03060107 (3) CITY OF CUPERTINO , `^� �' '��
BUILDING DIVISION PERMIT ONTRA ,Tn0R INF0RMAT�ION £1
BUILDING ADDRESS: REESE MARY PERMIT NO 03060107
OW NER'S NAME: "69'/'16/2003
6RMIT L$69�6/2 0 0 3
NE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uoo LICENSED CONTRACTOR'S DECLARATION
1 Wrtby frim that 1 am licensed under pmviaiom of Chapter 9(commencing Job Description
W Section 7")of Division Sof the Business and Prof=mm Code,and my H.C.m
in full forte and effect
3 License Class Lk.g FOR FINAL INSPECTION
. NLY
Dam comracor ORIG. #11847 (09/17/8r—ON F—
0
ARCHITECI'g DECLARATION
I undersand my ph.shall be used as public records
9;� Licensed Professional SUN 1 7 2003
OWNER-BUILDER DECLARATION
f I hereby ninon that I am eaempt from the Comrmtor's License Law for an
GO following mason.(Section 70313,Business and ProfeWnu Code:Any city or county D�ggg
$ which morula
s a permit In convect,alter,improve,demolish.m repair any aVN
uclum G
pp Mprior in its Issuance,also requires the applicant for such permit so rile a signed summeal
lost Imislicensed pursuanunthe provisions ofthe ConmcuisLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation
YS (commencing with Section 7000)Of Division 3 of the Business and Professions,
fessions Code)or
y .. thhe la exempt therefrom and the buss for the alleged esempllon.Any violation of $5000
Section 7031.5 by any applicant fora permit subjects the applicant to a civil penally of APN Number Occupancy Type
not more than five hundred dollars(5300).
Dl,umnmofthepmpeny,mmy,mployemwlthwagesu0mirmlemmpenudm, 35708016 . 00
will do the work and meatmrome taan,imendedoranend formic(Sec.7044,Business, .p��ygljlt'�d ins cellons
and Pmfeuiou Code:The Comnswufs License Law does ret apply m an owner of 10 1 — FOUNDA 1 1 vN p
property who builds,or improves thenum,and who d=such work himselfor through his
own employ=,provided dist such improsemenu are not intended or offered for stake.If, 102 — PIERS
however,Ne building or improvement is mid wRhin one year of completion.the owder-
builder will have the turbot of proving Out W did not Wild or improve fm yuryose of 103 — UFE R
sale')' 104 - REBAR
D L as Owner of the lmla ny,am exclusively communing with licensed conumma to
construct the pmjen(See TOM.Business and Professions,Code:)The ConumroYs U. 105 — ANCHOR BOLTS
cove Law d=not pply to an Owner of property who Wilds or improves thereon,and, 106 — SEWER & WATER
who concocts for such projects with a contras or(s)liceued pursuant u the Committees
Vr-Law. 202 - UNDERFLOOR PLUMBING
amesemptunder Sec .BAPCfor Niauuon 203 - UNDERFLOOR MECHANICAL
ItWOR/ • 'SCOMPENSATIDNDECLAfI,PA 204 - UNDERFLOOR FRAME
l hereby eRim er penally of pe juy one of the following declanfom: 205 — UNDERFLOOR INSULATION
I have and will maintain a Cenifictu of Cotes.to self-mu.for Wormes Compan- 301 — ROUGH PLUMBING
action,as provided for by Section 3700 of the Labor Code,for the pertmrnmce of the 302 - TUB & OR SHOWER
w
work for which thispermitssued. 303 - ROUGH MECHANICAL
D I have and will maintain Workees Computation Insurance,u reyvited by Section
3700 of the labor Code,for the perteromce of the work forwhich this permit is tamed. 304 — ROUGH ELECTRICAL
My Workefa Compensot ma Imers.prim and Policy number art: 3 05 - FRAME
Carrier. Policy No.: 306 - HOLDOWNS
CERTIFICATECOMPENSATION WORKERS'
TION NS RAN E 307 - INSULATION
(Thhsectlon necdnm becompleted ifiMpermh is forone hundred dollars(SIM) 308 - SHEETROCK
losi 309 - EXTERIOR LATH
1 unify thnt in the performance of the work for which thh permit Is issued,1 shall not 310 - INTERIOR LATH
employany penuniq any manocrm robe mo sub scum the Worken'Compcnsa0on
L.1Q11 oyyf��Calife�bu'dvrn 311 - SCRATCH COAT
NpQWE'TO APPLICANT.If.after making this Cen�amo Exemption,you should 313 - ROOF NAIL
become suhject to the worker]Compmustion previsions of the Lahm Code,you most
fuMwithComptywhhsuch pmvidnuorthisperank.hallWdoomed revokcd. 501 — FINAL ELECTRICAL ENERGY
z O CONSTRUCTIONLFNOINGA('iENCY 502 - FINAL PLUMBING ENERGY
I hereby am.that there iaac..Co.lendingtaenry for the performance of 503 - FINAL MECHANICAL ENERGY
>
the work for which this permitis Inwood(Sec.3157.Civ.C.)
Landers Nano 504 - FINAL BUILDING ENERGY
31 A
D z UmmesAddrtss 505 - FINAL ELECTRICAL
;)p I certify that 1 have mad Nis application and sum that the above information Is 506 - GAS TEST '
S.P comet.l agree to comply with all city and county ordinances and Ram law relating to
DU building construction. m
ction,andherebythodmrepresentativesOfthisCitytoenteruponthe FINAL PLUMBI G
i+a above-mentioned property for inspection purposes. 08 F I L
r WC)agree to save,indemnify and keep harmless the City of Cupertino against
W liabilities,judgments.tom and expcnm which may In any way stem,against mid City A
J z in consequence of the granting of this permit,
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 NG Date
SOU GULATIONS. _
Re-roofs
mum ofApplic oa sur �o am
AZARGOLIS MATERIALS DISCLOSURE Type of Roof
ME thea worm future Wilding Occupant mom or handle hu4rdous material
as defined by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety ('
We,Section 15531(4)? All roofs shall be inspec
❑Yes �NO ted prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
it Im.rdou air contaminants u defrod by the Bay Area Air Quality Management all new materials for inspection.
J inflct7
DYes mi<
It nused Ne hmsmous mamdals requirements un4r Chapwr6.95Of the Califon-
miaHealth 6 SafctyCodc.Sccaom 15505,15533 an475534.1 undcnmd Nm if rho building
does Out currently have a mount.that II u my responsibility M nodly the Occupant of the
w l hmust W I b cc of a ccrtlncatee Occupancy. Signature of Applicant Date
fv !d
sur authodra agent m All roof coverings to be Class "B"or better