01060091 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21398 METEOR DR AMERICAN BRANDS CONSTRUC ION01060091
OWNER'S NAME: APPLICATION SUB DATE
SLOMA RICHARD O AND JUDITH L 1145 HAWKS HILL ROAD 06/15/2001
. PHONE: (408) 210-4945 SANITARY NO. CONTROL NO.
a ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w- BLDG ELECT PLUMB MECH
aLJ L'J L_J L=1
Z5 v= LICENSED CONTRACTOR'S DECLARATION Job Description
0 Z_= 1 hcmby affirm that 1 am licensed under provisions Of Chapter 9(commencing
fvtr with Section 7000IafDiviint3of,haBusiessandProfessions Code.aoil mylicense PATIO ENCLOSURE.
a aI is In full force and L �e
d p 6 s4 License glass; L"..
ia I
Dae se'(gla nn Canlractw -GWT'+.i--fes
40 / Z -Yu,�Jers W enyfpWns shall be used a public records
ILLI
i i p p Licensed Professional
`ed� OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from she Contractor's License Law for the
F 2¢ following mason.(Section 7031.5.Business and Professions Code:Any city in county $20000
4 S C which requires n permit to construct.alter.Improve demolish,or repair any structure
Lm+:ct prior I A I. 9 theapplicantl hFor Formal Ild 'g W I I.mem,
'hat l ilicensed p t: ti thepin ftM1 CI L 1' 'Clausen9 Valuation
I'L f' ak
m" m: tgwlhsxt 7000jotDvik .3a1 do Baehte dlmics,ans cadet -;2� ! '32 44 -ft
0. oms-_ A^ ,
or deal he ii exempt shcmfmtn'anil the basis fw the allcgW exemption.Any violation
of Section]031.5 by any applicant fora permit.subjects the applicant to a civil Penalty
of a.,mwe than five hundred dollar.,Is5ool. 516APN VIT&L BUILDIN '""• Occupancy Type
❑1,as owner of the prapeny.On my employees with wages as their sale compcnsmion.
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'will'do the work,-and the structure is not intended or offered for sale(Sec:7141 - --
Business nod Profession%Code The Contractor s License Law does not apply to an Required Inspections, '• "
owner of pmpeny Who Wilds or improves Ihercon,and who does such work himself
or through his own employee%,provider that improvements
such arc not intended or
.--offered for sok If ho'wevcr.the WJding mprpvement is sold wishih one Ye3r'of '- ...... ..... .. -._.
oprove for the ower-Wilder will have dee Wnkn of proving that W did not WiW w
improve for purpose of sale.).
_ _ co I,as owner of the propery,am a Business a d Preling with Ikensehe Contract Io P
insect the project(Sec.7144.Business and roy who
ild,Coda, The ses them.,
License Law does not apply man owner of Progeny who builds se improves thereon,
1: .and who contracts for such protects.with a wmrxtoge)licensed Pursuants.the
Cmnlneoe License ., o -
❑lammpt�n�erS,
c. re
cm ., :B&PCfor lhiso.mn ��py��aC® •,,s`i
Owner "Dae ,``QQ��
WORKER'S COMPENSATION DECLARATION
- I,hereby affirm under Penalty ofp ri'duy one,of the following deelaralmras MAY 0 8 2002
❑ 1 have end will'mamodd'a'Csonic nte of Consent m«Ikin<urc for Workers p�
Compcmatim, mW.,owt for by Section 37mt00 of the Later Code far the BUILDING -
Performance of the work for which this pcit is
have and will minion.Workers Campcnsasian Isssomeb,as mquimd by Session
3700 of the W Wr Code,far the performance of she work for which
on,permit is
issued MpWorkewsCooncr a t,and IOI O rart:
Ce _
(;CERTIFICATION OF EXEMPTION FROM WORKERS '
COMPENSATION INSURANCE _ ._.__._ ..__ -_.... .. t s _.-_..._._..____ ._ _ ___._ -.
""(Thli sc<liittl necJ'ndt be cnmpincd If Ibe permit is for one M1undred d"Ilarx " I .` .� - �;...•Q"x':' �] .
IS Had or kss.l e ,
mo.
_ ..,.......�. -.... -- .. .. .y-. - .. ..-... ..
I cctfy.hua a the Petr nice Of ih rk'Por w1i Ih_oe ad
it Is Issuer,,
shall not employ any Person in any manner so as to became mbjce to she Workers - -
Conaperintaimin Law,of California Date
App( t ,... s.. .. _.. ...._. ... .. ._. ..... .. .... .. .. _
g ._ ifcae
_._ ... .. ..
NOTICE TO APPLICANT:It.after makin this Canof Exemption.you should e "
z Wcotesubject mlhe Workers Compemation provisions ofthe WWf Code.you must
Q0 not,to comply with such pm,doods or th is permit%hall bar deemed revoked.
FI CONSTRUCTION LENDING AGENCY ,
Ci ' '1 hereby afford that there is a connotation-trading agency for the performance
�- of thework for which the peon I is issued ISee Jfg)] Ov.C.1
Lenders Name
-U 0 Lender' Address - - .
I cenify that I have most this apicationd- t that the W information is
W. t x consist.l g to comply with all city J county ordinances and state laws miring
0_U aabuilding c r% t d herby authorize representativesflasc y in cidisrupon
>,:;4 -sheWmentioned.property( inspection purpose,
_
tiQ. 1W 1 g oax aderm .fY and keep harmless th C ty of Calandra,against 6-
h Iinbrnms,Iodgmmru,touts,nd expenses when may in a ry way sen a ago an said
V Z City i on,e'Unke of o .ting of Ihis perriil. '
iAP IL1\T U::DE t 'DS'AND WILI.COMPLY WITH Ay.N'y�S 1: Issued by: Date
�¢! U
Si Buri ufAIIW,.VCmmi , - - '. Dale Re-roofs
' HAZARDOUS hAIERALS
DISCLOSURE
illmeaVpcabiur�iircgocimPx9orhanle
Hmdmismaamaf
Type of Roof
as der CupertinopaametHealth mfcry' ........ . ...._...._........._ ... ._ _- . .....
Cade;Section 2553?lapel, � , ` ' < "- ��., i -
0Y°< All roofs shall be.inspected-prior.to-any-roofing-material being installed. _
• Will the applicartorfuture building occupant useyA equipment J ice% hem If a roof is installed without first obtaining an inspectirni;I agree to remove
emelt N contaminantsdefined bY to Bay Arca A' Quality Management
District? all new materials for inspection. Applicant understands and will comply with
❑Ye. ,.�1 -,.oNn all non-point rce re ulations.. . •.,, ;, ,,;; ,i.nl .
I have read the haevdao,materials requirements under Chapter 6.95 of they
California Health is Safety Code.Sections 25505.25533 and 25534.1 i ndcrnanJ Inst
l[Iheth do,don not cumently hme a tenant:Ihat it is my respon<ibilitym owifylh1_ - �-
uccu ani' q g e - ich must be met prior to issuaace of a Ceniticae of
mi
Signatur of licant Dale
., rot author /
of the rc uircm
Y
All roof coverings to be Class "B"or better '
Ow ed a em' .Date
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.. .. . .,'-..-. , . •. . . . : . .. -. OFFICE -