03010007 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ATI N"
BUILDING ADDRESS: PERMIT N0.
10313 COLBY AV
OWNER'S NAME: APPLICATION SUB DATE
TUTTELMAN IRWIN AND VERNA TRJS 01/03/2003
PONE SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
00 LICENSEDGONTRdunder$DEConsOfCON Job Df jptl'o
0i 1 hereby efBrm that I am licensed antler provisions of Chapter Y(commencing
!1K,11 A � ®
�¢ with Senom7016)Of Division 3 of NC Business and Pndessions Code,and my license is ,tV
r<� in full foreepndelteyl. X TEMP POWER _ '•^vs
zpq_ License cla�'._(w LI'c.Jr 719093
RATION FEB' 2 1
OyF ale C" Cunt Door 2003
F—mqq ARCHITECTS
K a I Understand my pians shall W usN ublic rnvrds
np�
i-ii: Licensed Professional BUILDING
OWNER-BUILDER DECLARATION
Sas�0 I hereby.(Gens that I I.S.exempt from the Cononss Co :Any c Law for the
se. which followinquires a Poch t ]NLBusiher.simprove.
ve.de Professions h.or Any city m emory
s�$ which cots iss a a permit re nmsnthe alcor,impose.demolish, file
repair any amount
r y Ourpriohe sIncensedpurumquiree sbovisio s I for such Cmurartniuot.maigncd summcm
umnionerria,wJpumuanuothe)),,fDionsof the eBusinessa LieenulawfC ode) Sq. Ft. Floor Area $➢'�0tion
a $ chat he
Crecrept therefrom
and the brands
sfmn r the
alleged
essanJon.Anynvi Code)or
thas io is camp therefrom and the bxeia for be alleged exemption.Any violation of
Section 7031.5 five
airy applicant fora permit subjects the applicant m s civil penalty of be Occupancy Type
not mom than Gve hundred dollen(g5oo).
❑1,u owner of the property,or my employees with wages a their wee compensation,
will do the work,and the atmewre is not intended or offered forsale(Sec.7W.Business
tend Profesaimu Cade:The C.OursetorS License law does not apply to an Owner of 304 — ROUGH ions
Property who builds or improves Hereon,end who does such work himself or through his
own employees,provided that such improvements are not Intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not Wild or improve for purpose of
sale k
❑1,as owner of the property,em exclusively contracting with licensed contractors to
construct the project(Sec.70N4.Business and Professions Code:)The Connector's Li-
cense Law does not apply so an owner of property who Wilda or improve thertor,and
who contracts for such pmjecss with a contractor(,licensed pursuant to the Contnnor's
License Law.
❑ I em exempt under Sm. .B&P C for this reason
owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby afrmm under penalty of perjury one of she following decimations:
❑ I have and will maintain eCeriflcate of Comm to self-iaum for Worker'sCompcm
I
tion,u provided for by Secular 3760 of the Labor Cale.for the performance of the
.,it far which this Dennis is issued.
❑I have and will maintain Worker's Compensation Insurance,n required by Section
37W of the labor Code,far Or,performance of the work for which this permil is burred.
My Worksr's Compensation Insurance carrier and
I' numMr art:
Calticrr /yAEPoli .: WORKER 7G 8`t
(fir
CERTI('IC OMPE SATION10NFRAN WORKERS'
COMPENSATION INSURANCE
(this section noul nm W completed if the Permit is forma hundred dollars(S IOII)
nr ICs.)
I certify Nal in the performance of the work for which this Permit is issued.I shall not
employ any Person in any manner so m to become subject to she Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:It,after making this Cent locale of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Code.you MUM
O z foMwith comply with such provisions or this permit shall he occurred marked.
O
CONSTRUCTION LENDING AGENCY
[-r I therebyenirm that there is a construction lending agency to, performance of
pep the work for which this permit is issued(See3047,Cii,C.)
VJ Q Lender's Name
=z Landcr's Address
U O 1 certify that 1 have read this application and slam Ow the above information is
Lk. P comet,l agree to comply with all city and county ordinances and slam laws relating to
O U building construction,and hereby authonee reprmnusives of this city to enter upon the
above-mentioned property for inspection purposes.
(We)agree to save,indcmni fy and keep harmless the City of Cupertino against
liabilities.judgments.costs and expenses which may in any way accrvc against said City
U r�7in APPLICAeNTeUfIAc graRSnttng of NOSIhis Permit,
AND WILL COMPLY WITH ALL NON-POWT Issued by: Date
SOU C I S.
6
Z Re-roofs
stun ofApp m MConoactor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hazardous materiel
a defined by the Cupenino Municipal Code,Chapter 9.12,and the Health and Safety
Cade.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes .
Will she epplicam or future Wilding occupant Liu equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mil baarNous air contaminants as defined by the Bay Arca Air Quality Managemem all new materials for inspection.
District?
❑Yes PW_`
I have mad the haardous mamrialarequiremenls under Chapmr6.95 clothe Califon
nim HcalN&Safety Coale,Sections25505,35533 and 25534.1 understand that ifdw Wilding
dos not mrrxatl int, tit is my responsibility m notify Ilia atopens of dm
ter w inn arrasiuuameof2Ccruram N,ccapency. Signature of Applicant Date
w3o All roof coverings to be Class "B" or better
caner or mathinzed agent Data