00070035 (2) CITY OF CUPERTINO
HUH.Drvo urv' F MIT CONTRACTOR INFORMATION:A1400070035
BUILDING ADDRESS: PERMIT NO,
07/10/2000
OWNUR'S NAME. APPLICATION SUIT DATE
PHONE. SANI'PARY NO. CONTROL NO.
G 7 ARCHITEC/ENGINEER: BUILDING PERMITINTO
O❑❑O EI.UG IiLF.CT PLUME SUCH
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LICENSED CON'irwal dirp DECLARATION ADD BATH WIh6Bfllldscription
O z=O I herchy,Thor,that I um licensed under P and
Pct ns of Chapmr 9 Uammecense
L.,wCw wieh Scnlorcemil o(Divlxiol19 of the lkuincxa and Pndusinm Coale,unJ my lissom
5 in full force coil ellen.
a e C 6 License Class Lic.tr
„o a.u Date Contractor .
w 3 ARCh ll1 ' use DECLAic CentON /
=O g 1 unJemnnJ my Plans shall M axil a,pWli<m<nNs
at
a a O O Licanscd Professional �/
c.
OWNER-BUILDER DECLARATION
6n, 1 hereby affirm that I am exempt form the Contractor'.License Law for the O
fnllewin,noun.(Section 7031.5.Itusinas,and 1'ndession.Code:Any city or cnunly
dF C which require.n Permit to enmwet,alter,improve,demolish,or repair any shuewrc r
3 primmits issuance,also requires the indicant for such leerient to file a signed statement - $300
a. — thin he it licensed paruam to the provistme..atthe C(mlmnors License Law(Cloider v Sq. Ft. Floor Area Valuation
(rnmmendng with Section BKXd)of Division 3 nit'the B..ine..and Pmfesxinns Code)
or(hal he ix exempt therefrom and the Nois for the alleged exemption.Any violmkar
of Section 7091.5 by any applicant for a remal subjects the applicant m a civil ja neby
of aid inn a man five hmdlmd dollars(S500). APN Number Occupancy Type
❑1,as owner of the prnlMny,or my employees with wages as their sole eomrensation.
will Jo the work,and the seruceum Is not intended or alined for sale(Sec.7194,
TL
Easiness Ived Professions Code:The Contractors License Law docs non apply to an 1Qty — P I E quire(I Inspections
,ir of pr.,my Who builds or i d,rovu marun,and who does such work himself . 2
t B ugh eke—employee..proviean than such inmmvemeel,arc aoe intended or 103 — UFER
interval for sale.If,however,the building(it improvement is sold within one year of .
Imnnpleuon,the owner-buildar will have the burden or peeving that be did no,build nr 104 — REBAR
prove Ila pmp9w of sole.).
❑1.asnwannnha revary.ame.elud.dyenlmeni �nrs1. 1.
meaning ANCHOR BOLTS
Limmm�the ponso(sea.7044,Emilie"and rmre,,ionx Code;)The Comrcmr's 106 — SEWER & WATER
cense Low d«s nm apply m nonvoter al pmpeny who mild-,in,prow,dectenn.
