03080027 CITY OF CUPSRTINO r ri+4 . uv � »�u?
Buu.nmcDlvlslory PERMIT C6NTRACTnRANI'ORMATION
BUILDING ADDRESS: MICHAEL COLLINS` PERMIT NO03080027
f ,R' AMV_ 10285 MORETTI DR PERMUISSUEDATE
NE: SANITARY 90. CONTROL NO.
4 `
ARCHITECT/IENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
IOo LICENSED CONTRACTOR'SD LARATION
E I hemhy affirm theI I em limned under provisit ,of Chapter 9(command's Job Description
with Section 7(%%n or Division Jo(the Buincasand P,rfu' ns Cmk.and my lironsa is
'?% in full forte and effecr.
iqb License Class- REVISION--REMODEL 1908 SQ. FT.
Data Cumnmr NO NEW PERMIT ISSUED/ORIG. #02030027
ARCHITECTS DECLARAT
f�G
1 understand my plana shall k wed as
puhlic rION
ecords
o Licensed Pro(usional
�q OWNER-BUILDCR DECLARATION
d<W 1 hereby affirm that I em exempt from the Contrectora License Lew r the
COD following mason.(Section 4031.5,Business and Profession,Code:Any city lir c my
<$� which requires a Permit to construct,alter impo wn.dcmollsh,lir repair any ssruct
Prior m its issuance,alsurcquisesthe applicant forsuch pcnnitso flca,ignad sutemc
that k is licensed pursuant to(be provisions Of Ne Contractor',littvc Law(Chapter 9 Sq. Ft. Floor Area Va j,)T
zFC
(commencing with Section 7")of Division J of the Business end Profession'
Cattle'
or - 1Y7000
ORS that he is exempt therefrom and the baso for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant M a civil penalty of Cr _.... _ Occupancy T e
net morothan r hundred dollars(ssaoL'- ---. - - - 37 OTD. 00-- P y' yp - --'
I,u owner of the preparty,or mY employcn with wages as t eir sole compenadon, -
willdotheworkanditeslrumu,is not intended or offered forsalc(Sec.1)14,Business Required Inspections
and Pmression,Code:The Contnant's License Taw docs not apply to an owner Of q p
property who builds or improve,thereon,and whodm„uch work himselfor through his 01 - FOUNDATION
own employees,provided that such improvements arc not intended or offered for sale.If, 102 — PIERS,
however.the building or improvement is sold within am you of completion.the owner.
builder will own,the burden of proving thl he did not build or improve far purpue of 10 3 UFER
,ale.).
❑ 1,as owner of the propeny,am exclusively convecting with licensed contractors to 1 O 4 -REBAR-
convect the projecl(Sec.7D4C,Business and Profusions Cade)The Contractor',Li. 105 — �NCHOR BOLTS.
cense Law does not apply n an owner of property who Wilds or improves de......d rD`
.no contracts far such jects with a cromactor(s)Iiccnsed pursuant m the Coerence. 106 - WER & WATER
Lipa Law. 202 - ERFLOOR PLUMBING
am ygdv Sec. .BI@PCfnr thi�ason
/y d�j 203 - UND FLOOR MECHANICAL
WORKER'S COMPENSATIONDECLARA I 204 _ UNDE '�LOOR. FRAME
I bercb alliin under penalty of perjury ane of the fol ing declarations: 205 — UNDERFLOOR INSULATION
IhaveenJ will meinulneCeniOnnnfConsenu9 self insure for Worker's Compun- 301 ..— .ROUGH PhI�MBING
setion,a provided for by Section 3700 of the labor Code,for the performance of the 3 02 — TUB & OR S OWER
work for which this permit is issmd. _
0 I have and win maintain worker,Compenmuon msuonm,ss required by Section 3 03
- ROUGH MEC I CAL
7700 of the labor Code,for the pcnarmancc of dte work for which this permit is issued. 304 — ROUGH ELECTR CAL
MY Workers Compen,ed m In' en
urm uand rfier Policy number me:Policy No.: 305 — FRAME
Gnicr, CERTIFICATE OF EXEMPTION FROM WORKERS' 306 — HOLDOWNS
COMPENSATION INSURANCE 307 - INSULATION
(This section need not k completed if she permit is far one hundred dollan(S I ran 308 — SHEETROCK
orlua)
I cam(y last in the phromtanm of the work for which this Perron I.issaed.I hall tet 309 - EXTERIOR LATH
employenypersonmanyrommerenastone,ame,ubjecHatheWmkeriCompensa0an 310 - INTERIOR LATH
Law,of California.Date
Applicam 311 - SCRATCH COAT
NOTICE TO APPLICANT:IL after making this Ccnificuc of Exemption,you should 313 - ROOF NAIL
become subjmt to the Worker's Compensation prevision,of the labor Cook,you mute
ZO foMwithcnmplY with such pmvi,innsmshis permiuMllkticcmrA revoked. 501 — FINAL ELECTRICAL ENERGY
ti
CONSTRUCTION LIiND:NG,AGENCy 502 - FINAL PLUMBING ENERGY
Ihanby cltrm Net there isacomw,.30D,dng agency for the perfurmenm of 503 - FINAL MECHANICAL ENERGY
1' the work for which this permit i,issued ISec.7097,Civ.C.I
Lenders Name 504 - FINAL BUILDING ENERGY
Z) z Lender,Add.
J p 1 canify Net I have read this epplmthm and um,Iha,the above information 1, 505 FINAL ELECTRICAL
y
chancel.1 agree re comply with all city and county ordinances and sate laws relating m 506 - GAS TEST
DU Wilding convection.and hereby authoriro esedry nPrntatives or this to enter upon MeIV
aWve-mentionedpmpcnY for inspection purposes. FIN PLUMB G
tiy (We)agree restive,indemnify and keep harmless the City of C.Ish n0 seinst O 8 FI
I% L \
y rzn liebilidu.judgments,cosh and expenses which may In any way accrue againsI2d City
Inco Cuenc U',he 'r ANDSting of thsPermit COMPLY WITH ALL ON-P Nr Issued by:5 ING Date
GULA Ns. ZG ,j
2-7
Re-roofs 514 NAL PUBLIC WORKS
of Apphcac r te
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
III the applicant or future Wilding e.Chapter
nom or anodic hvardou dSafrmaterial
defined io the Cupertino Municipal Code.Chepkr 9.11,and the Health and Safety
Sc❑ctYe'15532(a)? All roofs shall be inspected prior to any roofing material being installed.
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 havardnus air conuminants ss dcfn y the Bay Area Air Quality Management all new materials for inspection.
suict7
❑Yes a
I have real the hevaNrms materials requirements under Chapter 6.95 of the Cali for.
maHaalMhSafcty�Cq9dk�.Sccdou 15505,15577 and 155)4.l undersuM Mat if the Wilding
docs nm cumn0 hA:cetenenk Ma}iI,,my p nsibduyM %Mcu'cupanto(M0
require (moa Cmet orwi, cc f -cni0cate occur. 1(. Signature of Applicant _ Date
L7 1,
o rat anvcd ascot Dam All roof coverings to be Class"B" or better