02120054 CITY OF CUPERTINO '� w.� "^� ' • -
BUII,UINf.DIVISION PERMIT CONTRACTORINF.ORMATION
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BUILDINGADDRESS: JONES MASONRY PERMIT NO.
1568 ASTER LA 02120054
OWNER'S NAME: 1049 DELL AVE APPLICATION SUB DATE
BRIAN TRAM 12/13/2002
IONS 4083777512 SANITARY NO. CONTROL NO.
ARCIII"IIiCT/ENGINELR: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
wop LICENSED CONTRACTOR'SDEimoof hap Job Description
ON
¢u F 1 hereby affirm Out 1 am licensed under provisions of Chapter Y(commencing p
�Zw with Section 7040 of UivisionJofN 'ncu and Professions G,dc.and mylimnse is
mfall fnmagaerreet. C 1[ t4 , nry REPAIR FIREPLACE SNI
of� Z Date Gip Lica FIo QfA® E®
--a Date TS�i tprO 6a
— w ARCHITECTS 9RR:AR ATI
s� 1 understand my plans shall be used as public mnrdx APR R
aU 1 6 2003
w 3 u y Licensed Pndession it
L•u0< OWNER-BUILDER DECLARATION
c m<E I hereby al3irm Ihm I am exempt from the Cunoecmr'x License Law for the BUILDING
w�p 00 folN, ing re n.(Section 9(131,5,Business and Professions Code:Any city or county
6 X m LL which rx,mors a .it ID Cod,ldCl,alter,Improve,demoloh,ou rypm[say sure am
rZa priorly its issuance.also requires the applicant ter such permit o file a signed statement
qss that he is licensed pursunntto the peocionsof the Contractor's Limt.Law(Chapter 9 Sq. Ft. Floor Area $6Ylftition
aFP (commencing tui Or Section 7010)o1'Divisinn Sof the Business and Professors Coda)or
i that he is exempt Ocerflom and Np basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of dI1C OCCU
not more Nan five hundred dollars 15500). Occupancy Type
I,as owner of the pmpeny,or my employees with wages as their sole compensation.
will do the work.and Ne swclnm is not intended or offered for Safe(Sce.7040,Business — g�y}{'�{
and Professions Code:The Contractors License law does not apply tD an Danno of 312 - CHIMNE e[(�F$j-:[;j$pCet1ARSR PS
familiarly who builds or improve thereon.and who does such work himselfor through his ke Oc blt(H
own employees,provided that such improvements am not intended or offered for sale.If. 514 — FINAL PUBLIC WORKS
however.the building or improvement is sold within one year of completion.Ne owncr-
buifder will have rite burden of proving Nat he did not Wild or improve for purpose of
sale.).
El L as Owner of the property,am exclusively contracting with licensed comments to
construct the project(Sec.7(100.Business and Not Coded The Contractor's Li-
cram law does not apply to an Owner of properly who builds or improves theme,and
who cmnraas for such projects with a contrachn(s)licensed pursuant m the Contractor's
License Law.
o 1 am exempt under Sec. B&P C for this reason
Owner Data
70370WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty Of perjury one of the following declarations:
1 have and will maintain aCenificate of Consenuo self-insure for Worker's Compete
0
tion,as provided for by Section 37M of the labor Code,for Ne p,Romunm of the
rk for which Nis permit is issued.
1 have and will maintain Workers Compensation Insurance,a,required by Section
of Ne tabor Code.for Ne performance of the work for whit this petmil is issued.
y Wnr fs mp,nsauon Insure cerricr an Policy num is I �fION Nn.:
CERTI ATE OF EX MPI'ION FRO ORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the proud is forone hundred dollars($10)
Or less.)
1 sentry That in Ne performance of Ne work for which this permit is issued,1 shall out
employ any pmson in any manner ao as tu Mwme Subject 0 the WorkersCompensation
Laws of Califnmia.Dale
Applicant
NOTICE TO APPLICANT:IL after making this Cenifcate of Exemption.you should
become subject to the Workers Compensation provisions of the Labor Code,you must
0 z forthwith comply with such provisions or Nis perm it shat l hD deemed mvelod.
z O CONSTRUCTION LENDING AGENCY
F I hereby affirm Nat there is a construction lending agency for the performance of
W r7 the work lir which this permit is issued(Sec.3097,Civ.C.)
�W Q Lender's Nam,
z Lenders Address
U 0 I tinily Nat 1 have read Nis application and stale that the above information is
^: coned.1 agree to Comply with all city and county ordinances and slate laws relaling to
DU building construction.and hereby suthome representatives of this city to triter upon the
alnwc-mentioned pmpeny for inspection purposes.
(We)agree to gran,indemnify and keep harmless the City of Cupertino against
F' LO) liabilities,judgments.costs and expenses which may in any Way ammcagainst mid City
in
U Z r
consequence NDERSf due ntingos this Permit.WILL
Issued by. Date
NT UNDERST NDS AND WILL COMPLY WITH ALL NON-POINT
FOUL
T N /
3 Re-roofs
ofApplican orinacmr am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
ill the applicant ser future building Occurred store or handle ham duns material
by the Cupenina Municipal Code,Chapter 9.13,and the Health and Safety
tion 35532(a)7 res ablo All roofs shall be inspected prior to any roofing material being installed.
ll the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
nua air contaminants ac defined by the Bay Area Air Quality Management all new materials for inspection.
[D yr.' pa
1 have mad Nra
e hardoosmaterialsmquimments unikr Chapter 6.95 of IM Califor-
nia Health&SafetyCudc,SccNm525N15,25533 and 35534.1 un lkeroud lhard4ft building
dans ml rmntly hoc rant Nal it is my responsibility h,nodi IM farm of dm
mqui I,Wit an]l mmperat0isSDanecuraCendfieenf Signature of Applicant Dale
er l lhoriredag,m Dale I All roof coverings to be Class "B"or better