ant who.....tram,for xavh pr..,<ets with:t cmeemno4x)licensed ra....I to me 2202 — UNDERFLOOR PLUMBING
EIIareeve linorde Sae 2203 — UNDERFLOOR MECHANICAL
❑1 inn eaem n undo Stu. .R&I'C for this moron
Owner Dam 2204 — UNDERFLOOR FRAME
W'ORKER'S COMPENSATION DECL\RNPION 205 — UNDERFLOOR INSULATION
I hereby Whined under Penalty of perjury one of the following declarations:
301 — ROUGH PLUMBING
❑ I have and will .milled a CI,tame of 3700th m self for Worker's
eocepenxmlon, av ptovldea rot by seernn ono nr sea lamer endo, rot rhe 302 — TUB 8 OR SHOWER
perronnanae none work rnrwnicn tors pem,ir i.. ad. 303 — ROUGH MECHANICAL
❑I have and will maintain Worker's Compensation lmurnce.uxrequiredby Section 304 — ROUGH ELECTRICAL
371x)of Ibe lobar Cale,for Ibe pdonaa mi,of dm work her which chi,Permit is
issued,My Worker's compensation Insurance carrier and Policy mother are: 305 — FRAME
Carrier-1"olialNo' 306 — HOLDOWNS
CERIIFICAI[ON OF EKEMP LON FROM WORKERS'
COMPENSATION INSURANCE 307 — INSULATION
(This section need nor hecompleted ithe Penditis(or one hundred deltas 306 — SHEETROCK
ISI W)or less)
1 certify Ilem in ]to'ifornmme or IIm work Ihi
' ss
In,which IN,peonil Is iued.( 309 — EXTERIOR LATH
shad doe employ any Person in any manner so as to become subject to the Workeri 310 — INTERIOR LATH
Cons nsmion Laws of California.Data
Applicant 311 — SCRATCH COAT
NOTICE IO APPLICANC If.mkr making this Cerlif is lm of Iisen,aioll,you should
necnre.abiecttotheWorker,compensationprowaoesoflmLahnCodc.youmust 313 — ROOF NAIL
Z00 forthwith cmeeply with such pr..visa on.or Ihi,permit shall he deemed revoked. 501 — FINAL ELECTRICAL ENERGY
CONSTRUCTION LGNDINGAGISNCY
� > (hereby:damelhmmereisaeongmerionleading agencyfor meperfomance 502 — FINAL PLUMBING ENERGY
onhaWork for Which this Permit isi...d(sea.3o97.civ.c.)
N
Lender's Name 503 — FINAL MECHANICAL ENERGY
0.
z Lenders Address 504 — FINAL BUILDING ENERGY
v C) ImadymmIhave mdrhi,arphcminnands,are It.,tire ahow information ix 505 — FINAL ELECTRICAL
Pas Pemmel.I ogme Io c nal ly with all City and imism
county oI. mces and ,a Lows refuting
O U mbaildingcnnswaint ad hereby Wmhnlzara,m.Wntadve.nrtnodymenmturon 506 — GAS TEST
�. W lie above.memlrn,m p n,voy fa m,te,ti n purpn.a,,
pis 0. (%Val agree to save.indemnify and keep harmless the City on Cupeniiroagmad
ti habuiae,.judgeean...eo...amt cC,,,wh�Ch olay'Ie any way sam —
e aswno said 507 FINAL PLUMBING
C,7 z City in sawas,cnecof the granting of Phis pemhit.
r
APPLICANT
STANDS AND WILL COMPLY WITH ALL NON POINT Issued by: 508 — FINAL MECHANICRLDate
SOURCE
Signature ofA,dicanVConmat Date Re-roofs 510 — FINAL PLANNING
IIAZ RDOU S MATERIA IS DI SCLOS U RE
Will the applicant or future haildingeeeuparianone orhamllaha.,wae.material Type of Roof 514 — FINAL PUBLIC WORKS
as dermad by dee Cupeninn Municipal Come,chapter 9.12 and the Hand mal Sefny
Coale,Section 25532(a)l -
❑Yes DNo All roofs shall be inspected prior to any roofing material being installed.
Will the,tpplieamm.fatem mildia,.Cpantuse nirveece u'de,ke, IIivh If a roof is installed without first obtaining an inspection, I agree to remove
emit hanardeas eir ommmidenes as defined by the hay Arta Air Quality Mattagami
Di,ermn all new materials for inspection. Applicant understands and will simply with
D Ye, 0 N all non-point source regulations.
I have read the Inonotou,mmerials requirements under Chapter 6.45 of the
California Barth a Sualy Calc.Section 25505.25533 and 25534.I undanland man
film buildingdoes not current) o tenant, at it is my resrymsibiliey m notify the
accup n o m requireme t icl a he o prior in isxmnce of n Cenllicne of
O¢u
Signature of Applicant Date
owner or vumodzed again - V Date All roof coverings to be Class `B" or better
OFFICE