03010054 (2) crry of cul»r:e two Eek
BUILDING DIVISION PERMIT '�ONTRACT,OR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
921 S STELLING RD 03010054
OWNER'S NAME: APPLICATION SUR DATE
fik KAN JAMES AND CELIA 01/09/2003
1
ZONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
r00 LICENSED CONTRACTOR'S DECLARATION
n F 1 hereby afF nt that I am licensed under provisions of Chapter 9(co mencing Job Description
w with on,
Division 3or the Btheipevsand Professio CW0.and license is
into m andrffe 0 UPGRADE SERVICE PANEL TO 200AM w� /�
ZcVi Lice s_!' /�!—I.ic.V»ec,9T �:IN a'+p ED
Oy�qq,p Dam s l� ARrCIInLCCor" .ARATION
O2 VI n stand my plans shall be used as F.hire records
waw° LicensedProfieW,Fal JAN 2 2 2003'
N=yo� OWNER-BUILDER DECLARATION p�/�
3a f I hereby.(tient that 1 um cEasin from the Contractor's :Airy Law for,M1c BUILDING
m.p O following meson.(Salon]RJ 1.5,Business and he Conions Codc:Any city w county
n 2( which requires a permit m construct,ager,improve,demolish,or repair any.mnacture
f-Zaprior to its issuance,also requires the applicant lorsuch permit file a signed statement
That he is licensed pursuunnn the prnvitiomofthe Cuntnnnr's License Law(Chafer 9 Sq. Ft. Floor Area 1VAIQltlon
G (commencing with Section]gXp of Division 3 of the Business and Professions Cnde)if
s. that be is exempt therefrom and the basis for the alleged exemption.Any violation of
Section]031.5 by any applicant for a permit subjects the applicant to a civil penally of "bepOccupancy not more man Eve hundred coach;(S5110). P y T'Pe
❑ I,as owner of the property,or my employees with wages as their axle compensation,
will do the work,and On, net..isnot intended or offered for sale(Sec.7I144,Business ]]J�����WW{{'' gqSpgf,f
and Professions Code:The Contractors License Law does not apply to an owner of 304 - ROUGH B7s£ fTPl l'.A11ons
property,who W iMscr improves themon,and who does such work himself orthrough his
own employees,provided that such improvements are not intended or offered for sale.If, 505 — FINAL ELECTRICAL
however,the building or improvement is mid within one year of completion,the owner-
builder will have the burden of proving that M did not Wild or improve for purpose of
sale)
❑I.as owner of the property,am exclusively contracting with licensed contractors to
consumer me project(Sec.7844,Business and Professions Code:)The Contractor's Lf.
crimelow does not apply to an owner of progeny who Wilds or improves themon,and
who contracts for such projects with a contrmtor(s)licensed p re uanuo the Contractor's
License Law.
[] l am exempt er Sec B&P C far his
/r nc�h
OwvEr WORKER' COMPENSATIONDION r /
7C.mi":
I hereby aRbm under penalty of perjury enc of ding declarations:
I hats and will mandain n Cenilleme ofConsent)sclginaute forWorkers Comperetion.a grnvided for by Section 3]fM)of the Ichor Code,for the performance of the
rk for which Nis gcrmit is issoeJ.
1 have and will maintain Worker's Compensation Insurance,as required by Section
(X1 of the lohnr Cnde,ler the perfnrmenee ofthe work for which this permit is issued.
y Worker's Compensatinn Ins trove carrier and Policy number am:
Policy Nu.:
CERTIFICATE OF EX HIM PITON FROM WORKERS'
COMPENSATION INSURANCE
Anis section need not M completed If IM permit is krone hundred dollars(SI(XB
,it Iess.)
I Comfy Our in the performance of the work for which this permit is issued,I shall not
employ any mson in any mmnrr an as to kcome subject l9 the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker'a Compensation previsions of the"Me Code,you must
OO forthwith comply with such provisions or this Permit shall he deemed revoked.
Z y CONSTRUCTION LENDING AGENCY
[r I hereby affirm mm there is a Construction lending agency for the Performance of
Ne work lar which this permit is issued(Sec.3097,Co,CJ
Le /Y
W Q nder's Name
Aa
p z Lcndcr's Address t
U 0 1 certify that 1 have read this application and soon mat the above information is
V. F correct.1 agree to comply with all city and county oNinances and sumo laws relating to
0U building Constriction,and hereby authoriet repremnotivice of this city to enter upon the
>a W above-mentioned property for inspection purposes.
(We)agree m save,indemnify and keep harmless the City of Cupertino against I
,(•"y y liabilioies,judgments,com,and expenses which may in any way aceme against said Ci ly //
V Z inc,eewcuence nr the granting or This Fermi 1,
19el
APPLICANT UNDER ANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date
soulxcc RecuLnT 6 Re-roofs
elure of Applici n"Comm�mor
HAZARDOUS ATERIALS DISCLOSURE Type of Roof
Will the npplicam nr fmurc building occupant store or handle harudous material
as defined by the Cupeninn Municipal Code.Chapter 9.12,and the Health and Safety
I
ode,5yain sax All roofs shall be inspected prior to any roofing material being installed.
/KrfYcgy L.Sno
wise the
up
team or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit mourdous air contaminants as dclined by the Bay Area Air Quality Management all new materials for inspection.
isnic ///���
Y /1- XNo
I haww the Weallous materials requirements underChapmr 6.95 oftW Califim
x Halm&Safcl Cndc.Sad(im 59)5,25533md MS34.IuMnmdthmifthc Wilding
oes not conte are a ran m.that it is my msfaaibilily o notify the aeupent of Ne
quiremenB ch mum melpryrrnTlSNmtnfaCmifiateaf -C .76) Signature of Applicant Date
v ! 9
own rmthnrivcdagen, � n,r All roof coverings to be Class "B" or better