03090157 (2) CI'T'Y OF CUPERTINO `y: .
BUILDING DIVISION PERMIT ICONT"CT RiINF�ORMATION
BUIL DING ADDRESS: BOYD THOMAS C AND JANE P PERMITN003O9O157
,R'S NAME: PERMIT ISSUE DATE
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
±tee, E LICENSED CONTRACTOR'S DECLARATION
iI hereby affirm that I am acrosell udacr provisions of Chapter 9(commencing Job Description
with seen (U))af Division3Df NCB sand Professions Code,and my license is
o. w fuse rut d c
Lee Ile," a 97 DECK (E) BACKYARD
Da cum CONTRACTOR: FREIDIN LANDSCAPING & DESIGN
FARCHITECT LARATION
f C understand my plans shall he used as public records
G Licensed Pndcssional
PINALED
7 5
OWNER-BUILDER DECLARATION
Contr ON (� Q �J
2<I I maxam affirm on I am exempt from Nc Comms Co :Ad,c Law for the OCT 1 a/ 2003
5 O O which ire rcmon.(Section 11151.5,Business and rProfessions Code:Any maty of county
$ which rcyu;ma a petmi(m construct,eller,imposes.,demolish,or repair any dstate inn
_i y mionn sB i licensed
pursuant
to the thovisio al of for Contractor's
to 0ense Law statement
that he islicensed purstion 7Ne at Divinnof theeBusinessa License Law(ChapterCode)or
Sq.Ft. Floor Area �' 11 d(RDIIQ 00
e dommmneing m.,It Section and
the
Division the
theeged and Professions ,�11„a/�
��$ that he la eacmpl Nertfrom ane dte brats(or Ne alleged exemption.Any violation of �}�h
Section 7031.5 by any appimset rot a permit subjects the applicant to a civil penalty of B M1W��erOO Occupancy Type
nos mart than fiw handled dollara SSM). - -- --- - --" P Y ------ -
❑I,as owner of the property,or my cmploycea with wages as their auto compensation,
ME do the work and Ne structure is not intended ormff ddd(Quare(See.7044,Bu,imm
and Professions Code:The Conubmbw,License Law docs not apply to in owner of Required Inspections
properly who builds or improves Nercon,and who does such work mrmatior through his 101 - FOUNDATION
own employees,provided that such improvements tie not intended or offered for sale.If. 102 - PIERS
however,Ne building or improvement is sold which one year of completion,the owner.
builder will hathe burden of proving Nat he did not Wild or improve for purpose of 103 - UFER
1. 104
ve
❑1,as owner of the Property,am exclusively contracting with Ifeenmd contractors to
1 04 - REBAR
convect Ne paoject(Sec.7014,Business and Professions Code:)The Contractors Li- 105 - ANCHOR BOLTS.
crow law does not apply to in owner of property who Wi ids or improves lhncon.md 106 - SEWER & WATER
who contracts(of such pmjeco with a convactor(U licensed pursuant to Nm
e Concmr'a'
°omLaw' 202 - UNDERFLOOR PLUMBING
m exempt under Sec. O At P C for this moon 203 - UNDERFLOOR MECHANICAL
137MWORKER'S COMPENSATIONDECLARADTION 204 - UNDERFLOOR FRAME
I hereby efforn under penalty of pwr;ury one or she following declarations: 205 - UNDERFLOOR INSULATION
ese and will maintain a Certificate of consent to ulf-iosam for Worker',Compmn- 301 - ROUGH PLUMBING
u provided fur by Section 37W Of the labor Code.for did performance of die 302 - TUB & OR SHOWER
for which this permit is issued.
ave and will maintain Worker's Compenation Insurance,a mr,lmd by Section 303 - ROUGH MECHANICALof Nc labor Code,rot the performance ofthe work fnr which Ni,permit is issued, 304 - ROUGH ELECTRICAL
orkets Compensation Insurance carrier and Policy number art: 305 - FRAME
Carrier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS' 306 - HOLDOWNS
COMPENSATION INSURANCE 307 - INSULATION
it,Ices.)(no,.0.need no he completed if the permit is fm one hundred dollars(SIM) 308 - SHEETROCK
1 certifyNm in Nc pts roan.of the work rot which But,permit u issued.)shag but 309 - EXTERIOR LATH
employ by
personi yma2n s y�te .come subject the Wmkeri Compensation 310 — INTERIOR LATH
uw,orc,Rry ace tt311 - SCRATCH COAT
Ap is I -
NO TOAPPtCANT:1 altermaking this yisionsorofExemption,dyou ahoust 313 ROOF NAIL
e suhjcct to the Workcu Camlenmtion provision of the lahnr Cnde,you must
] ,Z ronhwiih comply with such provision orthis permit shall hi,deemed mvoked. 501 - FINAL ELECTRICAL ENERGY
Z O CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
I botchy am. at
them i .tion umelinn lending agency for Performance of 503 - FINAL MECHANICAL ENERGY
Y the work rut which the permit ts issued(Sec.3097.Civ.C.)
x7 p IandetsName 504 - FINAL BUILDING ENERGY
Lender's Address
DZ 505 - FINAL ELECTRICAL
;,>p I ccnify that I have read this application end u m that the shove information is 506 - GAS TEST
y F correct.1 agree to comply with all city and county ordinances and state laws totaling to
�U building construction,and botchy amhorim repreuma0ve,of this city to enter upon the FI&&ING
G
4 above-mentioned Property for inspection purposes
y (Wc)agree m rove,indemnify and keep harmless the City of Cupertino against 0 8 F IL
y
liabilities,judgments,costs and expense,which may in any way accrue agaim(mid City 5
of did
J z APPLICANTcUNDERSTANDS this
ND TWILL COMPLY WI ALL NON- DINT Issued bY:5 Date
SOURCER UL
Re-roofs 4 NAL PUBLIC WORKS
S' na re of pdical Comoro, Date
AZAR MATERIALS DISCLOSURE Type of Roof
Will the applicant ar future building Occupant score or handle hararduus material
defined by the Cupertino Municipal,Code.Chapter 9.12,and the Irealth and Safely
Section 2ss3xa)T A All roofs shall be inspected prior to any roofing material being installed.
Yc,
Will
Ne applicant or furore buildingocv:upam tau equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
i(booldious air contaminants m de0ned by Ne Bay Area Ali Ouali(y Management all new materials for inspection.
rxvic(7 /t
❑Yes ae:rJJyla.-
I ftw mad the hmarduua materials leyuircircno under Chapter 6.95 of the Califon
nix Health k Safety Code,SOO(ow 25505,35533 ad 25534.1 understand N(ifIW Wilding
the4 not v'urtcnl y M1avc a Icnan4 Nat it is my rcsporoihilily m nnti y the t'cupant are
rcyuiremc b met Mor issuance of a Certificate of Occup cy.
"` g tureofApplicant Date
rte; Da All roof coverings to be Class"B"or better