01100134 CI BUILDINGcDIVISION
ONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1032 WESTLYNN WY BAY AREA SUNROOMS 01100134
OWNER'S NAME: APPLICryTION S B DATE
HOFFMAN MABEL A AND MICHAEL 17 W 41ST AVE 10/ 25 2001
PHONE: SANITARY NO. CONTROL NO.
(650) 341-6201
c z ARCHITECT'ENGINEER: BUILDING PERMIT INFO
C BLDG ELECT PLUMB MECH
aim I-'—t 17 J I-J
N Z LICENSED CONTRACTOR'S DECLARATION Job Descri tion
1 hereby affirm Thal Ivan licensed under provisions of Chapter 9(commencing
?yCa isithSection70YRofDivision3oftheB i sand Professions Code.and mylicense PATIO ENCLOSURE ON C CONCRETE SLAB .
c Y y is in full force an eff t.
K w a Lice Clacn 'Llc.e -
i o a u Dae L_ S DEC ter q__
a L o ARCHITECT'S DF.CLAR IO
1 undersand my plans shall be used as public records 7 )
1 e-,6
3 00 LicensedProfeni.nal
e LL OWNER..cUILDER DECLARATION /
I reavo.(Grtn thin 1 1. a¢mpn from Inc Cessions r•s Littna law for Use O
C?a following reason.(Section 7031.5.Business and Profemions Cede:Any city or cnunly 19000
eZG Whlh n,
...thin laawny(CSTINapClWerR9
_ Valuation
pro to Us
issuance.also requires the applicant for such Permit
to fitea signed statement,
It
(conmicn g with Sect 7")of Division 3 of the Bu ions?and gmfessions Code) t'i:��113§9'� d2 f.S;k
or Ih,he is exempt therefroiii and the basis for the alleged aempbon.Any violation
of Section 703 P.5 by any applicant for a Permit subjects the applicant to a civil penalty
of net more than five hundred call...IS5(R). l O 1APN N3t9�l AT I ON "' " Occupancy Type
01;as owner f the propery,or my employees with wages as their sole compensation, 102 PIERS
will do the work,and IM1e structure is not intended or offered for sale(Sec.7044,-
'Business and'Professions Cello:no Contractor's License Law docs not apply to an 103 - UFER Required Inspections':
own.
r of property Who builds or in,mveiflumen,and who docs such work himself 104 - REBAR
or through his own however.t provided that such improvements arc not intended year
or
-.offered for sale.If,howuilde the l hvbuildingor improvement sold he did otic f - -
prov<m<n year° 105 - ANCHOR BOLTS i � -., � �' ����"r -
emproveoo,ane ore of
will have the burden of proving than he did nm build or
improve for purpose nt rare.). 106 - SEWER & WATER '
oLasn n«onneprnpertr.am aewsm<lyeommedngwanR en u6ont�dodlo 202 - - UNDERFLOOR PLUMBING--- -�'S,v. ,... . ..
;. ..
construct he Project(Sec.704.4.Bislness and Professions Code:)Tim Contractor's 203 - UNDERFLOOR MECHAN I CAL ' .
- '- License Law does not apply to an owner of p.o,mmy who builds or improve thereon, `
'1 and who common,for such projects with a contravori licensed purmann.Io one.
2 04 --UNDERFLOOR- FRAME.-.._...._.. .... ..... . .. ... ._ . . -
01 am .c License Law.
- ❑lam<x<mpnimersee. - s .'B'&PCfar his reamn 205 - UNDERFLOOR', INSULATION
owner Date" 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby affirm under penally of perjury one of the following de<lanttions: 303 - ROUGH MECHANICAL
❑ 1 have and.will maintain a ccrtircmc of Consent to self-msia for Workers 304 - ROUGH ELECTRICAL
Compensation, as provided for by Section 3700 of the labor Codc.-for the
- - ptrformante of,he work for which Irishermit is iss.m., . 305 - FRAME
0l have and'will mainmin Wmkin s Compensation Inur
sance,as required by Scction 306 - HOEDOWNS
3700 of the Labor Code,for the performance of the work for which this Permit is 307 - INSULATION
issued M Workds C M _�n/9n hummnce carrier and Poly be a
�; ,� 1 . q(� 308' SHEETROCK : - :—
s lamer [�palicY No 'II� Zb/D'�.�o Sr - •r,t- k...._ ... -..
