02070171 CITY OF ;Y. '. .. _.
BUILDING DIIVISSIIONNO COIVTRA}CTORxILVFORMIATION:?
PERMIT :`CT,-sr. .Wj j
BUILDING ADDRESS: PERMIT NO.
725 PARKVIEW CT BAY AREA SUNROOMS 02070171
41
SANITARY NO. CONTROL NO.
(650) 341-6201
O O ARCHITECTIENGINEER: BUILDING PERMIT INFO
w C BLDG ELECT PLUMB MECH
4a CI CI 1.=1 I___I
N`s LICENSED CONTRACTOR'S DECLARATION
O Z EI z 1 horeM1y aRrm mat 1 am reensed and pnwisi.n.rcha 9 Job Description
O p Mer (commer,rmg
witbI,injrS�g��tinn]IOBofDivisionl°f,heeu�YmaXIt I Can of license PATIO ENCLOSURE ON NEW CONCRETE SLAB
s 6 Liuda�C"ree am
a�3aL` at RCHITECT:S DF.mam TIO
d 1 u.J:Ifandl my plans shall be used as pu lic records
of
C Li-Insed ProLssional OCT 14 2002
nffOWNER-BUILDER DECLARATION
1. I hereby affirm that 1 am exempt from the Commemr's License Law for the
l:Z a following reason.(Seen..2031.5,[h oinea,art Profession,Code Any city ar mumy
neO which requires a permit to construct,alter,improve,demolish,or repair ivy structure llILDI W 0 0 0
a3� poor to its issuanuires ce.also reqthe applicant for such permit m rile a signed statement
shut he O liROVUl III...I telbe pow,litsof,he Corrientes License Law(Chapter vCySQ p�s.rp1W,Or ea Valuation
(comm inS with Section 2000)of Division J of the Business and Professions Code) 316 7 b 1 J V V
or that he is exempt therefrom and the busk for the alleged exemption.Any violation
of Section 2031.5 by tiny applicom for a permit subjects the opplicam nt a civil pens ly t�,',,,�
of not more than rive hundred dNma(850(0. 101 '4PNFOUNT5AT I ON Occupancy Type
❑1,as°caner of the property,or my employees with wages as their sole compensation,
will Jo the work.sni me Came:
Th is no,intended en a Lawered for sole(Secapp( toa n 10 3 - UFER Required Inspections
Business and Pmfen Who
b Cute:The Contractor'sthereon.
License Law does not apply to an
owner of his ow bodes or improves t thereon,and who encs n n work intended
ff
or through his .can however.employees. budded that such Improvements is solda within not intended or 104 - REBAR
c0ered for sale.IL h.wuilde the building ser impmvrnmm is whin hdd not year of
completion,the owner-builder will have the burden of proving tore he did not Wild or 105 — ANCHOR BOLTS
improve fsnpurpose of vale.). 106 — SEWER & WATER
01,a,owner of the pr°perty,am exclusively contracting with licensed contractor.to 202 - UNDERFLOOR PLUMBING
icensecttheoesn (See.AW.Bbuinowner od and PmR.aho b code:)The
ves tremor's 203 - UNDERFLOOR MECHANICAL
License Law dos of apply t.an owner a Corey who builds se improves thereon,
and who comma for such pmjcnx with a wmncmrta)Licensed pur,uont tu the
Contractors License Law. 204 - UNDERFLOOR FRAME
❑I am exempt under Sec. .B&P C for this reawa 205 — UNDERFLOOR INSULATION
Owner Date 301 — ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
Ineren Rirmunderpenal, of 302 — TUB & OR SHOWER
ya yo try one 303 — ROUGH MECHANICAL
0 1 have and will initiation a Certificate of Comment to,elf-In,nre for Worker'. 3 04 — ROUGH ELECTRICAL
Compensation, as provided for by Section 3200 of the Labor Cale. for the
mbow
.,
performance of the work for which this Permit i, ed. 305 - FRAME
❑1 have ate will maintain Worker's Compensation Insurance,as ecquined by Section 306 - HOLDOWNS
3200 of the Luton Code,Por the po,don once of the work for which this pond,i, 307 — INSULATION
issued.M Wurkce ompenmtion Insurance carrier P I vy mma
(This section need not be completed if the permit is for one hundred dollars 310 — INTERIOR LATH
ISHm)oncso.) 311. — SCRATCH COAT
