01050052 CITY
I BUILDINGUDIIVIISSIIONNO CONTRACTOR INFORMATION:
' PERMIT
BtJIIj31f'C�A4DDRFSSs'-S,TA DR-CARPORTS PERMIT NO. 01050052
°11�UUp Wit IINLO COMMUNITY SERVICES AeP�c Tfo s)$Q161
PHONE: SANITARY NO. L tJ U CONTROL NO.
l.
q p zO ARCHITEC-DENGINF.ER: BUILDING PERMIT INFO
w BLDG ELECT PLUMB MECH
6, '
LICENSED CONTRACTOR'S DECLARATION
Job Description
IherebyaRof Db that oftheeduMcr pndI'mmofns Code.a(commencing CARPORTS /�
y2_, wiNSal frau c(rmdl Division3 of Business and Pnffcssions Cole.and mylianse � LED
- Lcense (lace nna eRr �'�
3 rc w a Dole Class Lic.p
u u Dam Conoacmr �) �]
_tv y i AR Hall xu a DECLARAec APR R U 2 2003
1 underrated my plain shall he used as public rccnrds
p;0 Licensed Professional
o OWNER-BUILDER DECLARATION •- LUG
1 hereby all mat I am exempt fmm she Convector's License law foe B
the 'LO —
t?< following rennin.(Section 7031.5.Business ad Professions Code:Any city or county
Y O which requires a Permit to construct,alter improve,demolish,or repair any struaurc
ma _ -pr t t e,ulsrcg stlrcaplt fm xuchpern'sUlnsngne(Ch.plain ------ ------- V -- -- --- ---- - ,
commencing
mer lr dpde l n Chep Dain nn the usins and
dPrlawonsCor9 Sq. Ft. Floor Area. r .. ky Valuation
(commw cnimptsh emmnvin0a The bas Division Business ex mpion.An vi Coats) y 'Q al Y:.,�';
or Nn Section
is escmpt fhcrtGdm'and The basis for bj cts the eaempnt to Any l penalty `
of.. am
sanYapplicants o[]far aPermit subjects the applicnnnoaevil penalty
arnm mate roan five naoarca aanare(sSao). l O lARN IFQII]RgDAT I ON Occupancy Type
111,anroffle pmpcny,or employees with wages us their sole compensation. 102 - PIERS
will"do�the�work.'eadlhe cuuction is not intended"lir ntfrmd'for sale sec.7614, 103 - UFER -
Businexs'and Pmfasiom Code:The Contractor's License Law does not apply to an Required Inspections
owner ofprapanyWhoWildsatimprovesthereon,andwhodoes.vahworkhimalf 104 - REBAR
or inmuh his own employees.provided that such improvements am not intended or
offered F,r sale:If.ndwever,the budding o7 improvement m sola within one year of .. . .. 105 -- .ANCHOR BOLTS --
mpletion,the owner-budider will have the burden of proving that he did not build or l
improve for purpose ofsmel. 106 - SEWER & WATER
-
ng with liccnscd c --' 202 - 'UNDERFLOOR PLUMBING_---
' O 1,as owrrcr of the prnpcny,a xdusivdy comraniontnmon to
consumer the project(Sec.7114,1,Business and Professions Code:)The Confiscates 2 03 - UNDERFLOOR MECHANICAL
License Law does not apply to an owner of property who Wilds or improves themon,
1:[ and who contracts ensefor.Such.pmjecuamran
.with a.corrs).icenud.pursuant m the ...__. ..... .2 04- - .UNDERFLOOR- FRAME -
0
NDERFLOOR-FRAME _..
_ _ . ..._ .. _.._. ........__._ -._
°I Ain exe pt undo See. ",B&PC for this reason 205 - UNDERFLOOR INSULATION
owner Date 301 - ROUGH PLUMBING
0 WORKER'S COMPENSATION DECLARATION 302 = TUB & OR SHOWER
-khereby aif,.unclerpedultyofperjuryoneofthe following declinations: 303 ROUGH MECHANICAL
° 1base and will mainmia d Cerificate or Consent to self-insam for Worke a 304 - 'ROUGH ELECTRICAL
Compensation, as Provided for by section 3700 of me Labor ease, roe the 305 FRAME
performear of fM wink(or which thin permit is issud,
°I have and will mu ident Worker's Competuvion Insurance.as required by Section 306 - HOLDOWNS
3700 of the labor Code,for the performance of the work for which Nis permit it 307 - INSULATION.
