00070164 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:',
BUILDING ADDR17SS: PERMIT NO.
00070164
OWNER'S NAME: APPLICATION SUB DATE
HODDER 07/25/2000
IONS: SANITARY NO. CONTROL NO.
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O O ARCHITECfBNGINFER: BUILDING PERMIT INFO
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Z y 5 LICENSED CON'ITACIOR'S DECLARATION - Job Description
G z,-, 1 hert•M1y a1Into mat 1 am licensed under provisions of Chapter 9(conane.mg
into$eminr](KKB of Division l of the Ominess and Professions Cmle,arN my license tll11ALED
aYC m'amtmnerreer.
License Cl..Class Lic.tr 560 SOI. FT. LI
Sa.z -
aWr 3 u�
Data Contiii HITIim'S DECLARATION
0e 29 Six. FT. PORCH 1/
}J 1 understand my plans shall be used us public rentNn NOV O 2003
�Rg•p p Licensed Professional
W e OWNER-BUILDER DECLARATION
Woi 1 hcraby affirm W,I am exempt from the CulturalLicense Law for the BUILDING
s•].< following reason.(Section 7031.5,Business and Professions Cade:Any city or county
�x❑ which require,ape nn it tet constorl.alter,improve,dcmolim,nr repair any a manor,
63$ poor In its issuance,also requires the applicant for such remain to file a signed mmement
- ,hot he is licensed pmxuammthe pmvrvomofthe CmmmemrsLicerm,Loo,(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Swoon 7am),d Livid o 3.1 the Roomer,mW 1'ndemion,Code)
radial he is exempt therefrom and the basis for the alleged nempticru Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
ol'mo nctmmlive handrmdallar,S5a11. APN Number Occupy
I,.,owner of the property,at my employees with wages as their sole compensation,
to the work,and the stmcone is not intended or opered for sale(See.70,14, -
Business and Professions Code:The Contractor's Licenx Law does not apply to un 354'?4tb0�egp d Inspections
ocaner of property,Who builds or impBottom.ereon,and who does such work himself
r through his own employees.provided that such iorprovemems a,not intended car
offered for sale.IL however,the hnilding or improvement is sold whhin one yea of ,
completion,the owner-builder will have the brrdernrpcithat hedid not hnddor 101 — FOUNDATION
iar"o"rmr parpoxc oamad.
❑I.as owner of the property,am exclusively contracting with licensed contractors to 1.02 — PIERS
construct the project(See.7844,Business and Profcsions Cont The Cnmmnnr's 103 — UFER
License Law does no,apply m an owner Of property who hu Ids or imtproves thereon. 104 — REBAR
and who co%WORK
ch Prot as with a con racam/x)licensed pursmm m theConnor e,en �L B&P C ter mi,reamn, 105 — ANCHOR BOLTS
7 /7-q 106 -• SEWER &� WATER
V COMPENSNUON DFCLARAHON
202 —,UNDERFLOOR PLUMBING '
I hereby M.order pe..try of perjury one of the following declaration'' 203 -• UNDERFLOOR MECHANICAL_
1 I have and will atomism a CeniOcme of Conical to sel6imare for Worker's
ompeometion,-a, provided for by Section 3700 of the Labor Code, for the 204 — UNDERFLOOR FRAME -
,dormunce of the work far which this permit is issued,
205 — UNDERFLOOR INSULATION
❑I have and will r Cost,
Worker's Compensation Insurance,m which his
by Section 301 — ROUGH PLUMBING
9]W of rho Labor COdo,for the perfommnm al.the work for which this pemdt is
coed.My Worker's Com,cluatonInsurance carrier and Policy number ore: 302 — TUB & OR SHOWER
Corrine CER'I'INCATTONOil EXEMITIONFROM WORKERS' 303 — ROUGH MECHANICAL
COMPENSATION INSURANCE 304 — ROUGH ELECTRICAL
(This.actio i need ore he completed it he perdlt I,rte Doe hundred dollars f 305 — FRAME
rsI(plorlcss.l .
1 caitiff moo in me pxrronmmce it the work for which his permit is i„oed.1 306. — HOLDOWNS
shall nor employ any person in any manner so a,n account,subject to the Wooe: 307 — INSULATION
ComPnnation Luna o(C.1,monio.Dote
Applicant308 - SHEETROCN,
NOTICE TO APPLICANT:IL after making this Cenificale of Exemption,you should ,
Z becomesubjecttotheWorkmesCompensatinnprovisionsofthelaborCWe,youmust 309EXTERIORLATH
Q 0 ronhwith comply with such provisions or this permit shall he deemed revoked.
Z r`q mnn Jan ONSTRUCr10NLENDING AGF:NCY 310 — INTERIOR LATH •
1 hereby amere is.eon,troetinm lending'9 se,far the crolomm'e 311 — SCRATCH COAT
of the work for which this perandisissued(Sec.3n97,CiaCa)
Q Lender's Name 31.3 — ROOF ARIL
fir
Q z Lender's Address
0 Imnlfythat Ihim,readthis application and aatehot the above information i, 501 — FINAL ELECTRICAL ENERGY
;z correct.1 ogrea to comply with ml city cad county molumacs and.late law,remmrg 502 — FINAL PLUMBING ENERGY
Q t.: aWilding cn...oreion,and heiehy olthxtrime represenmtives of this cirym enter upon
W theaWve.n shred property for inspeononpurposes. 503 — FINAL MECHANICAL ENERGY
0. (W a me.+cave,mm
deni y� ds,keep harmlethe City of Cupenino.,.las
tn liabilities tad dent,,cast,atm tr
se,whic may in.try way rcm
ee ega —
imt said 504 FINIAL BUILDING ENERGY
City in t rise cote af the g to Odd pc it.
r-t APPL111 RrUNDERSNSN D L C MPLYW' LLNOy� INT Issued by: 505. — FINAL ELECTRIC�6
am phcHAZARDOUSMNIERIALSDISCLOSURi: tam Re-roofs 507 — FINAL PLUMBING
Wil
l
me applicant or future building oecuprm more at handle haxaMGn,material Type of Roof
axdcenedbythe CapaNnnMunicipal Code.Chapter 9.12,and the Health and Safety 506 — FINIAL MECHANICAL
Come,Section 2353Na)] IUp� tot,,,RRR&Jadl
ores C1 No All roofs shall be iAAcQ� teap>�oRpg�ityC� gkal being installed.
y Will the applicant or mom buildingoecm+ant.,anlmipn®ntOrdcviceswhich If a roof is idstaller9hAoutfFsTl7UTafilltl >7On 1areetoremove
II emit M1.+^roas air mars mina.¢us defined by the Bay Arca Air Quality Management
imrier7 all new materials ft55W§peCticf-AI Iic I ill comply with
nye, ❑No all n6 i int source re u ationS.
1 hove read the heanNous mmenal,requirements under Chapter b.95 of the
Calif.”' iwlthSoSolctyCade, cctiur,25505,35539 anit25,134,1understandthat
if the ildi gdoes nmcurte ave nnut .thm it it nryrcnry+nsihilitymnmtify. the /
t nt o1 the oil Ox s ich un met poor to issuance of a Cenifica¢of
a aney — 7�
�- / igna Bre of Applicant Date
m
woe rtmonrexf 71 - Dote All roof coverings to be Class "B"or better
OFFICE