03120033 CITY OF CUPERTINO ,�zdsr '- �7 �' ' `
BUILDING DIVISION PERMIT ,c-0W.-.RICTCIR I1V yaRMA'TZON
BUILDING ADDRESS: PERMIT NO.
ALL SEASONS PATIO ENCLOSURES 03120033
fR'S NAME: PERMIT ISSUE DATE
ONE: SANITARY OL NO.
ARCHI ECr/ENGiNEER: BUILDING PERMfT INFO
BLDO ELECT PLUMB MECH
�oo LICENSED CONTRACTOR'S DECLARATION
1 hoody of ata that 1 em licensed under previsions of Chapter 9(commencing Job Description
with Section 70011of DlNsi s3aftho Businenand Prafeesium Code.end my license is
to� in fmLforaudefrea Gj 102 PATIO ENCLOSURE (355 SQ. FT. ) -
j I Z License CI Llc.N
z Dem L CO.,
ARCHITECTS DECL3R O i
IunMmnd my pisco ahsil he used As public records
5 cad Licensed Professional /
3 OWNEmeacrDER DECLARATION
Coma ON J
v� I hereby M.Net I 1 exempt from the Contrsemrs License taw for the
i
no following meson.(Saban]1UI3,Business and improve.
de ali Code:Any city or aunty
$m which ju issuance,
n permit to ems don pli nfor such
h Permit i ore a sir any structure / ,
FZ�, priemiuivuemo.absre ththe don for anchpm'sLfile Law suumem `V
F< (come is licensed pummt come ofDivision
ivismofdxcanuecmleliauelAw(CMIner9 _� Sq.Ft.FIOOr'Area Valera On
'bat(co
ho cumpthoneion 7000)romandlivbash n3 ofteneged csamdan.Any vi Comm(
Nn k b aumpt therefrom sato the bub for W alleged ssemptiom Any violNan a( -✓�
Section 70313 by eny applicant for a permit subjecu the applicant M•civil peruuy of 4r0,0 Occupancy Type
not mom than five hundred dollars(SSW).
❑L as ower ache propen➢,or my smpmym wlN wages u dxbsamcompewuan,
will do the work,and mesarueturt b notimended aroRertd mrsak(Sac.7044,Busircu /
And Prefusimm Code:The Commoners Llcerde taw does colt apply m an owner of -�Req r `�eCt10HS
pmpeny what builds or impowa thereon,and what dos each work himself.manage hie
own emPloycv,p nvided mu such imp memeamme not intended Mattered fouls.IL
however,the building or Improvement is Bald within one year of mmpletio,me Marc,.
builder will haus time burden of proving that M did nut build or imprew for purpme of
ark.).
❑1,As owner of the property,am exclusively comrseting with licensed contractors to
construct de project(Sec.7044.Busineu and Professions Code:)The Contractors U-
teem law don nm apply to an owner of property who WHO or imprayss Merton,and,
who contracts for such pmjecu with acomrsetor(q licensed pursmm to the Conuanars l
License Law. / -
em uemp under See. .B At P C rear this resin
Date
WORKERS COMPENSATION DECLARATION
1 hereby Affirm under penalty of perjury am of the following deelaralona:
1 bow end will maintain•Cenifiesu of Consent to self-im neon far WadmesComp:n.
saran,As provided for by Seeman 37M of the Labor Cade,for me performance of the
work for which this permit is issuM
i.kf.evc and will maintain Worker's Compensation Inuwtm,u acquired by Sudan
W of the labor Code,for the performance of me wort forwhich this permit Is Issued.
My Worker���,gpmm a}mmuotinmnnm curie and Policy number ate:
Canter. `�//"� a Policy No.:0-b YIn
C bMllebMlle (TMUN FROM WORKERS'
COMPENSATION INSURANCE
(This section need not becmnpleted If ah permit is foram hundred dollars($101))
or Iva)
1 certify that in me performanea of the work for which this permit is Issued,I shall non
employ any pvmn In my manmrm u in barome subject to de WMIOW Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Costliest of Exemption.you should
become subject to me Woduces Compensation previsions of the Lahr Code.You area
.J O forthwith comply with such provisions or this Permit shall be deemed revoked,
Z CONSTRUCTION LENDING AGENCY
[-r I hereby affirm slut more is construction lending agency for the performance of
ai the.,it rat which this Permit is bared(Sac.3097,Civ.C.)
lg1 Q Landers Nurse
LcnderSAddrtas
V O 1 certify that I hoe read this ApplicWon and sum Wt the above Information Is
it,F coma 1 gree to comply with nl city and county ordimnces and sou taws retailing to
O V building construction.and hereby suthodm representatives of this city to enter upon me
W shove-mantiomd Property for inspection parms-
(We)agree to save,Indemnify and keep humlass the City of Cupertino against
y IIabIIlmu,Judgmenu.cuis and exPmms which tory In any way mens against old City
V Z in consequence of the=,let of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
_ Re-roofs
Signature ofApplic HAZARDOUS MATERIALS DISCLOSURE or Dsm Type of Roof
Will the applicant or fu Ilding oaupantaore or Nndle hevrdousmateriai
Med by Ne Cupertino miptl Codo.Chepmr 9.1 3,end the Health and Safety
Section 35532m)] All roofs shall be inspected prior to any roofing material being installed.
❑Yes I ❑No
Will the applicant or re.m ilding aaupaa'um equipment or dcvicu which If a roof is installed without first obtaining an inspection,I agree to remove
emit huaNnus air amaminarta defined by dm Bay Arca Air Quality Mmeproorn all new materials for inspection.
District]
Oyu No
I have mad the hmsNms mamrialsrequimmems under Chapmr6.93of the Califon
ala Healthk Salary Cade.Sections 35703.25333 and21534.1 understand Waif the Wilding
does not currently hew a eam4 mut it is my responsibility to reify the occupant of the
MMA ichmuube ear...r.conaticatearoccypalft Signature of Applicant Date
L
owner nr. rind en oto All roof coverings to be Class"B"or better