01090097 (2) CITY OF CUPERTINO '
BUILDING DIVISION PERMIT CONTRACTOR-INFORMATION;
BUILDING ADDRES& _ 5 PERMIT NO.
. �., 4�7847SCREEKLINE DR 01090097
OWNER'S NAME:' , APPLICATION SUB DATE -
CHEW KENNETH AND MARY L 09/21/2001
PF2HO SANITARY NO. CONTROL NO.
O O i
ARCHITECT/ENGINEER:' - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR's DECLARATION r Job Description -.
z- I hereby affirm that I am licensed under pmvisions of Chapter 9(commencingi
mEE with Section 7000)of Division 3 of the Business and Professions Code.aA my licenses ;
f`ced is infill Pomen ffe 1
_.��< LiAt, _ Lie,. INSTALL VINYL SIDING ON FRONT
i3°�.r °" SF)Mn } OF HOUSE. ICBG ER 3663 .
a O rn RCHITECfS DECLARA ON
y�al l undersmnd my plani shall be osed as public recorda
3 O O Licenced Professional -
' �_� . OWNER-BUILDER DECLARATION !
I hereby affimt that 1 um exempt from the Contractor's License Law for that
following re n (Section 703 1 5 Business and Professions Code:Any city or county,
-
which requires n permu to c i mct,ider,improve,tl rahsh or repo r any stmcmrc
ys $ : prior to its issuance,also rill res the Applicant for such pe it to file a signed statement __ __ ... _ ,..._..... -. ..... ...... .. _ _ _
thatha I e dp is a ft'thep vii Rh C t t rs L¢ence Law(Chapt 9 S Fc FIoor Area,,a atlOn
"bx ongwithSect 70)0)ofDlvtea3ofththalm edPmfeanansCad) Q.:' V �,-tq�'Y� .lr.. L'+h1, vlliATT r } $806ak'
or
Out he is exempt therefrom and the bra,far the alldged axe peon Any violation
of SAction 7031.5 by any applicant for a permit subjects the applicant in a civil Penalty Occupancy e
of t re than fve hundred dollars(55(10). 1 _ 3 6..at71�t.N19n.b6 n + p y Tye
_ O 1,as owner of the property,or my employees with wages as their sole compensation,, L 1�1��T . l/
will-,do the work,and the structure is oat intended or offered far sale(Sed.7044,'-
M1 `Business and Professions Code:The Contractor's License Law does not apply to an; 305 - FRAME Required Inspections' , "'• �'
' owner of property%a builds or improves thereon,and who does such work himself•
or through his own employees provided that such improvements are not mended or' 307 — INSULATION r
offered fix sale.If.however the Wildingor improvement rs sold within one - - ' _. - . '-
cmlevon,theownerbudderwllhavetehunden f`n year 601 - ROOF TEAR OFF I'"'
completion, proving that he did not build or' j
'improve sir pamose of aale.). _ 602 - ROOF PLYWOOD NAIL
603 ROOF BATTENS
.D I as ow of the property,vn eulosi lycontracting with licensedcontractors t ! .,
constructLa does
rm p, 7044,Businowner roerf Professions Cntremmi, 604 ROOF IN—PROGRESS
License co does not apply man owner of property who)lice seimproves thereon
and who commis for such protects with comracmr(s)licensed d pursuant to the' .- .. f .. .._,...Owner _-
' .. .. .
' B&P C for thin reason;
Cot t t L nae La
D I e pt oder s ., .._
pate FIN,q l �8�
WORKERS COMPENSATION DECLARATION I
I hereby affirm under penalty of perjury one of the following declarations: ' DEC 7 1
❑ I have land will rail a Certifcam of'Consent to self-insure for Worker's, 2001
•� .Compensation, us;provided far by Section 3700 of the Labor Code, for the.
perfo a of tae w rk for hich this pemvt s i sued.. i 7
' ❑I hoe and'will mental Worker's Compensation Insurance,as required by Section BUILDING
3700 of the Labor Code for the Performance of thework for tach this permLL s'
iss d My rkers C pe y;s, ',m M Pot be am
Carr 1 l „ 'Policy No
•RTIFICATIONO E%P.MPTION FROM WORKPR$1 - -
COMM SATION INSURANCE_
m
n s action •' t dollars
completed if the permit is for one hundred tlolla
(SIOo)or IE6R.)
_ . ..»... .... .. ..... ..... . .. .
o aa
1 cnify than in th pert nhoof rk for which th petmn's ism ed,l
shall not employ any pe aon nyy mannerr so as m becom s b)at to the Workers' `
Comant on tarns of California: e
ie:Dam NOTICE comesubject
APPLICANT.If,after sinking this Certificate o of Exemption,you should -
comeaubl it theta ker Compensation cur, provisions ll the Labor Code,you must' '
Z r orth N ply with hp Provisions thi permit shall -d ed yoked.
F X 'CONSTRUCTION LENDING AGENCY .ui .
1 h rcby w R th t th sw u n lending agency f the perfoimnnce
Le Nafowhichuh permit's'ssued IS J097 C Civ.C. _ 4
z rm
Isnd Add
V Q f
1 cert f)that I have read this Application and stale that the above information is;
11
W'[-i correct.I agree to comply with all city end county ordinances and stem laws relating
to building conswction and hereby on lmil representatives of this City to enter upon'
W the above-mentioned property for inspection purposes._
,. (W)agree t.save,indemnify and keep harmless to City of C p n no ag lost
y liob'll judgments,cost tl expenses,which may in any way ecr a go,. said
V City n'eonsequcnce of the grat g of thisp rmit
APPLICANT UNDE AND WILL MPLY WITH ALL N O '
SOURCEAEGUL '* 'I Issued by: Date
sigA re of AppgcantaCanusa �... " ,. •t '..•� .'. , Date" Re roofs
HAZARD US MATERIALS DISCLOSURE
As def ed b th C n n M pal Code Chat 912,and th H lth and S material -Type of Roof - ... . ...... .. .... _.. ....
.: W ll N ppl"a t f tire,Wilding occupa t t r handl Load oa
Code ❑Yhan
es 255321e) ti oa p t 9 f ty a"W J.4 i a
" All roofs shall be inspected prior to any roofing material being installed.
. ..writhe Applicant or future W fired occupant as Air Quality
devices Manait amt If a roof is installed Without first obtaining an inspection, I'agree to`remove
d
ich
An n heza d' Qual ty Management
bone? ontammantm an fined b he Ba A ¢Air all new.materials for inspection. Applicant understands and will comply with
r r
°Y all non-point source regulations. „ it I,
1 have Health
&Safety
h zCd os materials regm25533 a tinder Chapter 6.95 d the
Caleb n Heald s Safety Cade,Sections 25505.25533 and 25534 I undersmnd that
"if the bcildin does not currcnd hale ale -
g y ennnt,that it i;no mspnosibility m notify the
occupant of the rats which must be m prior m issuance of a Cettifc m'of
pa q
eSignature of Applicant
Date
Date r amlmared agent All roof coverings
to be Class 'B"or better
.! ;`�' ,.. '. •} OFFICE
L12 j....