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03110044 iz RTINO -n ISION PERMIT C0NTRAC 1)R 1NF0RMATj0N- '. PERMIT NOO 3110044 nFRTTrR ng - PERMIT ISSUE DATE CARSON 2003 SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH i00 LICENSED CONTRACTOR'S DECLARATION- Job Description u C I hereby affirm that i am licensed under p.aslone cf Chapter 9(commencing P +�w with Suction 7000).(Division 3 of line Business and Professions Code.andmy license is � mfuufarceandeffeet. GAS & ELECT UPGRADE . PINAI.E® jnZ Licenac Clara Lie.Ar Dae Contractor E � ON Iunderstand mypl ssshllbeusN°e publicreco FEB 1 2 2004 a d C w to Pmfenitmel .aa OWNER-BUILDER DECLARATION 'yL<I 1 hereby affirm that 1 am exempt from to Contractor's License Law for the g1''L�j1� p o following reason.(Section 7131.5,Business and Prnfessoms Code:Any city or county V 5 which requires a permit us construct,aloof,improve,demolish,or repair any.structure iy poorm its issuance.also requires heapplicam for such permit to file a signed statement ISIQOO ^0 that he is licensed pursuant In the previsions of the Contractor's Licensc Law(Chapter 9 Sq.Ft, Floor Area Valuation u $ (commencing with Section 7000)or Division 3 of the Business and Professions Cmlc)or s that he is exempt Ihcmfrom and Ne basis for Ne alleged exdmpd.r.Any violation of 37516024 . 00 Section 7031.5 by anyapplicmn for apermh subjects the Applicant o a civil penalty of APN Number Occupancy Type N not more an five hundred dollars(5500). _ ❑.Lasownerof the property,or is cmntendes withweedsas Nei(sola n,44,B sines, will Pr rehe work antler he Concis Nati Licenim offered formic(Sec.too 14.Business And Professions Codd:The improves or.License Law does not apply if an owner of Required Inspections property who builds or improvesh improvements and who does such work himself of through his awn employees,provided that suchen.is sold within arc not intended m leered roe sale.owner- builder thebuilding orimprovementg that within ane year of completion,the . sae will have the burden of proving Na he did not build or improve for purpose of sale]. QQ 1,as owner of the pmpeny.am exclusively contracting with licensed contractors to c' a met the project(See.70x4.Business and Professions Cade:)The Convector's Li. cense Law does not apply to an owner of property who builds or improves thereon,and who commett for such projects with a contractor(s)licensed pursuant o Ne Cornmetmes License law., ❑ lam ex/e,It un/�e/Sec. B&P C for Nis reazon IrWORK -SCOMPENItErt SATIONDEC��p `I'lON I hereby affirm under penally of perjury ane of IhA allowing declarations: ave and will maimatn a Ccnificale ofConscat to self-insum forWarker'sCompcm,as provided far by Section 3700 of the labor Code,for tine performance of the for which Nis permit is issued. ave and will maintain Workers Compensation Insurance,as required by Section ofNe Lobar Code,for Ne performance of the work for which this permit is Issued. orker's Compensation Insumnce carrier and Policy number am: Cartier. Policy No.: ' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thissection need nm he completed if the fermis is foram hundred dollars($100) or less.) I cenify tad in the performance of the work for which this permit is issued,l shall not employ any person in any manner so ns to become subject to the Workers'Compoeatinn Laws of California.Date Applicant NOTICE TO APPLICANT.IL after making this Certifieale of Eacm prion,you should became subject to the Worker's Compensation provisions of the labor Code,you must Z forthwith comply with such provisions or this permit shall M deemed tevoked. ZO CONSTRUCTION LENDING AGENCY I hereby affirm but there is a canslrumina lending agency for the performance of Ys> the work for which this permit is issued(See.3x97,Co,C.) :Ll Q Lender's Name G Lender's