06050121a ami
C .
01
z.
W'
6r �
U i
UC
LL 0E
CITY OF CUPERTINO
7a
A.TIa(i
BUILDING DIVISION PERMIT
).COITI2AGTC)R.'IN'4n $
BUILDING ADDRESS:
DAVIDMICHAEL CONSTRUCTION
Mser NO -06050121
19133 COZETTE LN
OWNER'S NAME:
PERMIT ISSUE DATE
EUGENE & SANDRA ALBRETSEN
476 S. 2ND ST.
2006
E;
SANTTARY NO. CONTROL NO.
(408)295-1919
ARCHITECVENGINEER:
BUILDING PERMIT INFO
RLDO PLUMB MECH
O
j LICENSED CONfRACIDR'S DECLARATION
lob Description
P
1 hereby affirm Ws I am licensed under provisions of Chapter 9 (commencing
with Section 7001) of Division 7 afthe Busimus and Profcesie Cade. and my license is
in full fares AM Affect.
ADD 192' -MSTR BEDROOM/LAUNDRY-430' 2 CAR GARAGE
Lieenw elan Lma
Dam Corn
REMODEL KITCHEN/RE:-ROOF (E) ROOF
DELL
ARCH DECLARATION
SANITARY IS SUNNYVALE'S JURISDICTION
etah use
1 undersmnJ my paw atoll M1c used As public mcnrrb
Licensed Professional
3 OWNER -BUILDER
BenDECLARATION
sumps from the Conualo License taw tar the
F 1 hereby a?Ire that 1 exempt
o shy or county
following reason. (Section 7(15 Lq Business and Pmfwiom Cam:
1.
i which, alma hnprove, demolish. ri per
sig soy immummer,
a permit re <orres
ft e a
priormim lssuanm.tlw requires tie applicwl for inch Permit fileaelgned summer,
us Isu
<thal licensed Carman's limine Law (Chapter 9
Sq.F E0000r Area
Valuation
he is pursuant m the provismm of the
(=nnoo ing with SuUan 7000) of Division J of the Business and Prolusions; Code) to
$170000
9
and the bub for the alleged mompliam Any violation of
me he is asemps dissolved b
Section 7051.5 by any applicant for a permit subjects me applicants m a civil penalty of
APN Number
Occupancy Type
not mom than Rve hundred dollars ($500).
1, as owner of the property, or my employee with wage As their note compeosadon,
Required Inspections
the °`c°ommeure is rceintended
u` La:`m ;°� o
and Praf�a" Co ee' 71.d apply At an Owner
propertywho buildsor improves demon, and who doessuchwark him cifor through his
awn emplayeu, provided that such improvemene ve molnended °ranered (orale. If,
however, de building or Improvement Is sold within am year of campledon, the owner.
buimer will have We homes of proving that K did nos WWW ser improve far purpose or
sale I.
I, as mares Of the property, am exclusively contracting with littnsed mnbamora m
•' construct the projem (Sec. 7064. Business sad Prafealam Cade:) TM Contractor's Li.
cons, law does not apply man minor of property who builds or improv demon. and,
who renes for such projects with a mntr cmr(U licensed pursuant to the CondecmM1
License law.
11 Am a^mpt/user Sec far umaoa
�.B&PC
�
0
-IM
WOR PR'S COMPENSA7TON OECLARA ON
alarm under peaty of perjury arc of the following deelarWorts
1 thereby alaea
have arm win maintain Acoruscate of consent he elf -Wise fa wakeh coupon.
sation, As provided for by Smdon 5700 of the labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will madmen Workers Compensation fnsurm e. As raqumcd by Section
.. _
570(tof site Lobar Code. far me performame of rhe work fa which this permit is bwed.
My Worke's Compeaatian Insurance eanuer and Policy number am:
Came.. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mossemion mm motmconpmmd if the Fund, is furaehun&cddalisrs (SIM)
of lam)
I cer i(y that in the performance of tho work for which this permit is Wised. I shall not
employ any person in soy menmr Dare come subject m the WorkerCompensation
Tawe of Call f Dam
Appu i+;m st6 ars
NOTICE TU APPLICANT: If. army makingtea Cemncam ofempuon, you should
become aubjm in the Warkera Compensation provisions of th, Lada Cade. you muse
forthwith comply with such provisions Or this permit shell be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 herby afMn dist siert bs mnRluc. agency lathe pMormance of
30 7, Cing
the wuricroes fa which this permit b bsucd (See. 5(197, Civ. C.1
'
Lenders Name
,
Lenders Address
�
I mNfy that 1 hive mud this application And sem this she above information is
'
correct. 1 Agra m comply with all City And county ordinances and ere laws relating m
building construction, and hereby authorise mpresenelims of this city to enter upon the
L7 ahove-memiuncd properly for impccdon purposes.
(We) agree to save. indemnify and keep harmless the City of Cupertino against
liabilities, judgments. cats and expenses which may in any soy accros agaiml said City
>' in carucquca:e of the grinding of this permit.
APPLICANT UNDERSTANDS AND WILL CO PLY WITH ALL NON -POINT
Issued by: Date
SOURCEULA-n9�p+s.
6
_
Ll�/ _
Re -roofs
Type of Roof
site of AppliuHAZARDOU a
HAZARDOUS MATERIALS
uS DIS
WIIIdeeCApplicant aforum building mmpwteorta handle hasmoanmamrisi
occ re or handl
As de0ned by site Cupertino Municipal Code. Chapter 9.12. and de Health and Safely
Code, Boom. 25532(a)? /
Yu
All roofs shall be inspected prior to any roofing material being installed.
❑ e
If.a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building asu red um equipment a dcvlees Mich
I huardous air conaminanm u dcOmd by Be Bay Area Air Quality Megement
all new materials for inspection.
Disuio7 ,'
Oyu QNo
1 have reW thehoamanmamriW requirements uakr Chapmrb.95af the Cal lao-
n. HUILK&Sa(cl Cam. Semlaos255M.25555 am125554. 1 undcrsmrm°uslyde building
dos ucs cu have A mast, that it b my responsudaty m sadly, the Occupant of the
`mquire�..�nr�ichr(m�ysI�M mmpdalmia lace neaearOcaT
Signature of All:gpplicant Date
All roof coverings to be Class "B" or better
Owner or authorized agent z D