03020104 CITY OF CUPERTINO, >K)�*s *� ',�' �' tl `•` y` . . ,:; ;
BUILDING DIVISION PERMIT SCC►NTRACTORTN>i'O1LMA"CION.
BUILDINGADDRESS: - ALL SEASONS REMODELING PERMIT NO.
*20128 LAS ONDAS WY 3020104
R•s NAME: 219 DEMPSEY RD PERMrr ISRDATS
STAHLER CATHY A TRUSTEE 02/25/2003
PHONE: (408) 586-8004 SANITARY N0, CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMBMECH
0 0 0 0
Sop LICENSED CONRIACnOR'SDECLARATION JobDescri tion
1 hereby,flim then 1 em licensed under provisions of Chapter 9(mmmenring p
with Satlon]O(IB)nf Dlvt,iOn Jof the Businew ChM Prufwin,u Cade and mylicmuob FIN ,Qp,tt E®
LIC. "m and cfft PATIO ENCLOSURE (170 SQ. FT. ) Iii�@3SII6r✓►tFa
S 3 Licenso Lk.M
o.ta ITICrS "cot Yd/ELECTRICAL ON CONCRETE PAD
,e ARCHITECTS DECLARATION
y� 1 understand my plans shall he used u public cardMAR 2 8 2003a �/✓6' -
it: Licensed Licevcd Pmfuslanel BUILDING
OWNER-BUILDER DECLARATION
Contract
<f I hcrtby.(firm on 1 1. exempt from me Contactors e:A License city
o for me -
e9off• followingmaenn.permit
7(131.5,Buslnes,and Professions Code:Any city nrcounty ,
which myulrca issuance.pcmit ac cares ft alters i t for sex h permit fi mash any stmdum
poor mit, ensedpalsum umm to do ftapplicantof for such permit UmnsaLawdatament
FF< IWlhcincin$wid puntion70is)ofDiWou nfnrlk the Business Lmnmsslo(ChapterCode)
Sq.Ft.Floor Area Valuation
d� (coo a is exempt
pth Hamilton
and ofDivision 3.Rhe ag Business and t Proon,Anynvi Cale)of $5100
that M h exempt themfmm and the ball fa W dleLed esempllon.Any violation of
Scalon 7031.5 by any Applicant for A Permit subJecta the Applicant to A civil penalty of APN Number Occupancy Type
not mate man flue hundred dmlu.($50e). 36930027 . 0 0
0 I,As owner of the property,or my employeas with wages As meirsom compensation.
will do the work and the structure Is not Intended aroffered for sale(Sec.7W.Business ygD�r
and Profession Code:The Conmcmes Lt.=Law does net apply m an owner of - 101 — FOUNDK�j72LV Inspections
property who bulldsor lmprown memo.,and who dmi mb wok himtelfor through his
awn employees,provided mel such lmpr.wmenta are not intended aro@cod forsale.If. 102 — PIERS
hmewt.the building Or Improvement keotd within one year ofcompletion.the Owner. 103 LIFER
"
builder will haw the burden of proving mat ha did not Wild or Improve for purpose of"k.). 104 - REBAR
[3 1.as owner of the property am exclusively convecting with licensed mnuscton to 105 — ANCHOR BOLTS
comuuct due project(Sec.7044,Basin=and Profession,Code:)The Contractor's Lt.
cense Law due.not apply to an Owner of properly who builds or lmprowa thereon,and - 106 SEWER & WATER
who contracts for such Infect,with a conuacmr(a)licensed pursuant to the Cannanore, 202 - — UNDERFLOOR PLUMBING
Law,
exemptunde,Sm. ,B&PC An,this aA.on 203 - UNDERFLOOR MECHANICAL
Data 204 "- UNDERFLOOR FRAME
WORRERSCOMPENSATlONDECLARATIO" 205 UNDERFLOOR INSULATION
Ihereby amten under penalty of perjury amofthe muawingdak.ations: 301 — ROUGH PLUMBING
❑IMw and will maintain a Certlecate ofCansent to self-Imum for Worker's Compcn. 302 — TUB H OR SHOWER
sedan.As pmvlded fa by Section 37 (the the Labor Cade,for the performance of tho
work sur which this permit I.kesned. _vl 303 - ROUGH MECHANICAL
Pllbaw and will maintain Wmmes Cc6peoution Instance,As requited by Section 304 — ROUGH ELECTRICAL
3700 of the Labor Cml for the performance of th",Ak far which this permit is Issued.
My Workcra CampensmI. serene.carrier and Palicy number r: O/0 305 — FRAME
ante - Policy Na: 306 - HOLDOWNS
CERTIFICATEOFEXEMCOMPENSATION INSRANCBDRKERS, 307 — INSULATION
(This natural need not mmmpmedlithe permit sfmaahundred dmlaa(SIM) 308 — SHEETROCK `
o`less) 309 - EXTERIOR LATH
1 Comfy mel In the PC,famanco of the work far which this Permit is issued.I shall not 310 INTERIOR LATH
employ any person in any manner so"Io became subject to the Workea'Compensation
Laws of California.Dal
Applicant 311 - SCRATCH COAT
Laws
NOTICE TO APPLICAND If,after making this CeniO"ta of Exemption,you Mould 313 — ROOF NAIL
.J Zbecome subject to me Workees Compensation provisions of ma Labor Code,you must 501 - FINAL ELECTRICAL ENERGY
forthwith comply with such provisions or thi,permit shall he domed mvnked.
z o 502 - FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY .
F+� Ihemby aRrm thsl dart t,acanewninn kndinpgcay far cite Performaae of 503 FINAL MECHANICAL ENERGY
>
the work for which this permit i.iaud(sce.J097,Cit,Ca
Lenders Nun. 504 - FINAL BUILDING ENERGY
DJ Ca
�Z
Lender'sAddma505 - FINAL ELECTRICAL
p I certify that I haw mW this appliwdon and ate that In,now information is 506 - GAS TEST
ly F COMM I agree to comply with all city and county ordinances and sae lawn relating m 7 - FINAL PLUMBING
V building construction,And hereby authorize mPrtsematlws of this City o enter upon me
above-mentianre to
mpcny findmnifyan kmpM 0 - FI I AL
r In
(We)agree to ase,indemnify And hick humlw the Clay it Cupertino aLmw
fO Ilabilitlu,Judgment,,costs and expenses which they in Any soy amroe ageinn aid City I
U in ;M of the gaming of this Permit. Dale
APPLI UNDERSTAN AN I L COMPLY WITH ALL NON-POINT Issued by: 5 ING
SOU E ULAT Ns
Re-roofs
SignuecofApplicant/Can coW �k
HAZA' DOUS MATERIALS DISCLOSURE Type of Roof
Will dta applicant or future Wilding occupant nom or handle ha ordom material - .
fled 7
Wby the Cupertino Municipal Cade.Chapter 9.12,and the Health and Safety
W
seed..zss3z(.)?
❑Ye. All roofs shall be inspected prior to any roofing material being installed.
prvo
Will the applicant or,future building occupant oo equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hainwous air contaminants As defined by the Bay Arta Ah Quality Management all new materials for inspection. .
District?
❑Yea
I haw mad the h"aNlws m,tarids mquiamenuunder Chapter 695 of the alifor.
nix Health&Safety Code,SOCti.m 25505,25533 and 25534.1 orders"thin if the Wilding '
dot not Indy haw a anent, et h is pyTuponsihility m nutify the C.P.1 of On
myulm cn whichmuslhc 'on s cOofaaflines3k.fOCePanay. Signature of Applicant Date
D
caner or amhonred agent Dale: All roof coverings to be Class"B"or better