03020077 CITY OF CUPERTINO " �-max"•
BUILDING DIVISION PERMIT <GON�TRACTORRINFORMATION
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BYIMI"'NESCENT RD LEI & SCOTT ENNIS PERMIT NO.03020077
w 'sNVESCOTT ENNIS PERMTIss`6aA7E10/2003
,.JE: SANITARY N0, CONTROL NO.
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ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
jop LICENSED CONfRACMR'SDECLARATION n N�
I U I hereby affirm that I am licensed unser provisions of Chapmr 9(commencing lob Des I
•T2 with Section RWr)of Division 3 Orion Business and Professions Code.and my license is
s in full forte and effect.
?LIEucenseCtu. Lie. ADD 643 SQ. FT. (GARAGE T �Cl
2F Dam Coat roewr
e ARCHITECT'S DECLARATION
c I understand my plans shell M used as public ucmds
Q< Licensed Professional OWBy
y OWNER-BUILDER DECLARATION
I I hereby alTrm that 1 am exempt from the,Contractor's License Law for the
❑o following reason,(Section 7031.5,Business and Protestors;Code:Any city or county
5$ which requires a permit In continues.alter,improve,demolish,or repair ser mixture
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prior it)its issuance,also requires the applicant for such permit to flc a signed statement
4o that he is licorend pursuant in[be provisions Of we Contowtor's License Law Chapter 9 Sq. Ft. Floor Area $4(Y�gzljion
I� (commencing with Section ftXID)of Division 3 of NC Business and Professions Code)or
3
that M is;exempt Nemfrom and IN,bum for Ne alleged exemption.Any violation of
Section 7031,5 by any applicant for a permit subjects the applicant to a civil penalty of e DN.hie�pl.e�O O Occupancy Type
not mare Nan five hundred dolha 3A(5500). Vf 4` O'
❑1,aowur of the property,or my employees with wages u Heir sets compensation,
will do the.,k...dthmucane i...tbrooded or offered for sale(Sec.IDs/,Business 101 - FOUNDAWj6WdInspe
and Professions Coes:The Creosotes Licenes law sou oat apply m an owner of O�
property who build.in improves themon.and whodoes such work himalror through his 102 - PIERS FINALED
own employees,provided Nat web improtemenu as not intended reoffered for ak It. 103 — UFER
however,fie building or improvement is sold within one you of completion,the owner-
Wilder .will have the W Wen of proving Na M did Mt build or improve(tar purpose of 10 4 - REBAR S EP 1.6 2003
EyI.. 105 - ANCHOR BOLTS
IJI L u oxer of the Sec.property,em exclusively and contracting with licensed romreoon m
causwu Neesojot apply
in nmixe of property
Professions Code:)Mice Cremator,Li. 106 - SEWER & WATERcausQ���1 �`11NG
who conwdoe.noupplywmawrcrafprorcny who sedplds rrfmprova Crewe &., 202 - UNDERFLOOR PLUMB
who contracts for such projects with a conuurorp)licensee pursuant m Ne CrnmmrM1
Of L'" 203 - UNDERFLOOR MECHANICAL
Qlens exempt under5 c. B2WV_Af.11 OCUCIIn 204 - UNDERFLOOR FRAME
MPENSATIONOECIARNT1. T 7— 205 - UNDERFLOOR INSULATION
- Ihemby eRtrrtt underpenaltyo(Perjury one of the fallowing dttl,rtdome: 301 - ROUGH PLUMBING
❑I have andw ill riamutina Certificate,of of Consent self-bourn Tor workers Can. 302 — TUB & OR SHOWER
.effort,a .aided err by Section 3700 of the labor Code,fee 0.performance.(,he 303 - ROUGH MECHANICAL
work fm which this permit is issued.
❑1 have and will maintain worker's Compensation Inwrsocc,a required by Section 304 - ROUGH ELECTRICAL
7700 of the tabor Code.for the perform,rca of the work per whim this permh is sound. 3 0 FRAME
5 —
My Workers Compensation Insurance carrier and Policy number art: 305 — FRAMEHOLDONS
Cartier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
(Ibhunion nttJ nm Mcampleod if permithfnrnnc hunemddullaro(510117 309 - EXTERIOR LATH
or leu.)
Irenin the the rnrm.ntt er New kmr rain rcrmh is iaaed.l,n.B ort 310 INTERIOR LATH
employ any pgtw oyer neer u hoc a ret ra�ompensulon 311 - SCRATCH COAT
Laws of Califm a.Dau
Appli rat 313 - ROOF NAIL
NOTI ,DAPPLI : La akingthia nificeoorExcmption.YOU.hould 501 - FINAL ELECTRICAL ENERGY
boce a jam to do Worker s Com r r Coda,you muss
Do forthwith comply with such provisions or thispermlSullWdecmcdrevoked. 502 - FINAL PLUMBING ENERGY
ti CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hereby aRirm that Nem lice natwction lending q.ncy for Ne rcrfwmance of 504 - FINAL BUILDING ENERGY �✓ —
Ya Ne work(tar which this permit i.fuse (14/
d(Sec.3 .Civ.C.)
i IM L ndersName 505 - FINAL' ELECTRICAL f
Z Leader'.Addma 506 - GAS TEST
:)Q 1 exi i(y Nu I haw end Nie application aW sum Nn the sow information i.
COMM l agree to comply with all city and county ordinances and mute laws routing m 507 - FINAL PLUMBING
f)r�
`•' buildingconstruction,and herebyeutherimrc eemetivs of Nis cit to cnteup^nthe
ehovcendunedpropeny for inspection PUmWwL
FIN MEC ICAL
(We)agree to sew,indemnify and keep harmless the City or CurcOino against Q 9 FI 1�
ti h
liabilities,judgments.cons and eapeaus which may in any way accrue against said City 5
;J z in conxyucncc of the gr min uhhis pc S NG
APPLICANT UNDE ILL COMPLY WITH ALL Otjr DINT Issued by: C WORKSDate
SOURCEREGUL ON
�3 Re-roofs
5ig err Applicm Co ctDOE
NA2 RD S MATERIALS DISCLOSURE Type of Roof
Will the applicant Lure building occupant store or handle havmdous material
a donned by the Cupertino Municipal,Cows.Chapter 9.12,and the Health ad Safety
Cod.,Section 253324)? ��Jyd/ All roofs shall be inspected prior to any roofing material being installed.
Cl Yu
Will the applicant or fulum build' g occupant tau cquipmsm or devices which If a roof is installed without first obtaining an inspection,I agree to remove
on,
hat.mmus air contaminants uJ dby Ne Bay Aoa Air Quality Mmilgtornt all new materials for inspectio .
DimricR
❑Yn
Ihave mW theha rwmaterielsmyti nu under Clupter6.H5 o(tW Glifor- /
ria Health ga Safmy Code don. 305,2 2553a.l undcrnuW Nuifde ilJing
Jou not curomly heyc tenant tit' responsihiliry m mttify 'see nr Ne
require cnuwhich stbcme rssuanceofaCcnifcau �r Signature ofApplicant Date
1
Owner tar authodad agent rte All roof coverings to be Class"B"or better