" CERTI9CATIONOFE%EMPTIOIJ� WORKEARSr f-' M1' 309 t —%xEXTBRIOR,•LATH'%
COMPENSATION INSURANCi? ' ..-......-
(This section nark nm be completed inn.Permit is far one hundred dollars 311 - SCRATCH COAT
(SUM)I c<mfy,that n. „ , 1 - 1 ..
."I' 313 - ROOF- NAIL•
the performmnce of the wnik hn wpicM1 anis pc_ro:d e'issued:1 ~.•. • -L
snarl till nanner��i94gbr['ne�sli�jeq to N�wod<r� 501 - FINAL ELECTRICAL ENERGY"'`
cmin,mv, cal umU.aD rICU/_Ll� 502 EINAL..PLUMBING..ENERGY. _
Applicant -- - -
NOTICETORP LICAN':If.alle malimgUniCedilicamofExemption,-you should 503 - FINAL MECHANICAL 'ENERGY
become subject to the Workers Compensation provisions of the Labor Code,you must
O (5 fonnwitheomplywhnsimprovisions ormispermhsnallbedeemedavoked. 504 - FINAL- BUILDING ENERGY
.^moi ' 'CONS TRUCTIONLENDING AGENCY, 505 - FINAL ELECTRICAL '
1 her h 'uRnn shat Ihere is a'conxwction lendia a enc for the rfo`mnance
afther'aNa.which lhikpermit is issued(Sec.3097;Cia CJy a 506 - GAS TEST "
W'Q Lender's Name -
ar "° •:-, "' 507 - FINAL- PLUMBING
r"Dt Z' .Leneer's Address" ,. .. . . ' ,
I certiNmo fy that i'have read ibis application and state that the above matn
formiuis 5 0 8 - FINAL MECHANICAL
r fL.F correct 1 agree to comply with ell ciry and evo my,ordinvnces militant laws relating 509 - FINAL GRADE
O,.V to building construction,and hdrcby noontime representatives ofm&city to enter upon 510 - FINAL PLANNING
', .W the above-mentioned property for inspection purposes., , _
ti 0. (We)agree to save:indemnify and keep harmless the City of Cupertino against 514 - FINAL PUB IC WORKS
to liabilities,judgments,corns and expenses which may in any way acre<.guinst said
U�Z City fib. ling of this p<rmin:'' '
�PP AN]' ERS -NDS for I:LCOMPLYWITNAEI.NON-PO{NT Issued by: Date
�yOIJRC UL TIO -!/- /� I�,/I,t, y .
//747 n ofApidcvntlC t ct rm...�t��gr<--//t I ( I Ot If Re-roofs .
e HAYARDOUS MATERIALS DISCLOSURE an
W 11 We appica 10 f( b ilding nt t r handle naivre
doia material Type of Roof,.. --- -- -
azdef d hY th C pen M pal C Ch pt 9 12 and th Hullh and Saf ty q s -i s.
Code Seal 25532(.) q3 I. ,.t .. \. 164 `.' f.s•.' •.:
❑Yes o.❑.. All roofs shall be.inspected pnor to_any roofing material being installed. _
` Will the applicant ofuture buildi;gfi option use equipment or devices:vshich. If a roof is installed without first obtaining an inspection;Pagree:to remove
con
tM1isard - rum reams as deft by the'By Area Air Quality Man.gm<nn
Dist ct all new materials for inspection. Applicant understands and will comply with
all non- oint souice re ulations;
1 hale read the'lecom oui'mvmnals requiremetits'under Chip¢r`6.95 o(�the
California Heal h&Safety Code,Section,25505;25533end 25534.1 understand that
Rau: Iti snots Five.mwt that n is my responsibility to notify the- .- ..
parni.cittt q6 t Most be met Prior to issuance of a Certificate of
o° c Signature of Applicant Date
owe. ant All roof coverings to be Class "B" or better
s• .'`. ...' . \' I OFFICE. .... .. .