03040102 (4) CITY OF CUPER'CINO �"�"' "-" " sa *' '-'a'> + area
BUILDING DIVISION PERMIT CONTRACTOR INFORMATIO.N.` -'
BYrU3,rSV'nSTINE AV JEFF & MARY HULTQUIST PERMIT No.03040102
O 2.. NAh1E. MARY HULTQUIST PERMIT IS9kd al/F21 2003
,JE: SANITARY NO.al/
L CONTROL N0.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
!00
LICENSEDmthatICONnstd underSDECLARATION
wC I hereby affirm that 1 am licensed under provisions of ins Cook. 9(commencing ]Ob Description
2<W with Section ndefef Division 3mftheB.inesa and Rufessiu.Cale,arta mYlicense u
' in cull fume and effect.
i'
License Class sae.♦ REPLACE E . BEAM RIVALED
erW Dam Coronet.,
p ARCHITECTS DELL DECLARATION -
f W U 1 understand my plana shall W used as public recnrda APR 1�
4apa Licensed Pmfcssamal "• R J 0 2000
OWNER-BUILDER DECLARATION {��
E I hereby afrom that 1 am exempt from the Contractors License Law for the BUILDING0 0 following reason.(Section 70315.Business and Professions Code:Any city nr county
5 m� which requires a pemnit m construct,eller,improve,demnliah.or repair any struetum
-Z„ prior m its issuance.ahm requires the applicantforsuch permit to file a signed statement
:z< that he is licensed pursuant In the previsions"(fire Contmaitura License Law(Chapter 9 Sq. Ft. Floor Area d�$I�a'OIOn
(commencing With Section 1000)of Division 3 of the Business and Professions Code)or YY
— mat he is exempt thcmfrom and dle burs for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit objects the applicant to a civil penally of
not mom than five hundred dollars($500). 3 AM t49rHl0-[ 0 0 Occupancy Type
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work.and the suuctum is not intended otoffimd foraal.(Sec.10414,Business 101 - FOUND7 d Inspections
and Professions Code:The Contractors License law docs not apply to an owner of
property who builds or improves mereon,and who does such work himselfor through his 102 — PIERS
Own employees,provided BOB such improvements are not intended or offered for sale.Il, 103 — UFER
however,Ne building or improvement is sold within one year of completion,the owner-
boilder will have the burden of proving that he did not Wild aimprove for purpose of 104 — REBAR
sale.).
01,as owner of the property.am exclusively contracting with licensed eonoaetors to 105 - ANCHOR BOLTS
mn'timet the projec"(Se e7B44.Business and Profusions Code:)The contractor's Lb 106 — SEWER & WATER
cense law does not apply to an owner of property who builds or improves themon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's 202 — UNDERFLOOR PLUMBING
Licensehaw. 203 - UNDERFLOOR MECHANICAL
lamame tunticr See ,B&PC ar thi meson
204 - UNDERFLOOR FRAME
n`r wo R COM ATION ECLAROateION 205 - UNDERFLOOR INSULATION
I hereby aRrm unser,natty o perjury ane of the tono ;gaeclaratiom: 301 — ROUGH PLUMBING
I have and will maintain a Ccnmcaa ofConeento self-insure par Workerieumpen- 302 — TUB & OR SHOWER
aalion.0 provided for by Section 37M of the Labor permit Code,for the perfommnce of the 3 0 3 - ROUGH MECHANICAL
work for which this peit is issued.
❑1 have and will maintain Worker's Compensation Lorena,a required by Section 304 - ROUGH ELECTRICAL
37M of me labor coda for the performance or the work for which this permit is issued.
My Worker's Coma
Compensation Insurance rt305 — FRAME
C-17111: artier and Policy number Be 305 — HOLDOWNS
taer PolNFROM
307 - INSULATION
CERTIFICATE OF E%EMPr10N FROM WORKERS'
COMPENSATION INSURANCE 308 — SHEETrROCK
rbss.Cfhisaccdmn need notbccompleted itme permit is formichundreddollim Slm) 309 — EXTERIOR LATH
1 cpnify that inrthe per grmancc of the work for which Nis Permit is issued.1 shall nut 310 - INTERIOR LATH
employ any yman r Ip pe subject to lm Workers*Compensation 311 — SCRATCH COAT
Laws of Cali Dam `
313 - ROOF NAIL
N IC APPI Ie .If,after mangnprovinircamoeLaborExemption.
de,youhmust 501 - FINAL ELECTRICAL ENERGY
15
beeow Ajca to the Worker'a Compensation provisions of IM1c Labor Code,you mus
]Q mnnwimanmplywimsumM1pmvism.orthisp mitanalhdemedmvoked. 502 - FINAL PLUMBING ENERGY
z'� CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
Ihereby which thi that thea issued((Sec.301D,
ding agcney for @c Performance of 504 - FINAL BUILDING ENERGY
x
the work for which this permit is issued(Sec.J(N1,Civ.C.)
nA Lender's Name 505 - FINAL ELECTRICAL
Z) lcndcri Address
� Z 506 - GAS TEST
;J Q I certify that 1 have real this application and salt duet Nc about infonnaliun is
correct.l agree m comply with all city and county ordinances and sum laws relating to 507 - FINAL PLUMBING
�U building contraction,and hereby autharire represcrumias or this city to enter upon the
�a W above-memiuned properly for inspection purposes. — FI99NORK
AL
—, gy (WO)agree to save,indemnify and keep harmless dm City of Cupertino against (] — FI
h liabilities,judgmcros.cossandcapc.cswhich may inso,way...a fliumaxiodCity 5
j Z m consequence of the granting of this permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: _ SDate
SOU C REGULATI NS.
ore ofA li an onnacm D.
D Re-roofs '
HAZARDOUS SMATERIAISDISCLOSURE Type of Roof
Will the applicant or future budding occupant store or handle lot"Odous mmcdul
as defined by the Cupeoi no Municipal Code,Chapter 9.12,and the Hcalth and Safely
Code.Section 25532(41)? / All roofs shall be inspected prior to any roofing material being installed.
FM's
Will thea applicant or future building Occupant usee equipment If a roof is installed without first obtaining an inspection, I agree to remove
PP g p qui for Marta which g p
t hemrdnus air contaminants u defined by[he Bay Arca Air Quality Management all new materials for inspection.
cl?
Cl Yes t(No
1 have read the Wradous ntamriah mq.inamems under Chapter 6.95 of the Califon
ria Health&Safety Code,Sectio.25505.25513 and 25534.1 understand dual ifine Wilding
does not curtendy have a mnank that itis my responsibility m nndl'y Or spent of the
require c which re a mel m issuance a Cenificam of Oce p cy.
D Signature of Applicant Date
net uraumo a enl All roof coverings to be,Class "B" or better