Address VC) 1 certify that 1 have read this application and sum that the shout information is " F contact.I agree to comply with all city and county ordinances and state laws mining la 0 building conswction,and hereby autherim repmsenmtives of Nis city to enter upon the Hab -mentioned property for inspection purposes.aove (We)agree to save,indemnifyherders and keep haless the City of Cupertino against A f/) liabilities,judgments,costs and expenses which may in any way accrue against said City V (� V 4 in consequence of the granting of this permit. APPLICA UNDERST S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUR C EGUyy�qgION . 1 JG Re-roofs- Signatlefe o r pplXant/Cu t Date -ioe HAZARDOUS MATERIALS DISCLOSURE Type of Roof tore Will the applicant or future building Occupant& or handl erardoerramfiai defined bythe Curtino Municipal,Cade.Chapter 9.12,and the Health and Safety Section , pyea tNa 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 it harardoas air contaminants ea dcli by the Bay Area Air Quality Management all new materials for inspection. isaiot? ❑Yes We , 1 have mad the havaNnusmatenals requirements under Chapter 6.95 of the Cali for ria HcaIN&Safety Code,SCeuoes 25505,25833 end 25534.1 andcmmnd thmifthe building d,:.not cmtendy ave a Lenart, I' s my responsfbility m notify the wcupanl of the mquiremcntsw ' moat me t iaaaanccora Certificatcorac panty. Signature of Applicant Date !O—b Owner oraahmindageat - Date All roof coverings to be Class "B" or better ''t E'a BUILDING DIVISION PERMI, O,iV�,'RAGTO , INPORMA = BUILDING ADDRESS: PERMIT N0o 3 110 044 OWNER'S NAME: PERMIT I5SUE DATE MICHAEL CARSON 11/10/2003 E: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 0 100 LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 am licensed under provisions or Chapter 9(commencing lob Description with Section 70(y))of Division 3 of Be Bnameas and Professions Code.and my license tQ� 0 o infuBmr.and effect. GAS & ELECT UPGRADE . RNA.. Licemc Close Lic.if O Dam Coronae, � f1 e�IJ` ARCHITECTS DECLARATION l-r rB 1/'g�2094 I understand my plans shall be used as public records l_ 1.0 eon L'.:cnscd Professional BUILDING } p pp��,/�± OWNER-BUILDER DECLARATION IGBA�'Y�.DIAtlB71 S 1 hereby ofrom that 1 am exempt from the Contractor's License Law for the 11�� Y V VN 00 following reason.(Semlun 703 1.5,Business and Professions Code:Any city nr county <m� which requires a permit to construct,alter,improve,demolish,of spat,any structure 81000 azi prior na it issuance,alw requires the applicant rorsuch permitou file a signed statement -a that he is licensed pursuant m the provisions of the Commuter's License Law(Chapter 9 Sq.Ft. Floor Area ValUahOn g�0 (cum mencing with Section 7")of Division 3 ar the B usiness and Professions Cod0or 37516024 . 00 xs i $ that he is empt therefrom and the loads for The allcgcd exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to.civil penalty of APN Number Occupancy Type not mmc than rive hundred dollars(5500). ❑1,as ownerof the property,or my employees with wages as their sole compensation, will do the work.and Ne structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Contmcmr's License Law docs not apply in an owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his Two employees,provided that such improvement ve not intended or.fir rod for sale.If, however,the building or improvement is sold within ane yam of completion,the maner. builder will have the burden of proving that he did not Wild or improve for purpose of sale.). r�1,as owner of Be property,am exclusively connecting with licensed contractors to con met the project(Sec.7044,Business and Professions Code:)The Conmemr's Li. cense law does not apply to in owner of property who builds or improves thcmon,and who contract for such project with a