03030010 ;BUILEDI
Y OF CUPERTINOf � '
BUILDING DIVISION PERMIT �C®NTRA.CTORINFORMA' I,ON
NO ADDRESS: TES COMPANY PERMIT NO.
8151 PARK Iii CT,
PERMIT ES R'S NAME: 1944 MINTO DR.JANET WENG
E: _ (408) 929.-7773 SANITARY NO. CONTROL NO.
ARCHITECDENGINEER; BUILDING PERMIT INFO
Ii ELECT PLUMB MECH
loZ' LICENSED CONTRACTOR'S DECLARATION Job Description
- '
dvi 1 hereby affirm that I am llmnwd under provision,of Chapter 9(commencing I=b De io E
< with Sal 7 )of Dl on 3 o(No u' ayand Profeuimu Co^sed Ikcnw is
in fullo deffat .—fl v W NEW ELECT PANEL
icenw w. �•a MAR 0 6 2003
1 tic ARCHITECT'S D RATIO
run sto d m plana chair W used ss public Word
kte Licensed Professional
y0 OWNER"BUILDER DECLARATION BUILDING
II I Wmby affirm Nat I am exempt frum the Contractor,License Lew for the
0 o following reason.(Section 7131.5,Businem and Profculuro Cale:Any city of county
$ which rectums a permlt to construct, di Improve,demolish.or mPW any atrmrere
S^ pdmmluiuuanm,ai mquirestheapplicantfmwchpermltmfileetgnedamm I
Ihalheislimnwdpur,uammthepmvisimoofthe Comrwmr'a Limnw Law(Chaper9 SQ.FL Floor Area h�21�6100
$ (commencing with Section 7000)of Division 3 ofthe Businesaand Professions Code)or 4
i},B
that W 4 exempt therefrom and the basis for the alleged cxem alae,Any violation of
Section 7031.5 by any applicant for a perch sobjena the appliesnt m a civil Faulty of 3AEN NOliallor 00 Occupancy Type
not more Nan Rve hundred dollars(1500). _
❑1,As Owner of the property,or my employers with wages as their wk compensation.
will do the work and the structure is not intended or offered formic(See.7OµButtress —
And Prof..law Code:The Cirmaxe ais License Law does not apply to an owner or 304 — ROUGH Required
ns ,
property who build,orlmpowa therm who docti work himwlfmaxam hhos
Own employes,provided that such improvements am notlnuMed muffemd for We.If, SOS — FINAL ELECTRICAL
however,the building or improvement 4 mid within one year of completion,the owner-
builder will have W burden or"ing that he did not build or borrow for purpose or
sale.).
❑1,ai owner of the property,am exclusively contracting with licensed convenor m
construct the project(Sec.7014,Business and Prnfandom Code:)The Conuwmri Li. .
mroe Law dace not apply to an owner of property who builds of Improves themem.lied, - -
hom wcufm such no CIA theconmacwr(U licensed Pursuant to lie Convenors
L JW.
am esempl undo Sm, .Bk PCfor Chit recon .
13700 er Da¢
WORKER'S COMPENSATION DECLARATION
1 hereby afRmt under penalty of perjury one of the following declarations: - - -
hove and will mtnWn a Certificate of Content to selBinaum for,Workers Canapes
n,u provided for by Section 3700 of the labor Code,for lie performance of the
for which this permit is issued. ,
have and will maintain Worker's Compensation Insurance,as Occurred by Section
of the labor Code,far the performance of the work fa which this permit is issued.
Workers Compensation insurance carrier and Polity number ase:
ier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thu section need not W completed litho permit a forone hundmd dollars(SIM) - - -
1 ceNfy that in tic`rf ante o he wort which ails permil ts issued,I still ata
employ any peMo ymanncr o ores abject lie Worken'ComFenutlon
Laws of C,lifx i m
A Ile t
I TOAP141vilkAblili a it making this Ceribi of Exemption,you should .,
I me subjm to the Worums C mlensation pmvbion,of the uhm Cndc,you muss _
O forthwith comply with such provisiaw mi permit,hall W dcemed revoked.
z 5 CONSTRUCTION LENDING AGENCY
f" IhembyefRrm that them 4 a construction lending agency for the performance of
!Y' the work for which this permit is issued Sao.3097,Civ,C.)
W Q
Land r' Namc
z under',Adduaa
U 0 1 ci that 1 have send this application and sum that the show Information is "
D,F correct.l agree to comply with all city and county oNlronces and state law relating to
0tJ building construction,and hereby auboda representatives ofthu city menta upon the
UaWve-mentioned property for iropecdon purposes.
gy (We) time to Live,indemnify and keep harmless the City of Cupertino against
r.i fq liabilities,judgments,cnau and expenses which may In any way seems against said City
V 7 In camequcnee of the anting of this permit.
4 APPLICANT UND ANDS ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU NS.
_ Z. Re-roofs
(P 'um mAppIkA=RDOUS M IIS DISCIASURE OAKType of Roof .
Av,
Will theapplicant or future build g=upanutore or handle hatzrms material
As defined by,the Cupenino Municipal de,Chapter 9.12,and the Health and Safely
Code.Salon 25532(,)? All roofs shall be inspected prior to any roofing material being installed.
❑Yeses
Will the applicant or forum building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It howNaua air contaminants as dcfimd by the Bay Area Air Quality Management all new materials for inspection.
District? -
❑Yes IXNu
[have mad the hmnlmssmawriab requimmenu underCMptr S95af the Ctifor.
nia HOW A SafetyCode,Stttiau 25505.25533 Ani 1 wdemand thus if the Wilding
does ret cure iy hove vnant.that Itis my reeponaibilh m the macti of the
require c which mat pilar �Iasuencc of tem of x Signature of Applicant Date
oat.atbadred slit All roof coverings to be Class "B"or better