02060123 CITY OF CUPERTINO
BUILDIN°DIVISION PERMIT CONTRACnTOR INFORMATION:
,,ager.
BUILDING ADDR ISS: TE CHCON PERMIT NO.
10526 MANZANITA COURT
NER'S NAME: 17450 MONTEREY ROAD APPLICATION SUB DATE
CARLO PANACCIONE 06/19/2002
IIGNE' 4O8 778-1350 SANITARY NO. CONTROLNO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MCC"
o 0 0
�
reoc LICENSEDCONTRACrOR'S DECLARATION Job Description
w u F I hereby affirm that I am licensed under provisions of Chapter 9(commencing P
yZaj wish Seninn]IXXI)nf Division Sof the Business enJ Professions Code,and myli,cmc x
ot2y in muhtrceandeff 3 HARD�LANDSCAPE & GAS LINE
Zp�Z Liccnu Class _ LIC.M
0Zg, Dam • Conuaclar
F—q<q ARCHITECTS DECLA
� Bs IunokratanJ my plans shall he used �B���C®
J as public c �+r
GpWU
�o Liccnsedl4n(csxinnal DEC 2 3 2002
OWNER-BUILDER DECLARATION
I herchy affirm Nat 1 am cxempl from the Contractor's License Law for the
inti_p O following reason.(Section 7131.5.Business and Professions Code:Any city nr county
which requires a remrit to ennsouct,after,improve,demolish,or repair any.urucwre
"t+Zed pnnr In its issmnce.also reyuimsthcapplicant for such permiun file a signed statement
tqqpp< that he is licensed pursuant to the provisions of the Cootmcuu:c Liacose Law(Chapter 9 Sq. Ft. Floor a $7YiV&tion
aFP (commencing with Section 7000)of Division 3 of the B mines 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($500), be Occupancy Type
I,as no,of the pmpeny,Or my employees with wages as their to cumpensamn,
will do be work.and Ne structure is not intended or offered for aide(Ste.7M4.Business pW( .p Spe p��
and Professions Code:The Contractors License law dors not apply to an owner of 501 - FINAL L'l.. 1 l.H 1O i•.LV ERGY
proMrfy who builds or improves thcrepn,and whodoessuah work himulfnrthmugh his
own employees,provided that such improvements are not intended oroRered forsale.Jr. 505 — FINAL ELECTRICAL
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
gale.].
I,as Owner of she property,am exclusively contracting with licensed contractors to
construct the project(Sec.70,14,Business and Professions Cmn:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a conuactor(s)licensed pursuant to the Contractor's
License Law.
❑ I am exempt under Seo. ,B&P C for this reason
Off DatC
WORKER'S COMPENSATION DECLARATION
g
I hereby efnrm antler penally of perjury one of the following tleclualions:
1 have and will minimal n a Cenificale of Consent to self-insum for WorkersCompen-
13700
on,ss provided for by Section 377 of the labor COTe,for the performance of me
k for wM1iM Nis permit is issued,
1 have and will maintain Workers Compensation Insurance,as required by Section
of the lalav Code.for the performaoce of me work for which this permit is issued.
Worker' /m�rengafion lnsua(nm carrier and Policy number ase:
Cartier:___ `- � / Policy No.: /Q✓/
CERTIFICATE OF EXEMPr10N FROM C S
COMPENSATION INSURANCE
(This section need not be completed if the permit is forme hundred dollars($[(a))
or less.)
I certify that in the performance of the work for which this Permit is issued,I shall not
employ any proom in any manner so as In become subject to the Worked Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become Subject to the Worker's Compensation provisions of the Labor Code,you must
OO forthwith comply with such provisions or Nis Profit shall ae deemed revoked.
z = CONSTRUCTION LENDING AGENCY
PThereby alRrm that there is a construction lending agency for the Performance of
CYC Ibe work((it which this permit is issued(See3097,Civ.C.)
W !] ]soda's Name
z Lender's Address
U O 1 certify that I have read this application and state that the Axid information is
Cs. P correct.I agree to comply with all city and county ordinances and state laws relating to
0U building construction,and hereby allthOdX repsesenmtives of this city to enter upon the
W above mentioned property for inspection purposes.
