02080053 OF
CUP
CITBBUILDI c DIViSiONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10511 BARNHART CT. 02080053
tg,[.[Jah7E. PAKALA APPLICATION SUB DATE
:1r;r;ICHJ 08/12/2002
' PHONE: SANITARY NO. CONTROL NO,
09za ARCHITECT/ENGINEER: a BUILDING PERMIT INTO
m BLDG ELECT PLUMB MECH
<ai f-_ 1-'I
LICENSED CONTRACTOR'S DECLARATION
z 5 H? Job Description
O z_ I hereby afrrm that I am licensed unJq provisions of Chapinr 9(commencing
Fyf-w wishsaaona")ofDivisina3nrtneBu.�l+sandProfessionsCode.andm lanae CHANGE WINDOW TO DOOR/SLIDER
<ae fis in full force d f
C O 6 u Liccnu c / Ltc.a 7
3 y Date FBG ALT=r
ARC.fill'g D ATI N
S understand my plans shall he used as public records
w poo Licensed Professional AUG 1 5 20.02
c LL OWNER-BUILDER DECLARATION
m 1 hereby affirm that I am exempt from the Contractor's License Law for the
i-z< following reason.(Section 7031.5.Business and Professions Cube:Any city or county $4700
1 x which requires a permit to couwct,alreq improve,demolish,or repass any swcmte BUILDING--- - _
so Prior m in 'lance.shot reqtheapplicant for such,aims m file a signed smtemenr. _ _
Nat he Sl -nsed pursuant to the pro fou of the Contractor License Law(Chapter „37 'FtYLY- Vv
(core c grith Steaga 7") f Division 3 of the Business and Professins Code) `y'f�� �'s.... d rtf a�{',1:"j H,;.>� Valuation
or that he is exempt dicufom and Ne basis for the alleged exintiv ion.Any violation --
of Section 7031.5 by any applicant for it peamitaubjecu the applicant to a civil penalty
of not mart than Bve hundred dogma S5(i i 10 JAPN YeTU MAT ION Occupancy Type
01,as own,of the property,as my employees with wages as their sole compression, 102 - PIERS
-
will'do the work-and'the
-structure is not intended or offered for sale(SIC.70bL" 103 - UFER Required Inspections'
Business and Poressions Calc:Thve
The Contractor's License Law does not apply to an
owner of property Who builds or improves thereon,and who does such work himself 104 - REBAR
or through his own employees.provided that such improvements are not intended or
-oRtied for sak: f.however,the building or improvement is iold within one ye5r of - _--- - ----
eompleuon.meowner-builderwill have the burden or proving that he did not Wild or T05 – ANCHOR BOLTS . .
improve for purpose of sale.). 106 - SEWER & WATER
-- -- he property,pert._...__._...... -'- '-------
°Paaownerofthe ( ri.7( LBusinsssaid mracuameimrceaaThe CoamarsioCons --= UNDERFIiOOR��PLUMB ING 1- t. : r. .
License the oesctrspplToatowneroandProrahionaInde:)Toevestherom. 203 – UNDERFLOOR MECHANICAL'
Liccnu Luo does not apply so o owner th,coca who buiIds se improves thereon, "
". vans who wormers fLow. .pojccu wimps comncoa(s)licenud.punuanLm the.._-...._ .. 204- ---UNDERFLOOR---FRAME- - -
C3
--- -----'----
Contmcmh License Law. ---_-'— '
_ lam,emptunderg,C. ' B&?C formisreaan" 205 - UNDERFLOOR;i'INSULATION
owner me ' 301 - ROUGH PLUMBING
c WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
;v. 1 hereby affirm under penalty of perjury one of the following declarations:-
303 – ROUGH MECHANICAL
0 1 have and wiu'maintain'a'Cenifirme If'cmu nt I.self-insane for Workers 304 – ROUGH ELECTRICAL
+ Compensation. as provided for by Section 37W of the Labor Code, for the
Performance of the work for which this permit is issued. 3 05 - FRAME
01 have and'wdl maintain Workers Compensation Insurance,as na uthed by Section 3 06 - HOLDOWNS
37x0 of theLabor end far the perefnmrunee of use work r r which this proof is307 - INSULATION
eau My W keit Compc t Incur na c d Policy number I
308 –"SHEETROCK
,CERTI TION OF E% NP OMWORKE 3.� _309 t–�'BXTERIdl%LATH
.__: _ .,- COMPFNSA ONINSURANCE+ -
310:_: -INTERIOR -LATH–.. ...., -- — — –...... .._
°'
(This section
need not be completed'(the permit is for one hundred dollars 311 SCRATCH COAT a "
(SIo01 ar lessee
n
OF
1 rnfy thsnth pct n ce of rh Af h htl ,rent is
issued,1 5.02 -.. F.IONALNPLUMBING .EN
Corn 1pot tion any
yarc lr o�t�^ t become subject to the Workerss501 FINAL ELECTRICAf' 'ENERGY
Applicant . . ERGY - .
