03080010 F22261
TY OF CUPERTINO —* �'77757,547"x `+ �'"' -
13UILDINGDIVISION PERMIT CONTRACTQR�NF®RMATIQN
DING ADDRESS: TOM MCNAIR PERMITNO03080010
MER'S NAME: PERMIT ISSUE DATE
IM MCNAIR 11/17/2003
NE: SANITARY NO. CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BO ELECT PLUMB MEOCH
foo LICENSED CONTRACTOR'S DECLARATION Job Description
U-C 1 hereby of n.that I am hello d under provisium of Chapter Y(commencing P
U with SccnceAndO)uf 0iviaionJo(�hc Busincsaand Profcssinm Cade,end myliccnx is
.Our mmurnreeanacrmct NEW 2-STORY SINGLE FAMILY DWELLING
i g: License Class Lm.N
t axes Contractor LIVING SPACE 3311 SQ.FT. /GARAGE 427 SQ.FT.
ARCHITECTS DECLARATION
f Iunderstand mypiano shallWused AsPublic records THIS PERMIT IS REPLACE #01050208
pyu
s G Licensed Pnumadonal
cy3 OWNER-BUILDER DECLARATION
Contractors
ON
CO 1 Masa affvm on I ore exempt from the Comnnurs e:Any c Law for Inc
3 p o following reason.Aamit 1 Tomato Business and Pm(ce moll Code:Any city or roomy
$ which res Issu a permit m tai comatose"alwa improw,demolish,or a sig any tvement
I< Odor its Issuance.pmenum 1.the ponomitcam fm such f am Continuum',
ontin um'tofdcasigocdnammcm
€p (the,he comma cingwitPumtion7 )orDisiort,3orthe usines'amproLwcnaclsw(Chapwr9 Sq. Ft. Floor Area Valuation
22 (commencing with Senion](p0)n(DivisionJ of the Business eM Rufeuinns Gndc)tar $365534
A�$ Nat be le exempt d elefrom and Ne basis for des alleged esempdon.Any violation of
Section 7031.5 by any Applicant for a permit subject,the applicant to a civil penalty of APN Number Occupancy Type
not more than fiw hundred dollars OSOO). -
1,As owner of the property,or my cmployces with wages As mein eolc emn th ntlan,
will do me work.And the SIOClum is not Intended proffered mrs l.(Sec.7044,Business RC wired Inspections
and Professions Code:The Convector's nver's License Law does not apply m An owner of q P
poPerty who builds or improves thereon,andwho doessuch work formation through his
own employees,provided that such improvement,are not mooded or offered fm sale.IL
however,the building or improwment is sold within one year of completion,be owner.
Wilder will have mw Wrdcn of proving that be did not build or improw fm purpose or -
.to.).
❑ h as owner of the property,am exclusively convening with licensed comments to
cowmwt the project(Sec.7044,Business and Professions Code:)The Contractors Li. RED crone Taw dors not apply m an owner of property who Wilds or improw themon.and,
whocontractsLou.for such project,with a convactorp)licensed pursuant m the Convanofs
License La
igA am exempt under S. Bk PC(nr Oil,..A
0 Date
WORKERS COMPENSATION DECLAI�N
f 1 thereby affirm under Knotty of perjury am of dw following declarations: /
`J I own and will maintain a Cenlficam of Consent to ml6insum fm Workers Comport-
sation,As provided for by Section 3700 of the labor Code,for the performance of the
work for whickmD permit is issued.
❑1 bees and will modfloon Worker's Compensation Insurance,An required by Section
3700 of the Labor Cade.fai the performance of the wort,for which this permit is issued.
My Workcfs Compensation losarame carrier end Policy number art:
Cartier: Policy No.:
CERTIFICATE OF EK MMONFROM WORKERS
COMPENSATION INSURANCE
mus auction need not be complewd irthe Permit is(monc handled dolmen(1100)
or less.)
1 om ify that in the performance of the work for which this Permit is tssued,I shall not
employ any polziin any Am wneco jr gnu ' 9la the Woderi Compensation
Laws of Cali Dau
Appp,A.,, _ __
NOT; .ICANr:IL after making this Cenincnc o Exemption,you should _
theca' subject m the Workes's Compensation provisions of the Labor Code.you moat
.,O faMwith comply with such Provisions or Nu permit aloll to,deemed revoked.
CONSTRUCTION LENDING AGENCY
In j—i I hereby affirm met them ler construction lending gency l'nr the performame til
me work for which this permit Is issued(Scc,3097,Cl,C.)
fg1 Q Lender's Name
7 z Lcnder'a Address
U I ceni(y that 1 have mad Nis application end sues that we above information is
f-' co mut.1 agree to comply with All city and county ordinances and state laws mlating tt
0 building construction,and hereby aaxone,mpresentatiws of this City to enter upon me
til MOW-menunned Property for inspection Purposes.
Fly'd (We)agree to taw,indemnify and keep harmleu the Cary of Cupertino Against /
Lill liabilities,judgments.costs and expenacs which may in any way ettoc aSAinn said City
U 7 in consequence of the granting u(this Permit.
'7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURREGULATI
Re-roofs
afA"'canUContractor One
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will des applicant m future Wilding occupantnule or handle hrardous mawual
u dented by me Cupertino Municipal Code.Chapwr 9.12,and the Health and Safety
Code.Sec don 15532(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes friNu
0 will 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
It hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
R
❑Yea Ola
I hart real the
hears
under Chapwr495 of the Caliror-
niaHcalthkSafctyCodc,Sttumu2f503,25533and 534.Iundcmm�dmvifthc Wilding
does not currently hew•wnanL that it u at,maponsihitity m mut,the occupant of me
myu' mento h* uanceAACcrufeemofOccpancy Signature ofApplican[ Date
or amnnnized Agent t lam All roof coverings to be Class"B"or better