03010121 CITY OF CUPER'I'INO
BUILDING DIVISION PERMIT CONTRACTORANFO,RMA I,ON.
BUILDINGADDRrtiS: ALL SEASONS REMODELING PERMIT NO.
1104 ELMSFORD DR 03010121
'NER'S NAME: 219 DEMPSEY RD APPLICATION SUB DATE
/ f� 01/22/2003
ONE: 408 586-8004 SANITARY NO. CONTROL NO.
ARCUITKCn NGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�Oo LICENSED CONTRACTOR'S DECLARATION
U F 1 hereby affirm limit I and licensed under nmvisiona of Chapter 9(commencing Job Description
i ilb Section 7000)of Division 3 of the Business and Professions Code.and my license
full farce and,, 1. y� is PATIO ENCLOSURE W/ELECT (�t�T� [� RE AD
Fy�Z I.iccngc ,,,at r�6 , G'j}{I0tl' YJtl
=p Uam� Cnnlract �pr®/L Yb�
ory ARCHITECTS DECLARATION '?p'L g�Xl
IuntkmM
understand my plans shall used as Public records 1
a O Licensed Pmfpasinn tl 2 2003
MAR
OWNER-BUILDER DECLARATION
ro
<y 1 herchy a1Brm Nal I am caemPl from Inc Canuaaorg License law for Inc BUILDING
i n following reason.(Section 7031.5,Business and Professions Code:Any city or county
x m which rtyvims a Permit to ctmslrwt,alar,improve,dcmnrsh,nr repair any sari
_zypoor o of issuance,also requires the applicant for such Permit to rile asigncd statement
< that pe islimmedpursuant toshe provisionsonMComrulor'sLicense Law(Chapter 9 Sq. Ft. Floor Area $6YIOdation
QFC (commencing with Section llaXb of Division 3 of the Businass and Professions Code)or
y
that he u exempt dmrtfmm and IM basis for the Acted exemption.Any violation of
Section 1031.5 by any applicant for a permit subjects tM applicant to a civil penalty of aDC OCCU
not more than five hundred dollars(S50d), Occupancy Type
L o thew or.
re ind pmpertr,nr my intended
or
wagcg as safe
(Sec.
compensation,
willdolMwon,Coca: ah Contin norintended or offered for —
mra Pmreasmng code:Tare coauxnra Limase law dreg nil apply to as owner nr 10 2 - PIERS equlred Inspections
property who huildsor improves thereon,and who doesguch work himself ser thmugb his
own employees.Provided that such improvements are not intended oroRcied for We.If. 103 — UFER
however,the building or improvement is sold within one year of completion,the owner.
wader will have the wtdea of pmvmg that rte did and wad or I.,.for Indrae,or 104 - REBAR
sign')' 105 — ANCHOR BOLTS
❑L as owner of the pmpeny.am exclusively contracting with Learned contractors to 106 — SEWER & WATER
construct the project(See.light,Business and Professions Code:)The Contractor's Li-
«nse law does not pply to an owner of property who watka or improves thereon,and, 202 — UNDERFLOOR PLUMBING
who Lcensclaw�`nr such pmjecs with emmracmr(s)livened Pursuant to the Convector's 203 — UNDERFLOOR MECHANICAL
❑I an exempt under Sec. ,B&PC for this reason 204 — UNDERFLOOR FRAME
net Date 205 — UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 — ROUGH PLUMBING
I thereby aRrm on&,penally of pedo,oneaf lM fallowing declarations: 302 — TUB H OR SHOWER
14EInave and will maintain aCenificate ofConrm to self-insureforWorker'sCompcn-
nn,as provided for by Section 31W of Ne lbor Code.for the performance of the 303 — ROUGH MECHANICAL
kro,whichthinPemitisiasued. 304 — ROUGH ELECTRICAL
1 have and will maintain Worker'a Compensation Insurance,as required by Section305 — FRAME
1 of the LaMar Code.fur the perfrmance of the work for which Nis Permtl ix iWorkers Compensation breaanm canter and PolicynumM11. (I 306 — HOLDOWNS
Canto,:—V7;k/E FI/A/1J Policybfdn 3 DY OO( 307 — INSULATION
CERTIFICATECOMPPENSATIONION INSURANCEORKERS' 308 — SHEETROCK
Coustcctiom neednol Mcomplemil trine Armand isfonme hundred dollars($[(ad 309 — EXTERIOR LATH
Icr310 — INTERIOR LATH
employs.,
yy mm m Inc performance or me woo for whichjethis the Wit orkers issued.khan not 311 - SCRATCH COAT
empinyany pcmr any mangcpEaaarrMc are!yphjccl mtM1C Workcrs'Comlevatinn
laws ser Calirn a f!�/GOJ/ 313 — ROOF NAIL
Anprioaat
NOTICE TO APPLICANT:IL a@aking this Cmdddam of Exemminn,you should 501 — FINAL ELECTRICAL ENERGY
Mcnrne subject ser the Wnrkerk C Irovation provisions of the Labor Code,you must
0z forthwith Comply with such provisions or this Permit ahaBMdeemed revoker. 502 - FINAL PLUMBING ENERGY
zOCONSfRUCTIONLENDING AGENCY 503 — FINAL MECHANICAL ENERGY
eC >sit1hereby alErmflat note isaconstruction lending agency lot the performanmter 504 — FINAL BUILDING ENERGY
Ihewn,krotwhichthispermitisissued(See.3097,Cix.C.) 505 - FINAL ELECTRICAL
`0 Iandcr's Name
] z I<ndergAddmsx 506 — GAS TEST
U O 1 acidly Nat I have read oris application and gain that the above information is 507 — FINAL PLUMBING
CttF conal.l agree to comply with all city and county Orinancesand state laws relanngm
p U building construction,and hereby multioner representatives of rais city to enter upon the 5 FINAL MECHAICAL
W above-mentioned propeny for inspection purposes. 9 FIN
y (We)agree to vc,husbandfy d k c0 w mlcss M city of Cupertino against W-i-
0
h liabilitiesjudgments,costs and expenses which may in any way acerae against said City 5 NU Z i45@;n�
' f this pygal. Issued by51RKS Date
.. S ApID WII.L COMPLY W ITU ALL NON POINr
SStgnmareofrpmaanr •I D Re-roofs
HA] RDOUSMATERIALS DISCLOSURE Type of Roof
Will the applicant or future building tccupml sure or handle hazardous material
az def and by the Catarina Municipal Cttle,Chapter 9.12,and the Hcalth and Safely
ode, 0yea 25532(a)f All roofs shall be inspected prior to an roofing material being❑Yes No P P � Y g g installed.
Will mea applicant or future building Occupant use If a roof is installed without first obtaining an inspection, I agree to remove
PP b P a Air u or deices which g p
mit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District!
❑Yes
I have mad the huvilimsmaterials requimmentsuadc,Ch.me,6.95aflhe Califor- Aignature
ba Waldo&SafetyCan,sections 2551525513 and 2554.1 understand that ifthe building
docs nm oy It aUna at iti y sromihddy to mnily tM occlard of Ne
eoraeemneamoraeu xofApplicant Date
�rcr orauthorud agent �' m All roof coverings to be Class "B" or better