NOTICE TO APPLICANT If, fir malting this Ceniicate of Exemption youshamd 503 - FINAL MECHANICAL' ENERGY
Z become subject o the Worker s Compensation provisions of the Labor Code.you most
forthwimeomplyAimsuchpravimm�sorthisPermitshallhedeemedrevnked 504. ._. FINAL...BUILDING..ENERGY___..-.--._. —.-----
CONSTRUCIONLENDING AGENCY 505 - FINAL ELECTRICAL ' ' '
I h by Rrm that there nst ,ion lending age y for the pcnbrmana
or m ork for which mw
this pert is issued(Sec.3097,Civ,q 506 GAS TEST
L .Leader's Name ._ purr_. .'----.
:D z Leadcr'sAdduas . . 507 FINAL PLUMBING
v O " 50 FINAL MECHANICAL
I c n fy th t I h re d th pylic f ❑ sere mm m bo f mmasron is
a F corseil 1 s t comply 'mall ul d r ordinancesand state laws relating 5 9 - INALtGMDEthese ldngca t tiro dh by mon 0 r r z fth. tyt enter uponNG
yW mew ro t a,urnyr peck p pro a.., 5 0 - INAL0. (W) gree to sa e r demnify andk p hmmlass the City.1C pen no aginstVi nab Tie. judgments,eo s and ,case; wh ch y in any y ac me gainst said 51 – INALRKS r
V Z Ciry'nc uq Ince of theg t !7
gnf mil pc T /
'APPUCAM1TUNDER$T}SDSAN Dt41ILCOMPLY WI M1PDINT
ti uaCE R6� Issued by; Date
gwmre of AppbcaaNConwnor, re ' Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
. Will me apprconfor future building accuprom save or handle harardous nutedal, Type:of Roof-
p;defrost by the Cupertino Municipal Code Chapter9.12.and theN IN and Safety
f C6de Sect on 2553 Wr't 1,
' [ All roofs shall.be inspected prior to any-roofing material.being Installed. .
� of Will m applicant 9 future building ram use equipment a hien If a roof is installed'witbout first obtainingan ids ection;I agree to remove
e t hazardo- tam ants as defined by the Bay Asa A Quality Manage e t
°i""t _, _all,new materials for inspection. Applicant understands,and will comply with
//��� ..
' Y � � '' - all non-point source regulatrons.. ,. --- - -'
. 1 have read me hazar ll matcriith requirtmems under Chapter 6.95 of me '
Califumia Health&Safety Cade,Sections 25505.25533 and 25534.1 understand Nat
ifthe building does not currently have a boom.that it is my responsibility in notify the "' " " "-"' -' '-' - ---- - -- -- -- - - -- -
occupant of the requirements which must be met p or to issW ce of o Cemfcac of
money � I> _ [iJult SignatureofApplicant ,..,..._. , -_ _ _ Date
Owner or authorized agentAll roof coverings to be Class "B" or better:
...OFFICE_ ...__. . . . - .. ... _ . _.. . _.. ._ ....