03070029 Fc,rry 01 CUI'GR'1'INOe BUILDING DIVISION' PERMIT CONIRACTORANFORMATION-PINGADDRESS NEW HORIZON BUILDERS PERMIT 1103070029
a/
'R'S NAh1 E: 756 BEALE CT. PERMIT ISSUE DATE
NE' (925) 570-8237 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i o o LICENSED CONTRACTOR'S DECLARATION Job Description
p 1 hereby affirm them I am bosomed 2#,provisions of Chip.,9(commencing P
:Z, with Section 70(1))of Division 3 of the and Professions Code.and my license is
fulI roqcand c t.
i'0(? Lanx s r 5 ADD 744 SQ. FT. /REMODEL 2510 SQ. FT.
m V- CamratprAynw erso CONTRACTOR: NEW HOEIZON ILDERS
CHITECT�'LARATION
I w U �Yu`Jcrsta J 1 he used as public records
'E G; to,enxd Profa,au rd aftFina
OWNER-BUILDER DECLARATION
'vd a P I frothy affirm that I am exempt fru.the Cnmracour License Law for the
JUN 0 1 2004
Q O following reason.(Section 703 L5.Business and Professions Code:Any city or cottony
<$ which requires a permit to construct,alter,improve,demolish,or repair any structure
uzi priorto its issuance,also requires the applicant for such Permit to file asigned statement `y[��I,1
that he islicirmadpursuant tothe iirovimmmaoftheCommcmr'sLicense Law(Ch.mar9 Sq. Ft. Floor Area IL®BOV'IVP�C7T'P OOO
rs-O (commencing with Section 70Xp of Division 3 oflhe Busimmiand Professions Core)or
that he is exempt therefrom and the basis for Ne alleged catmption.Any violmion of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of 3 7mB315t"gr0 0 Occupancy Type
not more than Ove hundred dollars(SSOB).
1,res owner of the fiction,or my employees with wages m their sole compensation,
will do the work,and be awcture is not immrd,d or offered for sale(Sec.7044.Business
and Profcmiom Code:The Contractor's Lictme Law does not apply m an owner of Required Inspections
propcnywho builds or improves thereon,and who does such work himself or through his 101 — FOUNDATION
own employees,iuvideddot such improromenu our not intended or offered for sal..If, 102 — PIERS
however,the building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving that he did not wild or improve for propose or 103 — UFER
E]1.' 104 — REBAR
❑Las owner of the property,am a ices and contracting with:)The Compactor
S i-
comwetthe pmnot (Sec. owner
and Professions Cade)The Convectors Li- 105 — ANCHOR BOLTS.
whxLaw dnesrsuchllyeorwi0erorprnpenywho sedpmeds or impmvesCmarra,and 106 - SEWER & WATER
who contracts for such pmjccu with a convawr(s)licensed pursuam m the Canoanofs
Lietnse Law. 202 - UNDERFLOOR PLUMBING
C3 1 am meat"under Sec. .B&P C far this..an
203 - UNDERFLOOR MECHANICAL
°a 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
Ihereby afmmunder Penalty ofparjur,one ofthe following declarations: 205 - UNDERFLOOR INSULATION
I have and will maintain s CenfOcate or Consent to.self-inure for workers CmPen. 301 - ROUGH PLUMBING
sation,m provided for by section 370()of de"bar Code,for the performance of the 3 02 — TUB & OR SHOWER
work for which this Permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section 303 — ROUGH MECHANICAL
37W of the Labor Code.For the Performance of the work her which this poonit is issued. 304 — ROUGH ELECTRICAL
My Workers Compensation Insurance emrmr and Policy number am: 305 — FRAME
Cartier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS306 — HOLDOWNS
COMPENSATION INSURANCE 307 — INSULATION
(This Section need not w completed if the Permit is for one hundred dollars(SIIX) 308 - SHEETROCK
or loss.)
I eenify*k'at in he P if,, ante a k for which this permit is issued.I shall not 3 09 — EXTERIOR LATH
Law,. yper.nor yriE' Atn5pmembjn-uoteWorkeriCompensation 310 _ INTERIOR LATH
Laws of aliform Da r� 19
App s'� r ' 311 SCRATCH COAT
N0116rflo APPLICANT:If, facrifieliking this Ccmficam of Exemption.you should 313 - ROOF NAIL
wco subject to the Worker's Compensation provisions of the Lahr Code,you muss
Z forthwith comply with such provisions orthimPermit Shall wdatmadrevoked. 501 - FINAL ELECTRICAL ENERGY
? o CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
Iwmhy affirm that them is a construction lending agency for the perfoorana of 503 - FINAL MECHANICAL ENERG
x > Ne work for which this permit is issued(Sec.3097,Civ.C.)
m Q Lander'sName 504 - FINAL BUILDING ENERG
Z L`nd`raAddr`ss 505 - FINAL ELECTRICAL
U C) I certify that I have read this application and mute Nat Ne above infamamn is 506 — GAS TEST
F cancer.1 agree to comply with all city and county ordinances and side,laws relating 1.
p V building construction.and hereby authorn,representatives of this city to enter upon the FIN PLUMBI G
r W
above mentioned
agree
Pra partySave for inspectionnikeep ha.
(Wju agme to cast,indemnify and kith hart in an the City of Cupertino against 0 8 FIN L
F' T0.q li Ihics,judgmcnu.cusu and cspcnscs which may in any way acctuc against said City
queues of the granI fthis permit. 5
PLICANT UNDERS AN AND WILL COMPLY WITH ALL NON-POINT Issued bY:5 ING Date
.. S URGE REGULATIO S.
Re-roofs 514 NAL PUBLIC WORKS
aturc of ApplicanVContma c3lfDmc
HAZARDOUS MATERIALS DISCLOSURE 'Type Of Roof
Will the applicant or future building occupant store or handle hazardous material
tlefncd by the Cupeninn Municipal Cude,Chapter 9.1 E,and the Health and Safety
AWk.,se Yea 25532(T)"no
All roofs shall be inspected prior to any roofing material being installed.
C3 No
Will the applicant or Nun,buildingeaccupenl use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
.a h...;dnus air contaminator a defined by the Bay Arca Air Quality Management all new materials for inspection.
Jis Vier
❑Ycs
1 have read the brouslo soru.n.ls mquimm ¢
enunderChaptef6.95oftheCalifor-
niaHralN&S9aayC u. um25N)5.25533m Z534.1um mm Nmifthc wilding
anTon
Jot currently ha ren 4 Nm it ion my 25pomihilitY m wdlY the wcuPant of the
mgoimminuwhich 011ie etpdortaiwua cof]Cmdfit fa'FOak cy. Signature of Applicant Date
,p Owner or authoriecJ akcnt
(I Ff1 All roof coverings to be Class "B" or better 61