03070181 (4) CITY OF CUPERTINo
BUILDING DIVISION PERMIT C0NTR-NOTQR INFQRMATIQN, _
nm1.DINe ADDRESS: SUNDANCE SKYLIGHTS PERMITND03070181.
ER'S NAME: 10585 FOOTHILL AVE PERMIT ISSUE DATE
ONE: (408) 842-9540 SANITARY NO. CONTROL N0.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
y00 LICENSED CONTRACTOR'S DECLARATION Job Description
U 1 Mmhy affirm IMI I..lift dun"or pro mons of Chapter 9(commencing p
with Sccao fD' n3of Ne But en Professions Code
and my he...,
Hi full Jmc lien.
Lice ea n Lie.A �� 2 SUN TUNNEL/1 SKYLIGHT r�� A
Z;: Date Cuntr r FUU�a6a LIED.
ARCHITECTS D A ATION
fund., and my Phns.hatl M used.public recnNs q
:�0 Licensed Professional AUG 1 V 2003
3 OWNER-BUILDER DECLARATION
<f 1 hereby affirm that 1 em exempt from the Contractor's License Lew for the
s n 0 f.11rwmfl mason.(Section 71171.5,Business and Professions Code:Any city or county I
K 2 which requires a Permit to construct,eller,improve,demolish,or repair any structure h a
wir prior to its issuance.also requires the applicant for such Permit to file a signed statement
my that he is licensed pursuant I.the rovimonsnfthe ComrasmiLao,,(Chapter9 Sq. Ft. Floor Area Valuation
me 0 p(commencing with Section 71100)of Division 3 of the Businessml Professions Code)or
r3$ Thal he is exempt thueh.m and the basis for the.11m,ed exemption.Any violation of
Section 707 L5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
not more Nan five hundred della.(5500),
D I,As Owner of the property,or my employees with wages As their sole compensation,
will do the work,and the.w.um is not intended or ormool(or sale(See.7044,Business 101 - FOUNDA d Inspections
and Professions Code:The Conuacmr's License law does cool Apply to m owner of
,,open who build,or improve thcreom And who daa.uch work himself.,through his 102 - PIERS
Own employees,provided that such improvements Art not intended or offered for sale.If, lO3 — LIFER
however,On building or improvemem is sold within ore Jets of completion.Ne nwnco-
builder will have the burden of proving dust M did not build Or improve for pump=of 104 - REBAR
sale.).
1,as Owner of the pmpeny,am exclusively contracting with licensed contractors to 105 - ANCHOR BOLTS
construct the project(Sec.7tM4.Business and Professions Code:)no Contractor'.U. 106 — SEWER & WATER
curse law docs not apply to an owner of property who Wilds or improves human,and,
who contracts for such project.with a conlnctons)licensed pursuant o the Contractors 202 - UNDERFLOOR PLUMBING
License
.la &w.
0I atm exempt under Sec. B PC(orbit mason 203 - UNDERFLOOR MECHANICAL
204 - UNDERFLOOR FRAME
er ate
WORKER'S COMPENSATIONDECLARADTION 205 - UNDERFLOOR INSULATION
Ihereby affirm under Penalty ofperjury One Of the following decimations: 301 - ROUGH PLUMBING
I
have and will main.ioa CertiOeConsent te or Conseno wl6lnaum for Worker's Compete 302 — TUB & OR SHOWER
motion,as provided for by Section 7700 of the labor Code,for 0.performance of the 3 03 — ROUGH MECHANICAL
work for which this Permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as rryuired by Section 3 04 - ROUGH ELECTRICAL
37110 of NC Labor Code.for she performance of the work for which this permit i.issueJ. 305 — FRAME
y Wo fir".Cj'p/m Pe ten nonce artier and Policy oumMr re: 306 - HOLDOWNS
— - CERTIFICFTIONYFRO R 307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
it,Ice.)(This sectioe need not W canplelNlftlte Permit u forom,hundred dollare(SIM) 309 - EXTERIOR LATH
I ccnify that in the Performance nr the work for which this permit Is ixsucd,Ishan not 310 — INTERIOR LATH
employ any person in any mannersnas In become subject o lMWorkcri Compensation 311 — SCRATCH COAT
Laws of California,Date
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT.If.aftermaking this Certificate or Exemption.you should 501 - FINAL ELECTRICAL ENERGY
Wcome subject to the Work.„Compensation previsions of be labor Code,you mus'
�zz forthwith comply with such pmviaine or this permit shall W decond rooked. 502 — FINAL PLUMBING ENERGY \
Z^ CONSTRUCIONLENDINGAGENCY 503 - FINAL MECHANICAL ENERGY
'F Mrenyarnrm
that thereisaconstruction lending agency for the Performance of 504 - FINAL BUILDING ENERGY
rl .� Ne work her which this Permit is issued(See.301 Civ.C.)
i p LenderxName
505 - FINAL ELECTRICAL
= andersAeem.
z 506 - GAS TEST
U O I certify that l have read this application and some that the above information ix 5 0 7 - FINAL PLUMBING
Iy comet.l Agree to comply with all city and county ordinances and sate,I....ela'ing to
OU building construction,and hereby authorim representatives or Nis city to enter upon the FIN MECWNG
CAL
C Hove-memioned property for inspection purposes.
(We)eS.d to save,indemnify and keep harmless the City of Cupertino against O 9 F I
y liebilitiu,j.dgmcnts,costs and expense may in any way eecmngalnal mid Ci'y 5 z in consequence of Ne prming of thisiAPPLICANT UNDERST DS D OMPLY WITH ALL NON-POINT Issued by:5 WORKS Date
SOURCE TIO -^
/ Re-roofs —07
i etas of Applican on ctor Date'
AZ DOUS MATERIALS DISCLO RE Type of Roof
will the app(ce of fuwrc building occupmfemrc or handle henrdous material
As
if
by the C Winn Municipal Code.Chapter 9.13,and the health and Safety
Jc, 0yes 35573(.)? NA. All roofs shall be inspected prior to any roofing material being installed.
❑Yex
Will the'nRcam Or future JJi d9mo.pam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hanNnus air c.ntaminan. defined by .the Bay Area Air Quality Management all new materials for inspection.
District?
DYcs N.
1 have mad the handms materials requirements under Chapter 6.95 of the Califon
hie Hcalth"afetycodc.SccUmu S5J7 and2553C.l understand but five Wilding
does not c ntl here nam,Net 11 my r pomiM1ility b hoary the occupant of the
r tai chm ois.. cerofic.temrae.p `y' Signature of Applicant Date
er or authon adtit Dam
All roof coverings to be Class 'B"or better
Ow
7