03090056crrY of cuPGRTNNo
CONTRACTOR INFORMATION:
- PERMIT
BUILDINGADDRESS: PER-
, .. ... s.:...., ., ..
. -"W� "'" ,
.OIL ADDREss:
ERIK KNEER
PERMIT NO.03090056
R'S NAME:
10697 MORENGO DR
PERMIT 140E DATL
ERIK KNRER
fNE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job DeSCFIPII
1 hereby affirm that 1 am under provisions of Chapter 9 (commencingm
sis
S of NC Rosiness mJ Professions Code, and my license is
w] rthe Bu
ithll
��®
in (.me andeffect.
DEMO IN GROUND POOL
Lkan.ClassnJ
Luc k
Dole-ConmC`ar
FEB 1 9
ARCHITECTS DECLARATION
2004
1 understand my plans shall M used as public records
BUILDING
Licensed Professional
DECLARATION
OWNER
-BUILDER
1 hereby affirm 1 Law for the
exempt from the Conlon
Co e: Any C
fallowing rcmstn. (Section ]1131.5, Business and sinus Code: Any city nr manly
on 1.
d
alter, improve, demolish, or
improve, Saygned StruncLustatement
which n:yuisu a permit I.re
a Sir
pots to its issuance, also requires the applicant for such permit m file signet natemcnt
airs the
Sq. FL Floor Area
Valuation
thathe wit pSectiot nuhe the License
tracmr anProflsw (Chapterome)or
of Divionsn
Division3 tithe Businessand ProfessionsCome) or
mencing ofthe B
(commencing with Section
37534017.0n
Nat he u exempt therefrom end Ne breis for the allege) exemption. Any violation of
and the
- APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than love hundred dollars ($500).
❑ 1, u no, of the property, or my employees with wages as their sole compensation,
704 - DEMO Required Inspections
will do the work, and the swcture is not intended or offered for sale (See. Business
and Professions Code: The Contractor's License Law does not apply to an owner of
Q-
pmperty who builds or improves fhercon, and who does such work himself or through his
n em ployces, provided that such improvements are not intended or offered for sale. If.
however, the building or improvemem is sold within one year of completion. Ne ownco
builder will have the burden of proving Nal he did net build or improve for purpose of
sale.).
❑ 1, as owner of the property, am exclusively contracting with licensed comneters It
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's U.
cense Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
f u Law.
I am exempt under See B& P C for this mesion
.rte ate
WONOXIVOICOWENSATION DECL ION
I hereby affmn under penalty ofperjury one aft f owing declare home:
I have and will maintain a Certificate ofConsent to self-inwm fur Worker's Compere
sakes, as provided for by Section 3700 of the Isbor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as requited by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance eamim and Policy number am:
,
Cartier: Policy NO.:
-
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed lithe permit Is for one bumdmd dills. (g101p
or less.
1 certify that in the performance of the work for which this permit is isaued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Dare
Applicant
NOTICE TO APPLICANT: If, after making this Cemifcme of Exemption, you should
become subject to the Worker's Core catation provisions of the Labor Code, you must
foMwith comply with such provisim s tr this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the Performance of
the work for which this Permit IS Issued (Sec. 3(197, Civ. Q
Lender's Name
Lender's Address
1 certify that 1 have read this application and sum that the above information is
correct. 1 agree to comply with all city and county ordinances and state laws relating to
building Conswction, and hereby amhmne remosenutives of this city to enter upon the
above-mcrtliorich property for inspection purposes.
inst
an the City of Cupertino against
andof
(Wc) egme It save, indemnify and keep hay
e1.cos.
42
mayinany wayty
Iiahilitiesjudgments, and cartoons in against said
in conuqueacc or the granting of this permit.
APPLICANT UNDERSTANDS A ILL COMPLY WITH ALNON. DINT
Issued by: Date
SOURCE REGULATIONS
%e -roofs
Type of Roof
nature of App' actor Data
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant stere or handle hm,arduus m aerial
CS dAned by the Cupeatino Municipal Code, Chapter 9.12, and the, Health and Safcty
radion 25532(a)?
All roofs shall be inspected prior to any roofing material being installed.
?00❑YCE
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipment or devices which
dl hazardous air contaminants a defined by the Bay Area Air Qualify Management
all new materials for inspection.
vict?
❑Yes
I have mad the haaamtus`materials requirements under Chapter 6.95 of the Califn>
ria Health & Safety Code, Sections 25515,25533 and 25534.1 undcrsund Nat if the housing
docs not cu ndy hew a tenant. Nal it is my rcsptnsihiliry te ntdl'y m:cupant of the
mquiremc ichmost Es, m anmofaeemncatenfoe pan .
Signature of Applicant Date
,3
All roof coverings to be Class "B" or better
Own r uthorimd I Date