03010132 CITYOFCUPERTINO 7*��� 1�y7(� `7�f� '�j y� .e BUILDING DIVISION PERMIT r ca rrx� �roR NFORM' 'I'1'0+1;::;F0 ADDRESS: PERMIT NO. -
7810 LUNAR CT PINIA1 CD
R'S NAME: a Mir 1kaft Im - PERMH'ISSUEDATE
GREG & SANDRA WENDSCHLAG 03105 /2003
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO .-
WILDING I
BLDG ELECT" PLUMB MECH
p
�1 Cp LICENSED CONTRACTOR'S DECLARATION Job Descron
ipti
�1 Wrcby.affirm hat I am Ikonsed under provisions of Chapter 9(commencing -
with Station 7000)of Division 3.f the Business end Professimu Code.ad my lknne to
n in full force and erfen . ADD 546 SQ. FT. /REMODEL
,A_
g License Chos LIC,N _ -
p Dole Contract.,
pW< ARCHITECTS DECLARATION
1 understand my Plans shall be used as public records -
Du
w Licensed Professional -
5q0 OWNER-BUILDER DECLARATION
Contr°N -
9 . 1 hereby.(sect o n I am exempt from the Contractors License Law for[be
00 which
following reason. er iti ?03 coir ct.alteraind mpr ve demolish.or
Any dty.smoone
$� wM1leh requires;a preterit w ennnmeL.item improve,demolish,car rcpelr any atnmlum
He,U116 issuance,alsonc.i.the applicant fWallch permit to file a signedalalemem
G
that he is licensed pursuant to the provisions of the Contractors Licene Law(Chapter 9 - Sq.Ft.FI00r Area .$'71(1J> lOn
s8$ (commencing with Section 7000)ar Division 3 of the Buslnessand Professions Code)or '
that he is exempt therefrom and the bub for the alleged exemption.Any violation of
Section 7831.5 by arryapplium fora permfl subjects the applicant 10•civil penalty of 3 API`I Maher 0 0 - Occu
not mom than fn hundred dollars($500). pane y_TYpe
❑h an°vino of the property,or my employcss with wages as their sok Compensation,
will do the work and theabuctum is not intended or offered for sale(Sec.7044.Business L J J. — d Inspections
and Profession,Code:The ComracloM1 convertU..Law does not apply 1.an convert 102 -- PIERS p'
propenywho buildsorimproves thamon,andwhodoessuchwmk himself orthrough his -
Own employees,provided that such improvements amnothrendedoroffeedforssh.If. 103 — 'UFER
however,%e building or Improvement is sold within one year of completion,the owner. -
builder will neve the burden or proving that he did not Wild m improve for purpose or ,104' — REBAR -
sole 3.
105 - ANCHOR BOLTS
K.as Owner of the property,am exclusively Contracting with licensed coneacmra to10 6 - SEWER & WATER "
contimet the project(Sec.7044,Buinen and professions Code:)The C.ntractel U. --
cameLaw does not apply loanmemorofproperty who builds or improve,demean.and. 202 - .UNDERFLOOR-.PLUMBING
who Contracts for ouch projects with a contractor(,)licensed pursuant to the Contractor,
Lime Law. 203 - .UNDERFLOOR MECHANICAL
amexnmplund� Se .B RPC farthis on 204 ; - UNDERFLOOR FRAME -
orgi D.CA S205 UNDERFLOOR INSULATION ,
WOR ER'S OMPENSATIONDECLARAJ N -
rcbyaRmtuderp
-hy ipally of perjury one of site following dtalantiom:- 301 — ROUGH PLUMBING
1_1I hrvnand will meinbina CeAOcateolco...ttoelf-Insumfor WnrkeM1Compen- - 3O2 - TUB & OR SHOWER
satlon,u provided for by Station 3700 of the Labor Code,rte the Performance of the 303
- ROUGH MECHANICAL
work for which rola work la issuee. " 304" — ROUGH ELECTRICAL
❑1 have and will maintain Workers Compensation Insurance,as required by Section '
3700or Ne labor Code,for the performance of Nn work forwhich this permit is issued. 305 — FRAME -
MyWorkersCompensationlnsurancecarrierand Policy number one. 306 HOLDOWNS
Carver: PolicyNo.: 307 = INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 — SHEETROCK .
(Thisstation need not be completed lithe Permit is lmoaehundmddollan(Sigp 309 - EXTERIOR LATH
.,leas.) o
I certify that in the out mo m or the work for which this permit is Issued,l still not - -3'1'0 -— INTERIOR LATH - - - -- - '
employ any person in any manbrsna an become subject to the workers'Compensation 311 — SCRATCH COAT -
LewsofC411frmla.Dae 313 ROOF NAIL
Applicant
NOTICE TO APPLICANT:If.after making this CortlRcae of Exemption.you should 501 - - FINAL ELECTRICAL ENERGY -
become subject to the Worker's Compensation provision;of Lha Labor Code,you mat .
0z forthwith comply with such provisions or this Permit hall be deemed Conked. 502 FINAL PLUMBING ENERGY
ZO
CONSTRUCTION LENDING AGENCY 503 FINAL MECHANICAL ENERGY
I hereby affirran that were Is a construction landing agency for the performance of 504 FINAL BUILDING ENERGY
04 the work for which this permit isIssued(See,3897,Ch,C.) 505 - FINAL ELECTRICAL
W Q Umles',Name
�Z LenderaAddrea 506 - GAS TEST
U O I certify that I have rod this application and state that the above Information Is 507 FINAL PLUMBING [[��////yy.-.�5''
Ur f~ coned.I agree m comply with all city and county ordinsnces and auto laws misting In K
0 building construction,and hereby authorle representatives ofthis city to mate upon the FIN MEC CAL (///
Lf7 alcove-mentioned property for inspection purposes.
�"fY (we)agree to ave,indemnify and keep harmless the City of Cupertino against 09 FI -
Uto lumoldca,judgments,Coon and expense,which may In any way acmueagatnsl said City NG
U 7 in consequence of the granting of this permit.
ri APP (CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-Po' Issued by:5 C WORKS Date
U CE U n
Re-roofs
IS to ol'Appncantrcon aam Dam 6E3 OOF BATTENS
i xnza Dous ATERIALSOISCLOSURE TypeofR��4 - ROOF IN-PROGRESS
Will thcapplicant or lurelldingmeupantslmcmhandlcharAMousmacrial
Bned by the :. no, pal Code.Chapter 9.12,and the Health and Safety
Seedon 2ss3z(.)7
❑Yes -4,N.. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cmll hactardous nit conisminann as deOmN by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yea 1AN14o
I haveead the hasNnusmeterlalsrequircmenu undcrCMpler6.9S.f the Gllr.r--
W.HealthRSafey Cede,Sumiomn505,25533 and 25534.1 ua dthnlftite Wilding
does a oily naves a enter,that itis mY rcsponsiM1ility to and f upat of the
reyulrem n .rt t r eof.cerdReae r r. Signature of Applicant Date
O
ow. . .themes agate Dae - All roof coverings to be Class "B" or better