03060144 CITY OF CUPERTINO
BUILDING DIVISIONPERMIT CONTRACTOR INFORMA'�.ION `.
BUILDING ADDRESS: WECKS FRANKLYN E AND LOIS """D03060144
21221 17AI: PIT
OWNER'S NAME: PERMM ISSUE DATE
E: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
RLDG ELECT PLUMB MECH
o l�
'�00 LICENSED CONnRACmR'S DECLARATION lob Description
1 hcrehy at an
that I am licensed under provisions of Chapter 9(commencing P
Z� with Senion)IXeffec DivieionSaf Ne Business and Rufcaiom Cnde,and mylicensc is
<< LenseClin=and effen. ADD 560 SQ. FT.
j Z Date Class Lk.N
;ro Dart Comsat.( 1
q ARCHITECTS DECLARATION
WU I understand my plain shell be used as public¢cords
C�to Licensed Pmfesai...I
5 OWNER BUILDER DECLARATION O
2 0 1 lasso .(Sect that 11. exempt from the rennons Co License c law for the
o G which ng reaoa.Permit
to construct,
0.Business and improve,
dcanns Calle:Any oily or county
Im which rtyuirts a permit m ennswcL Blur,improve.demnlixh,o repair any atmnurtrnngn
-Z>• prior to its issuance.also lequira the applicant for such permit to file reigned statement
EnZ< that he is licensed pursuanttotheprovisions nrthe Con.acwr'sLicenulaw(Chancr9 Sq. Ft. Floor Area - luation
that
(commencing with Section 7")of Division 3 of the Business and Professions Cade)or
.. Net he is exempt therefrom and the basis for Ne alleged exemption.Any violation of 36205014 . 00
Section)WI.3 by any applicant for a permit subjects Ne applicant to a civil lehalty of APN Number CCupanc ype
not more Nen Ron handled dollars($300).
❑L as owner of the property,or my employees with wages u their sale compensation,
will do the work,and the str ctum is not intended or offered for sale(Scc.7044,B omen.
and Professions Code:The Conmaors Liana Law does nut apply to an owner of d Inspectio
property who buildsorimpmns Unclean.and who daessuch work himselfor through his 102 — PIERS
own employees,provided thal aueb improvements are not intended or offered for sale.Ir, 103 - UFER
however,to building or improvement is mid within one year or completion.Ne owner.
builder will have burden of proving Nat hm bu
e did nild or Improve for purpose of 104 - REBAR
ale')' tau b 105 - ANCHOR BOLTS
L a owner of ct property,am exclusively contractingfess %with Ilmnacd ntracmen m
c tun me not (Sec.n an owner
of and property
who Wilds
Code:)The Conmcwrs Li 106 - SEWER & WATER
ttnseLaw dounsuppytom with
aomaoperty whosedmorimpmw Neleogmd, 202 ' — UNDERFLOOR PLUMBING
who comrau for avcA projccu with v contrutoHs)licensed pursuant to Nc Convan.h
L ense law. 203 - UNDERFLOOR MECHANICAL
1 amexempta Sec. B&PCf This aro
204 - UNDERFLOOR FRAME
Dwner WORKER'S COMPENSATIONDECLARATIONJ!_ Data� 205 - UNDERFLOOR INSULATION
I hereby M.under penally of perjury one of the following declarations: 301 - ROUGH PLUMBING
have and will maintain a Certificate of Consent o ulGinsum for Worker's Compen� 302 - TUB & OR SHOWER
cation,as provided for by Section 581(1 or the labor Code.for the Performance or the 3 03 - ROUGH MECHANICAL
work for which this permit is issued.
❑1 have and will mainudn Worker's Compensation Insurance,as required by Section 3 04 - ROUGH ELECTRICAL
5700.1'NC labor Code,for the perfmmmee of the work for which this permit is Issued. 305 - FRAME
My Workee.Compensation Insunme cortin and Policy rourk,ale: '3 O 6 - HOLDOWNS
Carrier. Polity No.: _
CERTIFICATE OF E)EMPTION FROM WORKERS' 307 - INSULATION
COMPENSATION INSURANCE 308 - .SHEETROCK .
or kis)(This section need not heconpleted itthe Permit is for am hundred dollars($IN) 309 — EXTERIOR LATH
1 certify this in the perfomancc of Ne work Thr which this permit is issued.I shall not 310 — INTERIOR LATH
employ any Nixon in any manner m as in become subject o the Workeri Compensation 311 — SCRATCH COAT
f
Laws of California.Disc
Applicant m
313 - ROOF NAIL
NOTICE TO APPLICANT':If.after makingthis Ccnificate of Exemption.you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation previsions.(the Labor Cnde,you must
,J',z Forthwith comply with such provisions orthis permitshall hcdeemed revoked. '502 - FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hereby affirm Nat thcre is a conslructinn lending agency lot Ne Performance of 504 - FINAL BUILDING ENERGY
LL'.moi the work fur which this permit la issued(Sec.3M,Civ.Cd
W O Lenders Name 505 - FINAL ELECTRICAL
= Z Leader',Address 506 - GAS TEST
V Q I certify Nat I have rod this application and state that the shove information Is 507 - FINAL PLUMBING
12. F curvet.I agree to comply with all city and county ordinances and sou laws relating to
OU building construction,and hereby mNorin lepresenutivra of this city toenmr upon the FIN MEC CAL
r 4 ah.vu.men iuned Property for inspection purposes.
C. (We)agree to ave,indemnify and keep hamlw the City of Cupertino against 0 9 F I
liabilities,judgmen6,Costs and eapeM1Sa which may in any way acme against aid City
U in consequence of the Starting of this permit 5 NG
^' A�2
APPLICANT UNDERST NDS AND WILL COMPLY WITH ALL NON OWT Issued by:5 C WORKS Date
SOURCE U T
Re-roofs
Signaore.f ApplicanVComrator De
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant ter future building occupant soon or handle hrmdous matenel
a defined by the Cupertino Municipal Code.Chapter 9.15,and the Ilcallh and Safety
Coda,Section 25532(a)? All roofs shall be inspected prior to an roofing material being Installed.
❑Yes KN. P P Y g 8
Will the applicant or future building occupant use equipment at de.icu which If a roof is installed without first obtaining an inspection, I agree to remove
harardnus air conuminsnu u defined by rite Bay Area Air Quality Management all new materials for inspection.
Diwicl?
❑Yes XNr
I have rt W the hanNomsmeterials rtquirtmenuun,kr Chapterh.95 of Ne Califno-
nia Health&Safety Code,Savour 25505.23533 and 25534.1 understood that if the building
docs net currently be.a tea Nat it u my mapoaihildy lonotily Nc occupml er du
rtquiromcn khm. tp wiananwn(lcenifieaunrfx n. SignatureofApplicant Date
tuner.(a.N.rived orcin p te All roof coverings to be Class"B"or better