04100098 CI'T'Y OF CUPER'1'INO �r-'
BUILDING DIVISION PERMIT , CONTRACTnR�INFORMATION s
BUILDINGADDRESS: CORINTHIAN LANDSCAPING PERMITN8,4100098
0496 MANZANITA CT
OWNER'S NAME: PER,MTT L6UE DATE
MICHEAL BRINKMAN 25239 BART PL 1Q/14/2004
NE: SANITARY NO. CONTROL NO.
(559) 675-3361
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
uoo LICENSED CONTRACTOR'S DECLARATION
j,Z
up L hereby arumlicensedtnm
m al L am licensed unser nsians r.r ChapterpChapterv amen
rmeing Job Description W wimsc ](lfX))efD' isionJof the Bn�and PrufcuionsCodc,andmylianu is
mlrntle DETACHED PATIO COVER/FIRE PLACE
i );.iccnsb Clu
w Dalc_ A Cum or
an shallN use DEC ATION
cu tundcruand my plans shall he uuJa pantie rcenNs
DoHYsfcssional -
g OWNER-BUILDER DECLARATION
0 L hereby shat that 11. exempt from the Contractor's :Any c Law for the f�
O G followhich requires
a annit t 7031.5.Businessmpr ve demolish.
Cone:Any city m manly �^1
K m which¢yui,rs a issuance.also m construct.alma improve,demolish,nr repair any structure (J 2 000 OO
Fly that he it, ensedpursarequires the applicant far Cororsuch rmiuuicensrile ae Law
Natemem
pin (commencingudpurstion7uant )of Divisioor n of theBosirwas niccnxlzon&Cocmr9 Sq. Ft. Floor Area Valuation
`z� (commencing with section](N1B)nfDivisionJ of the Business and Professi�nsCmk)nr
i that he is exempt Ihemfrom and the buffs for the alleged exemption.Any violation of
Section]031.5 by any application for a permit subjects the applicant to a civil penalty of 3 4 A611
&; bc00 OCCU anC Type
non roam thad five hundred dollars(ss110). P Y YP
❑ 1.u owner of the property,or my employers with wages as their sole compensation,
will do me work,and the swcmre is not intended or offered for sale(Sec.]044,Business
and Professions Code:The Contractor's License Law does not apply m an owner or Required Inspections
property who builds or improves thereon,and who does such work himselror through his
own employees.provided that such improvements am not intended or offered for sale.IL
however,the building or improvement is sold within one year of completion,the owner
milder will have the burden of proving not he did not Wild or improve for purpose of
sale.).
D 1,as owner of the property,am exclusively chronicling with licensed contractors to
conauuct the project(Sce 7044,Business aad Pordessiom Coded The ConOacto..a U.
cense Law docs not apply to an owner of property who Wilds or improves thereon,and.
who contracts for such projects with a emtracou s)licensed pursuant o the Contractor's
License Law.
❑I am exempt under,Sec. ,B h P C far this mason
Owner Date
WOR KER'S COM PENSATION DECLARATION
I hereby affum under penalty of perjury one of the following declarations:
1 have and will maintain a Ceniffea c of Consent to ulf-insum for Worker's Compere
action,as provided for by Section 37W of the labor Code,for the performance of the
work for which this permiL is issued.
❑1 have and will maintain Worker's Compensation Insurance,az required by Section
3700 of the Labor Code.for me performance of the work for which this pemtit is issued, '
My yVorkcr' �do tlnsura a ane,and Policy
^^numM``r laImqq:II//`` \�\ ^o^I
CaniS 9 t ofcy No.:4J (J/�
ER I C EO^ XGs ION FROOAAtr'WWORKERS' 1 I
COMPENSATION INSURANCE
Tna cretin.need not he completed if the pared,is for one hundred dollars(IIM)
m Wis.)
1 cenify than in the petfmmance of the work for which this Permit is issued.I shall not
employ any person in any manner so as to hecome subject to the Workers'Compensation
Laws of California.Doc
Applicant
NOTICE TO APPLICANT:if,after making this Ccnificam of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code.you must
�zfinnhwith comply with such provisions Or this Permit shall Od deemed mvokcd.
Z0 CONSTRUCTION LENDING AGENCY
j- I hereby affirm that there is a cm¢uuction lending agency for the performance n(
the work for which this permit is issued(Seat,3W7,Civ.C.)
C Q Lender's Name
=) z Lender's Address
V O 1 certify that 1 have read this application and state that the above information is
ft' F cotteet.I agree m comply with all city and county ordinances and Stam laws relying to
t]V building constmetion,and hereby authorise representatives of this city to enter upon the
r C enovc-mcmiuncd pm for Inspection Purposes.
(we)agree sa ,indemnify and keep harmless the City dr CuwrLino against l
F'VI liabilities,judgmen osis and expmt,es which may in any way accrue against said City
L)Z in consequence of a gronting of this perm it.
APPLI U ERSTANDS AND WILL COMPLY WITH ALL NON DINT Issued by: Date
SOU C RE L TIQNS- ' D /
SI y 6_
Re-roofs
pp m/Contractor Dae
II HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Rhes licanl or future building Occupant store or handle hassNuus material
as do recd by the Cupertino Municipal Code,Chapter 9.17,and the Health and Safety
ewe. 0 en zssJz(a)r All roofs shall be inspected prior to any roofing material being installed.
�Ycs /Y��/\'^��'
Will the applicant Ori fu'ure building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
havardous air contaminant,as defined by the Bay Arca Air Quality Management all new materials for inspection.
JtYlrwi?
❑Yes x
gathardous materials requirement,under Chapter 6.95ofthe Califor-
,Sections 75505.25533 and 25534.1 understand that'ifthe Wilding
a hin OL dim it is my responsibility to ntify List Occupant of the
st he dm It.waraanfaccmreaIOfw parerSigna[urcofApplicant Date
rm (� ate All roof coverings to be Class "B" or better