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03020068 (2) CITY OF CUPERTINO * ' � " �° �� < •' ' . we 's�' BUILDING DIVISION PERMIT CONTRACTOR INF,ORMATIQN^ BUILDINGADDRFSS: MATZ CONSTRUCTION PERMIT NO. - R'S 10574 ORANGETREE LN APPLICATI A w; PHONE: (4.08) 257-6376 ONSANITARY NO. CTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Lao fiONnRACrORSDECON I Mmhy affirm that Iamlicensed under provisions nfChapkr Y(commencing JobDescri Description wishScnon] m FINALE® o In to «e N KITCHEN REMODEL/WINDOW UPGRADE 0 j Lice C v OCT 2 2003 ARCHITECTS DEQ� ARATION y @� 1 undcrstend my plena,hell M uecJY3pumic records a LicensedProfcasimal BUILDING OWNER-BUILDER DECLARATION pa�y <Y 1 hemhy affirm on 11. exempt from Ne Contractors License Lew Ro the o O which ire mason.(Section]1131.5.Business end improve. de o demolish. Code:Any city os county X$ which requires n Permit re uir construct.eL Jur.improve,do ermit t or repair any structure prior m its issuance,also requires the applicant for such permits.tilt a signed aukmcm AZO that he is licensed pumrant to the provisions of the contractors license Law(Chapter 9 Sq. Ft, Floor Area Y $256b161ion $ (commencing with Section 7000d of Division 3 of the Business and Foresaw.Croke)., Vu A. Nat M is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by eery applicant fore permit subjects Ne epplicanno a civil pertly of 3}1�,� ggl�er00 Occupancy Type not more Nan five hundred dollars(SSW), ❑1,As owner of the property,or my employee,with wages a their sole compensation, ' will do the work,and theathroMe isnoNntended or offered for sale IS".7044,Business 101 — FOUND and Profeashms Code:The ContractoM1 License Law does not apply to an owner of Qid Inspections property who builds or improves Hereon,and whodoesawlt work himselfor through his 102 - PIERS . own employees,provided thauuch improvements Are not intended aro@red for tele.If, lO3 — UFER however,the building or improvement is sold within one year of completion,the owner builder will have the burden of proving that M did not Wild or improve for purpose of 104 - REBAR tele.). ❑I,as owner of the property,em exclusively contracting with licensed convectors to 105 — ANCHOR BOLTS construct the project(Sao 70W,Business and Professions Cade:)The Convsmori u• 106 — SEWER & WATER sense law does not apply to an owner of property who Wilda or improves thereon.and, 2O2 — UNDERFLOOR PLUMBING whocom for such projects with a contractor(s)licensed pursuant to the Cantranor'a L1eC 203 - UNDERFLOOR MECHANICAL m'1 em exemp under Sec. .B&P C for this Much - 204 - UNDERFLOOR- FRAME WORKER'SCMPRNSATIONDEC OON 205 UNDERFLOOR INSULATION I hemhy elBrm under Penalty of perjury...of the Following decluanons: 301 - ROUGH PLUMBING ❑IhnveanJ will mainWne CeniBcek ofCnnsemloself-irtsumfor Worker'.Compen. 302 — TUB & OR SHOWER scion,a provided for by Section 37W of the Labor Code,for the Performance of the 303 - ROUGH MECHANICAL ..,it for which Nis Permit is issued. ❑1 hats and will maintain Workers Compensation Insurance.As requited by Section 304 - ROUGH ELECTRICAL 37M of the labor Code,for the performance of the work for which this Permit is Issued. - 305 — FRAME My Worker's Compensation Insurance carrier and Policy number art; - 306 — HOEDOWNS Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 307 — INSULATION COMPENSATION INSURANCE 308 — SHEETROCK lir lcssJ(This section need..[beeompleted ifthe permit is Damns hundred doll0(SIRB) 309 — EXTERIOR LATH '— Iccnit Nei�in the pe prmance of thc'work for which this Permit is issued.)shall not - 310 — INTERIOR'-LATH employ any pe ni nymannersna m become subjauothe Wmkcrs'Compe.sail n 311 - SCRATCH COAT Lawsof CJifomi u APith t 1 313 - ROOF NAIL N TO APPLICANT:If,afurmaking this OcnificaleofExemption,you shoulJ , SOI — FINAL ELECTRICAL ENERGY Mmdle'aubjm to the Worker's Compensation provisions of the Labor Code,you..at oz forthwith comply with such provtionsorthis Permit shaBbedeemed mvokcd. 502 FINAL PLUMBING ENERGY z CONSTRUCTION LENDING AGENCY 503 FINAL MECHANICAL ENERGY [r rNi I botchy affirm that there ls.emo=tlan lending agency for the performance of C> the work for which thiape.it isissu.d(Sec.YN7,Co.C.) 504 FINAL BUILDING ENERGY. W q Lender',Neme 505 - FINAL ELECTRICAL 6r Lendcri Address U0 I certify that I have read this application and sou that the aMve information Is 506 - GAS TEST caed l ag me f.nop1r iutrancountrominans and auk laws ng to 507 - FINAL PLUMBING OU building consuuction,and hereby othome rcpmsemetives of this city to enter upon the aMve-mentioned property for inspection purposes. FI&&NG CAL r0. (we)agree to save,indemnify and kap harmlen ties City of Cupertino against - 0 9 F I (n hablliBes,judgmcnta,costsand expenses which may in ayweyaccrue agalmstssid City 5 C.1 in APPLICANTeof the UNDERSTANDS Aof tND WILL COMPLY WITH ALL NON POINT Issued by:5 WORKS Dat S ERCGU TI NS. Z5? fqA 'r 12' 47:3 Re-roofs nstumMApplman/Contracto, - DateHAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant.,future building occupant storcmhan chevardua mekrial defined by the Cupertino Municipal Code,ChaPur 9.12.And the Health and Safety Sictim,oYm,255324 60. )? All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future Wilding occupant on equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove emit ha,amoa air contaminant rado d by the Bay Arca Air Qumity Management all new materials for inspection. District? QYea I have mad the havam.ua materials requirement under Chapter L.95 cribs Califon lila Hcutth&Safely Crate.Secdoahatit.25533 and 25534.1 undersand thkifthcbuilding run not cu cntly have a h that 0 is 35 m 2553.1 to understand t n ifthe b of the / rb reyu ,which mus et pri Tri cm Ccnific� a ,mer. Signature of Applicant Date r or wthorizeJ agent Dak All roof coverings to be Class "B"or better