(We)agree In gave,indemnify and keep harmless be City of Cupedi no against
r0./r Iiabi lilies,judgments,cosss and expenses which may in any way accrue against said Ciq
his Fermi I.
U z APPL CANT UND RSTANDSnsequence of granting of IAND WILL COMPLY WITU ALL NON POINT Issued by: Date
SOURCE REC`tlL IONS.�r
/./. Re-roofs
Signam nfA IicaHAZARnO Dare
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
dR the applicant O future building sa:cupant store m hanJle ha/eNous marenil
efined by the Cupenino Municipal Code,Chapter 9.17,and the Hcallh and Safety
'Ole.Section 255ffiIz)? All roofs shall be inspected prior to an roofing material being Installed.
❑Yea ON. P P Y g g
Will the applicant or future building Occupant use equipment ardevices which If a roof is installed without first obtaining an inspection, I agree to remove
mit haaardous air continuous as defined by the Bay Arca Air Quality Management all new materials for inspection.
District')
❑ye, ❑No
I have Quad the h iomlims mmerials.,fno menus under Chapmr6u5 of me Colifor-
niu Ilem b&Safety Co dc,Sections M505,25533 and 25534,1 understand than ifthe huildmg
does nnt cumemly hu e a tenant,that i1 is my responsibility In notify BVI Occupant or the
rcyuimmema aa1lem primm m ce racertmpamer0.cupancg Signature of Applicant Dale
o cora mrivedagent Dale All roof coverings to be Class "B" or better
E,"'— EYDINGADDRESS:
TY or curr:R•rcNo '_ o77777777, " � N •;
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
9e„ •;um�6 s, aura,asst e e4'h ✓g grr, ,>•sr
- MC SOLAR ENGINEERING PERMITNO03080045
.R'S NAME: 1168 ASTER AVE PERMIT ISSUE DATE
DEBBIE LEE
NE:
(408) 261-1211 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
:ore LICENSED CONTRACTOR'S DECLARATION
!w C I hereby affirm that 1 am licensed under provisions or Chapter 9(commencing JobDescription ����,-Q�rte®
2 W wird rection]IX10)nf Division Juf NC Busincs d& fcuinn Cock,- my license is kL��
NUNmeam rrr / a,7IQ3° PHOTOPOLTAIC SYSTEM . (2KM)
p a�Z Liccnu Cl x �G Lic.0 0 Date , , G�, AUGhlV l� 2 : 2003
SS ARCHITECTS DEWARATION
I C< 1 un crst nd my plans shall he used es public records
° U BUILDING
�(n Licensed Pmfcssionel
OWNER-BUILDER DECLARATION
<F 1 hereby.(Erre that 1 1. exempt sfourn
an Ne Conlrnctm'a License Law for Ne
O O which re mama Permian 7031.5.Business and improve,
de nus Code:Any city or county
<m�+ which requires a permit to cnnswcL alcor,impmn,JcmoluA,or repair any structure
pnDrtoiii smanne,also rtgnims the applicant ror such prrnlll to file a signedstatemrnl
ma< that he is licensed pursuant to the previsions or the Contractor's License Law(Chapter 9 Sq. F[. FloorArea
Area Valuation
aF0 (commencing with Section 7")of Division 3 or the Business and professions Coati r 342610
O F S Ntherefrom and he is exempt therefroand Ute basis for flat allcgcd exemption.Any violation of
08 . 00
Section 7031.5 by any applicant for a permit subjects the applicant o a civil Penalty of APN Number Occupancy Type
not more than five hundred dollar.($500).
