08050062 CITY OF CUPERTINO �g.•a€�«wv ��^%�xhzxi-�Csr%� �: az � a
BUILDING DIVISION PERMIT CONTRAGTORINFORIVIATION
BUILDING A DRESS: PERMITNO.
1173 DOROTHY ANNE WY ALL SEASONS REMODELING 08050062
46 NER'S NAME: PERMIT ISSUE DATE
GORDON 219 DEMPSEY RD 05/20/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 946-4744
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
-BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
1Chap lob Description
wC 1 hereby )of i t 1 3 limed n= provision•ors Cwho, 9(ammomm i- P
ZW withlif T1110)afDividon3afthe Bowness and Prafc66Code and my liccma is ADD 136SQ PATIO COVER
j<< in full forte a,W eff
aiO Lice,tse Cl - 3 Idea �"' .
=p Dao CDmrurar -
e 7W ARCHrfECTS DELLA ATION
e U 1 underwstiW wu re
nd my plans ll ed public cords
y o Licensed Professional
OWNER-BUILDER DECLARATION
f 1 Wrehy alum Dat I am exempt from dm Contractors license Law for the
E a o following..a.(Section 10315,Business and Prolamin.Code:Any city or county
$(v which m ralres a Parent
to wmemac,deer,improve,demolish,or.Pole any soueb,c
priorbsliccn dpuncamgoim pmvi&iomofOc Conpmmitbrl..Ug dsummant .
< N.tW;,lienedpan••tbdmpm.i:iaMarmecaawebrau<nrtuw(eastm9 Sq.F[. Floor Area Valuation
Y (commencing with Secdon70(10)o(Division3ofth,BusimmundProfeuionsCome)mr $6000
Q e3 3 that he u exempt drertrrem and dm basis far tho alleged exemption Any Holauon of
Section 7031.5 by any applicant fm a Permit subjects the applicant to a civil penalty of Number
nm mom Nan five hundred d (IS
alLm (D). 36654123 .W Occupancy P Y Type
I,as ownm of die:pmperty,m my moploycu with wagu u ftbmle eompensadon,
andde dee wort ands: he Con tsmotthundeee Law
an b,eovrcv
and property
h ons Calc:The Canusetor's Lieuva law dew cot appy lf,t owner of Required Inspections
.eny wyees.provided
improves ch impar nd.hod cno,inuluch work Mm•elrar WvugA Au
.employees.Wilding
prsuchimpmvemmuam not earofcmoRvrd me fousals.If,
however,Ne building m Wpmvemmn is said within ane year of I m Improve
the ewer
builder will hate IW burden of proving that he did Out W;Id w improve fm Purpose of
umJ.
❑1.as awnm of dm property,am caulusivel,contracting with rammed contractors;b
mnsuu,t the prejcct(See.7064,Bwireess and Profusions Cade)The Coouxbr's U.
cense law does not apply to an owner of property who Wilds or improve daemon,and
who contracts for tach pmjeeu with a conu oars)licensed pursuant b the Conuawrh
License law.
❑1 we exempt under See. ,B At P C for this reason
Poor Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under fora ty of perjury arc of dm following decluetionc
❑I W.e and will anamuna ACeNOom orcm eam an anti-L,sum fm WmFc!•canape.
radon.at provideA fm by Section 37011 a dm Labor Cade.far the performma ar dm
wort for which Nis permit is issued.
❑I have and will maintain Wollner.Compcmadan Insurance,M acquired by Section
3700of the Latham Code.fm Ne mceof
perforanthe were fmwb;da tiespe.iit ismy issueA. b
Carrier. -�I; � 7, Pal ry Na.:
a ce number
t 6 V3 61tn O f f�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sudor aad not W cmnpkbd aft permit 1e formic hundreddoBss,(SI00
nor le.)
I mnify that in dee pmfmmawae of the work rte which this permit is issued.l shall amt '
employ any rerun in any manre,an ss to become mbjec,,o the WarWn'Cmmpom adorn
Laws of California Dam
Applicant
NOTICE TO APPLICANT.If,a0er making this Ccrdncam of Eacmpdon,you shm id
became subject b IW Worlds conammunion provisions of due labor Code,you am
.J z forthwith comply with such providons or this permit shall W deemed revoked.
?r CONSTRUCTION LENDING AGENCY
F I hereby which
Nat Vert is s cal(Sm.0 7,Cing,genry for dm pmformance of
!Y dm woes fm which dais permit u iumA(Sm.3(19'1,Civ.C)
Lender's AName
dd
Z)z IeMerY Aedrau
O Q I certify Nat 1 have fwd Nis application and sure Nat dm show information i,
[L ^. contact.1 agree in comply with all city and county•N;inure and sum laws mlating to 1
Wilding coeooction,•rW hereby mNodse mprxnudves or this city to enter upon Ne
1,,ve-mentioa0 Property far
peetion purposes y a b(We)Agree sere,indemnify and keep harmless the City of Cupertino soma
h liabilitiw.joegments.cam andd uprn...which may in any way ecmuc ageimtaeid City
V z in eo oegwnce of Ne gmating of this permit.
ti APPLI Nr UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC REG LAf10tl♦S. v
p, ssurt A on teRe-roofs
r Data �-
H OUS MATERIALS DISCLOSURE Type of Roof
Will theePPlicantmfuture buildMunicipal Cada,
CIantstoreorand "Health andI an,
e deRned by the Cupertino Municiptl Cade.Chapter 9.13,and tM F1eIN and Sa(ety
.Section 85324)? ,J
❑Yes I�JNa All roofs shall be inspected prior to any roofing material being installed.
Will the. licsnt or mtum Wilding Occupant use e m If a roof is installed without first obtaining an inspection,I agree to remove
IN g P g proem or devices.hien g
eDm'Ncu nes air conumin•n�u�u defined by Ne Bay Ama Air QuNity Management all new materials for inspection.
r]Y. [3f No
I Mw read Ne hvardous, emutt rtquirtmenu underChapter 6.95•fthe Calirm-
nia Health&Sdr IYC•ec,Sc vmu 755f15,25533 and853d.l undrnwd NmifNe Wilding
wast me cuncndy have A tenant tins it Is my maponsibility b notify one accocom of dm
rcquimmeots wh hoe me ' rb, uanro ofa Ccnircem of occupancy. Signature of Applicant Date
Owner m athmd e.gan Date - All roof coverings to be Class'W or better