03040132 CITY OF CUPERTIRIDsy.z`:
BUILDING DIVISION PERMITCONTRACT®R TNFfORMATI®N..
BLp@11709°R610HANSEN DR PERMIT"°.03040132
o & ELIZABETH GILL "'W29/2003
PRME: SANITARY NO. CONTROL NO.
ARCHITECT&SIGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
L o o LICENSED CONIRACrOR'S DECLARATION
1 hamy�effnm That l am licenxch der provkdons of Chapter 9(commencing Job Description
n�2 wIN Sc�onJ1�1�1l)nf Dlv Io,3 of the ossa :ft, i aCo ,end mylicense is
in fullfn�PT acrbcl. 3 PATIO COVER ENCLOSED 302 . 6 SQ. FT.
�? Leenm C'Iu5 ic.M
-� Da o Conlrac r - D d ONTRACTOR: AFFORDABLE SUNROOMS, INC.
1q- I CIIITECISB LARATION
2 1 undcralend my plans shall W userilks public meet&
Oast
Liccrl¢d Professional
OWNER-BUILDER DECLARATION
K a O 1 bomso .(Sr t That 11. exempt from the Cosies is License taw for Ix JUL
O '7 00']
O O following reason.(Section]1131.5,Business and Pia,darn li Code:Any city or county L O L J
$ which its imsI.•permit re construct.alert improsu de urnit a or.pair any truchtattoo a
prior a ill ietnNtt.olion ito Me po ritionanl forMe Conda pefmllrofileablgned Chap11Cn1
L-b< Nonto n licensed a lionwthepfDis ion3of CB acmi.ndi elaw(Chaptm9 Sq.Ft. Floor Area BUValuauon�
FFG (cmnmendngwithseelion]000)of basisnr the
Alleged
ee andon.An vi Cnde)of ILL/IIC
y $ dw x b excmpl Npefrom and the bub for tx alleged exempdol Any violation of $22000
Section 7031.5 by any applicant for.permit wbjece Ne applicant AS a CMI penalty of APN Number Occupancy e
not mare Nfiv
m e hundred dolbn(350D). P Y�YP
I,uowner of the property,car my employ.with waguss Nov hak wmpcnsstion,
37537066 . 00
will do Bewotk.and Nuouctum Isnot InUndede Law does
Act a(Sec. wner of
gg
and anywhau Code:The Contferean.IJccue Lew dors or apply if an owner of 101 - FOUNDAT i ON Inspections
pwpenywhohuil provided
i d that
tuch imp.end who are
essuchwned!or aelforthmugh his
hunemployusilding r ImIcnmentis Sold within
nneyear ftmmOered for Owner. 102 — PIERS
however,Ne building orimprovement Ishathwithinone year ofcompletion.Neowner-
builder will hew Ne burden of proving Net he did not build or improve for purpose of 103 — UFER
"le')' 104 - REBAR
❑1. a owner of the property,am exclusively contracting with licensed contractors to
construct he pmjcet(Sec.9Daa,Business and Professions Cole:)The Contractor's U. 105 — ANCHOR BOLTS
cesse Law does not apply to an owner of property who builds or Marrows Ncteon,and, 106 - SEWER & WATER
who contracts for meh pmjeeo with a conmactur(0 licemed pursuant to Ne Contractor's
License law. 202 - UNDERFLOOR PLUMBING
❑1 am exempt undo Sec. .B k P C far this moon
203 - UNDERFLOOR MECHANICAL
Data204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
I hemby affirm under penalty of perjury one of Nee following doelmdom: 205 - UNDERFLOOR INSULATION
❑l haw end will malnwn A CudOcateofComenl to self-insure for WorkefaCoopen- 301 — ROUGH PLUMBING
sada..As provided for by Section 3700 of Ne Iabm Code,for the performance of tie 302 - TUB & OR SHOWER
work forwnmhthispermnlaissued. 303 - ROUGH MECHANICAL
❑1 hast end will maintain Workci s Compeuetion luunnce,As required by Section
3700 of Ne taWrOade,for the pertomrana or Ne work for which MIS permit b rssmd. 304 — ROUGH ELECTRICAL
My Workeri CompenssSlan lnsun�n�a/�ortivand Poli .Nals"ersam:
Cani / .St-1� w^V Polity .:_V GZC-0Z -4Tics, 305 - FRAME
CERTIFICATE OF EKEMPn OM WORKERS' 306 - HOLDOWNS
COMPENSATIO SURANCE 307 - INSULATION
(ITIS scetiw need not he eonplemd if the permit is format,hundred dolls(IM) 308 - SHEETROCK
I it..)MIS
- EXTERIOR LATH
employ ecrtify Nater then any mann of Nc work for which Nis permit is isswom a nsa nut
Low,o C.I.r. I.many menneranssmbecome subjwuo the wmrkcri Compensation 310 — INTERIOR LATH
Lawsca ce0rorole.Date 311 - SCRATCH COAT
Applicant
NOTICE TO APPLICAND IL arm,making this Certificate of l mmptwa,you Should 313 - ROOF NAIL
become object to the Worker's Compcuation provisions of Ile Labor Codc,you must
Jp mmwithenmplywith Such prrwhoua.,this Permit."]Ixdecmedresnkea. 501 - FINAL ELECTRICAL ENERG
'Z " CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERG
F IhemhyaRumMet mcmisaconstruction kndi .) ryfor Neperformenttof 503 - FINAL MECHANICAL ENE G
rG> tint work for whim Nb permit b issued(sec.3097.Co..C.)
W p^ LeodersName 504 - FINAL BUILDING ENERGY
LANcea Address
U0 505 - FINAL ELECTRICAL
UO 1ttNfyMat oeI tymWlibtyandcounandsineNalndaboveinformationb 506 - GAS TEST
w U bunett 1 grtt tui empty with ell city and county ordinances Of anal sum lens r up ng m
OU building construction,ro and herebyhathon prpoescnudws of this oily to enter upon the FIN PLUMB G
w ahwc-mentioned property for inspection pugexe
(Wee)agree to saw.indemnify and keep harmless the City of Cupertino aga nst O$ F I L
Ilabllidesjudgmenls.eosu and expcescs which may in any way accrue ageinstaeid City 5
C.3 Z in consequence of Ne granting of this permit. /
APPLICANT UNDERSTANDS AND�kWILL COMPLY WITH ALL NON- O-IINT Issued by:5 ING Date
SoURCFa,{f G LATID" / _/ wi-��/ FJlure
.I] —
Sr luurreofA�pplicent/C.mractt., Data
Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future building occupant Store or handle hazardous material
AS defined by the Cupenino Municipal Code,Chapter 9.12,and the Health and Safety
Codc,gectio.25532(.)7 (b No
All roofs shall be inspected prior to any roofing material being installed.
❑Yca
Will rx.Applicant or future buildin haw ant use If a roof is installed without first obtainingan inspection,I agree to remove
PP g p Area
Air euordeviceswhich P
emit huardoes air contaminants u defined by Ne 8ry Arcs Air Quality Management all new materials for inspection.
DiSVicl9
❑Yrs eNm
I hew mad the ha>abwsmaterialsrcquimmcnu underChapxr6.95 ofd.Glifor-
nbHeal6g:seelycodc.Sxdwu25505,25533atu1255M 1 rdefsurW detiftie Wilding
dins not curmntly haw a unml,dot Ir b my m Np Wliiy notify Ue occupmt of the
mquiremcn i maR a 'o'bu venceof.Cem wof Occu Q Ignature of Applicant Date
owner .uNndma seal Dae All roof coverings to be Class "B"or better