02100114 CI'T'Y OF CUPERTINO P r ,r „;
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION ,.,
BUILp 151ipsg70HNSON AVE JIM MYERS PERMFFN®2100114
1 RIsMAWYE RS APPLICATITrUyRf5y 2002
ON13: SANITARY NO.// 77 CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
WOO LICENSED CONTRACTOR'S DECLARATION
e w P I hereby affirm that 1 am licensed undrr provisions of Cnapar 9(commencin pe5 II
Gs” with Section 7("did'Divixion3ofineondneasand ProfessionsCode,and mylicense g NEW SUN ROOM .�f. )
w in lull force and effect.
Ft2z Limn.Class Lic.N
NFw Dom Contractor �/
ARCIIf1EC1'S DECLARATION
oi< 1 undcntano my plans shall he used as public records . '
06O 1
3 a Licensed Prnfcssinwl 0
�'sov'i OWNER-BUILDISR DECLARATION
ay 1 hereby affirm that I am exempt from the Contractor's license Law fur the 0000
w S n O following reason.(Section 7031.5.Business and Professions Code:Any city or county
n w$ which requires a permit m condoner,alter,improve,demolish,or repair any structure
Fay pnorto its issuance.also requires the applicant for such permiuo Glc a signed statement
C that he shouresed pursuant to the provisions ofthe Contractors License Law(Cholocr9 3951134ail.A1QID Valuation
re $ (commencing with Section 7005)of Division 3 mf the Buame, and Professions Code)or
on 3— that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty,of
not more than eve hundred dollars(S50% PN N Occupancy Type
102 - PIERS
L o thewowner of the the sproperty.or my employees d or
wages az their(Sec.
Se.compensation,
will do the work,and the dmaum is not intended oroff'rcd for sale(Sec.7t144,Business 1:03 UFER
and Professions Code:The Contractor's License law does not apply to an owner of 104 - REBAR Required Inspections
property who builds or improves Bremen.and who does such work himself or through his
howemu
ployees,provided thatsuch improwmenve not intendedoroRercd forsale.If, 105 — ANCHOR BOLTS
ever.the Wildingm improvement issold within one year ufcompletion,the owner- 106 - SEWER & WATER
builder will have the burden of proving that he did not build or improve fm puryose of
yk')' 202 - UNDERFLOOR PLUMBING
❑1.as owner of the progeny.am exclusively contracting with licensed contractors to 203 - UNDERFLOOR MECHANICAL
construct the pmject(Sec.7064,Business and Professions Code:)The Contractor's Li-
erse Lawdoes not apply toanowner ofprogeny who buildsorimproves Nemon.and 204 - UNDERFLOOR FRAME
who concocts for such projects with a comracmr(s)licensed pursuant to the Contractor's
License Law. 205 - UNDERFLOOR INSULATION
I ant exempt under See. ,B&PC or Nia.,in 301 - ROUGH PLUMBING
`t n�4nRMI S EN6TIo�A NDECLARA to 302 - TUB & OR SHOWER
I herebaffordbYaffordunder penalty of p'rjury one of the following declarations: 3 03 - ROUGH MECHANICAL
❑I haw and will nourad it Cenificneof Coosenuoulf-Insure rm Wmm,'a Compen- 304 — ROUGH ELECTRICAL
sation,as provided for by Section 37N)of the Labor Code for the performance of the 3 05 - FRAME
work for which this permit is issued. 306 - HOLDOWNS
❑1 have and will maintain Worker's Compensation Insurance,az required by Section 3 0 7 - INSULATION
3700.1' Lab
o,Iar Code,for Ne Peof....of the work for which this permit is isated.
My worker,Compensation msunnceCarrier and Policy rum far ax: 308 - SHEETROCK
Canot: Policy No 309 - EXTERIOR LATH
CERTIFICATE
PTION FROM
COMPENSATION E
INSURAWORKERS'
N 310 — INTERIOR LATH
(This Section need not be completed if the permit is formic hundred dollars(S BMp 311 - SCRATCH COAT
role".) 313 - ROOF NAIL
I certify than i the (,mance f Ne work for bath this permit is issued.I shall not
mplorany a . nrman aceto mm" mmew'norsConi'mraon 501 - FINAL ELECTRICAL ENERGY
Ap I I R -t e 502 - FINAL PLUMBING ENERGY
n i _,C_;,�,�_� g�
A ICETO.�fP�IC/CNI^.'Ifaru`eEng 1CcnificalcofEacmption.yousM1nu5 503 - FINAL MECHANICAL ENERGY
mmc suhjma to the Worker's Comps or this Kohn
mf domed Labor Code.you must 504 - FINAL BUILDING ENERGY
Z forthwith Comply with sucker a COMnsor this permitshall MhecLab revoked.
ZO
CONSTRUCTION LENDING AGENCY
505 - FINAL ELECTRICAL
a h I hereby affirm Nat Nem is a coneweeon lending agency ter the Performance of 506 - GAS TEST
the work ln iwhich this german is issued lSm.3(19].Civ.C.7
Lender's Name 507 - FINAL PLUMBING
Le
Z
Lenders 508 - FINAL MECHANICAL
U O 1 cunity had l have read Ni.,appecaaon and dare that the anow mfmmaaon n 5 0 9 - FINAL GRADE
F' correct.I agree to comply with all city and county ordinances and suite laws existing to
OU building Conswction.and hereby iumminereprcsentadwsofthis City tocnmr.,inhe lb
FINAL PLANNING
above.menoomdpropnrrorm'pnronpmrpus. FIN PUBLIC WORKS
F D. (We)agate to save,indemnify and keep harmless the City of Cupertino against
p3 firm limes,judgments,cons and'Spens"' ich may in any way accrue against said City O Y 00 NAIL
U z in conscyucnm of Nc gnming of Nis n.
^ APPLICANT U DERSTANDS AN ILL COMPLY WITH ALL N N-POINT Issued Date
SOU CE REGU ATIONS.
nammol'App o. l/Cmd a Re-roofs
IA"LARDOUS E LSDISCLOSURE Type of Roof
Wi11N pplicant mfulum building mpam.dore orbandle haiardnus material
bed he CuPcnino Municipal Cod Chapter 9.12,and the health and Safety
as de. nano 25532(.)'/ (�,���
❑rex All roofs shall be inspected prior to any roofing material being installed.
Will me applicant ormmrebuildregoccupantuse equipmentordeviceswhich If a roof is installed without first obtaining an inspection,I agree to remove
emir hmaNnus air contaminants az dcened by the It
Arca Air Quality Management all new materials for inspection.
District) I
❑Yes hY 1
1 have mad the h m"dous materials requirements undo CWpCr695ormcCalifer-
res Halm&Safety Code.Sections 2.5.515.25533 and 25536,1 undcrocum Nm ifnhe building
does not currently ban a¢mart.that in is my responamility to no (e mempant of the
requircmeno h h m' nemetpnortoissusbecofaCcrricatri ca Signature ofApplicant Date
net or aomorixed agent All roof coverings to be Class "B"or better