02090054 (2) CITY OF CUPERTINOBUILDING DIVISION pg CONTRACTORINFUR ION '
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BUI(jD04Q)g5 1MILLCREST RD JIM NETZEL PERMIT NO 20900 S4
41 cD112f4AWETZEL APPLICAT09SP"TI,2 0 0 2
PHONE: SANITARY NO. CONTROL NO,
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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200 LICENSED CONTRACTOR'S DECLARATION
C I hereby affirm but 1 am Iiccnscd underinions of Chapter 9(uimmcncin e
<iC with Sc clan 7gNq of Division 3 of the Business and Professions Cock,and my borrow iss NEW SINGLE F SIS WI;LRJING
Or full force and effect.
4692 SQ. FT. LIVING SPACE
FZZ License Class Lic.N /
;-w Dam contractor 800 SQ. FT. GARAGE �®
ffCC ARCI I1TECf;S DECLARATION FINAL
y c< 1 understand my plans shall he used as public records
3`
Lt 0� Licensed Professional R pCT 2 4 2003
t.• < OWNEBUILDER DECLARATION
<f 1 hereby affirm that I am exempt from the Contractors License Law for the
u a O following reason,tSectinn 70335.Business and Professions Calc:Any city or county G
5 which requires a permit to construct,alter,improve,demolish,or repair any structure
Fir poor as its issuance.also requires the applicant for such permit to file a signed statement
O That he is lice.sed Pursuant to the I..vieonsof the Contractor's License Law(Chapler 9 Sq. Ft. Floor Area 776 ��I(llil[IO❑
$ (commencing with Section Was))of Division 3 of the Business and Professions Code)or
— that Ise us exempt therefrom and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant 10 a civil penalty of
not more than five hundmd dollars($500). be Occupancy Type
Q I,as owner of the progeny,or my employees with wages as their sole compensation,
will do dm work,and use structure is not intended or mbemd for sale(Sec.7044,Busineu
and Professions Code:The Cmdricim,License Law does not apply to an owner of 102 - PIERS equired Inspections
property who builds or improves thereon,and who Outwork himself onhmugh his
ownemployces.provided Nat such improvements are not intended oroffered forsele.If. 103 — UFER
however.me building or improvement issuld within one ycarofcompleuon,meowner 104 — REBAR .
Wilder will have the burden of proving mal he did not Wild or improve for purpose of
sale.). 105 — ANCHOR BOLTS
❑ I,as owner or me properlyam exclusively conlrecting with licensed contractors to 106 — SEWER & WATER
construct me pmjccl(Sec.76x4,Business and Professions Code:)The Contractors Li-
censeWwdeesnolapplymanownerofproPeny who Wilds or improves mcmnn,and 202 — UNDERFLOOR PLUMBING
who contracts for such projects with a ennvacmr(s)licensed pmsmnl It the Contractor's
203 — UNDERFLOOR MECHANICAL
lt`l am caw un c. ,Bar PCfm mast 204 - UNDERFLOOR FRAME
�� 205 - UNDERFLOOR INSULATION
Fir RKER'S COI PEI SAT]O rDECLARA N 301 — ROUGH PLUMBING
Thereby toe,under Penally of perjury one of the following dwhrauons: 302 — TUB & OR SHOWER
0]haw and will maintain a CcniOcam of Consenuo self-intim for Workers Compen-
sation,as provided for by Section 37(g of the Labor Code,for the Fcrfmmancc of the 3 03 — ROUGH MECHANICAL
work for which rots permit is issued. 304 — ROUGH ELECTRICAL
❑ I have and will mainum Workers Compensation Insurance,az¢stored by Section 305 — FRAME
370)of the"We Code.for dte performance of me work for which this pomp is issued.
My Worker sCompensation Insurance carrier and Policy number am: 306 - HOLDOWNS
Carter: Policy Na: 307 — INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 — SHEETROCK
(Thissecri.m nccJ nntMcnmplcteJ ifthc Tcrmilisliuunchundmddollars(kllal) 309 - EXTERIOR LATH
"I`if310 - INTERIOR LATH
I anifY that in me perfomtance of me work for which this permit is issued,l shall not
cm ploy any Fiction�i rt a er5�paetsj c tt,rclu)m,Worker comp nsa ion 311 — SCRATCH COAT
Ww.rrfcau "S"" ' 313 — ROOF NAIL
AppEcanl
ETO APPLIC :If.after making this CriiGcme of Ext prion.you ould 501 — FINAL ELECTRICAL ENERGY
c subject m rh�Worker's ComPcnsalinn provisions of the W Mu Ctrlc,you must
0 mmwimcomply with such pmvixionsorthis peraitshauthe deemed revoked. S02 — FINAL PLUMBING ENERGY
? O CONSTRUCTION LENDING AGENCY S03 - FINAL MECHANICAL ENERGY
s s r Performance of 504 - FINAL BUILDING ENERGY
[--� IWr which mi that here isaed(See 3 tendon aenc lonhe
x > theworkNuwnicnmis mirsiaatm(see3(re7,Co,
G')
l<ndcr's Name 505 — FINAL ELECTRICAL
34.1 Q
7 Z Under'sAddress 506 — GAS TEST
U O 1 certify mal I have read this application and state that the above information is S 0 7 — FINAL PLUMBING
Ly n toren.l agree to comply with all city and county ordinances and state laws relining to
p U building constoiction,and hereby authourrim Teprcwnmliyc.s of this city to enter upon the 5 FINAL MECHANICAL
Fw above-mentioned progeny for inspection purposes. O 9 — FIN $
y (Wit)agree losave.indemnify and mcpharmlccs the Cityof Cupeninoagaim,
h
liabilities.judgments,cosy and expenses which may in anyway accrue againsrsaidCity 5 N fi
U Z in cnnsequencco granting nl'IF permit, t! /
^ APPLIC ND A ILL COMPLY WITH ALL ON-P INT Issued by?1 WORKS Date r
50 ;REGUL ONS. ' ON ��
Re-roofs
Warmer bcanvcnnnt br Dae 603 - OF BATTENS
DAZARDOUS MATERIALS DISCLOSURE Type of 11&®f4 - ROOF IN-PROGRESS
Will me applicant or future Wilding occupant store nr handle ha/zrdous ma rnaf
az dcfned by the Cupeni01 Munm al Calc.Chapter 9.12,and the IIcaW and Safely
Je.Section 25532(a)7
❑Yea ;;Nu All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding KCOPamuse equipment ordevices which If a roof is installed without first obtaining an inspection,I agree to remove
emir hx/ardnus airconumio i moil by the Bay Area Air Quality Management all new materials for inspection.
Disuia3
❑Ycs No
I have read the bavardaus maNrials acquirements under ChapterM1 95 of me teCalifor-
nieHcalmdeSa�lyC�+ ,Section 25N15.25533 and 25534.f uokedard mal if On building
does our If�catty have nant my resplmialily to noufy IM nc.prom the
requi chair which onme riser ante ora Certs`—
ate of /P%'/
Signature of Applicant Date r
own r armor dag Dale All roof coverings to be Class "B" or better