1«airy that in the performm,ce ofthe work for which this .it is issued,1 313 — ROOF NAIL
shun ma
lsol,un 502 - FINAL PLUMBING ENERGY
N(yrICBRQHI'PLICAIf,agte kmg Ihra CeNI¢alc n1 Excmptwn,you xM1rn,IJ
Z becauesubjecttotheWorkerscmnpenationrovtoiomortheLaborCA,youmust 503 — FINAL MECHANICAL ENERGY
Oz O forthwith comply with such proem......his perm0 shoo W deemed revoked' 504 — FINAL BUILDING ENERGY
h CONSTRUCTION LENDING AGENCY
1 herehy striation there is n construction lending agency for the peffmmanm 505 — FINAL ELECTRICAL
wof the work for which this permit is issued(Sep.3097.Civ.C.) 506 - GAS TEST
d Q Lender's Name
o z Lender's Address 507 — FINAL PLUMBING
U O 1 cmify that 1 have mad this application cad state that the above information is 508 — FINAL MECHANICAL
ku is correct.1 agree to comply with all city and cnnrny ordinances and state laws echoing 5 0 9 — FINAL GRADE
O U re building emanation.and hereby..In city,.voter upon
me nbovcntenficei progeny for tnspccdon purposes. 510 — FINAL PLANNING
�r
Q. (We)agree mnavc,indemnify and keep harmos the City or Cupertino against
rF. Vg liabilities,judgment,rooa and cxpcme,which may in any way accrue against said 514 — FINAL C WORKS fCl
Uz Cit in wneeyuence of,hc&renting of this pennir, ll L�
' T UNDERSTANDS AND WILL COMPLY WITH ALL NON. OINT Issuedb :✓ Date
ULAI'IONS. y.
2!
Signe of Applicam/Cnmracmr Date Re-roofs
HAZARDOUS MATERI DISCLOSURE
Will the apPlicmn a,race builJin curynl amrc or handle M1azaN.ux inv,erivl Type of Roof
as de.Sed io the Cupertino Municipa ale,Chapter 9.12.and the Health and Safety
Cede.Section 25532fv):'
°Yes No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or fuwm buildin• cupom use equtome or device,which If a roof is installed without first obtaining an inspection, I agree to remove
mit I...of.nx nn'c.mmnimm�s a.Je d by the Bay Area Au Ouali y Management
_ soit
all new materials for inspection. Applicant understands and will comply with
❑Yes No
cont curve regulations.
1 have rcaJ roc hvzm Joux toren'aln requiremcn,s under Chapter 6.95 of the
California Health&Safety Cock.Serious 25505.15533 and 25534.1 understand that
if the building dues not currently hose n meant,rte it n my rcsponsihility m maify,hc
re
icIf m st be met prior,n issumme of a Certificate of
EveYp Signature of Applicant Date
1p
owner raumni,caagpn, D. e All roof coverings to be Class "B" or better
OFFICC-
Z
Z_
CITY CUPERTINOVISION
CONTRACTOR ffNIFO!I `'' EO',10
BUILDING DI
��
BLR LDING ADDRESS:
19725 PARKVIEW CT
BAY AREA
SUNROOMS
PERMIT NO.
02080115
ABAYNEH
17 W 41ST
AVE
APPLICATION UB DATE
0821/2002
PHONE:
(650)341-6201
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: o
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
• 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license
REVISION
--IN HOUSE USE ONLY
is in full force and effect'
(ORIGINAL
#02070171) NO NEW PERMIT ISSUED
License Class Lic.#
Date Contractor
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
-prior to its issuance, also requires the applicantfor such permit to file a signed statement
-• • •• -2.0 0 0 Q-- --- -
S F.t: Floor Area.,
��t '. q'
Valuation
thatlhe is licensed pulisuzrit to the `provisions of the Contractors License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code)
or ,haute is exempt therefrom and the basis for the alleged exemption. Any violation4
: _ t • ;
a , o ,,
15 00
• of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of,not more than five hundred dollars (s500).