- issued.My Workers Compensation Insurance artier and Polity number ere:
- 308 - '.SHEETROCK
c'miec(r CERT�CXF.MPI'ION' R ORKE9S/1G/ 9?' -1309. - v'EXTERPOR 'L'ATH",
.-•.., ._COMPENSAn°N INSURANCE ..___... _.31.0_;_ .-,INTERIOR- LATH.. .. _._... .
f7fhot secoiod need ma x corrindeded if he perind is far a hundred dollars
311 SCRATCH COAT ,.
ISI W)ar less) ',: 1
.313 - ROOF NAIL ... _ _ . . .._,_... _.. _. _... ._.. ....
fertlfy that in Tee amour;dmoe ohne work'fo,which this period is issued,r 501 - FINAL EliECTRI CAL"ENERGY '
shall nnf employ any person'in any manec
marine,so or to bomsubject bject to the Workers'
Campenxmmn Lawa°rcaifamia.Dom 502 FINAL . PLUMBING ENERGY
..Applicant
NOTICE TO APPLICANT.If,eller maAmg this Certificate of Exemption.you should 503 - FINAL MECHANICAL ENERGY
become subject to Ne Workers Compensation provisions of the Labor Code,you must
C0 1 forlovill,e ply w hh'.urnprovisions or this Permit shall be deemd revakd 504 - FINAL BUILDING ENERGY
toes Ruc ukNLENDwcnce AGENCY 505 - FINAL ELECTRICAL
F'� 1 hereby Jr.athin thele i on.t ct on lending Lgency for the performance 506 - GAS TEST -
fthe work for which thispermit is issued ISec.3097,Civ.C.) -
y � unit - Namc .._ _. .�__ _ .. ... . - ._.
Aum 0 <naeieAdarcss SOT = FINAL PLUMBING
I ebrifshin l have re ad thisaplicttion and stun that the above information is 508 - FINAL MECHANICAL
tL'O correct.1 agree to comply with all city and county ordinances and state laws inning 509 - FINAL GRADE
O.V to building construedon,and hembi oulourim mpossmantives of thnsay to enter upon 510 - FINAL PLANNING
;W-W the abovcmentioned property,for inspection,purposes.,
gg.... y (We)agree so sans.indennnify and keep business the City'of Cupertino against 514 - FINAL PUBI,4,1 WORKS
F. fA liabilities,judgment,.cosi end eepcnsra whichmays in any way scants against said
V.� City in consequence of the graining affil,permit. "" 602 OF Y' NAIL
APIP3LRIrC�ARM"Eff-UNDER gDDSSttAN AND WILL COMPLY WRH ALL NON:POINf Issued 0`A - Date
SOL_ UL/,r� ..•. . . 1//1 d Ap/ ESS
PROGR
Signature of A,plitanaCmandRn, 1 Date Re-roo - ROOF -
HAZARDOUS MATERIALS DISCLOSURE i':
Will drt applicant or future building occupant stare or handle hamNous material Type of Roof as def Eby the 320,) n M ntcnpel Cade.Chapter 9.12 and Ne liwhh and Safety . ,a tivk, ,',
Code.Section 255121e) yl'tl I _ �•; t 4 i 1'•. :
°Ye _All.roofs shall be,inspected prior.to any roofing material being installed.
will'he.,!ideal or fitm,Wildigoccupam use atntipmernor devices Which If a roof is installed without first obtaining an inspection,Tagree'to remove
.� em t hazardous no containmanfs as defined by the Bay Area Air Quality Management _ . . . .
Dimino all new materials for inspection. Applicant understands and will comply with
Dyes „'
�° all non-point source regulations;,
I hove mad the hamadmo'mamnar requirements uader,Chapter 6.95 of the
California Health&Safety Code,Sections 25505,35533 and 25534.1 atdemfand that-if the _
Wilding does not currently have a mnam;that his my fesponsibil'ny to notify the _
ace dam of 0 equiremem rch dun b mei poor to its antt f e Certircam of " -
O pont
Signature of Applicant- _ _ Date
.: tn(AUNon ant Date All roof coverings to be Class B"or better
>' :.! ;-•, -. : ,.r.. . ._ .OFFICE - .. . .. .
