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02090124Woaz FF. ZUZ tn<p Z oz° Q��u Cga: n p a'C L 0;1 h� LU x�E W^u t -z> F, I Luna 4 CITY OF CUPERTINO BUILDING DIVISION PERMI*O BUILDING ADDRESS: 18831 TILSON AVE. OWNER'S NAME: PHONE: ARCHITECT/ENGINEER: LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full fQuw yad effect. 71. License I c.A Dal��,rJt. t ` CHITECT"S TS ARATION understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended oroffered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ 1 am exempt un r Sec. , B & P C for this reason wn Dale K MPENSATION DECLARtI 1 hereby affirm under penalty of perjury one of the following declarations: ❑ ]have and will maintain a Certificate of Consent to self -insure for Workers Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (f Ais section need not he completed if the permit is forone hundred dollars (S 100) or less.) 1 certify that in the performance of the work for which this permit is issued. I shall not employ any person i n a ner so as to become subject to the Workers' Compensation Laws of California. makm-gtis tertificrue of Exemption, you should C -subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. ' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) i Lender's Name Lenders Address j 1 certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against j liabilities, judgments, cos and expenses which may in any way accrue against said City in consequence of the gr ting of this permit. ' APPLICANT NDE ANDS AND WILL COMPLY WITH ALL NON -POINT plrcankontractor Datc 11 HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑ Yes CNo Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? El Yes No Ihave readthenazar us materials requirements underChapter6.95ofthcCalifor- niaHealth&SafetyCode, ctions 25505,25533and 25534.1understand that ifthe building does not c ently have tenant, that it is my responsibility to not.' the occupant of the requir wn.cn st be met prior to issuance of a Cc y. Signature of Applicant Date , ,.. T.Da All roof coverings to be Class "B" or better �t�NTR�:CT4R �N�t��tAN: JAHAN CONSTRUCTION PERMITNO. 200 BURNETT AVE -310 APPLICATION SUB DATE 09/19/2002 SANITARY NO. CONTROL NO. Job Description VEW SINGLE FAMILY DWELLING 2263 SQ.FT. LIVING SPACE 400 SQ.FT. GARAGE Sq. Ft. Floor Area IM BUILDING PERMIT INFO BLDG ELECT PLUMB Required Inspections Valuation 101 - FOUNDATION 102 - PIERS 103 - UFER 104 - REBAR 105 - ANCHOR BOLTS 106 - SEWER & WATER 202 - UNDERFLOOR PLUMBING 203 - UNDERFLOOR MECHANICAL 204 - UNDERFLOOR FRAME 205 - UNDERFLOOR INSULATION 301 - ROUGH PLUMBING 302 - TUB & OR SHOWER 303 - ROUGH MECHANICAL 304 - ROUGH ELECTRICAL 305 - FRAME 306 - HOLDOWNS 307 - INSULATION 308 - SHEETROCK 309 - EXTERIOR LATH 310 - INTERIOR LATH 311 - SCRATCH COAT 313 - ROOF NAIL 501 - FINAL ELECTRICAL ENERGY 502 - FINAL PLUMBING ENERGY 503 - FINAL MECHANICAL ENERGY 504 - FINAL BUILDING ENERGY 505 - FINAL ELECTRICAL 5 GAS TEST 507 1 FINAL PLIUM_BI14G_ Type 5N CAL / tL Issued by5 0 Date Re-roofs514 - NAL PUBLIC WORKS Type of Iigf2 - ROOF PLYWOOD NAIL 603 - ROOF BATTENS All roofs6M0 be -in pTai-t&iL?Tn EE6%aterial being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection.