03010015 CITY OF CUPERTINO ' yf
BUILDING DIVISION PERMIT ' ' X � ,1Q0N
;s :a a�,.b
BUILDING ADDRESS: MECON % PERMITNO.
10440 MANN DR 03010015
.R'SNAME: 10629 AINSWORTH DR PERMITISSUEDATE
BRIAN BARRY 02/28/2003
IIE: __(_4_0__8_F2 45—15 O O SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
ELOPLUMB O
o LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am Iimmed under provisions of Chapter 9(commencing 'Job Description
with Senio�j0(m)of Di n3o(thc8 ArM Profeulons Code,andm Iimmeis
^n mannroreeeR4erfect. a •� ADD 1090 SQ. FT'. (GARAGE/L/RM)
License Clog Lk.X
a A CLETELT nmupuElierccnNa �`
? I undcrsunJ my ppm shall be me
3LL��U33 Limnsod Professional F'1YA'a■■
,E0
5m OWNER-BUILDER DECLARATION I�l�^eey -r syf� ,t
I hereby affirm that 1 am exempt from Ne Contmctoes Lkenm Law for the - MAY t [tJOY
p�O�, following ma#m.(Section 7831.5,Bminefeend Professional Cade:Any city or county -
which mquims a permit to construct.alter,improve,demolish,m repair any stmetum
prior N its issuance.Alan requires the applicant forsuch permit to file a signed statement
< Nat he is licensed pmauent to de provisionsof the Comnctar'a Lima.Law(Charter 9 Sq.Ft.Floor Area B ILDIN 17b7�i(JA10n
$ (commencing with Section 7000)of Division 3 of the Business and Professions Codn)or
a
that he Is exempt thcmrrom and the basis for the alleged exemption.Any violation or '
Section 7031.5 by any applicant for a permit subjects the appimsnt on a civil penalty of " Occupancy not more than five hundred dollars($500). r _ T'pe
❑h As ownu of the property,or my employees with wages u their sok compensation,
will do the A.and the street..is not intended coffered for sale(Sec.70th,Business
and Professions Code:The Commctu's Lim.Law does not apply to an owner or 102 — P I ERS egolred Inspections
property wtto builds mim,monsthemon,and whodoessuch workhimselforthrough his -
own employees.provided that such Improvements amnot Intended wormed forage.If, 103' — UFER
however.the building or improvement is sold within one year of completion,the owner- 104 REBAR
builder will have the burden of proving that he did not build or Improve far purpose of
ale•), 105 - ,ANCHOR BOLTS
I,as owner of the property.am exclusively cornnaing with licensed contractors to 106 — SEWER & WATER
` cons me,the project(Sec.7044,Business and Profession,Cotler)The Consumes Lf
came law does not apply to an own"of property who builds or improves Demon,and, 202 — UNDERFLOOR ' PLUMBING ,
who cownLA suchpmjecp wwe con torD)Iimnudpunearn hethe Contncmh 203 .—' UNDERFLOOR MECHANICAL
ex p oder See. ,B&pcf thiarc n 204 - 'UNDERFLOOR FRAME '
205 — UNDERFLOOR INSULATION
;�ork
WORKER'S PN ban earn
ATION - 301 - ROUGH PLUMBING
herehya umunderpeullyof perjury one otiho following declarations: ,302 — TUB & OR SHOWER '
nd will maintain sCO"IrltnofCouenttulf-lnsumforWukeriCompen- 3O3 — ROUGH MECHANICAL
provided for by Section 37M of t e Labor Code,for the performanm of conwhichthlapumitishsuse. 304 - ROUGH ELECTRICAL
and will maintain Worker's Compensation Insurance,as required by Section 305 — FRAME, .
3700 of the labor Code,for the performance permit
of the work forwhich this is Issued.
My Worker's Compemalion Insurance carrier and Policy numteram: 306 — HOLDOWNS .
Carrier. Policy No.: 307 ,'- INSULATION
CERTIFI RiiOF COMPENSATION INSURANCE EMPTION MOM ORKERS' 308 — SHEETROCK
(Thissxdm need not he completed if the reran Is in,mahundrcdlall.m($1011) 309 — EXTERIOR LATH _
01ka`) 310 INTERIOR LATH
employ that the performance of the work for which this permit is&CmIshallnot 311 - SCRATCH COAT-
employanypersoninanymanncrsoastabecomcsubjecttotheWorkcn'Compcmatlon
Laws ofCalifomle.Dam 313 - ROOF NAIL
Applies
N PPLICANP,If.after making this Certificate ofExemption,you should - 501 — FINAL ELECTRICAL ENERGY
been heel mthe Worker's Compensation provisions ofMen Labor Code,you mot 502 - FINAL PLUMBING ENERGY
0 Z forthwith
h
comply with such provisions or this permit shall be deemed mwked.
Z O 503 - FINAL MECHANICAL ENERGY
..y CONSTRUCTION LENDING AGENCY
[r 1herehyArlonMetthercisaconstructionlendingagencyfortheperformanmof 504- - FINAL BUILDING ENERGY
C� the work for which this permit lsIssued(Sec.3097,Civ,C.)
Lender's Name 505 - FINAL ELECTRICAL
W Q
aZ LcneeYaAddrees 506 — GAS TEST
U O I certify Nat I haw read this Application And stare that the show Information is 5 0 7� - FINAL PLUMBING" -
W F cones.l agree to comply with All city and county ordinances and state euro relating to FINAL MECHANICAL
OU building construction,and hereby authmire mimseaunwa of this city to enter upon be - —
W about-mentioned property for inspection purposes. S O — F I DE
f We)agree to saw,indemnify and keep harmle,a the City or Cuporiinc against
,.y y liabilitlu,Ju ments,cmuendexpeuu which may in Any way accrue sgelnsl std City — I NG .
f,7 mean sac of dm granting of lith permit.
r7I NDERSTANDS AP WILL MPLY WITH ALL ON-POINT Issued by: 5 IW
WORKSDate
LATION C1 s
ll. Z 0 Re-roofs
HAZADcOUS MTERIAIS DISCLOSURE Dem Type Of Roof
WIII the Applicant or future building occupant store mhandk Acutlou material
sled by Ne Cupertino Municipal Code,Chapter 9.12,and the Health and Safety 2553207 ,,{� All roofs shall be,inspected prior to any roofing material beininstalled.
❑Yes Y'\o g
WIII the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
alt huaAnu Air contaminants as defined by the Bay Area All Quality ManallArmw all new materials for inspection.
.iurict7 '
Dyes r \ -
I haw mad the hnaMousma`terialsrequiremenu under Chapmr6.95 of the Califor.
nia Hcal�uftc
ry Code,Sccdons25505,25533and25534.1andermandthmlfthe building
does not y haw a anent.Net it's my rcppnnrA�snfl to rusty the mcuranl of the
reyuircmichMost mclpno iuvangablCerd am of Occup ry. Signature of Applicant Date .
0 ro
end Age Dn,e All roof coverings to be Class or better -