APN Number
Occupancy Type
erty
❑ 1, as owner of the prop, °r my employees with wages as their sole compensation,
101
- FOUNDATION
will d° the work, and the structure is not intended or offered for sale (Sec. 7004,
Business and -Professions Code: The Contractor's License Law does not apply to an
10 2
- PIERS Required Inspections
owner of property Who builds or improves thereon, and who does such work himself
103
- UFER
or through his own employees. provided that such improvements are not intended or
offered for sale. If, -however, the building of improvement is sold within one year of
104
— R1-"S'BAR
completion, the owner -builder will have the burden of proving that he did not build or
improve for purpose of sale.).
105
- ANCHOR BOLTS
❑ I, as owner of the property, am exclusively contracting with licensed contractors to
106*
— SEWER & WATER - '
corswct the project (Sec. 7044, Business and Profusions Code:) The Contractor's
202
— UNDERFLOOR PLUMBING
License Law does not apply to an owner of property who builds or improves thereon,
.. and -who contracts for.such.projects with a conuactor(s) licensed pursuant to the
- - 20-3
- UNDERFLOOR MECHANICAL
Contractors License Law.
❑ I am exempt under Sec. . B & P C for this reason
204
- UNDERFLOOR FRAME .
Owner Date
205
- UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
301
- ROUGH PLUMBING
I hereby affirm under penalty of peijury one of the following declarations:
302
- TUB & OR SHOWER
❑ 1 hale and will maintain a Certificate of Consent to self -insure for Workers
303
- ROUGH MECHANICAL
.Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this peratit is issued.
304
- ROUGH ELECTRICAL
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
305
— FRAME
3700 of the Labor Code, for the performance of the work for which this permit is
306
- HOLDOWNS
issued. My Workers Compensation Insurance carrier and Policy number are:
.. _
307
- .INSULATION
Gartner Policy No.:
`
,CERTIFICATION OF EXEMPTION FROM WORKERS"
4.308 ..
'1 'SHEETROCK.
COMPENSATION INSURANCE ' " ' ;
EXTER'I OR -LATH
(This sectidn need not be completed if the permit is for one hundred dollars
310 '
- INTERIOR LATH
($100) or less.)
311
-:SCRATCH COAT -
,1 certify that in the performance of the work for which this permit is issued, I
313
- ROOF NAI L
shall not employ any person In any manner so as to become subject to the Workers
Compensation Laws of California. Date
501
- FINAL ELECTRICAL ENERGY
'Applicant
-
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
502
- F I NAL PLUMBING ENERGY
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
503
- F I NAL ME CHAN I CAL ENERtY
CONSTRUCTION LENDING AGENCY
504
- F I NAL BUILDING ENERGY
1 hereby affirm that there is a construction lending agency for the performance
505
- FINAL ELECTRICAL
of the work for which this permit is issued (Sec. 3097, Civ, C.)
Lenders Name
506
= GAS TEST
Lender's Address
50
FINAL PLUMBING5
I certify that I have read this application and state that the above information is
i correct. 1 agree to comply with all city and county ordinances and state laws relating
- I NAL ME CHAN I CAL
i to building construction, and hereby authorize representatives of this city to enter upon
5 9
- I NAL E
the above-mentioned property for inspection purposes.
i '(We) agree to save, Indemnify and keep harmless the City of Cupertino against
1 liabilities, in way acerae against
51
- I NAL
judgments, costs and expenses which may any said
City in consequence of the granting of this permit.
WILL WITH ALL NON
5 14
L RKS
V141
,APPLICANT UNDERSTANDS AND COMPLY -POINT
Issued b y <
Date
SOURCE REGULATIONS.
Re -roofs
Signature of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the appficamt or future building occupant store or handle hazardous material
. Type of Roof.
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
..
Code, Section OYes 255320? . . '0 No,
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
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
all new materials for inspection. Applicant understands and will comply with
°Ya 1:1 No
all non -point
source regulations.
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533 and 25534. 1 understand that
if the building does not currently have a tenant. that it is my responsibility to notify the
' occupant of the requirements which must be met prior to issuance of a Certificate of
OcC°pancy.
Signature of
Applicant .Date
All roof coverings to be Class `B" or better
Owner or authorized agent Date
OFFICE