08070032 CITY OF CUPERTINO
BUILDING DIVISION PERNHT k�t0NT1kACT;01WA1VPF0 ATIQN
BUI Ir�ai D FSS: PERMIT NO.
�1VM/� DEEP CLIFFE DR TBD — TO BE DETERMINED 08070032
wNER'S NAME: PERMIT ISSUE DATE
MR & MRS JOHN GEIS 09/16/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG BLECT PLUMB MECH
�Op LICENSED CONTRACTOR'S DECLARATION O O O O
1 homey,frim that 1 and li¢nssN ander,PocvWOns of chapter 9 ro mmmeing Job Description
Ux with Section 70(10)ofDmionn3oftheBusiness and ProfemovCode.and mylicense 13 REMODEL LIVING RM, MASTER BEDRM & FRONT ELEVATION
_=„ in full force and cffecr.'
Lieenm Class Uc.♦ CHNGD (3400SQ)WINDOWS,REROOF ENTIRE HOUSE 34 SQ
0 q Dam Conuacmr
ARCHITECTS DECLARATION w
U I understand my phos mill W umd as public retards
ka C Licensed Professional -
OWNER-BUILDER DECLARATION
a� f 1 hereby affirm that 1 am exempt from the Conus &.license Law for the,
p o following mason.(Section 7031.5,Business and Professions Code:Any city or county
$ which requires a permit to eonssuck alter.W prow,demolsh,m repair any structure
–i< Fria m is ismamx.alsu requires the applicant forsuch permit to file a signed statement
pp
that W is licensed pursuant to the provislom of the Contractor's Uccrux Law(Charter 9 Sq.Ft. Floor Area Valuation
Y�$ (commencing with Section 70(0)of Division S M the Business and Profusions Code)or 50000
Nat he is wept tbmefmm and tho basis For the almgcd catcouption My violation of
Section 7071.5 by any applicant for.permit subjects the applicant 10 a Llvll Penalty ofNumber Occupancy
dm mom than fiw hundred dollars(M). 35604009T'Pe
❑L as mumer of the property,a my employees with wages u de'v sole compcwtion,
will do rho week.and the awmum ismt immnded moRemd rmsam(Sa.706/.Businm
and Profe urns ecdc: m
The CommacLicenses LiLaw ducaltelo
t apply an owner of Required Inspections
properly who WilNaimpmwsthermn.and whoducamch work himselforthrough his
awn employees,prodded that such ireprowmans..or interded moRemE fmsaf If.
however.Ne building orimprowmem is told within one year of completion.the owner.
builder will hove the banded of proving Wt W did tet Wild or improve for purpose of
ulc.).
V
1,as Owner of tW property.am caclusivcly contracting with licensed contractors to .
datrom the pmjem(Sec.7054,Business and Professions Code:)The Conhacto's U.
ave law dao not apply te an ownm of propenY who Wilds or improssa demon,and
who contacts for such Projects with a coneracwgs)licensed purswnt or the Contracmer
License Law.
❑lson eawysmdou ,Bd PC this o
.mer Date96 D�
WORKER'X=MFENSATION DECLARATION
1 Wreby air=under perW ty or perjury m of the following declatatiov:
❑I ham and will maintain•Cerificam of Covent m ulf4usere fns Wmkers COmpmF
cation,as provided for by Section 3700 of the labor Code.for the Wrfmmama of de
work for which this Permit is issued.
❑1 haw and will maintain Worker's Compensation Insurance,as required by Section
5700 a the labor Code.for de purfomameofthe work fmwhich this pemit is issucL '
My Worke's Compenudon Insurance cannot and Policy number art:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE a
(Thismction used tet W cmnpleed athe permit is forOachundaed dmlisrs($I00)
or lea)
1'cmih Nat in the performance of then work far which this Permit s issued.I shall not
employ any person in any manneriq�p wee syb'iept mLWWmlcrs'Compenmtim
Laws a(Califo fa.yam 'f�)�y7/_t
NOTICE TO APPLICANT: , c making tiaca
this Cmte of Exemon.ptiyon should
become subject m the Wod.crs Compewtion provisions of tW lahor Coda you must
�Q forthwith comply with such provlsimns m this pcmiL mail W darted evoked.
z CONSTRUCTION LENDING AGENCY
(~ 1hembyalfim that there is a covuucdom lending agency for the perfumanen of
!Yi site work fur which that permit is vowed ed(Sac.3097,Civ.C)
W Looker Name
z Lender's Address
U O 1 entry that 1 h.w rod that application and auto that tW show Irrumation I, -
(y cancel I Ogren m comply with SII city and County mdlm.LW foam IM relating m
O Wilding construction,and hereby authorise mpresenstiwa of this city m order upon the
show-mentiemd property for Inspection purposes
F W (We)ag=to on,indemnify and keep harmless the City of Cupertino against
Z in consequens. ce
or tsdvuindofPerseswhtchmryin anY way¢cmc against said City
U z in PLICA T Of the grouting of this D WILL
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date Tom+
BO�URC�E REGUTA7WN 9/i
spplresn mnuamor (4,love, Re-roofs
/ Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicanturfutum Wilding occupamaweorsem hauNous memaial
as dented by 0e Cupertino Municiral Code.Chapter 9.13.and the HW th and Safety
Section
E)Y.25572(.)7 All roofs shall be inspected prior to any roofing material being installed.
E)rte pSur
an
Will do,applicant or I.W.Wilding aaupam use equipment m destices which
If a roof is installed without first obtaininginspection,I agree to remove
p
D It ho rdnus air comamimods as defined by the Bay Area Air Quality Management all new materials for inspection.
❑Yes
1 hew roaJ the hvardmsmateriais mquiemens under Clummr 6.95 ofthc Cilifor-
nial."k SentyCode,Scums 25505.2SM3 tad 35531.I mabaarel that 9 the building
des not currently how•—4 that itis my respovihility to nW r,decc
oupant of the
myuimm taw chmuatWmelpriormissuanao(aCcnilkamO(0, ry. b Signature of Applicant Date
Owner orauthmrind ac GD,m All roof coverings to be Class' "or better