03010198 (3) CITY OF CUPEWHNO =m" °
BUILDINC DIVISION PERMIT CONTRACTOR INFORMATION,:�.
«,. „mac;
BUILDING A DDRESS: REED ARTHUR M AND JEANNE K �J NO,
10990 MARIA ROSA WAY
NEWS NAMH. APPLICATION SUB DATE
REED ARTHUR M AND JEANNE K U 01/30/2003
IONF: SANITARY NO, CON'IROLNO.
ARCHITFC ICNGINEER: BUILDING PERMIT INFO
BLDG EISCf PLUMB MFCH
0 0 0 0
foo LICENSED CONTRACTORSDFCLARATION JobDescri lion
u P 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing p
with Seelien 7(XMp of Division 3 of me Business and Professions Code.and my license is
in taumrec and erred. SHEAR WALL IN FM RM P�NALE®
b License Class Lic.N
p N_ Date Cameeme
P—�� ARCHOFCPLA
S DECRATION
I understand my plans shall be used as pride record, MAR 0-4 2003
LLa Licensed Prolessional
OWNER-0UILUF.R DECLARATION
rc <s I hereby affirm that I am exempt from the Contractors License Law for the BUILDING
ma.O o following reason.(Section 703 L.5,Business and Professions Cale:Any city or county
a'x$ which requires a permit to construct,alter,improve,demolish.or repair any structure
1t0zj, pnnnn its ism:mm.also squires the applicant ler such Fermi t to file a signed statement
rqx < that he is licensed pursuant to the provisions of the Contractor's License Lms(Chapter 9 Sq. FL Floor Area $,g"tion
C�$ (commencing with Section 700h)of Division 3 of the Business and Professions Code)or
—
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant fur a permit subjects the aptilicanuo a civil penalty of
not more than five hundred dollars(550(1). E Occupancy Type
1,as owner of the property,Lir my employees with wages a their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.]fW4,Business Tot —
and Professions Code:The Ceremonious License Law does not apply to an owner of 102 — PIERS equlred Inspections
prepeny who builds or improve thereon,and who does such work himself or through his
own employees,provided that such improvements ere not intended or offered for sale.If, 103 — UFER
however,the building or improvement is sold within one year of completion,the owner-
budder will have the burden of proving that he did not build or improve for purpose of 104 — REBAR
sale')' 105 — ANCHOR BOLTS
C]1.as owner of the property,am exclusively contracting with licensed contractors to 106 — SEWER & WATER
construct the project(Sea]BW,Business and Professions Code:)The Contractor's Li.
cerise Law dor no applytoa owner ifpropenyw builds or improv theemn,end 202 — UNDERFLOOR PLUMBING
who cause rsae cap c icesedparsaambtheeentroemrs' 203 — UNDERFLOOR MECHANICAL
cent
lam xempt n c B&PCf rthis easnn 204 — UNDERFLOOR FRAME
1 30205 — UNDERFLOOR INSULATION
WORK ER'SCOMPENSATIO DECLAR 301 — ROUGH PLUMBING
/I hereby afinn under penally of perjury one O Ilan following declarations: 302 — TUB & OR SHOWER
❑1 have and will maintain Section
37me of the Lab r Code,
for t for Worker's ce of th-
sation,r provided for by Seninn 3]1X1 of the Labor Cndc,for the perfnrmencc of me 303 — ROUGH MECHANICAL
work far which this permit is issued. 304 — ROUGH ELECTRICAL
❑ 1 have and will maintain Workers Compensation Insurance,as required by Section 305 — FRAME
3]00 of me Labor Cale,for the pcomorm race of the work for which this permit is issued.
My Worker's Compensation lnsumnce caner and Policy number are: 306 — HOLDOWNS
Carrier: Policy No.: 307 — INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMP17NSATION INSURANCE 306 — SHEETROCK
O'hismctionnecdee pleted,fmc W�,011oroncundreJdnllars(Slat) 309 — EXTERIOR LATH
or leas,) 310 — INTERIOR LATH
I ecedly that in r an is issued.)shall not 311 — SCRATCH COAT
employ., .,a Sn an kers'Compensation
Lawps�nr rani 313 — ROOF NAIL
N,yG�IrO PL ANT:II.alter making 's Certificate of Exemption,you should 501 — FINAL ELECTRICAL ENERGY
beVV�Sme titter ro the Worker's Compensation provisions of the Labor code,you must 502 — FINAL PLUMBING ENERGY
O ,Z' forthwith comply with such provisions or this permit shall he deemed revoked.
ZED CONSTRUCI'IONLENUINGAGF.NCY 503 - FINAL MECHANICAL ENERGY
FI therebyrition Out there is a construction lending agency for the performance of 504 - FINAL BUILDING ENERGY
0' the week lin which this permil is issued(See 3097.Cis.C.)
W Len505 — FINAL ELECTRICAL
der's Namc
z Lenders Add is 506 — GAS TEST
U O I certify that 1 have read this application and state that On above information is 507 — FINAL PLUMBING
W P correct.I agree to comply with all city and county ordinances and state laws relating to
�U building construction.and hereby authorise represemmives of Nis city m enter upon the 5 FINAL MECHAN CAL
W obnve-mentioned property for inspection proposes. O9 FIN
F49a nify(We) to save,indemand keep hmmlcas the City of Cupertino against
h lixbilitiesjudipit culls and expenses!,hich may inany wayaccmeagaiml said City rj G
fJ z APF A c the grSpl'n DS hes D\ ILL COMPLY WITH ALL NON POINT Issued by51 — WORKS Date
S RC IKON .
3 Re-roofs
Si at rc of Applic.mu Commelor ale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will theapplicamorfumra triddingoccupam etoeeorh.rale ardouemaacmd
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
e.secret zsvzlan
❑Yes All roofs shall be inspected prior to any roofing material being installed.
'� o
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
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for Inspection.
DisncO
❑Yes >15010
I have it In irdous materials requirements under Chap ter 695 of be Califor
ria l Icahn rely al tions 3 5111umkreandmm if the holding
does not exod a le 0 it is m cep ibility m nosily the oecupmn of the
require cntsw It me
trmiss c ❑cenfirteor are Signature of Applicant Dale
orawhnriaed agent I Dmc� All roof coverings to be Class "B"or better