00090046 CITY OF CUPERTINO
nmLDINC DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: 1'1?RMnNo
MERRITT DR BAY AREA SUNROOMS 00090046
OWN'IiR'S NAMia AI'PLIG\'I LUN SUB LAW
17 W 41ST AVE 09/11/2000
HONE: SANITARY NO. CONTROL NO.
(F50) 341-6201
M n - .RCIII'ITCr/ENGINEER: BUILDING PERMI I'INTO
OO
BLDG ELECT PLUMB MECH
w—
Q�� f=1
�y y LICENSED CONTRACTOR S DECLARAPION lob Descriptionie 0 1 he:ch,elf n nn re1 am licensed under provisions of Chapter 9(commencing
mtw with Section 70QBof Duston 3 ufthc Bmioessund Pmfic,vins Cade and my peeress
'n fill force anti effect.
i:aa�`a i.i< .n I;; _ Z_ SUNROOM RDDT I ON
Oty+;U Dote J1N-11 l CnntractrW_ L.
h1 /- - ARCfIITi{T'S IIiiCI,ARATIO,
a O 4 1 undc scmd my plan,shalt he used as public records
i p O Licenced 1'ndcssinnul ,
OWNER BUILDER DITCLARAI ION'
W=m I hereby a01sm that I exempt from me Cs%ion%,r's Ciccone law for
t L<
following mason.(Section]Ul I.S.LBusiness andrpr me,dconns CWe:Any tiny lir county
Y�O whichreq penin cis, t Lei p Je Litt F1' Y.t ours
aim drort t c also 'titapplicant1 hpnrmum fileg A:rtemem
II„Ili licensed pnn;,,It n p nail Concramlia,l n. Lill(clime-a Sq. Ft. Floor Area Valuation
(commencing w'iR,Section 7111X0 of Utvhina 30 the Bm;mom',and Profess im,Code)
or that he is exempt therefrom and the basis I...the alleged exemption.Any violation
of section 70315 by any applicant for a permit suhji the applicant to a civil penalty
nano mase than five hundred doIters($500) A PN Number Occupancy Type
CI 1,asownnr of(he pmpcdy,onny employees with woges as l hair solc m...prasmlou, IAIAwill do the work,and the swore is nor intended or ollared for sale(Sec.70 1 -
Bunincss and Prolesaions G,Je:'Me Comment,,License law docs not apply man Required Inspections
r of property Who builds or„ mammas Benton,and who does such work himself
-,th
rough his a,I eaq,mye...,.....iced mat ranch impro—firma ore am imended or - 304 — ROUGH ELECTRICAL
offend for sale.IL however,tis building u,iia prove cut Is sold within one Ycut of
comple,ian,mown
e er-Imho,will has,L,herdic.of herdpnwng that he did nor build air 501 — FINAL ELECTRICAL_ ENERGY
imprsc for pmpmn of smc.l.
505 — FINRL ELECTRICAL
❑I,l rofje Pmper7amot ties,
enmmfrmgwithliee) The
R,
Dat,owner
ue,it (See 7044,Han aid ru,rns m,Codon The ,-diamn's
asense codoesalisrsuchounowerhaofflywhoviolrteImprventl,tolh1 FINALED
and who ,micas for such projects with u contmcmgs7 IiccnncJ Punuom to rite
rx License Ian:
01 nor 1 xm exempt under Sec. .H&P C cur this reau,n
Owne, Dnm JUN 16 2001
WORKER'S COAIPENSAI1ON DECLARATION
1 hcrchy avium ton cr penalty air perjury one of the following decimmion,
have will HIRIaLin a Cc,tlfsae oI C..m.eat In w[ H-insare Worker. BUILDING
nmpeu,sonn. m provided for by Section 3700 of the Labor Code, for the
,G,tmance,of the work for which this ps'm,it is issued, -
❑I have and will tnoinmin Worker's Compemntion In.sura,me,as required by Section
3700 ail,he labor Code,for tite Ptafnnuun,,of the work fur which dis.coir is
issued,Me ,W,orker',Cam�yTpsya�ul�utliiion.jjr,mance cimiicr�I I Pollicc,nature, T
Caricr:y�t
CIRlIFfCAUONOFEXEMl`TIUN FRI)�WORKER
COMPENSATION INSURANCIi
(This section need not be completed i1 the permit is for ono hundred Jolla..
(31N)l air less)
I verify that in the red mange of the work 1i,,whi,l.this permit is I...ed.l '
shall not employ trey PennaIIn any mannot nn Is to hecmne subject to the Workc;'d
Compemsmom Law,of Colifurniu.Data
Applicant
NOTICE TO APPLICANI..If.ahcr making this Certificate of Exemption,you should
hecnmnobjecthe Worker s Compensation prov inion,of the Labor Code,you must
Q Oe uo h rI1IW 111 enn,nly wie,such Inovhion..ar tit 1,pennil shot M demised revoked.
r V1 CONS'I'RUCTION LENDING AGENCY
a7I hereby action that here is a construction lending agency for the performance
k7 of the work for which this.snit is isual(Seo.3097.Civ,C.)
L Q Lender',Name
D Z Lender's Address -
U O 1 certify that 1 have mad this application and state that the above information is
fi [. 'core”.I agree to comply with all city and county ordinances and state laws,Wining
U to building ammmmtinn,and hereby aulhorirn representatives of this city u,enter upon
rho nbnve-n¢ntlnncd propan for Innpcchan parposan,
F y
(We) res,I,, or.indenceify and keep hnmless the City of Cupertino..gains(
y liabilities,judgments,costs and expenses which.may in any may acme against said
City in consequence of the graminmt
,or this per .
APPLICANT UNDERSTA' S W LY LTH ALLN N-PO .Issued by: Date
SOURCE REGULATIONS
O q"D
sieamare nrnppfeanocnmmunr —- i)ate Re-roofs
HAZArfulam h RIALS DISCLOSURE
way applicant or mmrendl Coal,"OpisrW 12.andme ummyrIb,a]marmamdal Type of Roof
u,A,Sec by the Cupcnin..Municipal Cute,Chapter 0,11.unA the f{cuhh and Sa[ery ,
Calc.Section 25532(.)?
❑Yes vNn All roofs shall be inspected prior to any rooting material being installed.
walthe fi,dwantorB,mrebulding«enpamno,cgmrmem-1dcvme,w'hivh If a roof is installed without first obtaining an inspection, I agree to remove
e,nit havardou.e;ar eontandnam.a an def by the Bay Area Ail m
Quarry M:nu,geeot
Din;detr all new materials for inspection. Applicant understands and will comply with
El ye, all non-point source regulations.
I M1mW read the haeardom materials requiremcros under Chapter 6.95 of the
CUllforma Health k Safety Code,Sections 25505,25533;in(]25531 I understand that
it he hilding does not currently lane a tenant,that ti is nsy msp..mihllity m notify the
reupant M' wt prior to Issuance of a Ccnlfrne ail '
Signature of Applicant Date
Omac,.. arm rt rat BILL,4S/ All roof coverings to be Class "B•'or better
OFFICE