03020059 CITYOFCUPERTWO *' `'u'° r` '"�" ' =" r`�"` �'
BUILDING DIVISION PERMIT CONTRACTOR F403ATI,ON
BUILDING ADDRESS: PERMIT NO.
STEVE NAN CONSTRUCTION 03020059
AM�q!F_A VISTA AV PERMIT ISSUE DATE
10599 N STELLING RD 05/23/2003
(408) 203-3933 SANITARY NO, CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
30o LICENSED CONTRACTORS DECLARATION Job Description
1 homey affirm that 1 em ficeucd under provisions of Chapter Y(commencing
fflwith Section 7")of Division 3 of the Business and Proamiom Code,and my license is
in full force and Affect.
aqz Liaere else Lfi.♦ DEMOLITION ��pnYAa ywA��®
Da¢ Contractor Y
n
ARCHITECTS DECLARATION
I understand my plans shall be used As public mcnrds
'
eQ Licensed Pmfessinnal JUN e 9 2003
OWNER-exempt frDECLARATION
0 y I hereby.(firm Net 11. exempt from the Cannaaoo License law far the
p0 whicfollowing taft,a anaiil ID3lnual3. ,m,.and Pmfeeilmuh.in Code: orcounty BUILDING
$ which its ist a s permit m ennasat.clue Imports,h permit i m repair my structure
thatkint iniuminsed c,also.Anito the theapplicantforsucdic Contractor's
permit LiceaeLaw ataumcm
(c.aineing wit punuaa to the of Division
of l�RC,B usinmrYLittnY1JW(ChapterCode)in
Sq.Ft.Floor Area h,7V3VtIOn
$ 'At he Is exam with Section RICO)of Division 3 of Ne aged ess andxempt Profeson.Any
Code)of 4 oo oo UU
.. Natio la 31.3 b anrtlrom and the bub for the subjects
an, eampnt to Any vloution of
Semon 7031.5 five
atty applicant fora permit wbjecu Ina applicant u a civil Tanalty of ��pt�,t W# Occupancy Type
not marc Nan Ove 6undud dollars(g3M). � 3�X117 Cl7xf TYerO 0 ecu ane e
o I.As,owms of the property,m my emplayrrs with wage As that,ale compewetlon,
willd0tncwotkandthcsl tomBnmimm�dedoroQezedforwk(Sec.7044,Buiruu '704 - DEMO Re aired Ins ec[ions
and Piercer.Code:The Conlnctork.Lianse law does not apply u m owner or q p
property who builds or imwaves thereon.and who does such work himself ar through his
own employees,provided that such improvements we not intended an offered for sale.If. -
howner,Ne Wilding or improvement Is sold within oro year of compl.d...the owner-
builder will have the When of proving that M did nut Wild w improve for purpose of _
I,a an,of the property,am exclusively contracting with focused contractors to
o rues the project(Sec.7044,Badness and Pmfeulwu Code:)The Carcinoma's U.
Law doer at apply to an owner of property who Wilds or tmprows ihemon.And,
who contracts for such pmjems with s eonuamr(s)licensed pursuant to the ConmouJa
License Law.
olamae under Sec .BkPCfar
�this mem.
Ow OR�C,'S COMPENSATION DECLARAe N ! '
1 hereby al7bm under penalty of perjury am of the following dafaratiou:
1 have end will malnWn•CCNOceteof COnsenuo self-ovum fm WortrM1 COmpco-
cation,as pmvickd for by Section 37M of the Labor Code,far the Performance of the
work for which this Permit is issued.
Q 1 have and will maintain Worker's Campenutlon Insurance,As required by Section ,
3700 of the Lebo,Coda,for the performance,of da work for which this permit Is loved.
My Worker:Cnmpeossol.Insurance tinier and Policy number ere:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(MA Balm need not W complesed lithe Permit B forone hundred dollars(SIM)
or lass)
1 certify Net in the rfnrmme fbc
Law
work fm hich thispermit u issued,I shall not
A mploy any my mwne n1 bac,P wnjeelmNe Wwken'Compenadon
of Cali ia.Dau -
AQQppI'ant
NOy10E TO APPLICA! I. gtbu Cenificac of Exemption,you should
oma subject u the Worker's Compensation provisions of the Lehr Code,you must
Z oMwM comply with such provisions or this permit shall be deemed revoked.
?O CONSTRUCTION LENDING AGENCY
(~ I botchy afEri that them is a cov Linn finding agency(in the Performance of
Ci> the work for which this Permit Is issued(Sm.3097,Civ.C.)
W�Q Lenders Name
z Lender's Addmas
(� I ceNfy that I has rad this application and me that the shove info.rood.is
commit.I agree a comply with all city and county ordinances and suer her relating to
0 TV" Wilding construction,end hereby Authorize mpsommadws;of this city to Acer upon the
W shove-mentioned property for impaction PugaseL
eF"+ (We,)agree to an,indemnify And keep harmless the City of Cupenino against
y Iiabili0u,judgmenu,mausetdespenses which may in anyway accrmagalna mid City
V 7 e onsequence of the gnming of this permit.
•7 AP ICANT U ERST��A//ND//SA��N�D��WILL COMPLY WITH ALL NON-POINT Issued by: Date
RCER /I A L�rJ/✓Yl//d I:P/ a� lRe-roofs
�l_ .
Signauze of ApplicAuUCo
HAZARDOUS
Da
US MATERIALS DISCLOSURE Type of Roof
Willthe ytepplkentor Tut ilI L.o ChUptamomhendle hauNous maerial
As defined by the Cupertino M ¢' a Cade,Chapur 9.11,end the Health and Safety
Code,Section 35533(07 All roofs shall be inspected prior to any roofing material being installed.
Yu
Witt the applicant w future building Occupant use equipment or dev,.=which If a roof is installed without first obtaining an inspection,I agree to remove
mh hmardous air conuminwu ac d[Oned by the Bay Am,Air Quality Management all new materials for inspection.
District?
D Yes
I have read the Nn nusmauduu requirenunu under Chapter 6.95of the Califon,
at.Heslth alety Cade.Sections
75505.25533ad755 Iundcrsmndthaifft Wilding
dors not cu n a anon Nat it u my rupoulbi t9, notify the mcupmt of the
requtreman fmaabcm p7¢ iae,an ter. R a 37'y 2 Signature of Applicant Date
.sumer or authorized agent
V( All roof coverings to be Class "B"or better