03050076 CITYOFCUPERTINO ,
BUILDING DIVISION PERMIT CO¢NT'RACTQItINI';OT.tMATIO,N q, _
Bu1LDING ADDRESS: TIMELINE -CONTRUCTION PERMIT NO.03050076
10670 MARTTNWOOT) WY
R7i NAME: 14589 S BASCOM AVE "ERAdIT`$`��"/'16/2003
REMY & LAVRA YACKEL
NE: (408) 356-1790 SANITARY NO. CONTROLNO.
ARCHITECE ENGINEER: BUILDING PERMIT INFO
BLD09 ELECT PLO O
MECH
�96 LICENSED CONTRACTOR'S DECLARATION ""
1 bunchy affirm that I am licensed under provision,of Chapter 9(commencing Job De rl t10n ~
Mlb Secdon 700IE ofDivialoo Sof the Business and Professions Cod=.and my license it n9
m rml ml.ands g 1 �9 qb REMODE.0j" @�E WAW/INSTVtIIL. 134AM9
5� coo Clw c.I �.
T'SD CL / RELOCA
5�i6u nuaARCHITECTS ECLA ON
lundcnd my plan,shall M1c used as pull 1 ZOO cord, p
g.� 1�g { P
®�I�v.1r toBi1trE
c Licensed Professional
3 OWNER-BUILDERexemptOE DECLARATION
1herebyreasoarRrm Nn tem cacmpts an Nclf.i.. oae:Ary.Law for the BUILDING
po which mgdj a Permits 7tD13,Bmincumr Re, ulm,s Ca de:Any eaymmeone only BUILDING
$ whim mquinca n permit re uir,the alter,improve,demolish,or noir any almGurc
S' pdormiucensed pomunth,thnheapplis of rorsucthe Cohpermit mon'mNcsdgn=daukmcnl
t (that hecommeslicenxedpuntion7 h)ofDivlomnfortheBnnessanccnselaw(Coder9 Sq.F[.Floor Area Valuation
ra
(commencing with Section 7")of Division]of the Business Profcuinm Colic)or
dual he is exempt Bumfrom and the bests for the alleged exemption.Any violation of $15000
Section 7071.5 by aro'•pplica d(or a permit subjects the applicant In a civil penalty of APN Number Occupancy Type
not mare Nan Bvo hundred dollen(5500),
01,u owner aflhe ppmty,or my employcu with wage,as their sole compensation, 36935036 • 00
willdo the work and mestmcture lino,intended aro@red Russia(Sec.7044.Business
and Profession,Coale:The Conuaors License Law dos not apply in an owner of 101 - FOUND R'j Ovid Inspections
property who build,u improves demon,and who drcuuch work himself or Ihmugb his
own employee,provided that such improvements art not Intended craEered for sole.If, 102 — PIERS
however.the building or improvement I,sold within one year of completion,We owser.
Wilder will have:the burde of proving Nat be,did not Wild or improve for purpose of 103 — UFER
"le')' 104 - REBAR
❑1,as owner of the property,am exclusively contracting with licensed eoneracmrt to
can.wot the project(Sec.70ta,Both.and Pmfesons Code:)The Contractori U. 105 — ANCHOR BOLTS
.rue law does not apply man owms of property who Wilda or improves thereon,and, 106 — SEWER & WATER
who contracts for such projects with.contrEter(t)licensed pursuant to the Contac s
License Law. 202 - UNDERFLOOR PLUMBING
❑.I am exempt cantle Sm .B A P C for this much 203 - UNDERFLOOR MECHANICAL
Da1e 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one or the following declantionse 205 - UNDERFLOOR INSULATION
130700
have and will maintain a Certmnte ofConsenuo self-Imum for wodmescampn. 301 — ROUGH PLUMBING
u provided for by Section 3700 of the Labor Code,for to performance of the 302 — TUB & OR SHOWER
or which this permit is Issued' 303 - ROUGH MECHANICAL
w and will maintain Workers Compensation Insurance,u required by Section
f the laborCode,f.theperformanceoftheworkmrwhichthisprchIsIssued. 304 - ROUGH ELECTRICAL
o305 — FRAME
: 306 - HOLDOWNS
CERTIFICATE OF EXEMPTI OM WORKE0.S'
COMPENSATIONI SURANCE 307 - INSULATION
(Thts vsem need natWamol=tedutbe pertnlU,area Wndrtd ialw(s 1010 308 - SHEETROCK
air leu)
I ceniry that in the performance of the wan for which this permit is issued,I,hall no 309 EXTERIOR LATH
employ any person in any manner an as to becomembjecuo the Workers'Compensnian 310 — INTERIOR LATH
Laws of California.D•IcAppl311 - SCRATCH COAT
Laws am
NOTICE TO APPLICANT',If.after making this Certificate of Exemption,you should 313 - ROOF NAIL
become subject to the Worker's Compensation pmvtnont or the Labor Code.yen most
.JO ratowiN comply with men Provisions air this permit shall W rc
deemed wkcd. 501 — FINAL ELECTRICAL ENERGY
CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
Iherchy affirm that then 1.acanmu=Rm lending agency for the performance or 503 — FINAL MECHANICAL ENERGY
rG + the work for which this permit Isissued(See.3W7.Ch.C.) 504 - FINAL BUILDING ENERGY
W Q Ienie's Name
Z Lender'sAddres, 505 - FINAL ELECTRICAL
U O 1 eerily But I haw mad this application and sum that the a1ww Information is 506 — GAS TEST
!" cones.1 agree to comply with all city and nobly ordinances and state laws totaling m
O Ir J' building commotion,and hereby suthorm representatives of this city to enter upon the FINAL PLUMB1,NG
W ahovc-mentiond property far inspection purposes.
,n (Wc)ogeeto esus indemnify cadkap hay in an theCityyirc of CupertinoagainstCity 08 FI S.6AL
fq inconsequencejudSments,of
gumming
capeme,which may In any way tarn against said City
tJ 7 A consequence of Ne RSTA of to permit
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 ING Dale
SOURCE RE ULATIONS.
S -03 Re-roofs
urtof Alrpli o/CmUsector —,/15HAZARDOUS MATERIALS DISCLOSURE ate Type of Roof
Will the applicant or future Wilding occumni now at handle hansrdom material
_11—defined by the Cupnino unici Code.Chapter 9.11.sed the Health and Safely
Seedon 15531(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ye, o
WIII tho epplicam or future Willing occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
II bavirdnu,air entrance
* Is as dcMcd by the Bay Area Air Quality Management all new materials for inspection.
uict7
(]Yu o
I havereed Ne ,Sxdon.23505tsncquimmcntsunder de p d.95ofthe CelOing
ole Helth&Safety Cod=,SaWnshat it is my r mmol Ja,I he rournd a occthe Wilding
Jo=e not currently haw a mnan4 Nn 11 I.my rraponalhlllly m notify the occupant or the
Ice nuwhichmustWmetpriororissuanceofaam eara.psury. Signature of Applicant Date
$ Date b All roof coverings to be Class"B"or better
Ow maulhmbsiagcnl psse