❑I.as owner or the property.or my cmployccs with wages as their mlc compensation.
will do Ne work.and the swnum is not intended or offered for sale(sec.71lut Business —
and Professions Code:The Contractor's Liccuc Law dues not apply to an owner of 102 — PIERS IERS d Inspections
property who builds or improve thereon,and winches such work himself or Nmugh his
own employcce,provided that such improvements arc not intended or offered formle.If. 103 — UFER
however,the building or improvement is mid within one year of completion,the owner.
builder will have the burden of proving Nat In did not build or improve for purpose of 104 - REBAR
role.). 105 - ANCHOR BOLTS
01,as owner or the property,am exclusively contracting with licensed contractors to 106 - SEWER & WATER
construct she project(Sec.7041.Business and Profmions Code:)The Contractors Lt.
LKn Law does not apply to an owner of property who builds or improve themon,ana 202 - UNDERFLOOR PLUMBING
truel.awu for uch pmjeets with aeonlncmNs)littmed pursuant to the Cuntnnuh' 203 — UNDERFLOOR MECHANICAL
❑I un exempt under Sea B k P C for this reason 204 - UNDERFLOOR FRAME
D.O. 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of Ne following declarations: 301 — ROUGH PLUMBING
I haw and will maintain a Certificate of Consent to sel6insute for Workers Copper. 302 — TUB & OR SHOWER
section,u provided for by Section 37M of Ne Labor Code.for the performance of the 303 - ROUGH MECHANICAL
work for which thisPernitisissued. 304 - ROUGH ELECTRICAL
❑1 haw and will maintain Worker's Compensation Insurance,as required by Section
3100 ofthe Labor Cade,for the performance of the work for which this permit is issued. 3O5 — FRAME
My Wmrkcr' CnmPensadon Insumntt articn�nalPa/lyyyy umber art: 306 — HOLDOWNS
Gore m/1 POR/Jo.:/SNOUye-01 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK
(Tbuscctionaccel not Wcompleted Box,Permit is foronehundrtddallars(SIM) 309 - EXTERIOR LATH
310 - INTERIOR LATH
I certify Nat in the Performance of the work for which this Permit a ismed,I shall nut 311 - SCRATCH COAT
employ any persean
n in y mm ke
anner u to become subject to the Worrs' m
Copus
emion
Laws ofaRmmia.Date 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT.Ir.after making this CC(IIR.alr of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker'.Compensation provisions of the Lahr Calc,you mus'
)Z, mrNwith comply with such provisions orthis pOonlshall bedeemed revoked, 502 - FINAL PLUMBING ENERGY
Z0 CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
`Z' I hereby affirm that there is a construction lending agency[or the ICTflumance Of 504 - FINAL BUILDING ENERGY
x > thcworkder'sName for which this p misisissd(Scc.J09l.Civ.C.1
Lender's 505 - FINAL ELECTRICAL
lal Q
=) Z <nderfAddrta 506 - GAS TEST
V O 1 certify that I ban read this application and slate that the above information is 507 - FINAL PLUMBING
correct.I agree to comply with all city and county ordinances and suite laws relating to
p V building convection,and hereby awhorim representatives of Nis city to enter upon the FIN MECHAN CAL
sea above mentioned property for onsia, aPurpses. 09 FIN
y (We)agree to son,indemnify and keep harmless the City of Cupertino against
N liabilities,judgments,costs and expenses which may in any way accrue against said City 55 NG
U in consequence of the granting of this Permit.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 WORKS Date
SOURCE EGU TI S.
Re-roofs
nature fA he-a Comncror Dec
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wil the applicant or future building mcupanl store or handle hazardous material
u defined by the Cupertino Municipal,Code,Chapter 9.12.and the Health and Safety
c,Section 25512(x)? �,/ All roofs shall be inspected prior to any roofing material being installed.
Will�lt ytuu
the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
nit hazardous air contaminants a defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes Nu
I have maJ the hazardous materials requirements under Chapter 6.95 of the Cali for.
ria HcuIN&Safely Cod.,Sccu..25505,25533ond 25534.1.ndc..d Nwif Nc building
does mol currcally hew a tcnmt Not it is my responsihilluy m notify the occupant of the
requirementsw ' hmu bcm pliorinissuanccaf.Cmlfima nramupanmy. Signature of Applicant Date
its
o nerurauthorizc te All roof coverings to be Class "B" or better