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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
C0N�T�R k TBR INFOR ATIyON
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n IOING ADDRESS;
ALL SEASONS REMODELING
PERMITNOID3120005
9340 CALLE DEBARCELONA
'R'S NAME:
PERMIT ISSUE DATE
.I.7�ISTOPHER MOULIOS
219 DEMPSEY RD
12/02/2003
NE:
SANITARY NO. CONTROL NO.
(408)946-4744
ARCHYFECTIENGINCER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that 1 am located under proviouns of Chapter 9 (commencing
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with Sec tion]{�7 fDi' ion Sofdo Rusin a dJimmosinnsC de,.n myliecnts is
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w wd mree (4, $ (P �
Liccnu Class Lic.0
Da¢ Cum)r,
PATIO ENCLOSURE
ARCHITECTS 1) 'C RAT ON
lea VV sa'�.i I�,pC
understand my plans tha11 W used as untie mcoNs
FEB 1 1 2004
Licensed Prefcssiovl
OWNER -BUILDER DECLARATION
t
1 hereby ,(firm that ten exempt from the Contractor's Liccnu Law rte the
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o
reaso ]constr Business and Prufcampi Calc: Any city nr munre
followingreason,a.
Perms t alter, improve, fi cash any
which requires a permit m
SUILMN 0 0
aimsthe(,
permit m Glc
h Permit t signed smmmem
prior bt its issuance. also "aims the the applicant for partment
_
Sq. Ft. Floor Area
Con s
tChe sceenudpursuant mthhorDivisionoftheBlmemrsu.ens.Law
aluation
,t
sCode)r9
(CommencingsSection Aa))or meegedexeand Code) or
emptb on. Any violation
that he is exempt therefrom and dm bazis for the alleged exemption. Any violation of
basis the
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for a permit subjcce applicant to a civil penalty of
Section 703 L5 by any applicanto N
^k p�(y ¢�i{ce� p
3 gpgra yMO(l1gQj00
anC Occu Type
Occupancy YP
not MOM man five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the struclum is not intended or offered for sal. (Set. )ford, Business
Required Inspections
and Pradmits oats Code: TIM ConOacwrs Lienee law docs not apply to lin owner of
property who builds or lmpmv) thereon. and who doessuch work himself or through his
own employees, provided that such improvemenas arc not intended or offered for sale. Ir,
however, me building or improvement is sold within me year of completion, the owner -
build., will lout the burden of proving that he did not Wild or improve for purpme of
sale.).
❑ 1, as owner of me property, am exclusively contracting with licensed contractors to
conslmel the project (Sec. 7Ued, Business and Professions Code:) The Contractor's Li-
ccme Law does not apply to an owner of property who Wilds or improves menton, and
who controls for such Nei with a contractions) licensed pursuant to me Contractors
License Law.
❑ l amcacmptundcr S.c. .B&PCfm1hixmxrm
Dam
WORKER'S COMPENSATION DECLARATION
I 1 hereby affirm under Penalty of perjury one or the following ch darmions:
I have and will maintain a Ceni ficam of Consent to self -insure for Worker'sCompcn-
vtion, m provided for by Section 3]00 of the labor Cnde. for me perrmmvme of the
work ter which mix Permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance, amrequired by Section
3700 of the labor Code, for the performance of the work for which mit Permit is issued.
My Werke ate Compensation lnsuranc carrier and Policy numl+er aa:
l net: LJ Policy N.,
CERTIFICATE OFE )TIO4 WORKERS'
COMPENSA ION INS CE
[Ibis uCo. need not he completed if the )omit is for one hundred dollars ($IIID)
or lots.)
1 certify that in the performance of the work for which this Permit is issued. 1 shall out
employ any person in any manner so as m become subject to lW Woriame Compcmation
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: IL alio making this Certificate of Exemption, you should
become subject to the worker s Compensation provisions of me labor Crete, you must
forthwith comply with such provisions or this permit shall he deemed mvokcd.
CONSTRUCTION LENDING AGENCY
I heathy affirm that mere is a construnin r lending agency for hat ferfurmanee of
Ric work for which this permit is issued )Scc. 30M37, Civ. C.)
Lender's Name
Lender's Address
1 certify that 1 have read this application and sum that me above information is
correct. 1 agree to comply with all city and county ordinances and sum laws relating to
building Construction. and hereby rumorire mpmunutiais of mix city to came upon the
above-mentioned propcny for inspection purposes.
(We) agree to save, indcmmfy and keep harmless the City of Cupertino against
liabllities.judgments, costa and eapen es which may in any way recruit against sell City
in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: e
SOURC ULATIONS. 12,
Re -roofs
Type of Roof
ter. Ap cam/C Co.' Dam
HAI OUS MATERIALS DISCLOSURE
Will the applicant ter writ building,recupam sarrc nr handle hmarduus material
defined by the Cupertino Munmi I Code. Chapter 9.12, and the Health and SafetySec
0 en 25532la)] o
Yea Nu
-
All roofs shall be inspected prior to any roofing material eing installed.
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If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipment or devices which
it ha'rardnus air comaminanuas cfncd by the Bay Arca Air Quality Management
all new materials for inspection.
uricR
❑Yes No
I have mad Nit Ivrardnus materials requirements under Charter 6.95 of the Califon
his Health or Safety Code, Sceuma 35505.25533 and25534. l undcrsmnd has if the Wilding
docs not currently hat a mount. that it is my responsibility Or noury IM racupant nr her
r requlrsom In hmYSlWmet prim toissuance ofaCertifies. foccupancy
Signature of Applicant Date
All roof coverings to be Class "B" or better
G ne O aumOri.ed ge