CITY
I BUILDINGUDIIVIISSIIONNO CONTRACTOR INFORMATION:
' PERMIT
BtJIIj31f'C�A4DDRFSSs'-S,TA DR-CARPORTS PERMIT NO. 01050052
°11�UUp Wit IINLO COMMUNITY SERVICES AeP�c Tfo s)$Q161
PHONE: SANITARY NO. L tJ U CONTROL NO.
l.
q p zO ARCHITEC-DENGINF.ER: BUILDING PERMIT INFO
w BLDG ELECT PLUMB MECH
6, '
LICENSED CONTRACTOR'S DECLARATION
Job Description
IherebyaRof Db that oftheeduMcr pndI'mmofns Code.a(commencing CARPORTS /�
y2_, wiNSal frau c(rmdl Division3 of Business and Pnffcssions Cole.and mylianse � LED
- Lcense (lace nna eRr �'�
3 rc w a Dole Class Lic.p
u u Dam Conoacmr �) �]
_tv y i AR Hall xu a DECLARAec APR R U 2 2003
1 underrated my plain shall he used as public rccnrds
p;0 Licensed Professional
o OWNER-BUILDER DECLARATION •- LUG
1 hereby all mat I am exempt fmm she Convector's License law foe B
the 'LO —
t?< following rennin.(Section 7031.5.Business ad Professions Code:Any city or county
Y O which requires a Permit to construct,alter improve,demolish,or repair any struaurc
ma _ -pr t t e,ulsrcg stlrcaplt fm xuchpern'sUlnsngne(Ch.plain ------ ------- V -- -- --- ---- - ,
commencing
mer lr dpde l n Chep Dain nn the usins and
dPrlawonsCor9 Sq. Ft. Floor Area. r .. ky Valuation
(commw cnimptsh emmnvin0a The bas Division Business ex mpion.An vi Coats) y 'Q al Y:.,�';
or Nn Section
is escmpt fhcrtGdm'and The basis for bj cts the eaempnt to Any l penalty `
of.. am
sanYapplicants o[]far aPermit subjects the applicnnnoaevil penalty
arnm mate roan five naoarca aanare(sSao). l O lARN IFQII]RgDAT I ON Occupancy Type
111,anroffle pmpcny,or employees with wages us their sole compensation. 102 - PIERS
will"do�the�work.'eadlhe cuuction is not intended"lir ntfrmd'for sale sec.7614, 103 - UFER -
Businexs'and Pmfasiom Code:The Contractor's License Law does not apply to an Required Inspections
owner ofprapanyWhoWildsatimprovesthereon,andwhodoes.vahworkhimalf 104 - REBAR
or inmuh his own employees.provided that such improvements am not intended or
offered F,r sale:If.ndwever,the budding o7 improvement m sola within one year of .. . .. 105 -- .ANCHOR BOLTS --
mpletion,the owner-budider will have the burden of proving that he did not build or l
improve for purpose ofsmel. 106 - SEWER & WATER
-
ng with liccnscd c --' 202 - 'UNDERFLOOR PLUMBING_---
' O 1,as owrrcr of the prnpcny,a xdusivdy comraniontnmon to
consumer the project(Sec.7114,1,Business and Professions Code:)The Confiscates 2 03 - UNDERFLOOR MECHANICAL
License Law does not apply to an owner of property who Wilds or improves themon,
1:[ and who contracts ensefor.Such.pmjecuamran
.with a.corrs).icenud.pursuant m the ...__. ..... .2 04- - .UNDERFLOOR- FRAME -
0
NDERFLOOR-FRAME _..
_ _ . ..._ .. _.._. ........__._ -._
°I Ain exe pt undo See. ",B&PC for this reason 205 - UNDERFLOOR INSULATION
owner Date 301 - ROUGH PLUMBING
0 WORKER'S COMPENSATION DECLARATION 302 = TUB & OR SHOWER
-khereby aif,.unclerpedultyofperjuryoneofthe following declinations: 303 ROUGH MECHANICAL
° 1base and will mainmia d Cerificate or Consent to self-insam for Worke a 304 - 'ROUGH ELECTRICAL
Compensation, as Provided for by section 3700 of me Labor ease, roe the 305 FRAME
performear of fM wink(or which thin permit is issud,
°I have and will mu ident Worker's Competuvion Insurance.as required by Section 306 - HOLDOWNS
3700 of the labor Code,for the performance of the work for which Nis permit it 307 - INSULATION.
