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02120061 CITY OF CUPERTINO BUILDING DIVISION PERMIT COIN,TRACTOR I40RMATI©Na BUILDING ADDRESS: PERMIT N0. 10313 COLBY AV 02120061 NER'S NAME: APPLICATION SUB DATE TUTTELMAN IRWIN AND VERNA TRJS 12/13/2002 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Opp LICENSED CONTRACTOR'S DECLARATION cY1iF I hereby affirm that l and licensed under provisions of Chaper 9(commencing Job Description with Sx'on7 Oof Divismn3ofthc Bassin sand P...ex,ontccul,andro,twensuis in fullfn� "cocci. ate$ EPAIR FIRE DAMAGED ROOF ��NALE® o z�: License ss 00 Ci ro F= � Da° . (30 YRS COMP. SHINGLES) ARCHITECT'S RA N I understand my plans shall used as public records JUN +t �OOk�] � a 1� 0e,i_ Licened Pmfectanal �j OWNER-BUILDER DECLARATION u<Y 1 hereby affirm that 1 am exempt from the Contractor's License Law for the BUILDING i�00 following reath son.(Section 7I.5.Business and Professions Code:Any city or county � 2 which requires a penin u,construct,alleq improve,demolish,or repair any structure HZe prior to its issuance,also requires the applicant for such permit to file a signed statement �0 that he is licensed pursuant or the provisions of the Contractors License Law(Crispier 9 Sq. Ft.Floor Area Valuation ^$ (commencing with Section 700.)of Division3ofthe BusinessandProlkssionsCode)or $60000 y that he is exempt therefrom and Ne basis for the alleged exemption.My violation of Y Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type not more Nan five hundred dollars(5500). 31629026 . 00 . ❑I,as owner of live property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Contractors License Law does not apply m an owner of 101 - FOUNDAff Med Inspections property who builds or improves thereon,and who does such work himself or through his own employees,provided Nat such improvements are not intended oraRered forsale.It, 102 — PIERS however,the building or improvement is sold within one year of completion,the owner- 103 — UFER builder will have the burden of proving Na,be did not Wild or improve for purpose of .tale.). 104 - REBAR ❑1,as owner of the property,am exclusively contracting with licensed contractors to 105 - ANCHOR BOLTS construct the project(Sec.7W,Business and Professions Code)The Contractor's Li- came Law does not apply to an owner of properly who Wilds or improves themnn,and 106 — SEWER & WATER who counter for such projects with acontractmod licensed pursuant to the Contractor's License Law. 202 - UNDERFLOOR PLUMBING ❑I am exempt under Sec. ,B&P C for this mason 203 - UNDERFLOOR MECHANICAL neer Date 204 - UNDERFLOOR FRAME WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION I hereby affirm under penalty of perjury one of the following declarations: 301 — ROUGH PLUMBING ❑Iheveand will meintainaCenificere of Consent to self-inaum for WnrkcrsCampcn- 3O2 — TUB & OR SHOWER cation.as provided for by Section 37M of the Labor Code,for the performance of the work far which thiapermhisissued. 303 - ROUGH MECHANICAL ❑1 ban and will maintain Workers Compensation Insurance,a required by Section 304 - ROUGH ELECTRICAL 3711(1 of Ne Labor Cotler for the performance of the work for which,his permit is issued. My WmkJ''sC;iacnsalion lnsumncecamicr and Policy number am: 305 — FRAME ca r: 4fiMf2a� /at. �o, Pdu :A0Z AC 48+ 306 - HOLDOWNS CERTIFICATE COMP NSATON INSURANCE 307 WORKERS' 307 — INSULATION (Thissenion need not W completed the peormisforonc hundmddolla,s(511k8 308 - SHEETROCK "rice°.) 309 - EXTERIOR LATH 1 certify that in the performance of the work for which this Permit is issued,I shall not 310 - INTERIOR LATH employ any Person in any manner so m to become subject to the Workers'Compensation Laws of California.Dale 311 - SCRATCH COAT Applicant NOTICE TO APPLICANT:If,after making Ibis Certificate of Exemption.you should 313 - ROOF NAIL become subject to the Worker's Compensation provisions of the labor Code,you must 501 - FINAL ELECTRICAL ENERGY Z forthwith comply with such provisions or this Permit shall be deemed revoked. O O 502 - FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY [—i4 1hereby affirm that them isaconslmnionlending agency forhePerformance of 503 - FINAL MECHANICAL ENERGY C4 �11 the work fnrwhich this PermitisissucdSec.3097,Civ.C.) 504 - FINAL BUILDING ENERGY W Q Lender's Name z Ledee'aAddress 505 - FINAL ELECTRICAL U O I cardify that 1 have read This application and ante Ihauhe shove m orm tion is 506 - GAS TEST correct.I agree to comply with all city and county ordinances and shoe laws rcIsing m w0 U building construction,and hereby surmise rcprcsentativesafthis city menterupnnthe 5 FINAL PLUMBING {tl above-mentioned property for inspection purposes. O 8 FIN HAN C L (We)agree to save,indemnify and keep boundless the City of Cupertino against p„ fan' liabilities.judgments,costs and expenses which may In any way accme,against said City 5 N D, V 7 iAnPPL CAenccof the grading UNDERSTAN of this ANDPermit. IL PL% ALL NON-POINT Issued by51 NG Date �r SOURC GULAT10 �2 Re-roofs store of ApplicantlCD ractor ate HA ARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant nr folurcbuildingoecup tstnrcorhandlc aaardouamamrial ns defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety .°c.Beetles 25532(a)T ❑Yes XND All roofs shall'be inspected prior to any roofing material being Installed. 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 hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District' .., ❑Yes XNo � 1 have mad the hnMous materials requirements under ChapNr 6.95 of the Caldor- l rain Ncalth&Safety Craft,Secduns25505,255JJ and 25536.1 unticrsmnd that if the Wilding �� does not currently have a tenant,that it is my responsibility in notify the occupant of the require ntswhichm mctpd nissu faC if¢ateofQc Wy. `\Vgnatureof plicant ate 12 VVV. r authorized gent ate All roof coverings to be Class"B" or better