01110119 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS. PERMIT NO.
7544 FALLENLEAF LA 01110119
OWNER'S NAME: APPLICATION SUB DATE
MC CARTY KEVIN P AND ELAYNA B 11/28/2001
PHONE: SANITARY NO. CONTROL N0.
1 ARCHI'I'E.=NGINEER: BUILDING PERMIT INFO
z u- BLDG ELE PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
v b rrrmmalIamueml.edander acrena vmnmmenc;n JobDescri [ion
f z_o <ae y es pnn; n per g P
_til w;t ecian]tlWlnrmvixma3nnneeasinexsandPro@edomscale.vaamrlmenxg LIGHT FIXTURES/REC - S .
e I_ - full forte and effem. c7
O'er",V ,seems Claes r
i LL c.F Ulc�� }� S DECLARATION•-nim-
ARCHaTEe...DECLARATION
I undersmnJ my plans shall be axes as public records
S
i`p z Licensed Professional
ed a that I a -BUILDER DECLARATION
w-v, 1 hereby aRrm on 1 1. exempt from the Cessions o License Law for the
t?< following reams l5camn]031.5.Business and Professions Code Any city or county $1000
F a which requires a permit to construct,alter,improves demolish,or repair any structure
ad3m _Prior toitsimaame,a!sorequiresihe applicant for such Permit fileasignW statement - -- -� - _. .. _ ___
s. Ibahe ii ligvsed puixJSni m the pmvtsions o(thc Contraclmi License law(Chapter 9
tt " ..f'•• q, {� ]AAs o Y )-S;. Valuation
(comm enc ingwiih Sectiefromand the basis
asisor Business exand Professions Code) i. \ nl'3 y "r l:�.r••=t�\o-4\It.;`.1 t.�,
or mai he is exempt therefrom and the basis for the alleged<sempn t to Any l pennon
-of Section]O)LS by any applicant for a pCRni1 subjects me applicant to a civil penalty
rnfa.,muse than fie hundred dollars a5W). ' 304`\PNNM1 9� ELECTRI At " Occupancy Type
01.as owner of the progeny,ser my emplvyece with wages ai their sole compensation. _
-will do the work;and the mucron,is not intended or offered for sale(Sec.'76Sa,-'
cBusiness and Professions Code:The Contractor's License Law does not apply to an 505 - FINAL EESWRRM*Eetions
owner of prep<ny Who builds or improves thereon,and who does such work himself
through his p1 y provided Ih I such improvementse not intended or _
-o a ,e 1 If h IM1<bu'IJ' So p t- IJ m y of s ----
completion,m Eu Id will have the burden f proving- h t h did t Wild or
mPro f P ld
p1 s I'm p eery Bassin ly t f with n-J I tr is -
construct m project IS ]BCG Business s d eProfessionsCode)Th s Contractor's
n, "
License whLa d I apply Ioo herthp pony ho).ltd p m sI to th �O
_ and.. h accts f such projects wim. o t toAs).1 c J.p chi,res me ..__...... . .... _/O
I
Cont n pt se S ---
❑1 cmpl under Sec `',B&PCT this reason ti ,n)I s• :
- Owncr Date '. .
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the Billowing declamations:
❑ I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation, as provided for by Section 37W of the Labor Cade, for the
" _ perfomwce of the work for which tail pmnil is issued.
❑1 have and will maintain Worker's Compensadi n Insurance.as required by Section
3700 of the Labor Code,for the performance of the work for which this Permit is
coed.My Worker'.Compensation Insurance carrier and Policy cumber are "
Policy N..:'
I':CERTIFlCAnON OF EXEMPTION FROM.WORKERSp, 1 �f'. ' aL li: tL.(°E-lsYljIi is :x k•3I . I (,r
ENSATION INSURANCE„ .''
.. COMP .. .. _ . ... k. .-.. s _.__.____. _..___._. .._.-_"_.._.___.._—.
a6dibtf sad not tie cnm ism it me
($100)or less.) P pennil is for one hundred dollen
.I certify that in the parImarna ce of the work for which'his permit is issued;I "- - ---”`• ' ' - .._. _ .- _ _, - •� •-,. _ ,
shall'.employ a y mann t become x b)a to m Work •• ' t - ,�t '
P< . Ion fClf -Dat:
z NOcoTmICcEaTbAN fknCfEximmamn.
fee,
mile Worker's Co tienpro simns ofthe Lobo Cush,,yed
fart id,comply wish such provisions orthis Permit shallbe t -
-"--
deem d cringed.
" 'an-CONSTRUCTION LENDING AGENCc
Yi I he for tics Ihm Ih re s ak.d I u lending agency for thepeRormance 1 It
� eme work for which this perinn is slued(Sec 309],Civ.C.) -
� Lender's Name_. i _" ._. .._:._.. ...._.. .
L Under's Addmss'
V � I certify that l have read this application and state that the above information is
FTs't.. m1dh11 agree Io comply,with all city and county ordinances and state laws relming
�.0 mbuilding conslrunion,and hhcby authorize rcpmsemarives of mil city to enter upon
>'i W the above-mentioned Property for inspersion purposes.
[.a 0. (W'e)igree m sire,indemnify and keep harmleu the City of Cupeiiinb against
M liabilities,judgments,cost and expenses which may In any way accrue against said
G ti City.. 1 the% i g of mis`pe I .. ' .-
'AP IC DER5TAKDSANDW COMPLY WITH
ALLNON-POINT '
s R GUULATiONs Issued by: ate LJ V
/ //2>,
_ lie trF>' ff1 pp'TdIrcntcto; - .Date. Re-roofs
HALeRDOUS MATERIALS DISCLOSURE '^''
Will theapplicant r m building o< p Imre i handlehazard`x at.
, Type of Roof
as der ed by m<C pen Municipal cad Chapter 9.12. d m Health and Safety e - -- - -
Code, OY n 255121 ) ❑N
g
All.roofs shall.be mspected.prior.to,any.roofing material being insta_lled._ . _
Will In applicant futurebuilding If a roof is installed without first obtaining an inspection;Jlagree:to remove
e IM1 rd Ppnm to defined by BpB yA qAP QIII dM Management �-"� -
District? - all new materials for inspection. Applicant understands and will comply with
ares ON.
allnon point source regulations. .•„
rw'I 1 have read thehazardo s materials requnemeats under Chapter 695 of me
California Health&Safety Cod 'Sections 25505.25533 andder C 1understand that
occu 'Iding down tcurrently an-lianant,mmit i.myresponsibility to notify the
m of the arms which'm s1 be met pd.,to issuance of a Certificate of -
._ l - pancy. - • . .
Signature of Applicant- -_ Date
r o ragent-. Date IAll roof coverings to be Class"B"or better
.OFFICE