03030005 (2) CITY OF CUPERTINO ' '° `°"°_ Karn. l''' '
BUILDING DIVISIONPERMITeCO..NRAC 'Ult INT+' . tTInN '_
BUILDING ADDRESS: PERMIT NO.
18731 TILSON AVE 03030005
OWNER'S NAME: PERMIrMUEDATE
PHILIP P. BOYLE 04/08/2003
SANITARY NO. CONTROL N0.
ARCHITECVENGINEER: BUILDING PERMIT INFO
RLDO ELECT PLUMB MECH
p
LICENSED CONTRACTOR'S DECLARATION
r1 I hereby aprrm that 1 am licensed under provisions of Chapter 9(commencing Job Description
^� With Suction i0Ig))of Division 3 off Bosinua end Professore Code,and my license is
in full fame and effect.
License Clue I Lm. DEMO
Dam
LL JJ Date Contractor
ECL
ARCHITECTS a DECLARATION
1 understand my plana shell be wed as public rtenrds
bra Licensed Pmfafi...I
OWNER-BUILDER DECLARATION
f 1 hereby aprren that I am exempt from the Contractor's License Law for the
C a 0 following mann.(Section 7031.5,Business and Profhui.n,Code:Any city or county
which requou a permit to construct,star.improve,demolish.or repair any s[rocum
F p poor m is lauence,elm requires the applicant for such permit to file aligned announce,
£ C that he isllronsadpursuant tothe provisions oftionConlnctatsLicenseLaw(Chapter 9 Sq.Ft.Floor Area Valuation
y � (commencing with Section 70D0)of Dbision3 of the Best..and Profusions Cade)., 7000
33 the[he e¢
is mpl themfme b
re and thu4 for Ne a legrA ammptlon.My viol Won of
season 7031.3 by any.pplicut for•permit subjects the applicant to a civil penalty of Occupancy�'Pe
nomom Na five hundred dollen($300). 3AN24'r00
❑i,uownu ofd.propWy.mmy employee with mgt,udairhale cemrenmdon,
will dathewon,,soh no
not apply water or Required Inspections
and oty who
Cade:The Contractor's and
who law data not apply tort owner of 704 - DEMO 9 P
own amp who bis ids iIreprove chicon,end who M esswh workhimself edNrougbhis
own employees,provided that such Imps mid wits art not Inu of m offered for cow if,
hawser,she Wilding Orden of proving
Is hath within ore year of cemple for she owar-
builder .will have Ne burden of proving Nat he did not Wild or Improve for purpose of
ale.).
k"
.u avmu of Use property,am teclusively contracting with licensed contractors to
nstrect the project(See.7001,Business and Profusion,Cade:)The Contractor's LI-
came law data not apply to an owner of progeny who builds or Improves thereon,and
who contracts for such projects with a cominc[or(s)licensed pursunuo the Co mosemes
License Law.
0 1 am exempt under Se¢ .B&'P/C far
arr this ran.
wnu D $
WORKER NJ 1 hereby alfitm underjury ane of the lowing declue[lons:
C` .w.nd will mainmi..CWBcam.fC...theselMmumfmWortrr'aCompen-
on,u provided for by Section 3700 of the Labor Cade.for she performance of the
k for which this Permit is Issued.
0 I have and will maintain Worker's Compensation Imuruta,u required by Section
3700 of the labor Cade,for the performance of The work for which this permit is Wised,
My Work es Compensation Insurance carrier and Polity number an:
Cartier: Polity No.: -
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section aned net Mmmplcad if the permit Is rucere hundred dollars(5100)
or mase)
1 ccnify that In the performance of the work far which Nie Permit a is eed,I shall not
employenypenonin yore 'muttheman subje iso a WmIm's Compeoulln
lawsafc Ito is —
Applicea
all
APPLICANT.ILOct making t cat tcatc of Exemption.you should
become subject to the Worker's omperwtion provisions of the labor Cade,you must
.JZ forthwith comply with such provisions of this permit shall be deemed revoked.
OCONSTRUCTION LENDING AGENCY
Fr I hereby apron that Nem its construction lendingagenry for the Performance of
a 7 Ne wort far which this permit 4Issued(Sec.3097,Civ,C.)
ALender's Name
z Lender's Addecas
U Q I certify that I have mad this application and sum Wt Nc move Information 4
kr F correct.l agree to comply with all city ad county on Inness and sum laws relating to
0U building construction,and hereby authorize repremmatlres of this city to enter upon Nc
4k7 .hove-mcnuaned property for inspection purposes.
6. (We).gree m an,Indemnify and keep barrel.da City of Ceramist gale
fA liabllitles,judgmenu.costs and expenses which may in any way accrue against Mid City
L) in consequence of the granites of this permit.
•^• APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
�-�- Re-roofs
natureaf Appiman Contractor
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupsntstore or handle ha ow material F7
as defined by the Cupe nn Municipal Code,Chapter 9.11.and the Health and Safety
Code,Section 13537(x)
❑Yu 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
heard...air con mane as dAmd by the Bay Ares Air Quality Management all new materials for inspection.
I?
❑Yes No
I have mW da hazard ousmamrlelsmyviremcnu under Chxpmrd.93of dm Califnr-
ole Htalth&Sefeny Cabe,Sadoru23503,23333end25311.1 undcrsund Nuif the Wilding
docs not curten0y haw a mmnL Net It is my mrporulhillty u se 0fy Nc .Pant M therequirement,which must be met prior Issuance arse CCflor, oloccu Signature of Applicant Date
0 f euthorired ase t Date
All roof coverings to be Class"B"or better