02120063 CITY OF CUPERTINO "�;.• •at a �a� wa.¢ �•
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDING ADDRESS: A Se H HEATING PERMIT NO,
20044 WHEATON DR 02120063
OWNER'S NAME 770 CHESTNUT ST APPLICATION SUB DATE
GARRETT WADE 12/16/2002
IONS: 4 p g 2 7-9—0 7 2 2 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLUG ELECT PLUMB MECD
0 0 0 0
�Co LICENSED CONTRACTOR'S DECLARATION Job Description
rc P I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing P
with Section 70x0 of Division 3 of the Business and Professional,Code,and my license is
�o„ i^fere^c�a a t. y FRUANCE CENTRAL A C REPLAC DUCTS
Z04Z License a •' 2(] Lie.p v� `� r / r
c-- Da _! L(v=p can PANEL UPGRADE/220 VOLT CIR. / IAY
ARCHITECTS D fARATI
ND w U 1 understand my plans shall he used as Public records
LLo LicensedProfeasmnal MAR 0 6 2003
OWNER-BUILDER DECLARATION
ti 2 I herchy affirm that I am asemPt from the Contractor's License Law for the
ti E Q O following reason.(Seclinn 7031.5,Business and Pmfessinns Code:Any city or county
$(L which requires a permit too construct.alter,Impnsve,demolish,nn repair any symctere B
�3< prior to its issuance,also acquires the applicant for such permit to file aligned statement
that he is licensed pursuant m the Provisions of the Connector's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
gHg (enmmencingwithSection70X)ofDivision3ofthe Businessand Professions Code)^r $11000
..
that he is exempt therefrom and Ne basis for Ne alleged eumption.Any violation of
Section 7031.5 by my applicant for a permit subjects the applicant In a civil Penally of ApN Number Occupancy Type
net more than five handled dollen($5011). 31623 088 . 00 r p y yp
❑1,as owner of the property,or my employees with wages m their ionic compensation,
will do the work,and the sudi is net intended or offered for tale(Sec.70th Business
and Pmfcssions Code:"Em Contractors License law olives not apply lir an owner of 301 - ROUGH I?ft {) I�Q�ections
Property who build&or improves thereon,and who doessuch work himself.,through his
own employees,provided they such improvements arc nay intended m offered for sale.If, 303 — ROUGH MECHANICAL
howeveq the building or impmvcment is old within one year of completion,the owncr-
builder will have the burden of proving that he did not build or improve for puryos,of 304 - ROUGH ELECTRICAL
sale.). 505 - FINAL ELECTRICAL
❑ I,as owner of the pmpcny,am exclusively contracting with licensed conuacton to 507 - FINAL PLUMBING
construct the project(Sec.7044,Business and Professions Cndc:)The Connectors Li-
crew lawdmsnot apply toannwnerofpmperrywho Wilds orimproves thereon,and, 508 — FINAL MECHANICAL
who canonical for sub pmjecu with a contractor(&)licensed pursuant to Ne Conuaaora
License Law,
❑Iva exempt under Sec. ,B&PC for Nis recon
Owner Date
WORK BR'S COMPENSATION DECLARATION
I herehy,affmm under penalty of perjury one of the following declvmion&:
I have and will maintain a Certificate of Consent to self-inure for Worker's Compere
73700.1'
ion,as provided for by Seclinn 3700 of the"hot Cndc,for the perfor ance of the
rk for which this permit is issued.
I have and will maintain Workers Compensation Insumace,m required by Section
the Labor Code,fill Ne Perandome of Ne work for which this Permit is issued.
lnsumnce carticranJPtr murex re:U� f/U 5 Po1my Nlt:N/`�/DZy37
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisunim nerd not Mcompleted if the Permit is intone hundred dollars($110)
1r less.)
I certify that in the Perfenuarec of the work for which this permit is issued,1 shall not
employ any permn in any manner so as to become subject o the Workela Compematian
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:IL after making this Ccnif¢ate of Exemption,you should
become subject m the Worker's Compensation previsions of tM Labor Code,you must
OO forthwith comply with such provisions or this Permit shall the deemed revoked.
Z `) CONSTRUCTION LENDING AGENCY
ti IhereM1 affirm Nat there is a construction lending['" Y gegcncy Lu the Pcrformancc of
Gl, 7 the wank for which Nis Permit is issue)(See.3097,Civ.C.)
zQ Lrmel.INamc
Lender's Address
U 0 I certify Nat 1 have read this application and sale Nat the above information is
U bonder I agree bs comply wile all city and nmmy oNimnces and slaye laws r upch the�U building cunslmction,and hereby auNmire rcpreuntatiscx of thiscityto enter upon the
,' W oho e-mer i^ned pmpeny for inspection purposes.
4 (we)agree m save,indemnify and keep harmless the City of Cupertino against
UZ in
of the
ranting expenses which may in anyweyaccmc against said City
U z A APPLICANT
ofD granting of thispermit.
`-' APPLICANT UNDERSTANDS A D WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCF, GULATIONS,
bmurt of Applicant/Con Re-roofs ramor Date
HAZARDOUS MATERI S DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hma ldro material
as defined by the Cupertino Municipal Code,Chapter 912,and the Health and Safety
code. yrs 25532a)?
ElyrsAll roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building tecupant use equipment nr devices which If a roof is installed without first obtaining an inspection, I agree to remove
mit haysldous air c^mamirsets as defined by Ne Bay Area Air Quality Management all new materials for inspection.
uve District?
❑Yes
I have read Ne haramnus materials requirements under Chapter6.95 alone Calika.
nia Health&Sefny Ccom,Secdnm 25",25533 and 25534.1 understand Nat if the building
tc
Js not currently haa serum,that it is my responsibility to Wary Ban occupant of the
uire eau which must W in xur it, cote Ccnif¢ate of . b. Signature of Applicant Date
� � p to All roof coverings to be Class "B" or better
O e awNnizdd agcm Date