02060076 CITY OF CUPERTINO -- -- "
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
, . 20138 RODRIGUES AVE R & Z DEVELOPMENT 02060076
OWNER'S NAME: PPLICATION SUB DATE
=AMPO DE LOZANO L. P . 21771 STEVENS CRK BL #10102/28/2002
/r ,.PHONE: SANITARY NO. CONTROL NO.
(408) 252-1101
O'O ARCHITECIENGINEER: - BUILDING PERMIT INFO
NZEE _ BLOO ELECT' � PLUMB MECH
i 1-11 I-'•l LJ I--I
LICENSED CONTRACTOR'S DECLARATION
z 5 El= - Job Descri tion
F�CwEl 1 hereby affirm DIA 1 am affibe d aide o u 'n p
is Scc,ion] Division3of the Businp(j'11'6�7g` n t G nseTOWNHOUSE-LOT 2 #B
IS In full force, a n. f�" ,6 Li;iwr u<." LIVING SPACE 1, 998 ' GARAGE 444 '
Cie.;LL . �lte COn[faLLoa v( ARCHITECr's DE SEE ORIG PERMIT 02020113 FOR FEES
laeensed Pmkssi naly plans shall h used aspe re<ortls
FINALE®
a' OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the APR 1 7 2003
F following reason.(Session 703 L5,Business and Professions Code:Any city or county
F C which requires permit to construct. Iter,improve demolish, rep any structure,
is -.p o m is us ante,alsorequires the applicant for such permit m file u signed statement.
3m ,quhq lsl enpd pis nil to rte provisions of the Contractors L L (Chapter9 S ,.Ft. 10 1•Areav- 'TSI n
,(c nmc _g�w'th Scctnn blink)of Di'v:.uon 3 of the Bused ndProfession, ode) �;+�,)"i 1�il3lA VA11Al kp:ii 21 L1^�10=t�ll 10,;�
or that h'Is exempt,h refmm and thehas s for the alleged' t married Any violation
-of Si 703 L5 by any applcam for o pmmit subject, he apphcam to a civil penalty AAppNNNN {
�fnot mmethan five hundred dmLm(ss00). - 3693Z00 m{Iea I .I....t, Occupancy Type
•.'t
the my enPl.ye,s with wa,,as their into contend,n t
ilt J the wv
Business and work:
add the ,Code:ct r The I, o intended offered far late(Sec'AHA" - r - -- - - -
-w 'a
ssions
Contractor's License Law does not apply to an 101 - FOUNDATINuired Inspections
miner of propeny Who builds or improves thercon.and who does inch work himself
or through his own employces.provided Nat such improvements are not intended or '
. ;,offered far sale.If.however.the Wilding Wim--- --.102,_,-_-.PIERS--,-----...............-.,____...- --.... _„_- - ... _. . ...
g provemem n sold within one year or - - ,,, y,,
^tcomple0to,the P.I.Ia uf .Itt.) will have the burden ofproving shin he did not build 103 - UFER a'
im ave for purnnse of.dale.).
104 REBAR
;o,or herutjectseeny,ameusinissandProfeisions adenttatCont<mtsto 105 - ANCHOR BOLTS
construct the project Igtt.]OqA,Business and Professions Cade:?The Contractor's .j„ ,
c L me Lu does not ap ly m n owner of propeny who Wilds or improves thereon 106 - SEWER & WATER -
'.
and.who contracts for. uch P jects.with a commands)licensed pursuant to.the-
Co,
he _.. ..... _.. ..... ... ..
f$msdl. 202 - UNDERFli00R-P,liUMBING
neer er:.`' `' •- B& emrmie rcawn 203 - UNDERFLOOR:�MECHANICAli
Z�s OM11PENs`orPoNDE LARATON 204 - UNDERFLOOR FRAME
” - 205 - UNDERFLOOR INSULATION
:int under penalty of Perjury arcs of the following dcclmatiom: - .
