03010100 CITY OF CUPERTINO ;
BUILDING DIVISION PERMIT 'CONTRACTOR INFORMATION '
BUILDING ADDRESS: BRUNER CONSTRUCTION PERMIT NO.
21088 GREENLEAF RD 03010100
W NER'S NAMI?: ThisIS t St 14886 RONDA DR. APPLICATION SUB DATE
ROBERT & DE�I�ISE GARLOW 01/17/2003
DONE: (408) 377-6993 SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
w00 LICENSED CONTRACTOR'S DECLARATION
n U F I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
�<c. with Sec`i1'n]1)fa)or0ivisinnJor the Business en roressionseotle and my license is L
inf°BR erreel / � ADD 360 SQ. FT. /REROOF
FyFp a CrS DE��a((��
2,� As shall
use Ds publico 10 7
�'�K I undcrstanJ my plans sM1all he used az public nttords J
HUOt' Licensed Pmlessional
g a m
-BUILDER DECLARATION
I hereby affirm that that 1 am exempt from the Contractor i
's License law for the
�00 following reason,(Section 7131.5,Business and Professions Gina Any city or county
w S� which requires a Permit to ter.
carrousel,al .;napdemolish,molish,or repair any strucwm
I- to pool illi usuance.alsoreomorsthe applicant forsuch Pmmimo lilcax;gncd.natcmcnt
that he is licensed pursuant M lM pnmisiom of the Comixttori License Law S Ft. Floor Area
s'a d 9 $80YCQtion
fit- (commencing whh5mfromindthe basis fon 3or
the alleged
esaandmpt Prnfuay violaodq or
y F$ that he is exempt therefrom and the baro for the alleged exemption.Any violation of
section 7031.5 by airy applicem for a pemnit subjects the applicanuo a civil penalty f
not mure than five hundred dollars(S50(). be Occupancy Type
1,as nwner of IN Pmpeny,or my employees with wages as their sole compensation,
will do the work.and the ssucture is not intended or offered for sale(Sec.7GPL Business
and Professions Code:The Conuacmrs License Law does not apply to an owner of 10 2 - PIERS equlred Inspections
property who bunds or impmvu thereon,and who does such wart himselfor through his
own employees.provided that such improvements are not intended or offered for sale.If, 103 - UFiER
however,the building or improvement is sold within one year or completion,Ne owner-
builder will have the burden of proving that he did not build or improve for purpose of 104 - REBAR
cals.). 105 - ANCHOR BOLTS
1,as owner of the prnpeny,am exclusively contracting with licensed captive-m
m 106 - SEWER & WATER
rtsuuct the project(Sec.7f W,Business and Professions CWe:)no Contractor's Li-
censeLawdoesnutapplytoanownerofpropenywhoholdsorimprovesthereon.and 202 - UNDERFLOOR PLUMBING
who contracts for such projects w4 a contractogs)licensed pursuant to the Contractor's'
License Law. 203 — UNDERFLOOR MECHANICAL
p 1 am inscriari underSom
yn�-iry��,,,� Ba<Pcfee this re"°" 204 - UNDERFLOOR FRAME
Dateer,4*.11 's ,'E 'LKrvsCrloN DECLARATION
205 - UNDERFLOOR INSULATION
1 herebyaffirm under B r 301 - ROUGH PLUMBING
Cc"iynofConeneoftheMre,forWmas'sCo 302 - TUB & OR SHOWER
❑ mars and will maintains Ccnificare ell ConsemmsdfinsumforWurker'sCnmPen-
sation,as provided for by Section 3700 of the Labor coma for the perfomnance of the 303 - ROUGH MECHANICAL
work for and ills permit is issued. 304 - ROUGH ELECTRICAL
❑ Ihave LawillmaintainWorker'sCunceoftewrkfmnm,azhisper by section 305 - FRAME
3](MI of the labor Code,for the performance of the wok for which this permit is issuctl.
My Worker's Compensation Insurance carrier and Policy number are: 306 - H/LDOWNS
carrier: Polii,NO: 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE 308 - SHEETROCK
(This section need nut be completed ifthe permit is fours hundred dollars P$100) 309 - EXTERIOR LATH
or less.) 310 - INTERIOR LATH
I ecnify Ihm in the P B c of olio work G^which this permit is issued,I snail nm 311 - SCRATCH COAT
employ any pe ny mpnecr�{o�ukMromc subjeamthe Wmkeri Compensation
Laws of Calif U VV-YL%% J 313 - ROOF NAIL
APPj1/F�.am gfiih
NOTICE TO APPLICA :If.after making this Ccnifcam ofEumptinn.you sM1nuld 501 - FINAL ELECTRICAL ENERGY
hhfC�� sunjcet m the worker's compensannn provisions of Nc IaMr code,you must
O� mnnwhM1mmplywlM1saxhProv;s;onamthia rmdsnml deemmmvokea. 502 - FINAL PLUMBING ENERGY
z I CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
F
I hereby offirro that there is a construction lending agency$Or the fa,riarmaner,of 504 - FINAL BUILDING ENERGY
m > thework fit,whichlhisPc.it isissucd(SceJIN].Civ.C.)In Lenders Name 505 - FINAL ELECTRICAL
a z L`"l"sAddr`ss 506 - GAS TEST
V O 1 cen;fy that 1 have read this application and state that the all information is
L,, context.Iagreetocnmplywithallcitya^dcountyordinariesandstumlawsmil'ingm 507 - FINAL PLUMBING
building construction.and hereby authorim representatives of this cit In entero upon�Uj ahtwc-mentioned for inspection p 5 FINAL MECHANICAL
proper y pee pkeep bar 0 9 FIN
F W (We)agree m save,indemnify and tech harmless the City of against
against
rel in consequence
judgments.minting expenses which may in any way ammc against mid City 5 N G
[) ,'� in ennseyucnce of the graining of this permit.
.. SS.
PU APPLICANT UNDERSTANDS
STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by51 - WORKS Date
m
mgnu of AApphca^VContra1 n�4~ �/p/ Re-roofs
ole
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle havmdous material
as defined by the CuPenino MuniciPal Code,Chapter 9.11.and the Health and Safety
Cudc, yr2553213)?
E3 ' All roofs shall be inspected prior to any roofing material being installed.
❑Ye1�JVn
Will the aPplicant nr future building Mcupaut MW equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mu hay.Naus air cormorimam as dcGned by the Bay Area Air Quality Management all new materials for inspection.
Di,ansO
F1 yes VNo
I have read the hvardoeess materials myuiremen¢under ChaPte,6.95 of he Cmifor-
nia llcalth&Safety C(mc.Se t)MS 2.5.Vt5.25533 and 25$3d.l understand Nat ifgc building
does t currently ban a initial,that it is my respontiolity to unify the u'eupant of Inc
reyuirtmam hichmuporntiazumccofaccnmca�QcoPan`g Signature of Applicant Date
�me,Or
o eroram odrcEagent Date All roof coverings to be Class "B" or better