03100055 CITY OF CUPEWINO "-*'r&- '.w .fav ,,, > x er
nun.Dlrvc mvlslory PERMIT tCONTRAC{COR INFORMATION , -
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BUILDING ADDRESS: ALL SEASONS REMODELING PERMITN003160055
f FR'SNAME: 219 DEMPSEY RD HRMIT ISSUE DATE
NE' (408) 586-8004 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: �n BUILDING PERMIT INFO
&A BLDG ELECT PLUMB MECH
i00 LICENSED CONTRACTOR'S DECLARATION lob Description
i C I hereby af0rm that 1 am licensed unJer provisions of C pRr commencing P
,¢6 withSenion7Q0jB ofDivisiopdohteB 'nmJ rrifcui oJe,eitmylicenseis �aa� ww..
.°e<n„ in mR mrce angE act. PATIO ENCLOSURE (161 SQ. FT. ) FINALE®
s tqZ Lic se Classes l
4p De`nidy� r andmy,thmssah111Wuxdiapublic¢mods OCT 3
C ✓Y� 2003
ayU
oG Licensed Professional
g OWNER-BUILDER DECO Contractors
ontr ON _ BUILDING X 1 wrehy affirm o n 1 am exempt from to Profession
License Law for she U
.m O followhich re much.a (Section 703 1.5,Business and w.dcroli CWr:Any city..uric my
which squires a permit to construct,thelm,,imprrsu h cmnit t or e a sir anygned nrunum
Sly Out also to be the applicant for men Permr*s LimasLaw(Catemenl
< (commencingwJPuction7 twpmvivision3or beCon
Limnselsw(C Code)or Sq.FL Floor Area Valuation -
�TF$ e is
(commencing Section and of basis
3 of the Busineu and Prorcuon,Any
lattion or
BOBNal he u aempt tcrtrrom and Bx buts(or B¢alleged exemption,Any violation of 37530011 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
nor more Nan five hundred drilla..(5500).
❑Las owner of the property,or my employees with wages as Ihelr ale eomPenution,
will do the workand to suucsure is not intended oroQcscd fernle(Sm.70414,Busineu 101 —
and D 'e; d IHSpeCIlOHS
Prefesson s Code:The Cmamctofs Liceme Law does not apply m an owner of
property who build,.,improves thereon,and who dresturch work himself.,trough his 102 - PIERS
own employees,provided that such improvements..at intended.,offered ferule.If. 103 — UFER
however,to building or improvement is sold within one year of eemplesion,to owner.
budder will have the burden of Proving tat he did net wild or improve for purpose of 104 - REBAR
ml`')' 105 - ANCHOR BOLTS
co 1,as owner of to property,am exclusively contracting Cod:itched enno-acmn t.
cease at looprone..pplyto n Business and rtywhoanads orimpro Convenor.Li 106 — SEWER & WATER
come Law does rs ahplyman owner ofprclany who wnmorimproves Ramon.ad 202 — UNDERFLOOR PLUMBING
who contacts far such pronates with a eommnodQ licensed pursuant m to CrinuanoM1
Liecre low. 203 - UNDERFLOOR MECHANICAL
❑l am exempt under See ,B@ P C for this poison
204 - UNDERFLOOR FRAME
`r Dram
WORKER'S COMPENSATIONDECLARATION 205 - UNDERFLOOR INSULATION
I hereby affnn under penalty of perjury am of to following declarations: 301 — ROUGH PLUMBING
I haw and will maintain a Cenifcam ofCamant to xl Nasum for worker Compen. 302 — TUB & OR SHOWER
mBon.u provided for by Section 3]00 of Ce Iswr Code.far loo performence of the 3 0 3 - ROUGH MECHANICAL
work
for which this Permit is issued.
❑I have and will maintain Wmkcr's Compensation Insurance,u required by Section 304
- ROUGH ELECTRICAL
3700 oft bor Cod.for Be performance of Be work for which this permit is issued 305 — FRAME
My ork Orion Insurance artier and Policy numd^er aim::, 306 — HOLDOWNS
er. Palicy�Ny+/
ER ICATEOFE(EMPnONPROMWORKERS' 307 - INSULATION
S COMPENSATION INSURANCE �(1Q� 3O8 — SHEETROCK
(Thusectinn oil not be completed if the Permit is for one hundred JolemI$B10) 309 - EXTERIOR LATH
it,1c,ij
I certify lost in the performance oldie work for which this permit is issued,1 shall nut 3 10 — INTERIOR LATH
employ any person in any manner so as In hmome subjem to the Workcri Compensation 311 — SCRATCH COAT
Laws of California Data
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT:IL after making this CeniOate of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Workers Companmtion pmvisiuna of the Iawr Cmlc,you meat
�Z forthwith comply with such previsions or this Permit shall the deemed mvoked. 502 — FINAL PLUMBING ENERGY
L2 CONSTRUCTIONLENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hcmby.Mom lost tone its mount:..a lending agency or dr,Performance of 504 - FINAL BUILDING ENERGY
Y> the work for which this permit is issued(Sec.3097.Civ.C.)
415 Lender'sNamc 505 - FINAL ELECTRICAL
Z) Z ndcrsAtldrtss 506 - GAS TEST
;3 1 cenify tat I hew read tis application and cum that to above information is
y F
correct.Iagree to comply wit all city and county oNinances and state laws misting to 507 - FINAL PLUMBING
�YJ building crinswnion,and hereby autorim representatives this citymcnmr upon lot FIN MEC CAL @
„U above-mentioned pmxriy for lupe..:...purposes. V
(We)agree m save,indemnify and keep hamlets the City of Cupenino against O 9 F I
, liabilities.judgments,costs and expenses which may in any way&come against mid City 5 NG
Z in consequence Of the granting of this permit.
APPLICANT UW.ZSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued bY:S C WORKS Date
SOURCE REGUL!s7L aVS.
-( � L ) Re-roofs
S' evert n(Appli ...thrum,
HAZARDOU TERIAISDISCLOSURE Type of Roof
Wil:BN applicant or future building Occupant store or handle haasNous material
as defined by the Cupertino Muni al,Code.Chapter 9.11,and to Health end Safety
1.1,
.Scnion15532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
Will the applicant m future b IJing occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
he.dna air c.nmmi om. hncd by the B y Arta Air Quality Management all new materials for inspection.
c"
[]Yet Nu
I have results harsNrws materials mWimmems unJer Ch&f mr 6.95 of to Ediror-
alNg:Safct Cout.Sxdo.nM5.25533 and 15534.1 understood Jur iflM building
oatcurrent y a v ant.Cst it Ix my mspontility m.odfy the.,want of Ce
mmcnu et pnarwissuancaiyof cep Signature of Applicant Datel � All roof coverings to be Class "B" or better
er tar auth lcd�✓ Dan,