 9(commencing
�, wiNScaion]NB)nfDivi5inn3ofNc0B.�5sanJPnlfcsrionsCoJe,and(mylicen g REVISION--IN HOUg�scrl I�{nONLY
Now int°I f eandef t. I/ 'jZ'rJ 0 n ORIG. #01010108, NO NEW PERMIT ISSUED
66{ us Lice lass U,, 'S -]
Oz�O D nn 'IDI
ARCHITECT ECLARATION
r�yYi -a I understand my plans shall . Jas public namJs _
KO U
Yl�LLi'� I.ICCnSCd PInfCS5111na1
C a OWNER-BUILDER DECLARATION
Contractors
Fd e f I hereby.(Bra that 11. exempt from the Cssions o :License Law for ay
i se O which re ream".(Section 9(111.5.Business and Professions h,Code:Any tiny or county
X,o which its requires a e,alsl re cores the alms improve.demolish or repair any tuuaum $5000
Fz< pdamshomance.aluant toithe irmym reantfor such etmr'sit)Licfile asigned smmmcnt
Oat menti gwitpumuamtolheprovisionsoftheGonwnndProclaw(Chaplm9 Sq. Fl. Floor Area Valuation
c (cat he is in with Senioon XXEand O basison 3fee O the ageBusiness aad in.A Stens Code)or
i 3�
that he is exempt ILerefmm and Ne basis for Nc alleged ezemptinn.Any violasinn of 34212 036 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Oeeu ane e
not more than rive hundred donors($500). 101 — FOUNDATION p y Typ
I,as owner of the properly,or my employees with wages as their sale compensation,
will do the work,and Ne suvaure is not intended or offered for sale(Sec.7(an,Business 3:02 - PIERS
and Profcssioms Code:The Contractor's License Law fres not apply to an owner of 103 - UFER Required Inspections
propcny who builds or improves thereon,and who does such work himself or through his
own employees.provided that such improvements arenot intended or offered for sale.If. 104 — REBAR
however,the building or improvement is sold within one year of completion,the owner. /�
builder will have the burden of proving that he did not build or improve for purpose of 105 .— ANCHOR BOLTS <
sale.). 106 — SEWER & WATER
01,as owner of the pmgeny,am exclusively contracting with licensed contractors to 202 — UNDERFLOOR PLUMBING
construct the es not apply
(Sec.]fano Business and Professions Codei The Contractors Li.
whocraft,
contra Juror such plyman with
a CDfprepenr who wu pursuant
improve themnctors 203 — UNDERFLOOR MECHANICAL S `
whence Lo contracts for such projects withaconmanmr(s)licensedpursuanum the Convamoh 204 — UNDERFLOOR FRAME l
License Law.
O l im ezempt under Sec. .B@ P C for this reason 205 — UNDERFLOOR INSULATION
at Dam 301 — ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
I moan,affirm under penahy of perjary,one of the following declarations: 303 - ROUGH MECHANICAL
1 have and will maintain a Cerlifcate of Cnnsenl to self inure for Worker's Compcm
tion,as provided for by Section 3700 of the lecher Code.for the performance of the 3 04 — ROUGH ELECTRICAL
work for which Nis permit is issued. 305 — FRAME
❑1 have and will maintain Worker's Compensation Insurance,ss required by Section 3 06 — HOLDOWNS
3700 of the labor Code,for Ne pertormance of On week for which Of,permit is issued.
My Worker's m n5admn m5"ranee comer aria`ahoy namberare: 307 — INSULATION
ca ler: L / Py�JNa: 308 — SHEETROCK
o ERT FICC 7 CAQMNI�AONFRON EORKERS' 309 — EXTERIOR LATH
(This acninnneed no,the mmpleted ifth,permit is formic hundred sells.(S Its)) 310 — INTERIOR LATH
mless') 311 — SCRATCH COAT
1 certify that in the performance of the work for which this permit is issued,I said not 313 — ROOF NAIL
employ any retson in any manner se as to become subject o the Workers'Compenselion
Laws ofCalifornia.Date 501 — FINAL ELECTRICAL ENERGY
Applicant
NOTICE TO APPLICANT:If.after making this Cent Teale of Exemption,you shnulti 502 — FINAL PLUMBING ENERGY
become subject o Ne Worker's Compensation pavisinns of the Labor Code,you muss 503 — FINAL MECHANICAL ENERGY
,Z forthwith comply with such provisions or this permit shall he deemed revoked.
z Q 504 — FINAL BUILDING ENERGY
.N. CONSTRUCTION LENDING AGENCY
rIwom,affirm Out Of.is"command..lending agency limhc performanceof 505 — FINAL ELECTRICAL
C > the work for which this permit isissued(Sec.3097,Cry.C.) 506 - GAS TEST
LLl 0 Under's Name
Z Lenders Address 507 — FINAL PLUMBING
U O I certify Nat I have mad Nis application and stem that the alove Information is 508 — FINAL MECHANICAL
!yF
correct,I agree to comply with all city and county committees and stan,laws relating to 5 FINAL GRADE
building construction.and hereby ardlamea mpmunutives of Nis city to cnmr uqm the
Wabove mentioned properly for inspection purposes. O — FIN I G
(We)agree to save.indemnify and keep havnless Ne City of Cupertino against �(
F-'h
liabilities,judgments,costs and expenses which may in any way amac against said City 5 N L WORKS
J z inconsequence
of the UNDERSTANDS anting of AND WILL COMPLY WITH ALL NON-POINT Issued by6s prounif 0 NAIL Dale / l
SOUR E REGU TIO
a �p apasakp� ���� Re-roofs604 —k-ROOF IN—PROGRESS
amof Appaan a oacmr Oam
HAZARDOUS MAT(RIALS DISCLOSURE Type of Roof
Will Ne applicant m Tuan building occupant store or handle haaardous material
fined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
.send.,25532(a)7
❑Yes All roofs shall be inspected prior to any roofing material being installed.
t Will the applicant or future Wilding up m use equipment mrd vices which If a roof is installed without first obtaining an inspection, I agree to remove
it harardous air contaminants as dcGned by the Bay Area Air Quality Management all new materials for inspection.
shier?
❑We
It ave mad the IanNnus materials mquirements under Chapter 6.95 of the Cxlimp
rustication Cndc.Smti.ns25505.25533 and 25511.1apJcrsmnd thuiflM Wilding
Jrex nm cunemly ba c a tenant Nm it is my respemihility mlµ'(y rhe omupam of Nc
requimmenks which mustbe tp rtoismammefa Ccniw r0.cupancg Signature of Applicant Dale
Ark 41) //$
OamNemedagem Da All roof coverings to be Class "B"or better