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03010159CITY OF CUPERTINO odV NTRACORINFORMATI'O NT BUILDING DIVISION N BUILDING ADDRESS: I'liRMl'f NO. 10430 PLUM TREE LA 03010159 W NER'S NAME. APPLICATION SUB DATE MIKE & DONNA SNOW 01 27 2003 HONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MPCII 0 Q 0 p DECLARATION LICENSEDm ONI'sed Job Description 1 nmeby off on that I under of Chapter 9 (commencing wimsecu a71 Nq of Divisinn3nf thc0 sines and Pndcssions Cole, and mylicensc is in tall ra c ( VINYL SIDING Licen CI Can DE use DE RATION I understand my plans shall M used as public records shall �n �® MAY 3 0 2003 Licensed professional OWNS DECLARATION 1 hereby affirm rn exempt foron License law for the I un ucmpt from the Comms C's following reason(Ration IDlls, ar ane emoli Cute: Any city BUILDING consultant, altess which improve, demolish, or repair stcounty issa a permit re ve, structure its restheeltea ed prior Rr its issuance, p also s to the the applicant lin such Panora m Na a, Law (Chapter that he is the SfI. FL Floor Area $8t9'S11f�1I100 eBContractor rofl<w(Chpmr9 with Section 7000) of Division 3 neva,ndProfessions (rot with Sectiounmc of Division 3 me Buenaseand Code) (it Any m on. vi 6 exempt thcmfrom and the .Pers for Ne alleged exemption Any violation of Nal he is exempt -3 1JkPWl41W;WU Occupancy Type io any objects Be applicanuo .civil Frothy of Section 703than five reddamforapermit not moor than Bre nandred dollars fssfn). ❑ 1, as owner o(thc property, or my employees with wages as their able compensation, eMed Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7Wa, Business and Professions Code: TW Cmtmctor's License Law cook not apply to an of owner 102 - PIERS progeny who builds or improves memon, end who deas such work himself or through his own employees. provided matsuch iraprorements acrot intendedoroRered forsale.If, 103 — UFER however. the building or improvement is sold within one year of completion, the owner - 104 — REBAR builder will have the burden of proving that he did not build or improve for purpose of sale')' 105 — ANCHOR BOLTS ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to 106 — SEWER & WATER construct the project(Sec. 7W, Business and Professions Code:)The Contractor's Li - Monte Low does nut apply to an owner ofpmpcnywho Wilds orimprove. thereon,enit, 202 — UNDERFLOOR PLUMBING each projects wnhaconmaor(U Bparsam licensed to the Contnnor: ' `cense Law. 203 203 — UNDERFLOOR MECHANICAL ❑ l am exempt under Sec. ,B&PC for oris reason 204 — UNDERFLOOR FRAME .act Dam 205 — UNDERFLOOR INSULATION WORKERS COMPENSATION DECLARATION 301 — ROUGH PLUMBING I hereby affirm under Frothy of perjury one of the following declarations: 302 — TUB & OR SHOWER l have and will maintain a Cenificam Consent of Conseno self-insum for Worker's Compan- orker sCompen- .if... .if... az provided for by Section 37M of Be lahm Code. for the if .... of me 303 — ROUGH MECHANICAL work ser which this parrot is issued. 304 — ROUGH ELECTRICAL ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3 05 — FRAME 37M of the Labor Cade, for N. performance of me work for which this permit is issued. My Workers Compensation Insurance cam crapro rl�f� mhrare: /,fir c'^aI �EOFEX PION n-,M�� 306 — 307 — HOLDOWNS INSULATION .%L' CERTIF�COMPENSATION IINS RANCE R 308 — SHEETROCK This section need not be completed if the permit is forme hundred dollars ($1110) 309 — EXTERIOR LATH ''`less.) 310 — INTERIOR LATH 1 comfy thal in the performance of the work for which this permit is issued, I shell not 311 — SCRATCH COAT employ any perusubject se in any manner air as to become subjeco the Workeri Compensation Laws of Califomia. Date Applicant 313 — 501 — ROOF NAIL FINAL ELECTRICAL ENERGY NOTICE TO APPLICANT: If, after making this Ceailicale of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must 502 — FINAL PLUMBING ENERGY forthwith comply with such prnvisinns or this permit shall M deemd re evoked. 503 — FINAL MECHANICAL ENERGY CONS. ca. ON LENDING AGENCY lhereby agency for the Ferhomanccef rte mettnere isaco(Sec. 504 — FINAL BUILDING ENERGY w which MAleading m.work for which this permit is issued (Sec. 3(197. Civ. CJ Landers Name 505 — 506 — FINAL ELECTRICAL GAS TEST Lenders 1 cemry that 1 have read this application and amm that the snore iwsmmatinn is mint yt 507 — FINAL PLUMBING comm. 1 agree to comply with all airy and county and sum Jews relating m amnorirzrepmsemnivcs of oris city to enter upon m. iumins of 5 FINAL MECHANICAL abovenmennswcriogana for anovr(We)iraprolNry rnr7Os 09 FIN Itionparpmrs. agree m care, i oily ane keep harmless rhe City of Cupertino against (yAaPPL�NT gments, cos n expenses which may in any way acerae against said City rj N G er, Ithe gr lgol oris permit. NOE NUS AND WILL COMPLY WITH ALL NON -POINT I$$UCd hy51 WORKS Date LAT S. b _77 ATS, ��? Re-roofsC7 Type of Roof rt of Dam HAZARDOUS MATERIALS DISCLOSURE Will Use applicant or fmurc hail' wcupam start or handl. hamN.us materml as defined by the Cupertino Muni Code, Chapter 9.1], and the Health and Safely cele. Dyf5tion zss3zfa)7 All roofs shall be inspected to any roofing material being installed. o prior If a roof is installed without first obtaining an inspection, I agree to remove ccupant use equipment or devices which Will the applica futu/asined emit hazardous air contaminantsy the Bay Area Air Quality Management all new materials for inspection. District') ❑Yes I have the bora usmam' m.nrs un@rChaPmrfi 95 of he Califur- niallcalm cry Qwk, tinrn .Is 33ard S53a.lug Jens no ntly has a nnant my respomibiliry m tM rceupant of the re a wmchmr mmiMaartcenracenmcamo cPon, Na Signature of Applicant Dale � �� All roof coverings to be Class "B" or better rhnrirzJ agent Dam