02040123 (3) CI BUIL OF G DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
20881 TULA CT WM H FRY CONSTRUCTION CCMPANY 02040123
OWNER'S NAME: APPLICATION SUB DATE
MERALA MARK 10351 SAN FERNANDO AVE 04/22/2002
J ONE: SANITARY NO. CONTROL NO.
(408) 996-8173
rzz ARCHITECTM-NGINEEW BUILDING PERMIT INFO
m F9F BLDG ELECT PLUMB MBCH
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S�2 LICENSED CONTRACTOR'S DECLARATION
v= I hereby tiff that l am licensed under provisions of Chapter 9(commencing Job Description sss�
�.�ytw with Section 7000)of Division 3 of the Businessan Profession,Code,and my license REMODEL FIIVAL.E®
p< is in full art end crc r A
OW 6 License C - Lic.X S-Zu,7 S T
a. to Contrw.gy JL✓.w .11kl S�r 25
3'S.,, ARCHITECT'S DELL ATION DEC 1 2 2002
Pj 1 undersand my plc s shall be used as pobl ie records
i��f
t a o Liren,ed
Professional BUILDING
'a Oat I son exempt tr DECLARATION
t R-' 1 hereby.Mita that 1 exempt from the Contractor's is License law for the
t?< following requires
reason.permit
t 7031.5.Business and Professions Code:Any cin or county $27500
D
which q pc t io construct, h r,improve demolish,or repay any suucmre
prim rat ' eb yie th pplicwt(or such peminofleeagned stammem
lins. .-1' tlp n Chep ns of theCnno-cmisl,iccnselaw(Chepter9 „ $u,F(, II�n,�{ p�.> Valuation
fico e g tit Scct ]fila) f U a i t al the Business end air.Any vi Code) s,.( ��• ! 3 5.71"��,b L"• •V Fx.l'.).R`ft•! i�..h 4'
or that he n exempt thcrcTnm and the basis for the ellegetl exempt(an .Illy violation
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty A t� , Occupancy Type
:of not mare than live hundred dollar:(5500), 1014PN-i 8ft DATION `
°1,as owner of the propcny,or my employees with wages as their sole compensation, 102 _ PIER
will do the work,'end the swnure is not intended car offered for sale(Sec 761 -
'Bustm
Business and Professions Code:The Contractor's License Law does napply to an 103 - 'UFER Required Inspections
own ` '• `
er of property Who builds or improves thereon,and who doss such work himself
or through h' npl yeas.provided that such improvements are nor intended or - 104 ,,r, REBAR
offeredf -- I If.1 er theb"ld'ng p t s Id inn one Ycw of - _.__ _ ...__ .. .. ,.. .... ._,-.. ., ... -.__.. .._._.. _.
ompletion,the ownerbulder will have the burden of proving that he did not bola or 105 - ANCHOR BOLTS •"` ' '
improve for Purpose ideal"). 106 - SEWER & WATER __
- - -
. ❑Las owner or the pmpenr..m exdumdy commcdng with licensed commrtm,m - 202- - UNDERFLOORS PLUMBING ' _ •• .. ..• .. .. .
courtmet the project(Sec.7 4,Business and Profusions Code:)The Contractor's _
License Law duct not apply to an owner of property who builds or improves thereon, 203 - UNDERFLOOR MECHANICAL• '
_ r
.andwimcontracts for.such projects with a commmorty)licensed pursuant,to,Ne -2 _._-._...._._._._.-.__._....._
Cantmmors License Law., - _. "" 04"" UNDERFLOOR- FRAME__.__ --
❑lamexemptupaersea .e'&rcfor this reason 205 - UNDERFLOOR INSULATION
Owner'' Date 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
by affirm under Itrof 302 - TUB & OR SHOWER
I here
`y pia , pro an onnef°Bowingarolaadon.: 303 - ROUGH MECHANICAL
° 1 have and will onintain a Certificate of Consent to self-insure for worker's 304 - ROUGH ELECTRICAL
Compensation, as provided for by Section 37W of-the Labor Code, for the
performance of the work for which this pe m,it is issued. 305 - FRAME
°1 have antl'wili maintain Worker's Compensation Insurance,as required by Section 306 - HOLDOWNS
.: 37Oo of the Labor Cade,for the performance of the work for h 1 this permit is
C issued.My Worker's C°npensatian Insurance aro and PoI y number,am:. 307 - INSULATION
caber l714m r9L' •t.'S'.policyN I . 3108-1`-`SHEETROCK.--.,,5
CPRTIFICATION OF E%EMI'l ION FROM WORKERS'-
COMPENSATION
ORKERS COMPENSATION INSURANCE _ _
T0; =. `,INTERIOR--LATH -- i.
