03040122 (2) CITY OF CUPERTINO " '" `• �`"'7 i-r- ,
BUILDINODIVISION PERMIT iCONTR�,CT�OR=IN 'UTiMA ,ION
s+$ xa'z.'Ce� b Y?9t� erlar; M. s-"�!,^£C
B211:F1Vla15DRMEGNART RD JACOBS JOAN L AND ELLIS L PERMITNG.03040122
UEPR JOAN L AND ELL I S L PERMIT ISEtUaAA 5/2003
E; SANITARY NtOJ.4CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 O O
loo LICENSED CONRACIOWSDECLARATION Job Descri tion
1 hereby allinm that I am licensed umlcr prevnsisioof Chapnr 9(commencing P
sx pp<pp
rnfull foeendwhuSeamsvolcffcel ADD 112 SQ. FT.)afDlvision3ofduBusinwmdProfeWnnaCode,mdmYlicentsis F11YAL.E0
j q 2L
oats Dam Class Lk,N
—Contractor DEC
ARCHITECTS DECLARATION OCT . 2 2003
f I understand my piens shall W recd a recordspublicrecords
J
uo'3 tI..
Lkensed Profeuinnal
a.77 OWNER-BUILDER DECLARATION WILDING
1 hereby.(Sm that 1am 1.,Busies from Bu Contractor's Ccx LiAny C Law for the
O o which following mess.(Section R)n1.5,Business and r Pre.dem nal Code;Any city m county
$ which its Issaapenin reennawm,ahe9impmw,h Permits me repair ig any mmmun
_ANY pdsroitsiensedprsunttouance.Alan the the of for smhpcmi'lU.n Law(ned Chapter
p€tro (co mecingwiit pursuant the provisions of or anBusiness
Contractor'. Pmfoaro Chapmr9 Sq.Ft. Floor Area $18V�� iOn
t (commencing Section and
of bail for
nftWeged exemton.Any viCnde)of Y
Q�$ But W ts exempt thcrtfmm and the baso fm ted alleged exemption.Any violation of
Section 7031.5 by any applicant for.permit subjects the applicant to a civil penalty of 3 6819 MMISer 0 0 Occupancy Type
not mom than five hundred dollen(SMO).
❑
1,As owner of the property,or my employees with wages As their into compensation, (�7�T
will do the work,and the swclure is not intended or offered for nlc(Sec.7044,Business — ryry(Eed Inspections
and Professions Cade:The Contractor's License Law dura ant apply t9 an owner of 102 — PIERS
property who builds m improves reon
the ,and who does such work himself an thmugh Ma
own employm,.pm'ided UMMAch improvements son not Intended oroffered fm We.It. 103 — UFER
however,lin Wilding or Improvement is to within on:5car of mmpleuon.the manner.
builder will have the burden of pmvmg that W did not Wild or Improve for purpose of 104 — REBAR
AMC.). 105 - ANCHOR BOLTS
❑1.as owner of the property,am eaclmlvely contracting with licensed contractors to
construct the project(Eec.7(4x,Business and Professions CWe:)no CsautaM1 Li. 106 — SEWER & WATER
cents Law docs not apply to an owner of property who Wilds or improves themon,and, 202 — UNDERFLOOR PLUMBING
who Contracts for inch projects with a commular(Q licensed pursuant m the Cantsutors
Ll ruse law. 203 - UNDERFLOOR MECHANICAL
f j
WI Am nempt r .B k P C for this meson
fY` m252-Sa/� 204 - UNDERFLOOR FRAME
WORKER'S CO PE A ON DEC ATION 205 - UNDERFLOOR INSULATION
I hereby anis under penally of d one of the following dedanliom: 301 — ROUGH PLUMBING
O l haw and will maintain a CeNfiouo mentoself-ImurefmwoionesCompen- 302 — TUB & OR SHOWER
union,As provided for by Section 7700 of the labor Code.for the performance,of the 303 - ROUGH MECHANICAL
work for wmehthis permulalaeed. 304 - ROUGH ELECTRICAL
1 haw and will maintain Worker's Compenutlon Insurance,As required by Section
3700 of the Ube,Code.for the performance of the work for which this permit is issued. 3O5 — FRAME
My Workees Compensation lnrunnce carrier and Policy number am: 306 — HOLDOWNS -
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
CMU section need nothecompmed lHW Permit s forme hundred dams(51110) 309 — EXTERIOR LATH
or k.s.)
1 ccnify roar In thdperfn ,once of the work for which Nis permit Is issued,I shell not 310 - INTERIOR LATH
employ any Peron lT mmncrmub Woman subject to Ne Workers'Compensnlon 311 — SCRATCH COAT
Lawanrcanr r 313 - ROOF NAIL
A Ik.m
N I TOcltoOnANDLacer ruking M..ts Exemption,you 501 - FINAL ELECTRICAL ENERGY
suomp to the Woth prof or this prrotti hal of the tabor wkc,yen mm
,J�. forthwith Comply with such provision or this pcmil.hallWdcemed towkcd. SO2 — FINAL PLUMBING ENERGY
�� CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
i--r Ihereby affirm that them isAconstruction lending agency for Onperformanceof 504 - FINAL BUILDING ENERGY
pG> the work for which this school isissued(Sec.3097.Civ.C.)
W Q Lender's Name 505 - FINAL ELECTRICAL
=z LeedefaAddna. 506 - GAS TEST
V O I certify that l haw read this application and tuts that the show information is 507 - FINAL PLUMBING
Iy Comet,1 agree to comply with all city and county ordinances and swe law totaling to
O building construction,And hereby authorice MPACAMMIRLIM of this city to enter Upon W FIN MECI CAL
{Ll alow,nu m omcd property for impecdon purposes.
gy
(We).gree to sew,indemnify and keep Months On City of Cupertino against O 9 F I N
A5 lubilitica,judgments,costs and expenses which may In any myeceue against lend City 5 NG
In conscquence of ft V APPLICANT UNDERSTANDS of IAIND WILL COMPLY WITH ALL NON-POINT Issued by:5 WORKS Date
SOUR E ULAn iS.
Re-roofs
ne of April...VC raninr Dau
H RDOUE MATERIALS OISCLOSUR Type Of ROOF
witi eapplica or future building occupant pore or handle hayardous material
As defined by the Cupertino Municipal Code,Chapter 9.11,and the Hcalth and Safety
Code,Section 355324P on All roofs shall be inspected prior to any roofing material being installed.
"Yu
Will the applicant or future Wilding occupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
CHI hamrdous air contaminants M kancd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes KNu
I have rtW the harudmsmaurlals toqultomems under Chapur6.95 ofthe Califon.
n6 IOBSdctycode.Snvwn 25505.25575 and 23534.I Understand thu BIW Wining -
dots n currently haw.Consul.Nat it is my respomibllity An notify the oneupant of Oc
mqu wic mostt anmiunance neenfre.wotGc n. Signature of Applicant Date
Owne,m amhodyed accnt k Odle All roof coverings to be Class"B" or better