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01080046 BUILDING DSIONO IVIISINPERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO, 10611 CALBERTSON DR KENNETH & GRETCHEN CATRCN01080046 OWNER'S NAME: APPLICATION SUB DATE KENNETH & GRETCHEN CATRON 10611 CALBERTSON DR 08/08/2001 PHONE: SANITARY NO. CONTROL NO. l AZO ARCHITEC`UENGINEER: BUILDINGP MITINFO _ BLDG ECT MB MECH L.J z 8 y= LICENSED CONTRACTOR'S DECLARATION Job Description 0 Z-O 1 hereby affirm that l am licensed under provisions of Chap¢r Y(commencing F•m t; with SeclionlWBlof Divlsim+Jofthe Buni.essund Professions Cmdc,andmylicense SERVICE UPGRADE-200 A m 8 n is in full force and effect, n ww C d V Licen.sc Class Lie.g a O N Dare Contmcmr is. ARCHITECT'S DECLARATION 1 understand my plans shall he used as public records �r z z O O Licensed Professional �ca. OWNER-exempt fr DECLARATION ,r 1 hereby affirm that I am exempt from the C scions Co Any c Law for the followC Z a which ire mason.]section 703 1.5.Business and Professions io demolish, Cade:Any tiny or coamy, $0 aro ea x si which requires a permit re sires del,alma improve,demolish,or repair any adearwre _i3=si pip t , axevimre9 the ismas of for Contramuu is gnadstammem (tomthat if sadpSectana to ion70hap svisionthe ftheBasin L Law(C'hapler9 $p.�Ft, ,OrF�C a Valuation (commenCg vh 5x10 70110)of DivispnJofNe liuslncs. d Pmfessiom Code) _ f3']TJ(1(1LJS V6 iA.4 q. .,('.�'1 „ or that he Is exempt thembeitit'und the basis for the alleged contraption.Any violation or Section 7031.5 by any applies.,for a permit sabjx,e the applicant as a civi l penalty q ��6 Iofnmmercthan rivehunaddulYam650o1. 304-lsNELECTRI Ali Occupancy Type °1,as owner of the property,or my employees with wages as their sole compensation, -will do the work.and fi e-strucame isnot Immaided'or offered for sale(Sec.1(1 - Busitlexs'and'Piofessioas Codc:•Thc Conuactor's License law does not apply to as 5 0 5 - FINAL E rRtllMFFtionst' owner of pmi Who builds or improves,hereon,and who does such work himself or B. employees.y p sided the,such improvements miisart not intended or In offs ed fdi'ale IT'ho the b ilding or wpmvemcht is soold w Ihm one year of mmove on,,h erh ilder will have the burde of proving that he rid not build or + ' ' sl improve for euf sale.]. .... _.,. .__.._,...,_._.____ dconst �• . sawnenoF the Proq:ny.am exdusivel <pnwnin with licensed commemrs to c wet the proixt(See 11MJ.Business and Professions Cork:)The Contractor's License law does asst app]p.io sp o�sner°f pmpcny who buddy or improves thereon, ..-and who otnsacu.for aytb 1c s ranogsll scrip tont.m.the xJ I wllh a.fanl CUmranor Llgdae Lid, ❑1 m unffe ' �' B&PCT this :pY 1 air Did I• 1'1 `WORK R'SCOMPENSAT] N CLARATION I hereby affirm under penahy of perjury ons or the following dxlmlions ❑ I have'and will maintain a'Cenifcale of Coaxes to self-i...re for Workers _ Compensa,ion,-as,provided for by Section-3704) or the Labor Code, for the performance of,he work,for which this permit is issued.., - -' °I have m6ifivill maimoin Workers Compenaniimi Ilisunricc,'u mquiied by See" - 31W of the Labor'Code,for the perfomtance of the wink.foi which this permit is ''•-- issued:My Workers Compensation Insurance carrier andPolicy number art: " Co .-fi't. .11 s.kY P.I yN ..j 1..,4,. j.' �' �..:'1.•lls,'.1.• ... -._. l 5"CERTIFICATION OF EXEMPTION FROM,WORKERS -` COMPENSATION INSURANCE __- f1�" (Th s section need nut he n+mpleted,r the permit is for one hundred dollars (SIM or lean.), t - .. .f.r.: ' I r nfythnIKpef e , s work which R 1taissued.I s shall , ply y pe y ,o become ubiecs i the Wo kers ' ' manner CImpsmatimn Laws of C I Tom a Oaie _.Applicant I reme .. __. _.. .. :'NOTICETOAPPLhe W. r f mkt this C n f am the I S^•r - he orae b tmthe W rkervC m � g Pt yap.lib Id' pens tip I ll the WS Cole you most z Q - uhc raptly with hProvisions or this pc 1 hall bed J kW. HyjCONSTRUCTIONLENDINGAGENCY' - -_-- , -` - -- 1 h by ff IM1 1 Iherc's c t c, n Ind g ag y f IM1 perf imz re W;Q ofd¢ kfo lith,ht penal s. d(Sx JB91 Civ C) Led Name z Lc do nAdde. fi ,,, C.I 1 certify that(have read this appli al n mid slam that tic above mfor myon s ¢mm I agree mpomplyswi,h alPciry'anJ county grJimnce.n and sin¢Isws mo ding constmc,ion.and he audarim mrc.iemalkes'of this city to enter upon the aMvcmemlio+tW PropI qfor inspection puryoxe1., ._ - y,L (Wc)egree to save:jndemni ad ep harmless d¢Cityof Cupcnina antitrust -VJ Bab�ll LIII ,n,¢co 111 pc xwhich y' any y against said C.1 Z C y co s V ncey C g mg pcm+n G ©/ s REQ s .. ' !LLCOMPLYIWITHAf.i ONoift-- Issuedby: Date � Q i. _ - igmture,of APPrcxmA7mamcax_i �- ,'. ,:SUals.'.p+ Re-roofs HAZARDOUS MATERIALS DISCLOSUR Will the applicant or uni building pa , 2,h dl h Halt Kemal' Type of-Roof ` ,C tie fnN bY,lhe Cupertino Municipal no un c paltCCode. Chapter 9 12, d the Health Safety nil 5 fc , I-, * ,. ,. - "' - "� "�+t, _ �-•«•.� u 5 t 2553�fa7 1 + eeq p 1 devices peh'. IFla roof islinstalled without first obtaining an,g mection being Installed, ..._.__.. a I it sin wumeapplicant ants building p , g inspection I agree[o:remove en ,h r, a c't n 1.'sdefined by the Bay Area Ali Quality Management -ni 1 1 all new materials for inspection. ., ]Tessa[understan0.ds and wall comply with °Y 1, ° all non point source regulations ,•j +v +: t 1 t i 1n a'm n, J < a imments ander Chapter b95' the, • Itf Hwth&Sittity J 5 , x 5 5.25533 it 25534 1 understandthi _ if bu din8do e phi ,lyh-- , ,hit Y P bltyt ppp Tama s nl of �rtquia , h mu tp to is a IlaC tify bf -� �0 '. SignatureofApplicant__, .. ._- . Date ;o z au,nodua ; All roof coverings to be Class"B" or better OFFICE, .. -- - -- - - -