03040059 (2) CITY OFCUPERTINO
BUILDING DIVISION PERMIT O. TRr1C'CQRN' tiMATTUN .�.'
BUILD"NO ADDRESS; PERMIT ND.
22045 CAROLINE DR ALL PRO MAINTENANCE 03040059
OWNER'S NAME: PERMIT ISSUE DATE
J & LUBNA KEVAL 10070 CRAFT DR. #1 04/10/2003
SANITARY NO. CONTROL NO.
(408) 718-1630
ARCHITEC RINGINEER: BUILDING PERMIT INFO
BLDG ELECT" PLUMB MECH
30D LICENSED CONTRACTOR'S DECLARATION O
fY 1 hereby a06m that I am licensed under provisions of Chapter 9(commencing Job Description
with Section 70M)of Division 3 of de Business and Professiuv Code,°ata my It.ie
" in full farts end coat.
:urtClass Us.0Contror REVISION--SUBFL PLAN/IN HOUSE USE ONLY .
ARCHITECTS DECLARATION NO NEW PERMIT ISSUED, ORIG. #01100139
1 understand my plena shall he used u public roods A
b� Licensed Professional
Oat I am exempt DesDECLARATION \C `
I masa .(firm that 1 em exempt from Nc Conuactao License law forth, O \\1
po
which
following mason.permit
7Id,construct.alesamr"ve. esinvh.ear Any Nty arcounty p
$ which !a Issu a pormlt m theBlur,Improve,d,Permit
t or oasis any ned structure V
pdmmialense dprhumquime theapplicantof for suchhpete Umme,o hie a aw(Cha comment
g�<
that he(commencing
pursuant to the of Divsio of the Co mrumrWauefawsCode)9 Sq.Ft.Floor, ." Valuation
(cnmmen exempt
Suit..70M)and
the
basis n 3for nfthe
eged cu pt Prore.Any
Code)or
that'la,ts eumpt Oemfrom mtl Ne bash for the alleged eumpdoa Any violation of
nowtmime mN nn eenercplican..issm}it objects de applicant m a civil penalty of ApN Number Occup ney Type
.t I,as awntt of the -Aqrn-�014 00
❑ property,mmytt Intends whhwages uNe(role compensation,
will Pr testre oh,and theTh Commre a not Intended Law dor offiened fmotapply he M,Budvsa
and Protest ons,cone:The Canuasmr,uanse law aa,not apply m.n owner or Required Inspections
proparly,who build,or Improves the.,aadwho aoeaaueh.,it himself.thumgh his 101 - FOUNDATION
own employees,provided that such Improvement art not Intended or offend for talc if.
however.the building or Improvement is mid within one year of completion,the Manu• 102 — PIERS .
,hams eat,will have the burden or proving that he dm not build or improve for purpose or
103 — UFER
❑1,as owner of the propttdy,am exclusively convening with licensed conVacbn to 104 - REBAR
construct the pmjecl(Sec.7041.Boatman and Professions Code:)The Consensuses Li-
come — ANCHOR BOLTS
cove law does not apply to an Manu of property who builds or Improves demon,and
who contnctfor inch project Milt aconamdor(al licensed Museum to hat Contractors 106 — SEWER & WATER
License Law.
❑1 o"exempt under Sea ,B A,P C for this mason 202 - UNDERFLOOR . PLUMBING
0. Data 203 - UNDERFLOOR MECHANICAL
WORKERS COMPENSATIONDECLARATION 204 — UNDERFLOOR FRAME
"hereby pmmunder Penalty orperjury one ofthe following declarations 205 — UNDERFLOOR INSULATION
.taw and will maintain a CaNGate of Covent so,elf-hue.forworkesCamper. 3O1 — ROUGH PLUMBING
erkfforwhichNtsfor
permitblSection
uued��oftneLabor C"aafor Wperfannenmorthe 302 — TUB & OR SHOWER
❑I haw and will maintain Workers Compensation insun est,as required by Section 303 - ROUGH MECHANICAL
3700 of the Labor Code,for the performance of dm work for which this permit is issued. 3O4 — ROUGH ELECTRICAL
My Workers Compevadm Insurance,carrier carrier and Policy number a
Carrier. Policy No.: 305 - FRAME
CERTIFICATE OF EXEMPTION FROM WORKERS' 306 — HOLDOWNS
COMPENSATION INSURANCE
(This sexame reed not he compleed"fthe permit iaforovhundnddollm(SIM) 307 — INSULATION
miss.) 308 — SHEETROCK
I certify dist In the pahomma of the work for which this permit is Issued.I shall not 309 - EXTERIOR LATH
employ any perm"in my manner as as in became subject to the workeWCompensation 310 — INTERIOR LATH
Lawn of California.Dau
Applicant 311 - SCRATCH COAT
NOTICE TO APPLICAND It.coeds making @h CenlRau of Exemption.you should
become subject to the Worker's Compensation provisions of the labor Code,you muss 313 - ROOF NAIL
tZforthwith comply with such provisions or this pneftshall be deemed revoked.
�Q 501 - FINAL ELECTRICAL ENERGY
tiCONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY
I hemby°Rem that Nem is a constrecdnn lending agency for the performance of
x�
the wurkfor which this Permit hissued(Sm.3M.Civ.C.) 503 - FINAL MECHANICAL ENERGY
;zl q Loathes Nsme�
Lenacr.Addn:ss 504 - FINAL BUILDING ENERGY Z
:,y Q I certify drat 1 haw mad this application and sum that the above information Is 505 - FINAL ELECTRICAL y
Fcorrect.I Agra to comply with all city tab county ordiv"aa and suis hw,relating in 5R6 - GAS TEST
U building construction,and hereby authodm mmesenmiwa of this city in enter upon the
°hare-mentioned properly fm inspection purport,, O FIN PLUMB G
(We)agree m save,indemnify and kap harmless has City of Cupertino agal
In IlabilWu,judgments,emu anusexprmseswhichmayInmymy°mueagainstmidCity 8 FI AL
J 7 In consequence of the granting of this permik 27
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 5 Date
SOURCE REGULATIONS,
Signature of AppllnRe-roofs 514 INAL PUBLIC WORKS
HAZARDOUS
Dau US MATERIALS DISCLOSURE Type of Roof
Will the applicant or filum buioccupldingat non orhuudous materialas eeo the Cupertino Municipal Coda,Chapter 9.12.and the Health and Safety
Code.Se io
2125532(1)7YU ❑No
All roofs shall be inspected prior to any roofing material being installed.
Yes
Will sec appiicAM or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ammousair contemlvns as depend by had,Bay Am Air Quality Mamigemenl all new materials for inspection.
eG
❑Ye, 0N
I have mW the hasardma ma sdals mquhc camas mar Chapter 6.95 of the Califer.
Me Health&Safety Code,Sations 25503,25533 and 25534.I understand thin Ills,Wilding
does not currently hew a tenant,Nn It Is my n"Pentild lly he sadly the occupant M the
requirements which muss be met prior to issuance ofd CcnlOcete of Occupancy. Signature Of Applicant Date
Owner or authorized spend Dam All roof coverings to be Class"B"or better