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03080013 'CITY OF CUPER'1'INO v BUILDING DIVISION PERMIT CONITRACTnR INFORRMATION '. NU,[MING ADDRESS: IIRMIT NO0 3 0 8 0 013 12009 OAT<nF.Tj, PT. 'NER'S NAME: PERMITL$UEDATE JANA & JIM WEBER 003 NE: SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUM0B MECH 0 0 0 +op LICENSEDCONTRACTOR'SDECLARATION ��s,,,nnn,,,,,,..�,, F 1 im 76 affirm that am licensed i.act provisions of Chapter 9(commencing JO Q�t(t{IQtt LC® wi@Scorceandeffec Division Jnf lhcBwinus ana Profession Codc,end mylicenu is ��a� G oh Inmllmueandermc` KITCHEN REMODEL jI�? Licchx Clers Lic.g n ZOOS r� Data.Contractor 7 ARCHITEM DECLARATION {g 2 OCT �+ vj 1 understand my plans shall be used as public records U �Gy Licensed Pndcssinnel BUILDING S OWNER-BUILDER DECLARATION BUILDING <y 1 hereby off roe that 1 em exempt from the Contractor's c:Any C Law for the 0 O following reason.(Section 81]1.5,Business and improve, drioox Cmle:Any ally or county t <R which reyuirn a permit m cnnnrvco,almq improve,demolish.m repair any suunum O 0 aiy priorto its issuance.alsumquirm the applicant forsuch permit to rile a signed sutement mm< that he is licensed pursuant othe Familiars oftheConuoxim''sLicense Law(Chapter 9 Sq. Ft. Floor Area - Valuation 2F$ (commencing with Section?1100)of Division 3ofthe Business and ProrcaxionsCsalo)or32639005 . 00 .. That he is exempt themfrom and the basis far dm eu alleged mption.Any vinlauon of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not mom than Eve hundred dollars(5500). - P Y - I, inewor ,And Me muctu myemntende with wageauNeir ec.70mpcumiess willdo the work.end theswnum is not intended araRemdfonale(SecJ044,Business — and Profession Cady.The C muutars Limits Law does not apply in an owner of 10 2 - PIERS d Inspections propcnywho builds or Inflationthcman,and who dramatics work himulfor through his awn employees,provided that uch lmprvemenu me not intended or offered for ole.If. 103 — UFER however.Ne building or improvement is within one year or completion,the awner- builder will have the burden of proving Nal he did AM build or improve for purpose of 104 - REBAR bele')' 105 - ANCHOR BOLTS ❑ I,as owner of Ne property,am exclusively contracting with licensed contractors r'0 10 6 - SEWER & WATER construct the project(Sec.7044,Business and Profession Cade:)The Convector's Li• cense law does rim apply to an owner or property who builds or improves Ammon.and 202 - UNDERFLOOR PLUMBING who contractsfor such projects with a contracmrR)licensed pursuam to the Contractors' 'l O3 UNDERFLOOR MECHANICAL License Law. I am exempt under Sec. ,B&PC for his tenon 204 - UNDERFLOOR FRAME iter D.I. 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION I hereby affirm unix r penalty of perjury one of the following daclantiom: 301 — ROUGH PLUMBING . I has and will maintain a Certificom of Conun,to til f-iasum for Worker's Compel 302 — TUB & OR SHOWER Milan,u pmvidcd for by Section 7700 of the labor Code.for the performance of the 303 - ROUGH MECHANICAL work for which thisPermitisissued. 304 - ROUGH ELECTRICAL ❑1 have and will maintain Worker's Compensation moron¢,n myuimd by Section 3700 ofthe labor Code,for the performance of the work for which this Frank is issued. 305 — FRAME My Workers Compensation Insurance carrier and Policy number art: 1 306 — HOEDOWNS Carrier. Policy No: 307 - INSULATION CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 308 - SHEETROCK COU,.,Iran need trot hccomplewd if the permit is for one hundred dollars(S L011) 309 - EXTERIOR LATH Isle'`) 310 - INTERIOR LATH employ Nato xummum the performance of em work for which Nis permit is issued,l ahetl nut 311 - SCRATCH COAT mployany pcwnin any manner bemebjecttbe Workcri w Competian ' Laws of California.Data 313 - ROOF NAIL Applicam NOTICE TO APPLICANT.If.after making this Ccnifcale a(Exemption,you shomW 501 - FINAL ELECTRICAL ENERGY become subject to the Workers Compensation previsions of the Labor Codc,you must �Z forthwith comply with such provisions or this permishall bedeemed mvoked. 502 — FINAL PLUMBING ENERGY zo CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby ofRrm than them is a construction lending agency l'nr the pterhomarea of 504 - FINAL BUILDING ENERGY x� the adc"NawmmhthiapmdlaiaMea(seLJ97.cm.c.) 505 - FINAL ELECTRICAL j:T7 Q Leadcia Add. z LnderSAaamss 506 - GAS TEST J Q 1 certify that 1 have read this application and soon that the above information is 507 - FINAL PLUMBING torten.l agree to comply with all city and county ordinances and state laws miming m �U building construction,and hereby amharme representatives of Nis city to enter upon the FIN MECHAN CAL alrovomentioned property for iaspenioA purposes. O9 FIN (We)agree to Ma,indemnify and keep harmless the City or Cupertino against ti In liabilities.judgments,cods and expenus which may in any way accrue against Mid Cl iy 5 A NG J Z in consequence or me grunting of this permit. Issued b 5 WORKS Date '-" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT y; SOURCE REGULATIONS. Signature of ApplicMUConuumRe-roofs r Data - HAZARDOUS MATERIALS pantamDISCLOSURE Type of Roof Will dimapplicantfor future building l.pat9,1ar lunate Hasth adus Safial ety u defined by the Cupertino Municipal Code.Chap¢r 9.11.and the Ncalth ad Safety oda Scodes 23531(x)7 - All roofs shall.be inspected prior to any roofing material being installed. ❑Yoe ❑Nu - 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 harnrdom air contaminants At carried by the Bay Arca Air Quality Management al I new materials for inspection. , - C3 Yes ❑Nd I have mail the huva dins materials acquirements under Chapter 6.95 of the Califor. nia HcalN&Safety Cmlc,Section 25505,35577 and 25534.1 understand than if the building ISlllcl? 7Jots not currently ham a moral,that his my responsibility to four,the accupant of thc requirement,wWchmusthemetpriortoissuaceeofaCenirme,ofOccupancy, Signature of Applicant Date Owneru annfri.dagcnl Dale All roof coverings to be Class "B" or better