contnetor(s)licensed pursuant to the Canmmors License Law l am ex wn ,See. ,.B&PC for this..on ❑ /yfip Own / Y"'� Date 11-��-V"'1 WORKER'S COMPENSATION DECLAite`f10N 1 hereby of lrm on penalty of perjury one of Niloollowing decloadhi e ❑1 have and will maintain a Certificate of Conserv m self-insum for WarkcraCompon- s him,as provided for by Section 37W of Be Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Workers Compensation Insurance,as squired by Secdon 37W of the labor Code,for the performance of the work for which This permit is issued. My Workers Compensation Insurance carrier and Policy number an: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Phis section need notlea,completed lithe permit is furenc hundred dollars($1010) nrlcia) I certify that in the performance of the work for which this permit is issued,1 shall not , employ any person in any manner so as In become subject o theworkers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT.IL alter making this Cemiliwm of Eacmption,you should pecame subject m the Worker a Compensation provisions or the Labor Code.you must z forthwith comply with such prnvisinrm or this permit shall be doomed revoked. z O CONSTRUCTION LENDING AGENCY ;-t I herby affirm Nat there is a Construction lending agency for the performance of yi F>. the work far which this permit is issued(Set.315],Civ.C.) W�Q Lender's Name /1 �z Lenders Address V 1 certify that 1 have read this application and sum that the above information is . l4 comeck 1 agree to comply with all city and county ordinances and state laws relating to V building construction,and hereby aummix representatives of this city to enter upon the W above-mtio enned properly for inspersion purposes. /' l (We)agree to save,indemnify and keep harmleas the City of Cupertino against 1V11f 1/ ray or, liabilities,judgment,costs and expanses which may in any way mora,against said City U Z in consequence of the granting of this permit. APPLICA UNDERST S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURC EGU ION . f � 1!- (D-D3 Re-roofs Signa-fit cof/cCpplicanUCo t "j' Dow _1W HAZARDOUS MATERIALS DISCLOSURE / Type Of Roof Will Ne applicant ur furore building occup.ntnorc or handlt"(arardo a mamrial as deRned by the Cupertino Municipal.Code,Chapmr 9.12,and the Health and Safety Code,Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yea u Will the applicant or future building occupant use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove -mit haaefdnus air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District' Cl Yes Wit I have read the hmardous materials requirement under Chapter 6.95 of the Califon .is Health&Safety Code,Sections 25X15,25533 and 25534.1 understand that if lW hi docs not arrcndy'a asnant t' my respmaibility m nodl'y the occupant of the rcyuircmcnt wh' mus me Isissuancc of a Cerdficate of Occupancy. Signature of Applicant Date t v_p owner pr.nmanand agent Dam All roof coverings to be Class"B" or better cL-C 2Q RECEIVI XTfZioC� {l` �n� CA `fSn1`f NOV 10 ZO w LL, • I pP.PRwED i N o D i r l C k-Ti o N S ITH:THEtCti'� Ofl IN:RCCOROAUCE':W t0AD1 Cf� . CUP_ERT•lNl� aD�' + I C�x�s-ni.x>) 1( b I OAif ;/EUTptLAlT1lvC, Ito V RL S SHvTOFF VAL_LC i. S1Gt�fU ia, speciiicgtions ppUST Thisset of P at all times and it 1S un P yept on tchange or alteratlens ADD NEw Z Zu v 3 -PRoA-v, 1?wful to m any ermission ksic „boat written P �LVG 3AB 6N ZZv V on same City of Cupartino. TuNL.Ti oN 3Ox . the building D01 t^ and to b@. 3 . 1 N i IO JLE Z� 1)0 -v The sta P of this Plan rmit®f 3HA oS thl beheld o Of aw�1 .Pt 0� OrdazosS 5occt 5 N SHowV LoeAitONS r'oeZ ✓EN TF4..A-T f�t,Cj 110 l/ SOCKET }ioOD t7,uS AuU,fLLAR`,° So cK5? W Fk6RG tic-A 6UG0,7 • '5mSTcp, • 000O , vc>J C� O� L, AS L.i nJE TL �! 1/A�Vc i i ' Z20 v GAS 3 - illko NG I I tZEGvLaTdZ i i I