03050029 CITY OF CUPERTINO �r' - m>ia• > a% ' "" �' ° n+ll`I' «j`'`'' S
BUILDING DIVISION PERMIT &CONMtTIU'CTORzINFORMATIUN l "
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BUILDINGADDRESS: - ROBERT BARNES CONSTRUCTION PERMrrNo03050029
10346 NORWICH
ER'S NAME: 1194 LICK AVE pE""IIT`EEFf J8/2003
VNINGSEN DARRELL E
PHONE: (408) 971-3955 SANITARY NO. CONTROL NO.
ARCHITECT(ENGINEER: BUILDING PERMIT INFO
flLDrO PLU=MB ME=CN
400 LICENSED CONTRACTOR'S DECLARATION
I moby a from that l&m I- dJI!�dcrprovisionso(Chapter9(commctrcing lob Description
�li with Sxtion 7IXgfp (Division Jof dm Bd4heareM Profeasiom Cade.end myllcenx is
<p Lice NEW t4` ✓ Y y' NEW WINDOWS/SKYLIGHT �����,�®
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I. ARCHITECTS O R ON CDIV ST�✓e10 g/V
I understand my phm Imll be rated i3 pub)cmcnrd. JUN 0 3 2003
D
21 Licensed Professor.]
OWNER-BUILDER DECLARATION
I hereby oRrm Nal 1 1. ecmpt from dr ComnsCo License Law for aha BUILDING
i O O following mann.(Section RD L4 Business and Improve.
de Professions Calc:Any city or e county
v�$ pooch require a permit to Consumer.alar,impmw,do ermit i ri repair any omment
HZ> poor miuiused puruantto re lbeisio of for Me,Communes
M^ne m rile a ccuseignedmmmenl
xx<
that me cttnscd pursuant to me of
nsnf OMComsides,And
Ph,flaw(Chepmr9 Sq.Ft.Floor Area Cy 8�b1®IIOn
a•D
(commencing iNSection efrom Add basisofr M the
cled exe andon.Anions Cd,on Or
of
� met he Is exempt therefrom and Ne bmLL for me Jlgcd exemption.Any viuletion of
Secdan 7031.5 by Any applicant for a permit subjects the applicant to a civil penally of 3 16&10haMer00 Occupancy Type
not more than five hundred dollen($500).
❑I,eownaofinepmpwy,mmyemployaawlNwaguntheirmlemmpewtion,
will do the work,and the structure h notimmuled ar.Bered far We(Sec.70th.Busircu LUT — FUUM dInspections
and Professional
Code:The Contrenara License law dais sot apply to in owner of 102 — P I ERS
property who builds or imprams Marcum.and whodunit such work himulf or t trough his
own employee,provided that such improvements w not ntended gartered torula If. 103 — UFER
however,Ne building or improvement is Sold within one year of completion,Ne Owner.
builder will Mw the burden of proving that he did not Wild or Improve for purpose of 104 - REBAR
sale')' 105 - ANCHOR BOLTS
I,as Owner of die property,am excla ively Contracting with licensed Contractors to 10 6 - SEWER & WATER
Construct the project(Sec.7044.Business and Professions Code:)The Con"Cusel U-
CO.Law doenotApply toA...ofproperty who Wild.orimproves thenon.And, 202 — UNDERFLOOR PLUMBING _
who knee LA..for such pmkcu wiNacotra
ncbr(s)lkmx
licensed pursuant Nu
e ConumrS 203 - UNDERFLOOR MECHANICAL
❑I am exempt under Set ,B&P C for this recon 204" - UNDERFLOOR FRAME
erDau 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
f Ihereby afBmt under penalty of perjury ane of the following dealataions: 3O1 — ROUGH PLUMBING
❑ I have and tall maintain aCenlOc&uofCamant in selbinsum for Worker's Compen. 302 — TUB & OR SHOWER
mica,As provided far by Section 3700 of Me ober Code,for me performena of tae 303 - ROUGH MECHANICAL
work for which this permit hIssued. 304 - ROUGH ELECTRICAL
❑I have and will maintain Workers Compensation Insurance,As required by Section 305 — FRAME
3700 of the Later Code,for de perform eco of Ne woo fa which N,permit h issued.
M Workefe ComPenaation lnsunne cartim m/�pliq number are: 306 - HOLDOWNS
�er STd'TE' Fi)vA SPmicy Na.:�Sad "shwa 307 - INSULATION
CERTIFI
COMPENSATION INSURANCE 308 — SHEETROCK
(Tho recd.reed not beeampleud if Ox permit is foram hundred dollm(SIM) 309 - EXTERIOR LATH
micas) 310 - INTERIOR LATH
1 Certify Net in Ne performance of the work for which this permit is issued.l sh.1i not 311 - SCRATCH COAT
employ any person in any muner m u m become subject me Workeri Compensation
Laws of California.Data 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT,If,After making this Ccnilicate of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become Subject in the Worker's Compensation provisions of the labor Code.you met 502 - FINAL PLUMBING ENERGY
.J Z forthwi tis comply with such pmu a sh
vaimthis permit all W deemed revoked.
?O CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
'E C'
1 hereby affirah Oat Main is a construction lendft.pric,for Me Performance of 504 - FINAL BUILDING ENERGY
> Mework(urwhichmispermithtssgd(Sec.3097,Civ.C.7 505 FINAL ELECTRICAL
W Q
Le 505 Name
]z LendCeAAdd.. 506 - GAS TEST
U O 1 ttnee that I have read Sob y and coon eM Aum met And
above iws haltNg Is 507 - FINAL PLUMBING
U correct.1 agree t comply with all city and countyruleordinances and atats laws relating la
O building eunmuction,and hereby aumoriee mpaienmiws Of Suis city m enter upon Me A MECHANCAL
W ahovamentiene4 property foNnspeetion puryaxs %FIN
FIN(We)agree ro raw,indemnify and kttp harmless tm City O(Cupenina a&aimt GV BLE
F" � liabilities,judgments.cgts And expenses which May in My wayacense&&Lima said City I G
U ti in APPLCANTCofOa UNERSTANDS Aof tND WILL COMPLY WITH ALL NO INT Issued by: WORKS Date
SO R GU A NS.
'017 Re-roofs
hgn ofApplmanUConuacmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Me applicml or future Wilding Occupant mom or handle hvardom materia
A,Inot ed by the Cupertino Municipal Code.Chapter 9.12.and me Hea dh and Safety
de.section V55320)?
❑YeAll roofs shall be inspected prior to any roofing material being installed.
o
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
h
..It lamardam air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection.
Diwrict7 ��//
❑Yes qlN.
I hew read the hema
ard us ater s rnquiramcnu under Chapter 695 of me Califon
his"calm&Safety Codd.Sections 25505.25533 and 25534.1 uedcrsuhd dot if the Wilding
J t cuncntly hew a mnanc mu it h my repomihiliay m iwu do acupant of me
q ' menta w mbeareapr.Ortommaor.Cent r OccoPancy. Signature of Applicant Date
Pct ("'r S�'O'j All roof coverings to be Class"B"or better
Owner or aumonecd agent Data