301 ROUGH PLUMBING
r 0 1 have and will mainmiti a Cenific;te of Consent to self-insure for Worker's
i. ;'i -
Compensation, m provided for by Seesion 3]00 of me Labor Code, for the 302 TUB & OR SHOWER
a omanaeanhewohfarwnicnmisp tiai„aed. 303 - ROUGH MECHANICAL
❑1 have and will mainumu Worker's Comperisation•Inst once,as required by Section 3 04 -. ROUGH ELECTRICAL
3]00 of the labor Code,for me kiformenee of me work for which this permit is -
" issued:My Workers Compensation Insurance carrier and Polity number are: 3 0 5 - FRA[V]g'
car:ieF:Yeti a'.'.^,Cel 4',%e"grey Nn:' ;x306, -h HOLDQWNS,, t•� `r, �u:.n ;
CERTIFICATIONOFEXEMPTION PROM WORKP.RS'1 I- p
COMPENSATION INSURANCE" '+ ' 307- INSULATION
' (This seciion need nnthcmnplered if the permits for one hundred dollars 308 . +SHEETROCK ,. .J
(stool qr less.) 309 - EXTERIOR LATH
` "wna rataaral 310 "-' "INTERIOR LATH
Ic niy thin shHomw 4 ft kfy( { - -'
slwll t ip :inY P o 'n a+ a lo'A b W rkcrs
cpmpnsar r 311 - SCRATCH 'COAT"
-
a e gExemption.-you should
-APpI. .. 31.3. ._-ROOF NALL - - - - -- —
�•N ,T - 1 ' Ce Ica¢o(
,� bee us rjei'n 'rk<r. ompcnsa,ia pro.,in
of the Labor cede,you rias, 501 - FINAL ELECTRICAL ENERGY
O O fdnhw,h ply with uch p 'ons r rut.perm t hall be deemed revoked.
..
502 FINAL -PLUMBING- ENERGY _,,...,
a':> i rhraTBUCT1oNLetNDIlennageo 503 - FINAL MECHANICAL .ENERGY; .,
1 hereby aRrm that there to u construction.(Slending,C.) for perfunnance - '
fi3.Q ofthel- lumme ohm pc' tis issued lStt 109].Civ.C)
a c Lenders Name . 5.0.4. ._._.EINAL. BUILDING..ENERGY ..._
U,C) Led road . 505 - FINAL ELECTRICAL
Q I,.mfytoc m Jmlcityandc d.,, mar ads a 'bort 506 - GAS TEST
Iy
UP cones, I gone t comply N all city and county r drove d state er ung
O U ,o bu lJ ng construction. ❑hem-bya Nonce rtp ur fm.city c m_ pin 507 - FINAL PLUMBING
W thehoe edp n " prpose 508 - FINAL MECHANICAL
F. f1r• (We)ngee to i Wr Andk ep hunnl ss the Ctiy fC pcmno agu ns,
U liu If c51 end t d,es se. tchmay j.my yac _ against,vid 509 - FINAL RADE
� em erLn
-I A I 1 q N'DEIf hA pr$ii ohhlLL-COMPLY WITH AI T
LI ',AO0 �]
s t, Issued -tom TNG Date
at I mcom ` . ' cPa Re-roo92 _ ROOF PLYWOOD NAIL
I{ALARDOU) ATFRIALS DISCLOSURE n
h':pylic mss lmure bi ldinya pm',ore rhndlc hemN - aerial .--,Typeo6 RaDf,- ROOF,•BAT.TENS - -
'af der br,se c pen M cad soaped 9.12 and one B his a surety _ -.-
cm sttto zsvzw) . 604' ti-' ROOF' INt,PROGRESS "
❑Y 3 slip f� F L.
All roofs shall be Inspected prior.to any too ing,material being installed
•:mdwhim ppr< t9 r, h data p ta. q p t device, 166 If a roof is installed with Ell first obtaining an inspection, I'agree tofteniove
D
hoe Jo s a c+r d tmeJ by the B Y Arrj Q li,r Mmi.immen,
.S, <t all new materials or in ection. Applicant understands and will comply wi[h
+ "`
Mons-oroere laf3ons 1 b eread the hoc do m coals req t emend undo Chap,cr fi.95 of,
Cant In H alto&S fiery tree 5 fan 25505 25533 and 2553A d rstand thatift ildm, cod ic"in ut hatursmymp millytano,ify,hcuip ms wh'cl must be inn prior m iWan cbfeC ifs to of �
(.. . .�. _ pp-.
a eofA Iia t Date
All roof coveri ngs to be Class B or better
,.... : ....: .. ..� - :. ... .. .- _ ...I. --- -...OFFICE. _ .. _ .. . _. . .-... :. .