02060021CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
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,aver _S!t�$�§'. �,, 1'��/geei,9, ?r;; •3@�.�.^!�'7l:"4
BUILDING ADDRESS: -
S U()NS'_URU(2'1'J()jN
S.RMITNO.
19929/99 STEVENS CRK
02060021
rsNAME:
RATOGA AVE
PERMITISSUBDATE
PINN BROS'CONSTRUCTION
02/28/2003
PHONE;
—
SANITARY NO. - CONTROL NO. .
ARCHIMCrfENGINEER:
BUIIDING PERMPTINFO
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BLDG ELECT PLUMB MECH ,
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LICENSED CONTRACTOR'S DECLARATION
Job DDSCIlpI100
I Itreby affirm Net I am licensed under Provisions of Chapter 9 (commencing
.JMSmlMr701ID)of Division Sof Mm Buainmeed N.I.W.es COM.-rdmyliceueN
GATE LOOP/DECTOR SYSTEM
in full force and effect.
License Claaa LIc. N
Dau Canusctor
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ARCHTTECrS DECLARATION
'
I undersand my pant shall W used u public r.nm,
- JUL 2 8 2.003
Licensed Prof.Winnd
OWNER-BUILDER DECLARATION
I hereby anion that 1 am exempt from Me Contractors Limmm Law for the
follnwig reason. (Section 703 1.5, Business and Professions Code: Any city or county
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which requires a permit m construct. alter, improve, demolish, or repair any stmmuro
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prior In is issuance, also require the applicant for such Pewit to file a signed statement
LIC Law 9
Sq. Ft. Floor Area
n
0Q1,It]AIGn
M k
Natheiaueanrcdp... am on the proviamti of Contractor's use (Chapter
(commencing with Section 1000) of Division 3 of the Business and Professions Code) or
_
that he is exempt Nerefrmn and Ne buts for the alleged eaempdom My violation of
RP14 er Occupancy Type
Secdon 7031.5 by any applicant for a permit subjects Ne applicant m a civil penalty of
nm more thin ftw hundred dollars (S5001 -
-
❑ I, a Owner of the property, or my employees with wiles as their sole compensation,
will do the work. arta dm,wctore N not intended m offered for We (Sec. 701,11 Business
and Profession, Code: The Convectors License Law does .t apply inan owner of
501 — FINIAL & pegIO°;ANERGY
propenywho buildsur improve, Maroon. andwho doeasuch work himsel(ar through his
ow employees. provided Nn such Imp mvemCosts as not Intended or offered for tel.. If.
'505 —'FINAL ELECTRICAL '--
however. the building or improvement Is sold within one year of completion. the owner.
builder will haw the Notion of proving that M did not Wild or impmw for purpose or
1, as owner of the property. em exclusively contracting with licensed Contractors m
as
Ne pmjecl (Sec. 7044, Business and professions Code:) The Canal. W9 LI-
.
sic Lew does not apply in in owner of property who Wilds at Improve thereon, and,
whocomeacuforsuchpmjecm thaea.uacmr(.)11. edpununtmMe Contrsmoe.
Lkenu law.
m axe p under Sec. .B&PC(o Nls
Dem v U
ri
r ORKER'SCOMPENSATION D L(ItAiION
.
I hereby It under pendty of perjury one of Ills followln{ declarations:
❑ I haw and willmdnulnaCeNOc.u ofConsemtaselPiesure for Wohers Compen-
ulian, as provided for by Section 3700 of IW Labor Cade, for the performance of Me
work for which Ni, Permit i, Issued.
❑ 1 haw and will maintain Workces Compensation Insurance, as required by Section
3700 of Ne Ube, Code. for Ne performance of Ne work for which this permit is Wood.
My Worker, Compensation Insurance carrier and Policy number are:
Camey, Policy No.:
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CERTIFICATE OF MEMPnON FROM WORKERS'
COMPENSATION INSURANCE
CHIN aeelian aced not W completed fruit porch is fora. hmdmd d011aa (SIM)
or IGa)
I certify the. In to P u owanae of the work for which NN permit Is issued, I shall not
employ any person In any manner an u to become subject to the Workml Compensation
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If. afar making this Cenifmete of Exemption, you should
become subject to the Worker's Compensation provision, of the Latour Code, you noun
forthwith comply with such provision or this pewit shall W deemed reveled,
I
CONSTRUCTION LENDING AGENCY
I hamhy efts. Net Nem I, a ceesvucthm andin{ agency for Ne perfomana of
' the work for which this permit I, Issued (S.. 3D97, Civ, C.)
Lender's Nam.
Lender's Addreu
i I mully that 1 have road Nis application and rete Nu the &bow informNun is
r coved. I gree m comply with all city end county ordinances and sum law missing to
building convection, and hereby authorim mPmsemstive of this city to emcr upon the
shove-mentioned ny fur purposes
( on indmnifyarmcdon
(We) agree a on. indemnify ted keep haymow the City of
i liabilitioa,judgmenu. cos e,xpenua which may In any wyacerue against WdCity
meagainits rd City
In consegnnce of Neg ling thia pewit.
I APPLIC UNDERST ND NO WILL COMPLY WITH ALL NON-POINT
Issued by:9 Date
SOUR � GULATIO r7
C
Re-roofs
Type of Roof
salimofIiranVContracr Oam
HAZARDOUS MATERIALS DI LOSURE
Will the applicant or furore building.[cupanblore or handle haoardooa material
^.Orad by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
.SeNo.25532(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑Yes, RINo
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or fuum building amupanl use equipment at devices which
Omit hazardous air smnmminanu as defined by Me Bay Arca Air Quality Management
all new materials for inspection.
District?
❑Yat 4Nu
I haw mad the hazamrwsmaterlals requirements under Chapmr6.95 oft Cahfor.
ria Health&SarelyCode u 25305, 25533and2353a.1undentendthaifthe Wilding
date not c ratty hew J n n II a mY rtes nihility m.at, Me occupant or Me,
regmre Em which mut ,e d r 1 Nan erMnaa rasa
Signature of Applicant Date
All roof coverings to be Class "B" or better
we mouth nedgem a,