03040096 CITY OF CUPERTINO ,"R N : ''` '/ f • ♦ e• f y��
BUILDING DIVISION PERMITu�"Lw � ��• L?",^
BUILDING ADDRESS: WEBCOR BUILDERS PERMIT Ncb3040096
ER'S NAME: 951 MARINERS ISLAND BLVD "ER"d"•L T/n6/2003
QLO EQUITIES ONE: (41S) 349-2727 SANITARY NO, CONTROL NO.
ARC HTTECrfENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
api00 LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby Affirm that I Am Ikensed un�el,provisions of Chapter 9(commencing
IN Scetion7 )ofDivI.m.3ofine BuauZmdpmfessiom Code.mdmylicenmie
snmRm effect. ✓ — 0 �p ELEVATOR/HY ULIC (PASSENGER)
5 ? LI me hh Lk.g
De i'ji� r
ARCHTIECrS LARATION
1 WdP3yglan all Ecu public ranNs I 1,
o Lka dProfaaionel
OWNER-BUILDER DECLARATION
I 1 hereby oRrm that 1 am exempt(man the Comactofs License law for the
i p O following meson.(Sacuon 7031.5,Business and Professions Cade:Any city or roomy
g which requires a permit to construet,altar,improve,demolish,or repair Any structure
prior in its issuance.alai requires the applicant forsuch permit m0leasigmd sutemenl
g CNat he is focused pursuant to the provisions of Ne Contractors License LAW(Chapter 9 Sq.Ft. Floor Area $k60
(commencing with Section 7000)af Divism3af the Bwinammd Proressions Cade)of ,
that he Is exempt tlmmfrom and dm basis for tee alleged exemption.Any violation or
Section 7031.5 by any applicant for a permit sobjecm the SPPlicam In A civil Penslty of 31kME Q12A*e10 0 Occupancy IYpe
not more than five hundred dollars(5500).
❑1,As owner of me property,or my employ=with wages as their mw compensation•
will do the warlcmd me swctum is cot intended or offered fm ask(Sm.7061,Business iul — d Inspections
and Prefeal0ns Cada,The ComV4Yar's License Law does not Apply w an awmr of 102 - PIERS
p
propeny w ho builds or im prom thereon•And who does such wart himsel f or through his
..employ=,provided that such imprnwmwu are not intended oroQered foram.If. 103 — UFER
however.the building or improvement is sold within am:year of completion,Ne awner-
builder will have me burden of proving that he did not bhiw or improve far purpose of 104 — REBAR
ale'). 105 — ANCHOR BOLTS
❑I.a owner or me property.Am exclusively contracting with licensed mWAMAS to 106 - SEWER & WATER
commset the psoj.a(Sec.7061.Bostn.and Professions Cade:)The Conuamul Li-
man Law does not apply wanmanes ofpmpenywho wilmorimpmmthereon.ad, 202 — UNDERFLOOR PLUMBING
Lnha� for such projects wiNacontrapor(.)liansed pmmrsuammtite ConuxraY. 203 - UNDERFLOOR MECHANICAL
❑Iameaemptunder See ,BkPCformmwan 204 - UNDERFLOOR FRAME
Data 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
IAmity Affirm under penalty ofpednym,eofinefollowing declarations: 301 — ROUGH PLUMBING
Iluw enc willmainuinA CeruOeste of Consemmself-Warm fa Wartefe Compen- 302 — TUB & OR SHOWERmion,As provident for by Sation 3700 of the labor Cade.for Me pact..-of the 303 - ROUGH MECHANICAL
.1forwhichthispermitisisaed. 304 - ROUGH ELECTRICAL
❑I Mw and will mainuin WorkeYs Compensation Inmrana,u required by Section 3 O 5 — FRAME
3100. eLaEor Code.for me perromance of Ne wart for which Nis pemitkiaued.
M'W' mpensauaninsunncee mendPaneymmberue: 306 - HOLDOWNS
�L%tFC PonyNo.: L/�¢3�9�i 307 - INSULATION
G" Fl
COMPENSATION INSURANCEEOaKERs• 308 — SHEETROCK
metzsecum need wrist,coe p
completed it Man is fam rohundreddollAm(5100) 309 — EXTERIOR LATH
orteas) 310 - INTERIOR LATH
I certify that in the performance of me work for which this permit m W.d.I shill nm 311 - SCRATCH COAT
employ any person in my mannerse as u become subject m Un Worli Compenation
Laws of California.Data 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT:If.after making this Cenillcam of Exemption,you Mould 501 - FINAL ELECTRICAL ENERGY '
become subject in tite Womenes Compemssure provisions of the labor Cod%you mut
OZformwimcomply mn
Peahmhedamadrevoked 502 - FINAL PLUMBING ENERGY
yo 503 - FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
E4 Ihembyai0mmum merel..conskwtrnnkndmg.gencyfor MePerfomanceof 504 - FINAL BUILDING ENERGY
a > ftvArkfar which mmpemit1.Wood(Sce3097.Civ.C.) 505 - FINAL ELECTRICAL
ILl 0 Lander'.None
o landeesAidma 506 - GAS TEST
U0 I certify Must I Mw read this application and sum mu the above Information is5 0 7 - FINAL PLUMBING
D. f" correc.I Agree in comply with III city arw county ordinances and sum Ia.rebsm
ting
0U Wildingconwucuaaand hambyaamorieempmannuumofthiscity Warner Upon the FINA MECHAN CAL -
w above-mentioned property for inspection purposes 0 9 F I N
y (We)agree mane.indemnify and keep loonless the City of CYPertma Against
res fn Iiabilides,ludiments.com and expenses which may in any way Accme Agunsl aid City 55 G
U Z in consequence of me gesnung of this semi.
r4 APPLICANT NDERSTANDS AND WILL COMPLY W,,yyy,,,fffffL,,^^^,ALL NON-POINT Issued by:5 WORKS Date
SOURCE ATIONS. S�G
�03 Re-roofs
SI of Airpliam/Cantrcmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will mo Applicant or future building occupant time whandle hatudous material
as de0ned by me Cupertino Municipal Code,Chapter 9.12.And cite Health and Safety
.Smmm25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes �No
Will the applicant orf future building aecupani um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haAmmus air comaminsnu as de0md by the Bay AMA Air Quality Management all new materials for inspection.
istct?
Dyes
1 haw reed Ne hawdamm 5505.2 equimmew under Clupterdtheof tite Glifor-
nmNeswasaretycade,s«,iatsss0s.sss33 arw25531.1 andertarw matirun wiwkg
date cotcmrentlY Mw Atensn.Nu ireumy mapof.cOrymmor eau sof Ne
regaire n which�aya�xm/mypnarmlmmyoseracanimnodif Signature of Applicant Date
�wner or auNorixd ai`t !� �' All roof coverings to be Class��B��or better