01110130us
OFFICE" .. ...
CI OF
BUILDING DIIVIISSIIONNOPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
19975 PEAR TREE CT
GRANT TERRY L
01110130
OW'NER'S NAME:
APPLICATION SU/3 DATE,
GRANT TERRY L
11/30/2001
IONS:
SANITARY NO, CONTROL NO.
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ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
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B1,Dli ELECT PLUMB MECH
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toLICENSED
CONTRACTOR'S DECLARATION
Job Deschption
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1 hatch, affirm that 1 am licensed under provisions or Chapter 9 (commencing
ADD SOLAR P.V. PANELS.
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xlmSection 7000)of Division 3ofthe BusioessandProfcsionsCode. and myImose
is in full farce and eRect.
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License Class Lic. a
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Date Contractor
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ARCHITECT'S DECLARATION
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1 understand my plain shall the axed as Public records
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Licensed Pr..fexsiannl
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OWNER -BUILDER DECLARATION
1 hereby afro that I am exempt from the Contractor's License Law for the
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following reason. (Section 703 1.5, Bacot and Professions Code: Any city or county
which requires a permit to conxtrua, alley. improve, demolish, or repair any structure
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JAN $50oQ
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.prion I -. a Iso pi te happlicantf hpe u ' illi 'i'mod'uncoodo
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t (,f _.Cir,3 Y�D'' t{t.�;
Valuation
tfia be is Peened pubminth6me picomer, ofm Connector'. Licarese V (Chpe,9c
(oto with Section 7000) fD J of the B dP f Code)
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or that he is exempt mcmdrom aid the bums for the nl leged exempt on Any violation
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of Section 7031:5 by any applicant for a pcmtit subjects the applicant to a civil penalty
or,not mom than five hundred dollars H500).
30, PN PtYf9�7E5H ELECTR
CAL' '' Occupancy Type
A1.asowner ofthe pmpeny.armyemployees with wages astheir sole compensation,
NAL ELECTR
CAL ENERGYELECT
will the work: and the mmcame is not Intended or effaced ler sale (see. law.
Biomexi and Professions Code: The Contractor's Limme Law does not apply to an
505 - FINAL ER�i t3ffl}aIlG? fdutions
owner of property Who huilds or improves Hereon, and who does such work himself
or through his own employees. provided that such improvements am not intended or
offered for sale. If, however, the building or improvement a sold within one year of
completion, the owncr-huildcr will have the burden of proving that he did not build or
improve for purpose of sale.).
111, n:owner nnhe property, am exclusively commning withod')
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and I'r Did aor's
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onstrun the project (apply
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o y Who b
ce, th
t proper, who builds se inparsdas thereon,
License law does not apply to an owner
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. and for such projecu.with a contrwtor(s) lianud.pursmnt m. the
Col rmoor, Livens
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empicunde Sec B & P C for this reawn
am exempt
❑ 1 em exempt under S��/ecnQ_� � sss
Owne `^c e..`s SA / TNN
W R' M NSATION DECL A I
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I hereby affirm under penalty of perjury one of the fallowing declvmions:
I here and will irminmin o Certificme of Cnn..em as self -insure for Worker's
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Compensation, not provided for by Section 3700 of the Labor Code, for the
performance of the work, for which, this permit is issued.
° 1 have and will maintain Worker i Compensation Insurance, as iequirad by Section
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3700 of the-IsMr Code, for the perfamance of the work for which this permit is
issued. My Worker's Compensation Insurance carrier and Policy number arc:
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Cm :', t f Policy No.: ..
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s s t .. 9k se I't, t`s
JCEMPTION FROM.WORKERS'
{ 1.CERTIFlCATION OF EXEMPTION
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COMPENSATION INSURANCE. _..
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(This section ncN not ba completed if the permit is for one hundred dollars
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1 1 «nify.thai in the performance or the work for which this permit is issued, I
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but employ any perso any manner so as to become subject to the Workers'
Compensation Lnws of Colifn nia. Data
Applicant
NOTICE TO APPLICANT If. after making this Certificate of Exemption, you should
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become subject to the Worker's Compensation provisions of the Labor Code, you most
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fnnhwith comply with such provisions or this permit shell be deemed invoked,
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'CONSTRUCTION LENDING AGENCY -
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"' 1 hemhy a[Bmi that mere is.e caruwnion lending agency for the performance
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of ork for Which this pormit is issued (Sec. 3097. Civ. C.)
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Lender'. Name ... .. .....
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Lender's Ad ii "
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I cent(, that 1 Wawa read this application and state that the above information is
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cancer 1 agree to comply with all city and county, ordinances and state laws relating
to huilding comnieion, and hereby amunioamprescntmive. oflhis city to cmer upon
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the above-mentioned property for inspection purposes.
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(We) agree to save. indemnify and keep harmless the City of Cuperino against
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liabilities, judgments. costs and expenses which. may in any way accrue against said
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City in consequence ofthegrantingofthispermit,-
APPLICANTUNDERSTANDSAND 'IL COMPLYWITH LLNON. INT'
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Issuedb :
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S I IL TIONS.
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A eat m ate
Re -roofs
H ' RDOUS MATERIALS DISCLOSURE
. Win the applic t or future building occupant stat or.handle haiallour ma¢nal
Type of Roof -- - -- - -
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
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Coda. Section 23532(.)' ., ! .1, 1 :.:. c .1 .
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All roofs.shall be inspected, prior roofing materia] being.installed....
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Will the applicant or future,bailaing occupant use agaip, ern or devices which
-to -any .
If a roof is installed without first obtaining an inspection', I agieeit0 remove
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mmnous air hNir conmmms as inadefined by the Bay AAir Quality Mattagami
iaricn
all new materials for inspection.Applicant understands and will comply with
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all non -point sotiice regulations..
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" 1 hive read the haadrdousminerals requirements under Chapmr 6.95 of the
California Health & Safety Code: Sidebars 25505.25533 and 25534. I under amnd that
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if the building does not comotly have a Iceland. ho it is my responsibilityto notify the
occupant of the requirements which must be, met prior to issuance of a Cerificate of
ceufame
Signature of Applicant _ Date _ .. .
All roof coverings to be Class "B" or better
ok�ynar oroath lie a est - are
OFFICE" .. ...