04110074ITY-OF CUPERTINO:_rBUILDING
irvPERMITON
CR
Li'LDINGADDRESS:ALL
"
CIS) NnIMMag'R, DR
DELING
SEASONS REMODELING
PERMITNO.
04110074
ER'S NAME: ..
F, cung TA KTzaAR
- -. -
PERMIT ISSUE DATE' .._
ONE: ,.
"
4 4
SANITARY- - ftkOL N0.'
ARCHITECTTNGINEER; -
_
-' -, BUILDING PERMIT INFO.
-
_ -
BLDG ,ELECT_ PLUMB MECH
-
` LICENSED CONTRACTOR'S DECLARATION
IOb DesCrl
mmennB
"Thereby affirm that] am bmuod uml Ions of Chapaer 9 (aa
3 Buai PnefessftemC dgand my Hear. is
_' UOn"
•. _ - --_ P
'�
who So t1..7 )afDiAsum of the
in mor error.
Lkense C a Lic. M Z
�GanlraClar
PATIO ENCLOSURE (156' SQ FT )- W/ELECT
- M
DBN
O
ai .•;
tors ndm Plans shill he usedu puhlic cords _
� T_ ._�
Licensed Professional'-
" OWNER -BUILDER DECLARATION
G. -
1 thereby affirm that l am exempt Irom the Connectors License Law for theS/
'
fallowing rcssan.(Scction llOLS.Buiness antl Professions Code Any<ity nr county
_ ^
(((
which requires . permit 1. construct. alar, Improve, demolish, or repair any structure
V
prior to its issuance. also acquires IM applicant for such permit to rile a signed stmement
��. Ft. Floor Area
"
'. Value
last he is llccoscd pursuant to the previsions of the Contractor's License Law (Chapter 9
,. .. .Sq.
- ion
(commencing with Section 7")of Division 3 of NC Business and Profession. Code) or
...",-,,.. ,,_., .-_-•,-a: .,-, -.:,•, -
•'
that he is exempt therefrom and the buts for the alleged exemption. Any violation of
,�pl�p}�}�.,,.�I,
' " 3 6'2?1r O+V `9YYe0 0 . •
-
•'. Occupancy Type -
Section 7031.5 by arty applicant for a permit subjects the applicantto a civil penalty or.
not mom than fin hundred dollars (SSM).
❑ Loolmomoftheprnpeny, army employ=s with wages u their sole compensation.
- ,,,,, ,.. a.,. ;.. ,_ _
Required Inspections
.will do the wuk,md the smactute is not intended orofrened Russia (Sec. 7044, Business
'arta code The Contractors Litton bow dons apply a an
Q P
hlobu or roug iof
hts
property who.
pmpemployabuildsiimprovuthemamve who dunoah work
- _,•£mac._t',howeownver,
araffermhrough
dedimprowm nts not ear dedofe moRemd for sale.
provematsuch
r.
the within of completion, Ons owned
however Ne of
r improvement solthat
-
he did
Wilder will rove Ne burden of proving Nat he did nm build or improv for purpose of
have the b build
_ -
u1cJ.
❑ 1, as owner of she property, am exclusively mounting with licensed emnuaemrs 1.
construct Ne project (Sec. 70x4. Business and Profession¢ Cade:) The Contractor's Li-
-
cense Law dos not apply to an owner of property who Wilds or improv, demo . and
..._ .... . ..... -_ . _ .. .. . .
who contracts for such projects with a contractor(s) Iiceued pursuant o Necontngor'e
License law.-
❑lamesemptunderSec. ,B&PCforthi'mossm
...
u Data
WORKER'S COMPENSATIONDECLARATION
I hereby affirm under penally of perjury one of the following declarations:
,._ ..
I banned will rnwataio.CcnifeW, ofC...., to self -inure for Wmkcrs Compen-
. _.. .
ss ion, u provided for by Section 37M of the Labor Code, for the performance of the
work for which this permit is issued.
Fl 1 have and will maintain Worker's Compensation Insurance, u requined by Section
3700 of the Labor Code, for Ne performance of the work for which this permit is hand.
My Worker's Crumpereass, nlnsunnm mrtiu and Palicy mberuc:
.
s r, / l
Cartier. r 0C::VX 7F FLJfVQ Policy No.;
CERTIFlCATE OF EXEMPTION FRO WORKERS"
- -
COMPENSATION INS
issectinn road not Wcompleaed iftbe permit is foromchuadmddollars(SIM)
to a.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any munerm u to become subject to the Worket%Compenaation
Laws of California. Data
_ _...
Applicant
NOTICE TO APPLICANT: If, after making this Cenlfcatc of Exemption, you should
become subject to the Worker's Compensation provisions of she Labor Codc, you muss
forthwith comply wish such provisions or this permit shall he deemed revoked.
-
CONSTRUCTION LENDING AGENCY
1 hereby off. that ft. is a connotation lending agency for the Performance of
_.
the work for which this permit is issued (Sm. 3097, Civ. C.)
Under's Namc
'
Lender's Address
I certify that I ban read this ipplicatlnn and same that the mm. lafalaut an is
cored. I spa to comply with all city and county ordinances and some laws relating e
building construction, and hereby muNome repmsentadves of this city to enter upon the
above-mentioned properly for inspection purposes.
(We) agroe to saw, indemnify and keep hamrlax5 Ne Lily of C•uperlon against
liabilities, judgments, costs and expenses which may In any way scant against mid City
in consequence of the granting of this permit
1
APPLICANT UNDERSTAN AND COMPLY WITH ALL NON -POINT
Issued by: Date
SOURC GULATIONIS.
Re -roofs
Signe red ApplimnUCon tar Data
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant store or handle huudous material
u defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
de, Section 25532(.)7
All roofs shall be inspected to any roofing material being installed.
oyes [d'Au
prior
. _..
-If a roof is installed without first obtaining an inspection, I agree to remove
Will the appfimm m home building occupant use equipment or device. which
mil havardous air contaminants as defined by the Bay Arm Air Quality x4m. omem
all new materials for inspection.
Diiuict7
❑�,/Yea j�
1 have rev! the harartlaus materials requirements undcrChaplar 6.95 of the Califor-
niaHaled&Safety Cadc,Scmiom MY)5,25533wd23M.lun&mwdOmifthc Wilding
Jas n rose ly haw a en Nat it' remn.muliay to notify, thc occupant of the
mqn m owhicpms an uanmafacer ficmc. a cy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
o er or authoriad ager m
I