02120026 CITY OF CUPERTINO atr *& s��aa,r aY+z "- �^4w's' 7r
BUILDING DIVISION PERMIT CONTRACT-0RpjNFURMATIQN -
BUILDING ADDRESS: ROCKY & DONNA LOWELL PERMIT NO 02120026
N17\7 T)p
'NER'S NAME: 'ESN
7 5/2003
JCKY U 1
NE: SANITARY NO. CONTROL NO.
ARCHm3C TENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
rap Lm ENSEDCONTRd under
DECLARATION
F I ion? affirm wOuthim.
I sus licensed under previsions or Chapter 9(commencing Job Description
Svi
with genian]gill raison Sof NC Busin�u and Pmfcuiuos Code.and my license is
,L1 inrulluCho
Z�- Dine Clus cm
du ADD 580 SQ. FT/RELOCATE GARAGE
ak Dam GmO
ARCHITECTDELLS DECLARATION
D*`
z 1 understand my prams shall w used pe rt
public cnrds O
u Licensed Professional
�m 5 OWNER-BUILDER DECLARATION
ta C 1 hereby.. ofOrm that 11. exempt from N,Co i..Co License Lew for the /
o O following reason.(Section 703 1.5, t,Mu ss and improve,
docous Code:Any city or coumy
x which its ism a permit re uirst h, almn improve,h pe m permit
ri sash any swmum
--„ priormiu tensed pummunt to requires lhovisio esof for uehp,emiuo Bcisele a,Law wmmem
s `e (commmcmmediumsion7")ofDisimtsnrthe cmmrsctdrandceor innsCpmr9 Sq. Ft. Floor Area $95�fPb
W
lZ- dn'hCcas Ing wit Smidomini n and th Dboutof r the ac alleged
exempt Professions Code)ser
y $ Natio u exempt.antroli and the aper for be cts dud exemption.Any violation of
Seton than
by any applicant for a permit subjects dee applicant m a civil Penalty of 3 2IR413,014t1Der0 0 Occupancy Type
raw mmrt Nan Bve ntrnarta acorn(s500). P Y YP
0 1.as owner of the property,or my employ.with wag.as Heb sok compensation,
will do the work,and the suumuo linos intended or offered for sale(Sec.7W,Business _ FOUND
and Pretensions Code:Tlic Conoxso's Li«ntee law does but apply in an owner of Ai&hiA102 - PIERS d Inspections
property who builds or improve Nmd
eon,and who .such murk through himselfor vugh his
own employ.,provided Nat such improvements are not intended or offered for sale.If, 103 - UFER
however.the building or improvement is sold within one year of Completion.the owner-
builder will have the burden of proving that be did not wild or improve for purpose of 104 - REBAR
sale .
0 I.as owner of the property,and exclusively conuaning wit licensed cunuactms to 105 - ANCHOR BOLTS
commoner the projem(Sec.1W.Business and Professions Code:)'n,ConuacmYS V. 106 - SEWER & WATER
cense law does not apply man owner of property who wild,or improver deems.and. 202 — UNDERFLOOR PLUMBING
who contracts for such projects with a convactor(s)licensed pursuant m the Commodes
Li se 203 - UNDERFLOOR MECHANICAL
I xe`ptun ec. B ,Pcrorthtsmaun 204 - UNDERFLOOR FRAME
WORK ' MPENSATIONDEC- Od 205 - UNDERFLOOR INSULATION
1 hereby affirm under penalty of perjury one of the following declanuorts: 301 — ROUGH PLUMBING
Ihave and will mainuina Cenificamof Consenttofor WorkcriCompen- 3 0 - TUB & OR SHOWER
anon,pe provided for by Section 3700 or due Labor Code.for the performance or Um 3 0 3 - ROUGH MECHANICAL
01haveword,for menNi,parmiiixitnd. 304 - ROUGH ELECTRICAL
❑I love and will maintain Worktfa Compensation lusurance,u rtquiud by Section
3]00 of the labor Code,for the peR,rmance of the work ror whim this permit is issued. � 305 — FRAME
My Well Compensation[introduce carder and Policy number are: 306 - HOLDOWNS
Cartier. Policy No.;
CERTIFICATE OF EXEMPTION FROM WORKERS' 307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
or le.)(ITU section need not w complowd if the permit is for one hundred dollars IS 100) 309 - EXTERIOR LATH
1.mfy 310 - INTERIOR LATH
1 unify Net C tM p�nrmence of Ne work for which Nis permit r in'Co I ma nos
employ any pc ymsnncrsoumboromewbjectto lw workeri Compepeation 311 — SCRATCH COAT
Laws afC fSie.D
Applicant 313 - ROOF NAIL
(JOTsf'ET PLICAN-. of nkingthis Ccnifcat Exemption.you should 501 - FINAL ELECTRICAL ENERGY
e subject in the Worker T6NmPeriodic.provisions or Laver Code,you most
.JZ ronhwiNComply with men provimmorthis Permit mail wdecided remlem, 502 - FINAL PLUMBING ENERGY
ZO CONSrRUMONLENDING AGENCY 503 - FINAL MECHANICAL ENERGY
(-' Ihereby afarmdoor dome i,aconsnctionlending agency for the performance of 504 - FINAL BUILDING ENERGY
C� the work fur which this permit is iuucd(Sec.3097,Civ.C)
Linda's Name 505 - FINAL ELECTRICAL
C 0
JZ anaernnddm.• 506 - GAS TEST
U O 1 Certify that 1 have read this application and sum that the above information is 507 — FINAL PLUMBING
UL correct.l agree m comply wide all city and sea county oNim"Ces and ,laws relating m
Wilding Construction,and herby authoria repreunaures of Ni,city to enter upon the U above-mentionW ro n for ,tion n FINA MECHAN CAL
p Pc Y isle p .poses
F 4 (Wer)agree to aeve,orindemnify and keep hasmleu the City of Cupertino against 0 9 FIN 1
eq liabilities.judgments,costs and expenses which may in any way see=agairm said City 5
U Z in consequence of the granting of this permit. G / Z
'-' APP NT UN STANDS AND WILL COMPLY WITH LL NON-POINT Issued by:5 WORKS Date I /
S RC 'T UN ONS.
Si ser rApprcan o Dam Re-roofs
H US MATERIALS DISCLOSURE Type of Roof
Will thcapplicamor um wilding occupant soon,or handle hrardeor material
u dented by Ne Cupertino M- ¢tial Code,Chapter 9.11.and to Health and Safety
Semen]ss31(.)? � All roofs shall be inspected prior to any roofing material being installed.
0Ype Na
Will the applies.or fmurt wilding oceupam eau equipment or dcvi.which If a roof is installed without first obtaining an inspection,I agree to remove
L
hazardous air contaminants u defined by the Bay Area Air Quality Management all ew materials for inspection.
Diwie
❑Yes
I have read the wrardn s .rials requirements under Chapter&95 of Ne Calir -
niaH lO&Sxf Code.Sadami5505.n533and7553a.lundc N ifm wilding E[
n c n y ave a¢nam-that it u my reaponnbility,mo Ito upact of the
q' us
musty tpriormissuameofa erllfMiseofOC ry. On ureofAp Icon Date
— S=0
o mer atrthm x a D,re All roof coverings to be Class "B"or better