02030085 OF
NO
CI BUI DING DpERONNo PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10114 VISTA DR AGRESTI AND ASSOCIATES, ENC. 02030085
OWNER'S NAME: APPLICATION SUB DATE
CUPERTINO COMMUNITY SERVICES 2175 RONDALD ST. 03/18/2002
PHONE: (408) 727-0404 SANITARY NO. CONTROL NO.
'
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
u❑ BLDG ELECT PLUMB MECH
NauSai LJ UJ LJ L_7
F?" LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am licensed under rens 9 Job Description
,Z,=- ) provisions o Chapter (commeacin¢
vyawithseaio ]IXp)afDivtsion3ofthe Brta 9a anarn,re.>i(,n.cea<.anamyh«n,e MODULAR OFFICE/MOBILE .
e se a t.
I p d Dana c.a< D
3 3 a N Dae
R H ECI"S DE Lar N'
u S I understand my plans shall he used to public records
1 p O Licenecd Prom.wional
�e P that I a -BUILDER DECLARATION
er m 1 hereby affirm ilia 1 am exempt from the ARACounnictor's License law for the
C?< following reason.(Section 7031.5,Business and Professions Cade Any city or county C 0
which requires a pcorml w co itima,alter,improve,demolish,or repair any structure 'f
63Q Mnrtat.' also re'rusesdar.,picat forsuchpermntohleasrgrcd suumem. - _____..,_ _,___
lic-ilhimesed lttwithSeuaon al) D ion3oCommnnrsLcensclzwcarsCar9 L pp pp qc(t'�y.�^yC//yy��gValuation
(commencingbe
with Section 7mAl)ofD"nsil a theidbusdeicim ,WiAnyviCoae)
oT that he rs eaempi thcrcfiom and the bass Tor the cts, he exempti to
Any violation
-
of Section 703 LS by any applicant for o permit subjttu the applimnt ro a rnil Penalty
of it mom than rise hundred douars(SSW). 101ApN lft�ffDAT I ON - ""'r''� Occupancy Type
O 1,as awner of the propcny,or my employees with wages as their sole compensation.
-will'do the work:and'thesmcmrc is no,intended or offered for sale(Set.
'Business and Pmrnsions code:The Contractors License Law does not apply to an 103 - UFER Required Inspections
ow,net of property who wiles or improves theorem,and who does such work himself 104 - REBAR
or through his awn have employees,provided r br such improvements ism Pat ended o
-offu<d fors0e lfhrw "il' blve t ormpm offino s: W tfidn eYe r' ._...
emplmm�,me owner-Wilder will have th<wmen orprovmg mm he as not build or 105 - ANCHOR BOLTS .. ,.,• •. ':..'r,
improve So purpose ofaal°'). 106 - SEWER & WATER
co 1.asowner of the property,7,ore Busin Holy d Professions
with licensed Connurers(t 2 02- - UND License the prefect Nstt.Yawn owner of entywhobs cme6 The ventarton. 2 03 - UNDERFLOOR MECHANICAL'
-andim<ear law a«.not apply to an ewmro er pmpcnr who builds or improves(carom.
: who.contmets for-such p ticcts.wifir camaaarls).fim.ma.,m seam or he _... .._.. -2 ..._._.. _____.....__._. _..
Comracmn Llaanseisw., 04' -= UNDERFLOOR' FRAME'
- _._._.._.._
°l am exempt under see. ' : '.93 P C for this rwson205 - UNDERFLOOR' PNSUliATION
i
ownN'"'' "" 'Dale'" 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
- 302 - TUB & OR SHOWER
Ihereby afrrmundgpempliyofPerjoryoneethe following dec,nra6°ns' 303 - ROUGH MECHANICAL
° I have and will riuimein'a Cenihcam of Consent to selr.m:are for Worker's 3 04 - ROUGH ELECTRICAL
Compensation, as provided for by Section 37W of the Labor Coda for the
po forim um of the work Tor which this permit is issued. 3 0 5 - FRAME
OI haveland will mmmmin Worker's�Cainpensation Insurance,as required by Section 306 - HOLDOWNS
37.W of the labor Code,for the performance of the work for which this Permit is
.- INSULATIONand,My W k fs Co penSIR on l surance carrierand Policy de a 3 07
Nq� (��9� 7rF30 ' SHEETROCKiT PI091' �PIEXTERIORi,L..
