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CITY OF CUPEWI'INO-`-
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
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BUILDING ADDRESS:
HANSON Sc ASSOCIATES
PERMITNO.
20745 SCOFIELD DR
03010079
OWNER'S NAME:
1539 EL OSO DR
APPLICATION SUB DATE
HONIG RODNEY M AND LUCILLE A
01/14/2003
IONS
(408)517-0300
SANITARY NO. CONTROL NO.
ARCH TE.CfIENGINEER:
BUILDING PERMIT INFO
BLDG ELECTPLUMB MP.CH
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LICENSED CONTRACTOR'S DECLARATION
Description
I hereby affirm that l am licensed under previsions of Chapter 9 (commencing
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with Section log)) of Division 3 of the Business and Professions Cook, and my license is
in full 0oamd T`et.a 5176 LTi 1
Lianse Cla' _l.ic
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REROOF �.'eNA��.
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ARCI IITI:T.TS'QE((uLARATION
Iunderstand myplans shaBl,resedli5
JAN 2 12003
Licensed Prnfcssiunal
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Coadmcior's Lianso Law for the
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following reason. (Section 1031.5. Business and Prefessinus Code: Any city or county
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which requires a permit nt construct, alter, improve, demolish, or repair any structure
prior m its Issuvnce, also requires the applicant for such imouL (it 11h, a signed statement
that be is licensed pursuant n the provisions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
$4 W610alion
(commencing with Second llkgp of Division 3 of the Bu4nces and Professions Code) or
@at he o exempt themfrum and Ne basis for the alleged exemption. Any violation of
-3 bXK4 t4PTbeP Occupancy Type
Section 1031.5 by any applicant for a permit subjects 0m applicant o a civil penalty of
not more than five hundred dollars (SSW).
❑ 1. m owner of ft preyed , or my employers with wages as their tole compensation,
will do fee work, and Ne strucmtte is not intended or offered for sale (Sec. 104x, Business
.it Profusions Code: The Communes License law docs of apply Io an owner of3
Inspections
property who buildsor improves thereon, and who dca us work himulfor through his
sen employees, provided that such imprommentsare not intended orolfemd for sale. If,
0 7 - INSULA j1lf@fed
601 .— ROOF TEAR OFF
mwtscr. the building or improvement is sold within one year ofcomplefion, the owner-
6O2 '— ROOF PLYWOOD NAIL
builder will have the burden of proimprove for Nat he did not build or improfor purpose of
sola.).
603 - ROOF BATTENS
❑I,urime, of On pmpeny, am eiveledely attracting with licensed ctmmactoato
604 - ROOF IN -PROGRESS
comwct Ne prejca (See. 70,W. Braine. end Professions Code:) The Contractor. Li.
cense law does not apply to on owner of property who Wills or improves thmeon, and
who contract for such projects with a ttmmactorfs) licensed plarmAnd 10 the Contractor's
License law.
❑ I am exempt under Sec. ,B&PC for this moon
Owner Dow
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of Perjury one of the following declarations:
1 haus and will maintain a Certificate of Consent to self insure for Wurker'sCompa-
satinn. as provided for by Section 3100 of the labor Code, for the performance of the
work for which this permit is issued.
❑ 1 hale and will maintain Workers Compensation Insurance, u required by Section
31W of Ne labor Code, for the Performance of the work for which this permit is issueA.
My Workers Compensation Insurance carticr and Policy yontar are:
Cerz) Poli
CERTIFICOMPEEXEMPTION MWORKERS'
COMPENSATION INSURANCE
(Thissection need not N complefed if the permit is foronc hundred dollars 5100)
,it less.)
1 cenify that in the Performance of the work for which this permit is iaued, 1 shall not
employ any parson in any manner so u to bacume whim to be Wtnkers' Compensation
Laws of Calnomia. Date
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Late Cole, you must
forthwith comply with such prnvisions or this Permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency Iia she Performance of
the work for which this permit is issued (Sec. Lyll, Co, C)
Lender's Name
Loofa Address
1 cenify Nat I have read this application and mide that Ne above information is
correct. I agree to comply with all city and county ordinances and slam laws refining to
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building construction, and hereby auNorim sepresenmtives of this city to enter upon the
above. mentioned property for inspection purposes.
77
(Wagain 1. cast, nd mand keep harmless the City of Cupcumm,Foliat
Habit tin. judgments, costs indemnify
yin mid City
ndeximpcswMeh may i
I'
in consequence of the growing of this permit.
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APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURC4 REGULATIO
Re -roofs
Type of Roof
Y/N/
Coactor Dam
tare of APPlicanUmf
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building fec dwom store or handle harardous mamdal
u defined by the Cupertino Municipal Cuda, Chapter 9.13, and the Health and Safety
Code, S❑lYinan25532()1 414n
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipment or devices which
•mil hazardous air comaminams as defined by the Bay Arca Air Quality Management
all new materials for inspection.
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Jces not currently base a moan(. Nat it is my respouibilify m tmtify t 'Captain the
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requirements It In the 1poor m issuance of. Certificate cy
Signature of Applicant Date
All roof coverings to he Class "B" or better
nor or authmOed agcw Das