- issued.My Workers Compensation Insurance artier and Polity number ere:
- 308 - '.SHEETROCK
c'miec(r CERT�CXF.MPI'ION' R ORKE9S/1G/ 9?' -1309. - v'EXTERPOR 'L'ATH",
.-•.., ._COMPENSAn°N INSURANCE ..___... _.31.0_;_ .-,INTERIOR- LATH.. .. _._... .
f7fhot secoiod need ma x corrindeded if he perind is far a hundred dollars
311 SCRATCH COAT ,.
ISI W)ar less) ',: 1
.313 - ROOF NAIL ... _ _ . . .._,_... _.. _. _... ._.. ....
fertlfy that in Tee amour;dmoe ohne work'fo,which this period is issued,r 501 - FINAL EliECTRI CAL"ENERGY '
shall nnf employ any person'in any manec
marine,so or to bomsubject bject to the Workers'
Campenxmmn Lawa°rcaifamia.Dom 502 FINAL . PLUMBING ENERGY
..Applicant
NOTICE TO APPLICANT.If,eller maAmg this Certificate of Exemption.you should 503 - FINAL MECHANICAL ENERGY
become subject to Ne Workers Compensation provisions of the Labor Code,you must
C0 1 forlovill,e ply w hh'.urnprovisions or this Permit shall be deemd revakd 504 - FINAL BUILDING ENERGY
toes Ruc ukNLENDwcnce AGENCY 505 - FINAL ELECTRICAL
F'� 1 hereby Jr.athin thele i on.t ct on lending Lgency for the performance 506 - GAS TEST -
fthe work for which thispermit is issued ISec.3097,Civ.C.) -
y � unit - Namc .._ _. .�__ _ .. ... . - ._.
Aum 0 <naeieAdarcss SOT = FINAL PLUMBING
I ebrifshin l have re ad thisaplicttion and stun that the above information is 508 - FINAL MECHANICAL
tL'O correct.1 agree to comply with all city and county ordinances and state laws inning 509 - FINAL GRADE
O.V to building construedon,and hembi oulourim mpossmantives of thnsay to enter upon 510 - FINAL PLANNING
;W-W the abovcmentioned property,for inspection,purposes.,
gg.... y (We)agree so sans.indennnify and keep business the City'of Cupertino against 514 - FINAL PUBI,4,1 WORKS
F. fA liabilities,judgment,.cosi end eepcnsra whichmays in any way scants against said
V.� City in consequence of the graining affil,permit. "" 602 OF Y' NAIL
APIP3LRIrC�ARM"Eff-UNDER gDDSSttAN AND WILL COMPLY WRH ALL NON:POINf Issued 0`A - Date
SOL_ UL/,r� ..•. . . 1//1 d Ap/ ESS
PROGR
Signature of A,plitanaCmandRn, 1 Date Re-roo - ROOF -
HAZARDOUS MATERIALS DISCLOSURE i':
Will drt applicant or future building occupant stare or handle hamNous material Type of Roof as def Eby the 320,) n M ntcnpel Cade.Chapter 9.12 and Ne liwhh and Safety . ,a tivk, ,',
Code.Section 255121e) yl'tl I _ �•; t 4 i 1'•. :
°Ye _All.roofs shall be,inspected prior.to any roofing material being installed.
will'he.,!ideal or fitm,Wildigoccupam use atntipmernor devices Which If a roof is installed without first obtaining an inspection,Tagree'to remove
.� em t hazardous no containmanfs as defined by the Bay Area Air Quality Management _ . . . .
Dimino all new materials for inspection. Applicant understands and will comply with
Dyes „'
�° all non-point source regulations;,
I hove mad the hamadmo'mamnar requirements uader,Chapter 6.95 of the
California Health&Safety Code,Sections 25505,35533 and 25534.1 atdemfand that-if the _
Wilding does not currently have a mnam;that his my fesponsibil'ny to notify the _
ace dam of 0 equiremem rch dun b mei poor to its antt f e Certircam of " -
O pont
Signature of Applicant- _ _ Date
.: tn(AUNon ant Date All roof coverings to be Class B"or better
>' :.! ;-•, -. : ,.r.. . ._ .OFFICE - .. . .. .