02080014 CITY OF CUPERTINOaaw,s'* <;Ivyv�e yr r+r�.>ces.,u;;ru
BUILDING DIVISION PERMIT XONTRA'xCTOWINFOR�MA IONI'.M
BUILDING ADDRESS: PERMIT NO.
22951 LONG DOWN RD CATHRINE DILTS 02080014
OWNER'S NAME: APPLICATION SUB DATE
CATHRINE DILTS 08/05/2002
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
O
m w BLDG ELECT PLUMB MF.CH
=i LICENSED CONTRACTOR'S DECLARATION
o h
1h u nt then 1 um lianxcd unJer provisions of Chu tar 9 Job Description
p commencing NEW STAIRS
K`:C with falliEcon ,if Divisionluf the Business and Yrofcssions Code, dmylicenu
a in full forts and effecn. F'
0 � ]Lianas Class Lich NAL.E
3 wEE6w umc
Connector
I unJenandmy plans ximll be seJns public
c record.,ARCIS DECLARATION
OCT 11
2002
p p Licensed Professional L
O ,I.,a exempt
m the ommON
—m I hereby.(Sero that 1 1. exempt from the Contractor's License city
o for the BUIL
�®
C s' following mason.(Section 703L5,Business andimprove.
Po.dimmi Cade:Any city or seamy
Sec i'❑ which requires v permit m,answer,nlmc improve,demulixh,or repair y structure
a prior o its ixsuvnce,also quires me apPlic tfor suchp miuo Elc vsigrcJ s...a,
that he is licenmd pumuvnfto the provisions of me Contmcmh License Law(Ch vpter 9 34$a,Ft.�j110r�q,ea Valuation
(commencing with Section 700so of Div inion 3 of the Business and Professions Code) hEb of v0�0
or then he is exempt therefrom am the hasis for the at legal emmption.Any violation
of Section 7031.5 by any appd icant for a permit subjects the applicant to a civil pemtl ly
1 of not mare than rive hundred dollar,(S5au), 10, APN�ATI ON Occupancy Type
❑I,as owner of the Property,Lir my employees with wages us their sole compensation,
will do the work,and It.structure is nm intended ar offered for sick,(Sec.7W.
Business and Professions Cale:The Contmcmr's License Law does not apply m as 103 - UFER Required Inspections
owner of property Who huilds Lir improves themon,and who does such work himself
or through his awn employees.provided that such Improvemunic arc not intended or 104 - REBAR
offered for undo.IL howevec, he building or improvement ix sold within one year of 105 — ANCHOR BOLTS _
completion,the owner-builder will have the burden of proving that he did not build or
impmvn for partes,ofsAe). 106 - SEWER & WATER
❑I,sxownerollhe pmlxny,am exclu.vively emtracting with licensM eco -rum 202 - UNDERFLOOR PLUMBING
cansmuct the project(Sec.7644,Business and Profession..Coded The Contractor i
License Law does not apply to an Owner of property,who builds or improves memon. 203 — UNDERFLOOR MECHANICAL
and who commen for inch projects with a cnmraetor(s)licensed puauato the
ro204 - UNDERFLOOR FRAME
t ntrcselrw.
I am exempt under Sec ,B&P C for this reason 205 - UNDERFLOOR INSULATION
o her lsD a 5 301 - ROUGH PLUMBING
W RKER'SCOMPENNDECLARATION 302 - TUB & OR SHOWER
Ihemby vlRrm unJer penehy of perjury one of the fallowing decluatiars: 303 ROUGH MECHANICAL _
❑ 1 have and will maintain a cnnneme of Content in xelf-munre for Worker's 3 04 - ROUGH ELECTRICAL
famna
Compensation, as provided for by Section 37W of the Labor Cade. for the
peruofma work for which mice permit le hoomd. 305 — FRAME
❑1 have and will maimuit Worker's Compensation Insurance,m remind by Section 306 - HOEDOWNS
37110 of the Labor Code,for the performance of the work for which this permit,is
issued.My workers Compensation Insurance carrier and Policy number am: 307 — INSULATION
Carrier: Policy No, 308 - SHEETROCK,
CERTIFICATION OF EXEMPTION FROM WORKERS' 3O9 — EXTERIOR LATH
COMPENSATION INSURANCE
This section need at W completed Vine permit is for ane hnnJreddallnn 310 INTERIOR LATH
(5100)aAess1 311, - SCRATCH COAT
1 certify that in the performance of the work far which this permit is issued,I 313 - ROOF NAIL
shell not employ any K 0 manna I me. a ey jest to the workers 501 - FINAL ELECTRICAL ENERGY
Compensatiop{nw.sa Celiforn .. vm L �O
Applicant_LL�oa 502 FINAL PLUMBING ENERGY _
ET1, PI'L CA ng this CerrJicme of Exemption.you should
Z no 503 503 - FINAL MECHANICAL ENERGY
�• tnnnwrtneamp wunaaehpmmxmnaanhtap mhmmdthedeemedresidual 504 _ FINAL BUILDING ENERGY t
f� CON ST RUCTIONLENDINGAGENCY 505 FINAL ELECTRICAL
thereby
u1Rnn this them is n camwction lending agency for the perf xonance
W a ftheworkfarwincla LicemitisissueJ(Sec.3W],Civ.C.) 506 - GAS TEST
� zLnder'.+Addm Name 507 - FINAL PLUMBING
Lender's Address
U O 1certify chat Ihave r,adthisi,idmatmnandstate chat tnevbovninratmatom x 508 - FINAL MECHANICAL
W H comm.1 agree to comply with all city and county ordinances and sum laws relating 509 - FINAL GRADE
Q t.1 to building construction, eru
ction,and hereby authorize mpreuativex ofthis city,.erutpon
fzj theahove-namianedpmpcny for impcetianpurlwsev.
Os (W,)agme m save.indemnify and kap humlessm,Chyof Cupertino against SIO — FINAL PLANNING
FI y liabilities,judgments,mss and exp,mis which may in any way=me vgainst said 514 - FINAL UB C WORKS
V r`zt City in consequence of the gmmingof this permit. ",
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL )N-POINT
S CE ul"ATIONS. Issued by: :�_`� G.--.- Date
S[u�/w(�G of EV6� Re-roofs
aguWre Lit AppbcvnIf amtvaor
✓JL/ HAZARDOUS MATERI ISCLOSURE
Will the upplDme
icum or fumm b at cu I.ill or handle hazardous mateml Type of Roof
a defined by the Cc in.Munici ak.Chapter 9.12,and the Health and Safety
Code,Section 25532(v)T
°vex 0 No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Ing accupvnt use equipment or devices which If a roof is installed without first obtainingan inspection, I agree to remove
emit hazardous air contaminants efinedbythe Bny Aron Air Qualityhfanagarent P g
District" all new materials for inspection. Applicant understands and will comply with
0 Y.'` ON.
all non-point source regulations.
I
have mad the hamolms maurials requlremems under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533 and 25531,1 understand that
if the building does oat currently have o tenant.that it is my responsibility to notify the
accupam of the requirements which must be met prior to issuance of a CeniGeme of
Ocmm�n
Signature of Applicant Date
ormnhttied agent 7 - All roof coverings to be Class "B" or better
OFFICE