02070009 CITY OF CUPERTINO ..'
BUILDING DIVISION PERMIT ,CONTRACTIORINFORMATION .,„1
Bu1gD@u2,JPjeF�sARMEN RD PERMITNO2070009
WIf 4NE* & SINGH MECKER APPLICATI9IjSPEqTR`2002
PHONE: SANITARY NO. CONTROL NO.
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
�Gpp LICENSED CONTRACTOR'S DECLARATION
WU F 1 hereby affirm shat I am mme
licensed under Provisions of Chapler 9(commencing ADD
C
with Section 7(XXBofDivision 3ofsheBusiness and ProfessinnaCWC.andmyliven.¢is ADD 962 SQ. FT. f3 Ogh'0_7l� 05 SQ. FT.
F EEE in full none and affect.
License Class Lic.st
pyo Date Contractor
FS'—m;£� ARCHITECTS DECLARATION
5CC I understand my plans shall w used as public records /O/ VIA dOyU ?
Licensed Professional �.2/Q�
FQ't=yp OWNER-BUILDER DECLARATION v
je 2 1 hcrehy alfirm Nal I em exempt from Jrt Cnnramnr's Liccnu Lew for the $150000
uy1�00 following reaam.(Section 70335,Business and Pmfeasinns Code:Any city ,,county
$� which requires a Permit to construct,alter,improve,demolish,or repair any structure
vai6 prior to its issuance,also inquires she applicant for such Permit to File a signed statement
€p Iw,heislicensedprotaorstothepmvisionsoftheCmul.no'sLiccn¢Law(Chapter9 3Sg702I0Q2A@6 Valuation
$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
Out he is exempt,hertfrom and the basis for the alleged esempron.Any vhuman of
Section 7031.5 by any applicant for a Permit subjects the applicant In a civil penalty of
not more than Five hundred dollars(5500). 102 p—NPIERS
Occupancy Type
❑I,as owner ofd¢property,or my employers wish wags u their Ole compensation.
will do the work,and she auucwre isnot intended oroffered for sale(Ser.7044.Business i83 TJFER
and Profession Code:The Conramors License law does not apply oran owner of 104 - REBAR Required Inspections
property who builds orimproves Hereon,and whodoes such work himselfor through his
own employees,provided that such improvements are not intended reoffered forsale.If, 105 — ANCHOR BOLTS
however,the wilding or improvement is mid within one year ofcompletion,the owner- 106 — SEWER & WATER
builder will have the burden of proving that he did not build or improve for purpose of
”) 202 - UNDERFLOOR PLUMBING
I,as owner of the property,sm exclusively contracting with licensed contractors m 203 - UNDERFLOOR MECHANICAL
construct she project(Sec.7044,Business and Profasstmu Code:)Tbe Conricmrs Lt.
ecnae law dom not apply to an owner of property who wilds or improves themon.and, 204 — UNDERFLOOR FRAME
who contracts for such project,with a contmeter(s)limmed pursuant to the Contractor's 205 - UNDERFLOOR INSULATION
License Law.
❑l ton exemrunder Sec y— B&PCf9r this asn 301 - ROUGH PLUMBING
�C�'T��'�/ Dau �n Z4 B 302 - TUB & OR SHOWER
WORKER'S COMPENSATIONDECLAR N 303 - ROUGH MECHANICAL
I hereby aRrm under Penalty or perjury one of got foll-wf liglarmions: 304 - ROUGH ELECTRICAL
❑I bars and will maintain aCerifcam of Consent to self insum for Workers Compcm 305 — FRAME
salon,u provided for by Section 37011 of Ne fmm
Labor Code.for He Krarm of the
work for which thispermilisissued. 306 - HOLDOWNS
❑1 have and will maintain Workers Compensation Insurance,o required by Section 307 - INSULATION
3700 of the labor Code,for He performance of He work for which this permit is issued.
My Workers Compensation Insurance carricr and Policy number are: 308 — SHEETROCK
Carver: Policy No: 309 - EXTERIOR LATH
CERTIFICATE
COMP NSATIONINSUREMPTION ANCcoRKERs 310 - INTERIOR LATH
rrnnaecrrmncednot wvmmpmmdlfthepermhis Boron nundrmdonars($100i 311 — SCRATCH COAT
1f1C5i) 313 - ROOF NAIL
I certify that in the Performance of the work for which this Permit is issued,I shall not 501 - FINAL ELECTRICAL ENERGY
employ any woon in an a canon omcsubecno de Workeri Compensation
IawsnfCelirnmi..Date G ��, 502 - FINAL PLUMBING ENERGY
Applicant. _ c. c1nf�H-�Sh 1�=c
NOT 0 PPLICANT:It.after making this Ccnilieate of Exemption,you should 503 — FINAL MECHANICAL ENERGY
born nice,to the Workers Compensation provisions of she La v r Code,you most 504 - FINAL BUILDING ENERGY
OO forthwith comply with such provisions or this permit shall be deemed revoked.
z CONSrRUCfION LENDING AGENCY 505 - FINAL ELECTRICAL
4 Ihereh alrum Na,Here isaconsruclion lending agency for the f rmonee of 506 - GAS TEST
F r s .)nt'r Per n
Winshework forwhich HispermitisissucJ(Svc.71x9],Civ.C.)
W
f31 Q Lender's Name 507 - FINAL PLUMBING
5z ndraAadmas 508 - FINAL MECHANICAL
U O I certify Out I liars read this application and sum goodie above information is 509 - FINAL GRADE
Iy
P: consent.I agree to Comply with all city and county ordinances and mile laws misting to 5 - FINAL PLANNING
building construction,and hereby authodu reprcunmtivcs of shin city In enter upm she
awve-mentioned property for inspection purposes.
�" y (We)agree manse.indemnify and keep harmless the City of Cupriino against 5 4 - FIN LIC.'AWORKS
sF�y liabilities.judgments,costs and expenses which may in any way accrue against mid City
U z in consequence Of 012 granting of this permit.
�+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUI(L'8•ILEG Jr NS v / Ip T 11 0
��� ` \ �' �/ �l Re-roofs
a,urc of ApplicaHAZAR O Dam
HAZARDOUS MATERIALS Dmomo,URE Type of Roof
Will the applicant,mfumm buildingoccupantem,1nrandth Health and Safety n defineJ by Ne CuPenino Municipal Cude,Chapter 9.12.and she Health and Safety
stic.Sermon 23332(a)T
-1 Y.. All roofs shall be inspected prior to any roofing material being installed.
M1�No
Will the applicant or fuuttture building occupm,use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cool hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
Cl Yes 9blo
In ave read Hw
e xardnus mamrialsmyuiremcnu unJcr Chapterh.95of the Califor-
nia Health Safety Code.Sections 25505,25533 and 25534,I undersand Hat if the building
Jrae not cunen0y have a moan],thin it is mY respmsibility m notify IM meupenl of the
mgti emswi, mush tpdorto issuance ofaCertifmamof Pon . Signature of Applicant Date
102y o
wncr or antwsiv xi agent am All roof coverings to be Class"B" or better