Ma acctwn tad not he complcied if the permit is for one hundred dollars +
(51a0)ar le,,.) 311 - SCRATCH COAT
1 c Noy that in&perfomian<e of the work for which this permit is i„ped,_1 - 313'..- .ROOF- NAI Lg_' i 'r;•I,. -'.-”"" . . "
shall temploy any pewn n any annersoastoNomewsubject t the Workers' 501 - FINAL ELECTRICAL' ENERGY i
NOFIC TOAD the kep,cm n -502 --- -FINAL--PLUMBING .ENERGY - - - --- -
ompcnsauon lawso al o Data
Applicant - _ _ -_
NOTICE TO APPLICANT'.WmIkf, Compensfill ator,provisions
Cesi fnso of Exempt ybuuh Id
'� ,. , pe soti spec rajhall the Labor you must 503 - FINAL MECHANICAL ENERGY
pp mrtnithrml wun,rn n or this permit,hmlbede ed re kee, . .._504.-.- -FINAL -.BUILDING_'ENERGY. ...
CONSTRUCTIONisaconstruction lending
AGENCY
m
E"'^�' •Ire¢byarmmunnemereiaeon,wmmnlendmgagenrytortneperfortnanre SOS - FINAL ELECTRICAL •
or the work far which this permit is ised(Sec.3097,Civ.C.)
y p -Lcndcr',Name'- su506 =- GAS_ TEST..—
D z Lend ,Ade 507 - FINAL PLUMBING.
UO 1enfythcompemad thappfcato dtmancesthe above telawsinformation lating 508 - FINAL MECHANICAL ! A Q
ri'Ea 1.brtlog t too
with it gand euorotlnacresand,atelawser ng 509 - FINAL GRADE
' p V nob Id gc i t and by th r p e move,of th",crymcnmr upon
>1 'he the oboe-men"
mad property for inspection purposes ,_ ., 510 - FINAL PLANNING
pa (We)agree to save,indemnity and keep harmless the City of Cupertino against
L In liabilities,Fragments.costs and expenses which may in any way arrive ageins!avid 514 - FINA PU I C WORKS
:C.);z City in consequence afire gmnting of this permit.
APPCi_ANm
I',UNDERSTANDS AND WILL COMPLY WITH'ALL NON INT v (/
Issued by: Date
�o
gnamre of Ap�nJcati tat—: ,.,. Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE .
Wm the applicant or future brilding occupant arm or hdleha,amau:material TypeofRoof.-. ... . - . . .
- as defined by the Cupertino Municipal Code Chapter 9 12 and the Health and Safety
-"
Code S-t ,.25532(.)] w . . . . ^. ..
All roof§shall be-inspected prtorttfi any roofing rnatena] being installed.
o
Will the applicant or future Wilding occupant use equipment or deuces which If a roof is installed without first obtaining an inspection;1'agree to'remove
nit he and air contaminants as defined by the Bey Aiea A' Quelin Managcmem ,
refs. w�T anrt rtuf all new materials for inspection Applicant understands and will comply with
ser! w q __. - - _ - .-. .. ., .
°Ye all°non-point so lice regulations
ha a rad the h ab material uucmeine under Chapin 695'of the
California Health&Safety CodeSect ons 25505;25533 and 25534 1 understand that
tthe building tdoesnotircutcen ly whaveaTenam, hot It omy. ss.aresibilimmrotify the -' --- '•' - -
occup- t of the requirzmcmx which man he met prior to issuance of a Cctificam of
Or a y" / \ , Signature of Applicant Date
�� / �f 4�zZo�t All roof coverings to be Class "B"or better
Qlner or authorized.gem die—
' .. t . . - ,, . . . . _... '. _.OFFICE.. ...... .. ..... . . . . . ..... . . _ -.