A"T.i
i r CERT19CATIONOFEXEMTON MOM woR e s�
COMPENSATION INSURANCE"': -
3r , INTERIOR—liATH; .-- -----
"� (This sect an need nm be completed if the permit is for one wndred dollars
f3]003 at leas3 311 SCRATCH COAT
3`1.3., :_= ROOF-NAI.L-.. •. - - '
I ri fy orb p '1 fth o'kfrwhichth,,Pr to issued,l — - --
ihell 1 p,oy any P r manner so aa)o become subject tome workers 501 - FINAL EnECTR I CAh ENERGY:;
Comps u n Laws of Calf .Date to,
.Applicant." 502 -- FINAL--PLUMBING. ENERGY___...
;been.NOTICE TO APPLICANT If,after Compensation
this Ceninsofda Exemption.de.you ould
most 503 - FINAL MECHANICAL ENERGY
become subject to the such Pr Colons or this Permit
the erred Coate,you must
zrecd revoked.
O O Ibnn tecomply witn rnp n arm x t nubraa .. ._.504 ... -__E.INAL...BUILD.ING. ENERG]i
n` t "1 CONSTRUCTION LENDING AGENCY " '
3 505 - FINAL ELECTRICAL
a "' 1 hereby Rom th uh c soda leading grncy for,the perfdrma«e t. r.
Lemework Nmew;1-'-ch 'prntnaowned Nsa.3- --Cin.ed 506 - GAS TEST: .. ... ... . .•-.._. _---.....,.._.___._._.._ ... .._... ...__-- -..
Lender'i Name 11;1—'.a.,-., .._..,v. .. '...r.___:, .c i._.. _... _- . .__. _. ., __._.. ._.
I<maerinuursz" ' - 507 - FINAL PLUMBING
v0I verifythin in I ioreneridms pliernio.andrtmam b've 506 - FINAL MECHANICAL nn
,(z F correct.1 agree to comply with all
Wilding
and county ordinances d state s509 - FINAL GRADEOCto w Id ng c t t n d herebyautwo e p sent eves o(th city to enter upon
1hc,Poc-rPcmPmcdIranian,f yang pm,. 510 - FINAL PLANNING
F„ L el,j dgme t. a e demo pe and keep hornless the City of C pen o a,said
m Cab1 consequence rva,< rs d x a h nmy .ter r r age score 514 - FINAL PU IC WORKS
CJ' City ANTNDE the granting- finis permu
APP (CANT UNDER. NO AN y WI -OMPLY WITH ALL INT'' Issued by: � Dale C)�
50 CE REGI' S',""'� ` Y
s ,mPmx ppIio.WCmPmcmo- ', .':':.., "oat Re-roofs �
.HAZIRDOUSMATERIALSDISCLOSURE I �'
Wit orn ppbcant r t w,a ';; part ororole haimshais mm al
aCsdAAff SMtby- tt -Type>- ' o
f Roof.
d Cupen Municipal Cod Chapter912 and theHealth ad Safety -• s 25532a n r
rrtOYe F. l
All roofs shall be respected prior(o-any.rooFpg material being Installed,
ty'h th applies t fuumbu li ng occupant useequipment orde mea hien If a roof is installed without first obtaining aro inspection','I'agree to remove
lemic hazvdous an conummmts as defined by the Bay Area Ali Quality Management
Diann all new materials for inspection. Applicant understands and will com 1 with
°Y .nt::. o" ' all non-point sou ce'regulauons. _
ha e'iwdl(ce mlrsacais mauthis¢gm¢mems under Chapter 6.95 of the
&Iifomfa Heuhh&S oficy.Code Sections 25505;25533 end 25534.I-understand that
d thb bu la n8d tc rrc ayh erect t roar t is raymsponsibilitymmaifthe .. _ _ _ _. __ .. ... _.. _ _ .. . . _ __ _..
oecupanr of the �jr�emejts/'n< t be t
,irmi,ni.issmone of a CCanr)Bcart of
j ocp can ✓ J71'! •d Signature of Applicant Date ..
f TW All roof coverings to be Class "B" or better
authonE[d eget . ,y '( Dmf.,,
J
OFFICE