06080103 CITY OF CUPERTINO ,.;tY;`x z •wsX,aI ,,— 7-• "*`",�Ma '3-+�.�:
BUILDING DIVISION PERMIT CUNTRACTOR IIWWWUT'IOL\Q
BUILDING ADDRESS: WESTWOOD CONSTRUCTION Pr"hIIT N006080103
7529 DE PQE DR
OWNER'S NAME: PERMITESUEOATE
MR & MRS JEFFRIES 223 N SANTA CRI17 AVE QR/94 /2nng
E: SANITARY NO, CONTROL NO.
(408) 395-9231
ARCHTIEC IE.'GINEER: BUILDING PERMIT INFO
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�0' LICENSED CONTRACTOR'S DECLARATION JOb Description F 1 hereby amrce Mut 1 am licensed under provisions of Chapter 9(commencing
'S2 when Section 70MB ofDivision 3 of the Bushes aM Professions Code,and my[too=1.
, „ ufullraaeandeffcM REVISION-STRUCTURAL ,AT KITCHEN/DINING AREA
x Dole Dasa C.nMxemr
Date REVISION DUE TO FIELD CONDITION-ORIG #06040010
mnlr
ARCHITECTS DECLARATION NO NEW PERMIT
i < I understand my pians Nail he used as public records
mdse
:0 Licensed Pmfessionsl
'v,5OWNER-BUILDER DECLARATION
I I hereby s(Em that I am exempt from IMO Conlntto's License Law for Me
a o following mason.(station 7In I.S.Business and Professions Cade:Any city or county
1$ which Inco mes a pm d(to construct,der.marrows,demolish,or mpair any structure
.Z pilar to its issuance.ahs requires the applicant for such permit o Iii euigned aulement
< thmheis licensedpersonalto the provisions of the Comment's Lkcnw law(Chaptor9 Sq.Ft.Floor Valuation
I�8 (com
Nh mencing with Section 7000)or Division 3 Ofthe Buiws4nd Professions Code)or $69392
5 at he exempt thuefrvm and the bash for the alleged exemption.Any violation of
Section 7031.5 by am applicant for a permit objects Mm applicant m a civil penalty of APN Number Occupancy Type
not mom than fmvo hundred dollars($500).
❑T,u owns of the pmpmy,m my wploym withmM a Nish tele eompewdon,
will do dim"rk,andlhe,wmure is actmuuled aalferedRussian senc.7044,Business 1 822 orRequired Inspections
as Profession,Code:The Cmuueumxe
trm's Lblaw does rou e
mmor apply an or of q p
property who builds miceprowa thereon,and who dnessoch work himWlar through his
own mnployees,provided that such Improwmmum countersued aruf mad for ask If.
however,Ne building or improvement is mid within roc year,ofcompleuan,the"a".
builder will have the burden of proving Nat he did ml build or Improve for purpose of
ueJ.
❑1.as owner of the property,am exclusively contracting with licensed conmcmn to
construct the project(Sec.7044,Business and Professions Cade:)The Contncuh U.
ante law dca not apply in an owner of property who hutlds or improv Menson.and
who comes for such projects,with a eonuuur(s)licensed pusuam to the Communes
License law.
❑Iamuempturrabo a .B&PCforenhmamv
Ow er
Data
WORKER'S COMPENSATION DECLARATION
1 hereby aim under penalty of perjury m of the following declarations:
have and will mainuin a Certificate OfConsent In sellme for WOrker'l Compen-
an,u provided for by Section 3700 of the labor Code.for the performance of the
work for which Nis permit is issued.
Q I have and will maintain Worker's Compensation Insurance,u required by Socdon
5700 of the Labra Code,for the perfamance of the work for which Nis permit i,hsocd.
My W.&.Compensation Insurance artier and Policy number am:
CaPol'eY No.:
me
r CERTIFICA OF (PMPnoNFROM WORKERS'
COMPENSATION INSURANCE
Croseceenocedmt completed llthepemituforone huscreddallare(5100)
or loss.)
1 certify thakjo_We.p\erf nee of the ark forrich this permit b Issued.I fiall not
scopic fpermnm R cr m to Me Worymn'Campensation
Law, fGlifomia.
App1i
NOTICE TO AP .after making this Certificate of Exemption,you Mould
become subject orke s Compensation provisions of the Labor Codc,you mus
,JO foMwith comply with such provisions or this permit Mall be deemed revoked.
CONSTRUCTION LENDING AGENCY
(-m I hereby aim ides them h a construction lending agency for the perfomanee of
ai the work fur which this permit is issued(Sec.3097,Civ.C.)
Ul Q Lead
efs Name
r7 z L4nder'a Address
U Q I comfy Nu I have mad this application and sum that the above Information is
U,E•' comet.I agree in comply with all city and county ordinances,and sum laws mladn{to
Q U building consuuction.and hereby•uthorim representatives of this city to enter upon the
r[i7 almvcmenduned property far inspection Purposes.
(Wee)agree m save,indemnify and keep harmless Me City of Cupertino against
mFi rrA liabilities.judgments.costs and expenses which may in any way game against Me City
U Z, in consequmee of de granting of this permh
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Si{neturt of ApplinDem
HAZARDOUS
US MATERIALS DISCLOSURE Type of Roof
WIII thea o sit t or forum bulking attupatMm or auntie Heardm omaterial
u deC
0ncd by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code.Section 25532(,)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes Pion
WIII the applicant or futum building occupant use equipment a devices which If a roof is installed without first obtaining an inspection,I agree to remove
huardous air canumirome as deOred by the Bay Ams Air Quality Management all new materials for inspection.
trlet?
❑Yen 0 N
I hese mad Mte hnaNnuntyyriels myulmmem under Chepter6,95 of enc Califory
ni Ads& a Cad.,sccdan RSlO3.25533 and 25534.1 understand that ifthe building
aoa not cu illy avo a moa this Il is my respoesihl,.,to notify the occupant of the
qutmmcnl yhi tr b el prioruiuuunaofaCcofeamof sup cur. Signature of Applicant Date
Owner a a h acro �6��"� or
All roof coverings to be Class"B"or better