02080101 CITY OF CUPERTINO j " - , A `
F.
BUILDING DIVISION PERMIT CONTRWCTORANFORMATION:
BUILDING ADDRESS: JM BA.SALDUA CONST PERMITNO.
10354 BYRNE AVE . 020R01 01
'NER'S NAME: 15 HARTNELL RD APPLICATION SUB DATE
TIM & LILIA LIMON 08/19/2002
PHONE: (831) 754-4788 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
for LICENSEDCONTRACnderp DECLARATION
zy U FU I hereby off roe shat I am license)under provisions of Chapter Y(commencing Job Description
<ZyI with Scclinn]I Bnf Divisinn3nf dle Business and Professions Codc.and mylicense is
��„ imm�mre it erfe� Q 603 (,os ADD 624 SQ. FT. REMODEL
ZOPA License Cla Lic.N
0y"O Da Con
�oq CHITECCS DEC AT N
a undcrsunJmyplaasxhallMuseda bhemomdx EXPIRED PERMIT APPL LTR SENT 12/30/02 . APPL EXP
a0
Licensed Professional
OWNER-BUILDER DECLARATION
�yy I hereby.(herr that 11. exempt from the Contractors Co :Anse Law for ma
unto COO following mason.(Section 7031.5.Business and improve,
dol eli Code:Any Illy or county
which requires in permit re censused alcor,improve,demolish, file
repair any thement
"I$ priortoIasi mance,also inquires theapplicantfor such Conitermilwicense Law
that he is license)pursuant ut the provisions of the Cunlrenur's License law(Chapmr9 Sq. FL Floor Area Valuation
aF$ (commencing with Snctian 7lkg)of Division 3 of the Business and Professions Code)or
�.-
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number cy Type
re th
not moan five hundred dollars(5500).
❑L o the work,
of me the someone
emntendedwish cared outside
compensation,
will do fie won,and the tlmRum is not intended Law do sensate(Sec.8144,Business
and arty who
Code:The ms Boston,License Law docs or applyhams to an owner of Required Inspec oar, ALEED
property s,prods vided that such improve who doessuromnot hundred
himself or through his B�I:YI
howown ever,thees,ping or improvement
improvements iss sold within
in not ouofedoroffered protein.al(• 101 — FOUNDATION
however,thebuildingorimprovementissoldwithinet yearofcompletion,the owner-
bander will have the barren of proving that he did net hui10 or improve far purpose of 102 — PIERS
DEC U 4 2003
x"`) 103 - UFER
❑I,as owner of the property.am exclusively contracting with licensed contractors to 104 - REBAR
construct me project(Sec.7044,Business and Professions Codc:)The Contraomr's Li-
ce _ s.„'�'NG
nse law does not apply to an owner of property who builds or improves therean,and 10 5 - ANCHOR BOLTS Bfa WR
who contracts for such projects with a contracmr(s)licensed pursuant to she Contractor's
License Law. 106 — SEWER & WATER
E]l am exempt under Sec. ,B&P C for this consent 202 - UNDERFLOOR PLUMBING
wocr Data 203 - UNDERFLOOR MECHANICAL
WORKER'S COMPENSATION DECLARATION 204 - UNDERFLOOR FRAME
Ihereby
andwiRrm under penalty of pedof
fConent self-instarthe eor declarations: 205 — UNDERFLOOR INSULATION
Italian,
and idemainminaCeniBcateolConsentrCralknsoremrwonerecompen 301 — ROUGH PLUMBING
rasion,az provided for by Section 3]W of the Labor Cute,far she perfurmenax of the
wonmrwhichthispermirxisued. 302 - TUB & OR SHOWER
❑1 have and will maintain Worker's Compensation Insurance,as required by Section 303 - ROUGH MECHANICAL
37M of the Labor Code,for to performance of me work for which this permit is issued.
My Workers��nm�ensadonlnn��e enter and Policy numMrme QIP 304 - ROUGH ELECTRICAL
Carrmr.S/li.K- 2�a a.AC Policy305 - FRAME
CERTIFICATE
FIR O
COMPENSATIONION INS R CE KERS' 306 - HOLDOWNS
(This section need nothccompleted if lM permit is ounce hundred dollars(SIM) 307 - INSULATION
orless.) 308 - SHEETROCK
1 certify that in the performance of the work for which this permit is issued,I shall not 309 - EXTERIOR LATH
employ any person in any manner so as m become subject to the Workers'Compensation
LawApplicanof California.Da" 310 - INTERIOR LATH
Laws and
NOTICE TO APPLICANT:If.after making this Certificate of Exemption.you shouW 311 — SCRATCH COAT
become subject to the Worker's Compensation mvisions of the Labor Code,you muss
o Z forthwith comply with such provisions or this permit shall he deemed revoked. 313 - ROOF NAIL
z2 CONSTRUCTION LENDING AGENCY 501 - FINAL ELECTRICAL ENERGY
r4 IherebyaffirmmalthereisacunsWctiorlendingagencylnrtheperfmmrneof 502 - FINAL PLUMBING ENERGY
04 j>. the work Nefar whirnthis prmhixissued(see.3B97,cia.e.)
Wo lender's 503 - FINAL MECHANICAL ENERGY
mc
0 z Under'sAddress 504 - FINAL BUILDING ENERGY
U O I certify that 1 have read this application and sate Nat she shove information is 505 - FINAL ELECTRICAL
{rr (~ correct.I agree to comply with all city and county oninances and state laws rclmingto
O U building construction,and hcrcby authorize representatives of this city to amen uponthe S GAS TEST
W above-mentioned property for inspection purposes. O7 FIN
Ow)agree m save,indemnify and keep harmless the City of Cupertino against
„y Va liabilities,judgmena,costs and expenses which may in any way Beane against said City 5 CAL
his pennot.
U in APPLICANT UNDERSTANDSof the granting of tAND WILL COMPLY WITH ALL NON POINT Issued by50 — Date
SOURCE GULATIONS. � t-:77-17
Re-roofs 514 - NAL PUBLIC WORKS
Sign of Applicam/Contmctor Dat
HAZARDOUS MATERIALS DISCLOSURE. Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by InctCupertino Municipal Code,Chapter,9,11,and the Health and safety
^ode.Section 25532(a)7 / All roofs shall be inspected prior to any roofing material being installed.
❑zea G�
Will 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
emit hawNous air contaminants s defined by the Bay Arca Air Quality Management all new materials for inspection.
Id strict?
❑Yes No
I have read the hazardous mamrialsrcquiremans under ChapNr(.95 of the Contra, ej
.is Health&Safety Crile.Sections 25515,25533 and25534.1undersund that if the building tt
does not currently have a termal.that it is my responsibility m nosily the cecupam of On
requirements which must M mel pour Isvuancc nfa Ccnifream of Occupan� Signature of Applicant Date
�xcda� �" «"� All roof coverings to be Class "B"or better
o I�'reJ stent g
lr