03010016 CITY OF CUPEWI'INOr y,„ :
BUILDING DIVISION PERMIT -CONTRACTORINFORMATION.�`.
BUILDING ADDRESS ALL SEASONS PATIO ENCLOSURE RRMI'rNO.
10295 CALVERT DR
OWNER'S NAME: 219 DEMPSEY RD APPLICATION SUB DATE
TRASK 01106/2003
HONE: (4 08) 94 6-4 744 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDGELECT' PLUMB MECH
0 L 0 0
rmu0o LICENSED CONTRACTOR'S DECLARATION
<u U I hereby affirm that I am lic meed under provisions of Chapter 9(commencing Job Description
Ni,y with Scmloa]IXX))t)f DivisiunJof ll,e B�Nncss and Professions Gavle.and mylicene is FINAL E®
Fey in faunZyI n. / 0�2 PATIO ENCLOSURE 280 SQ. FT. e� eta
Zp�z License Lte.a�l8
2,-I °a RCIIITEC S ARATI FEB 1 1 2003
na I undcrsunu my p R shall he used as public recnNs
mO60
Fvivin oi
LaccnscdPnrfcssiunal BUILDING
< OWNER-0UILDER DECLARATION
ed ada P 1 hereby affirm that I am exempt from The Contractor's Licenu law for the
A
n 00 following reason.(Section](171.5,Business and Professions Code:Any city or manly
S which mVuites a permit In construct,alter,improve,demolish,or action any suumuto
aa
Foy priorm its issuance.alsomyuires the applicant for such permit o file a signed statement
as thathe isliorrowd pursuant the provismnx of the Contractor's License law(Chapter9 S Ft. Floor Area
x o 9 $3019,10tion
6 r$ tat he is exemng pt cmfro]IXXll the Division r The
Business ration.Any violation
i Cade)of
3 Nat he is exempt any ap li ma the basis for be allege)applicant
to Any vio natty of
Section]o3L5 by any red dint for i permit subjects the applicam m a civil penalty or
not more man five hundred amlan ls5nn. Occupancy Type
❑ I,as owner of the property,or my employees with wages as their sole compensation,
will do me work,and the swcwre is not intended or offered for sale(Sec.7W.Business
and Professions Code:The Conoanors License Law does not apply to an owner of 10 2 - PIERS equlred Inspections
property who builds or improves thereon,and who does such work himself or through his
sen employees,provided that such improvements are not intended or offered for sale,if, 103 — UFER
however,me building or improvement is sold within one year of completion,the owner,
builder will have the burden of proving That he did not build or improve far purpose of 104 - REBAR
sal`') 105 - ANCHOR BOLTS
E)1, thepwner oftheSec.7( ,Bam exclusivelycofessinswithlicensedcontractocuo 106 - SEWER & WATER
conswct the projcm(Sec.]IW4,Business and Professions Codc:)'ITe Contractor's Li-enarLaw does not apply toanowner ofproperty who Wilds orimproves thercon,and 202 - UNDERFLOOR PLUMBING
who contracts for such projects with a comracmrts)licensed pursuant o the Contractor's'
License Law. 203 — UNDERFLOOR MECHANICAL
❑l am exempt under Sea ,B&P C far this reason 204 - UNDERFLOOR FRAME
Owner Date 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: 301 — ROUGH PLUMBING
I have and will mainwn a Certificate Coaxial to s
tar Coasaclbm
inm for WordursCompen- 302 — TUB
. & OR SHOWER
tion.as provided for by Section 37M or the tabor Code.for me parormance of the 3 0 3 - ROUGH MECHANICAL
work ter which this pnmtl is issutd. 304 - ROUGH ELECTRICAL
C]1 base and will maintain Worker's Compensation Insunacc,as acquired by Section 3 05 - FRAME
370X7 of the Labor Code,for The performance of the work for which this permit is issued.
My Work ' Comlenvdonrnmmace,camcrandPolicynumberam: 306 - HOLDOWNS
Cacti r: Policy No.: f 307 - INSULATION
CERTIFICATEOE:EMPTION YORKERS'
COMPCN9IATION INS ANCE 308 - SHEETROCK
less.(Tris Section need not be completed if dic Permit is for one hundred dollars S I f(B 309 - EXTERIOR LATH
I Cindy
310 - INTERIOR LATH
employ mat in the Performance of the wink for which this permit is issued.1 shag not
Lawsoanypermninany number maambcnTmc subject the Wmkeri Compensation 311 - SCRATCH COAT
Laws orcaliraama.Dat`
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT:IL after making this CcIm Reale of Exemption.you should 501 - FINAL ELECTRICAL ENERGY
Q 0 becomesubjecttome Worker'sro Compensation thonprmitshal of the lien yoked, masa 502 - FINAL PLUMBING ENERGY
becom forthwith comply with such provisions iompens this Permit he deemed revoked.
z� CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
a >F Ihereby a0irmthat beat isaconstruction lending agency toy the performance of 504 - FINAL BUILDING ENERGY
thew NamehiebmisPermit isIssued(Scc.3(XP.Civ,CJ 505 - FINAL ELECTRICAL
G 0 Lcndcr'1 Name V
� z Lendcr;v Address 506 - GAS TEST
UO lcertify that 1have end'his ty andciundnadina thinmeabove infomltiin,g 507 — FINAL PLUMBING
w F torten.I agree b comply with all city and omni,oNinanccs and slue laws relating lU
pU building constriction,and hereby aurhoriA,mprcscmative�oi taiscoytocrisrupranda, 5 FINAL MECHANICAL
above-mentioned properly for inspection purposes H 09 FIN 0.Wi (We)agree b save,indemnify and keep harmless the City(It Cupertino against
tin liabilities,judgments,costs and expenses which may in any way ammo againstsaid City JC N Gs
V z in con yucnec of the Fuming of this permit.
^ APP (CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by51 - WORKS Date
'O CBR GULATIONS.
f Re-roofs 603 OF BATTENS
37
Signawrcr p1 an omr Date —
HAZA OUS MATERIALS DISCLOSURE T Of
Will the applicam o lure fir ',uccuPam more tar handle havardous mammal y� �0f4 - ROOF IN-PROGRESS
as defined by the Cupertino Munyyy'A���///allll��fTTTCode.Chapter 9.12,and the Hcahh and Safety
CWc,Seniun 2553]la)'! / All roofs shall be inspected prior to any roofing material being installed.
❑Yes ,f(/A—T'Naa
Will mcapplica rnfuwre Jingoaccupmtuse cyuipmemordevices which If a roof is installed without first obtaining an inspection, I agree to remove
tharamnus airconuminants defined by lac Bay Arta Air Quality Management all new materials for inspection.
it
icl]
❑Iris Na
1 have real the ha armes materialsmyuimmenu under Chapter 695 of me Califoo-
nix Health&SafetyGxk.Secmms 25N)5,35531 and 355 1 unokrsm,d thin itdc building
doe .1 turmoil,have a tenant,that it is my mspuosibild tar notify TM occupant of de
To almmcnt5w 'h mu4 bC arml trlllrm il5Vd11tc Ufa Cfllia IC f YUpan[y
Signature of Applicant Date
net uthmimd T °„e All roof coverings to be Class "B”or better