01110090c (/, . ... ..:. OFFICE
CI
BUILDING
BUILDING
PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
10081 STERN AVE.
01110090
OWNER'S NAME:
APPLICATION SUB DATE
LISA JENNINGS CELIA
11/20/2001
,'HONE:
SANITARY NO. CONTROL NO,
ARCHITECT/[NGINF.F.R:
BUILD PERMIT INFO
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BLDG LE PLUMB MLCH
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LICENSED CONTRACnDECLARATION
Job Description
1 hereny affirm Lha I am licensed under mprovisions of Chapter 9lcommcncing
witnseahnnlaularDi.hmn3r-nneRa,inea.anarmm..n.mcaae.myran.e
REPLACE SERVICE PANEL -10 PS.
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` Lic. p
caro
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toss Class
Commaor
O
la CHITECuse DECLAR
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1 understand my plant shall bo used as public records
CLicensed Professional
OWNER -BUILDER DECLARATION
m
I hereby uffirm that I ant exempt from the CmanicaCs License Law for the
a, a following reason. (Section 7031.5. Business and Pmfcoiuns Code: Any city or county
er which requires a permit to construct, alter, improve, demolish, or repair any suacmm
$1200
j 3 m _poo I l once also equ .IM1 ppl' am forsuch permit asgned siammem
$z� L�
e'.ii tY.l 't ��:
Valuation
thin he 1 nsed purse a,,. die ins of the Convaaor's License Law (Chapter 9
1rKK)l ofDvrsma 3 o the Business and Professions Code)
(commencingwth Sect
or Sher therefrom unci 0e basis fns the alleged e,licar on. Any plauon
is 31.5
,'•,37 yV, O`.-5C),V
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of Section a than v any applicant !or a pcnnit subjects the applicant m a civil penalty
io b
of mm more than five hundred dollars (SsoB),
10�1PN 1�
� �• Occupancy Type
01, 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. )614:,
Business end Professions Code: The Common, s License Law does not apply m an
505 - FINAL EgWt q4 joA(Ntions t
owner of property Who Wilds or imptmo Ihemon, and who docs such work himself
or through his own employees. Provided thin such improvements ort not intended or
year
cuff rod'fr sale: If. however the Wildin or[ ._.. t is mW within oim -of
...... ... .......... ......._. ._ . ____...
completion. the owner -Wilder will have the bu b n of proving that he did oat or•-
improve for pmpnse or sale ).
ED L as mvnerpr jec Pmpeny, am a ntoning m
q �,.,po
PI— J 11 `V' ,,.. I • Pt • ' . . i — - -� - _
sinuses, and ns Cucen) The Contractor's
.: constrain the project (Sec. ]loan Business and Professions Code:) The or's
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License dues not apply man owner improve, me
License who build or impmva Ihto
as es
with a contY th,
and -oho co for such projects with a contmemgsI licensed Pursuant to the,
oaf
-� - - -
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er Liens
- C nlmao/s License Law. v
❑lam exempt unser get. •'a •• ,B&PC for this reason
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Owntt
1, p�/�
WORKER'S COMPENSATION DECLARATION
BUILDING
I hereby affirm under penalty a] perjury one of the following declarations:
O I have and will unitarian a Ccnificae or Consent to self-insum for Worker's
Compcm tion, as provided for by Section 3100 of the Labor Code, for the
perfolmanm of the work for which this permit is ivi
C I have and will mainmin Worker's Compensation Insurance• as mqulrtd by Section
3100 of the Labor Code. for Ihe.,re fo..... f Ne work for which this permit n
' issu y Worker's Compensation Insurance carrier and Policy number we:
ONOF RS
%CERTIFICATION
.. ...
oS-
XEM IO WORKERS'
EXEMPTIONi'
t'` •• I s s
COMPENSATION INSURANCE
_ .. ___
(This senior need not W completepermit is if the peris for one hundred dollam
131001 so
that in the the walk for which this to t e issued, 1
, hal
y ✓, „
a employ n in ma n ct
shall not employ any person In any manner so as m bmomc subject m the Workers
Compensation Laws of Caliramia. DamAicant'
u-
NOTICE TO APPLICANT: If. atter making this Cendicalf, of lode.
stuns
of Labor you
Wcome subjecttothe Compensation prow isionsoRM1c IJWr Code, you most
such
� 0 forthwith comply with sucM1 pmvisinns or this permit shall be deemed invoked.
7 ""• ` " CONSTRUCTION LENDING AGENCY
"; I hereby affirm that there is o cnmlm,iinn lending agency forthe perfonnanve
`I
-� of the work for which this permit is issued (See. 3091, Civ. CJ
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Name
(, LcndciName
Lender's s'
0 1 ocnify that 1 have mad Ihis application and state that the above information is
w correct.I laws
-F agree to comply with all, city and county,ominanees and state relating
V to Wilding construction. Wal hereby iuNorize apmsenmtives of this city to enterupon
w' W the above-mentioned property for inspection purposes. _
y 9L (We)agree'msive,indemnify and keep haimless the City of Cupertino against
ZZ) liabilities. judgmenu, c use and expenses which may in any way accrue against avid
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city inc cgmmoem'dicgmmingof �upermil.
r ERSTNDSA VILDCbJPLYWITHALLNIOM O PJ01'T
Issued by: Date —�
SOPP
GU
UI'C'tF.MON
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Re -roofs
Si cof Avid an✓Cnmmcmr' .. ,. "'.Dale
HAZARDOUS MATERIALS DISCLOSURE
Will c applicant or for= building occupant state or ha a le hazardous mat
Type of Roof __ .. ..
defined We Cu nano Municipal Code. Chapter 9.12, and the Health sena Safety
- Y R P P cry
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•.
Code, Secuon 25532(11 -' ., s •, ,
❑re:• .' -❑N0 `
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-.. All. roofs, shall,be inspected.pnor to any roofing. material being instal led. .__.__-_ -
Willtheapplicantorfuture Wilding occupant use o,uipment or devices which
If a roof is installed Without first obtaining an inspection; I agree to remove
cavil huxardous sir mmamiwms as defined by the Bey Arcn'Air Quality Management
District+
all new materials for inspection. Applicant understands and. will comply with
p urea oNo' -
all regulations.
non -point source .,
ha 'read he•liazardous mamdols requimmants and r Ch pier fi 95 bf the
Cal mi Health & Safety Cdde; Sections 25505, 25533 and 25534. 1 accentual that
if a Winding does not curemly have a swam, that it is my rciponeibility m notify the
---
' pao(of Ne requirements which fou met poor to issuance of a Certificate of
Signature of Applicant -_ _ Date
All roof coverings to be Class "B" or better
own a modaeaagemt '• Dam
c (/, . ... ..:. OFFICE