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CITY OF CUPERTINO
INk'ORMATION``i..
BUILDING DIVISION PERMIT
CONTRACT$QR
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BUtlfl ADDRESS:
Allis S�L4 FLOWER CT
ANTHONY HODDER CONST
PERMIT NO.
08050082 .
.R'S NAME:
PERMIT ISSUE DATE
WITT RUDOLPH J JR AND DOROTHY
7504 BOLLINGER RD
05/29/2008
PHONE:
SANITARY NO. COMROL NO.
(408) 257-4317
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG E{ECT PLUMB MECH
0 0 0 0
LICENSED CON'TRACTOR'S DECLARATION
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Job Description
d under m e, of Chapter 9 (a enumcmg
I lemby sRrm Inti 1 am Keenem
with Section 7000) of Division 3 of the Business Ld Profesriam Codednd my license is
KTCHN& DININGRM STRCTRL 275SQ RPLC 2 WNDWS &
in full force and effect.
Lt.. Class tic.•
ELCTRCL
Dow- cmudem,
ARCHITECTS DECLARATION
I mus rsead my plan mall W tial as public mcaNs
Licensed Prefcui... I
OWNER -BUILDER DECLARATION
I hereby affirm that I am acmpl from the Contractors License law for IW
following esson. (Section 10 31.5. Boston. and Profession Code: Any city an county
which requires a Permit m Construct. abet improwe, dcmalish, or epatr any strucmm
prior to its issuance. onto mcf.ima the mplicrun for such permit a file a signcd mummcns
that he is licensed m the of the Convector' Incense Law 9
Sq. Ft. Floor Area
Valuation
pursuant provision (Chapter
(commencing with Section ](BO) of Division 3 of the Business and Profession Code) a
(•
$ 2 0 000
dent he Is aempt Nemfmm and the basis for lie alleged eumption. Any violation of
Section 7031.5 by any applicant for a Permit wbjcm Ne applicant to a civil penalty of
36618040.�Number
Occupancy Type
not mme them fin hundred dollars ($5M.
❑ 1, u -war of the property, a my employe WiN wags u thou wlc ampenadon,
wi0 de the work, ad Ne wmenmt U;.1 mandcd a alfeed for aale(Sec. 7W. Bumiw
and Profession Cade: The Conoacmrs Li. Law does at apply an an owner of
Required Inspections
property Orion Wilda orimpmw thereon. ad who deessuch work himmIfor dough his
matemploycea, provided that such improsemenu an not intended oraRnred forasle IL,
however, Ne Wilding or improvement is sold within one year of completion, the owner,
builder will ban the Wrdcn of proving that he did not Wild or hempen for purpose of
ask.).
I, n owner of the property, am aeluively contracting with licensed contractors m
c wet Nc aajca (See. 7044, Business and Profession Cade:) M Conduc s U.
conn Law does not apply m a owner of property who Wilds or talent themen, hard,
who cannons for such projecu with a conuacurds) licensed pursuant m the Contractors
License Law.
am aemptunderSee ,B&PCf Ihishae.
er �f 2`.�. -• Dae 9
WORK SCOMPFN� $ATION DECLARATION
1 thereby affirm under penity of perjury one of the following declaration:
❑ I haw and will maintain aCenifiate ofConsurt to elf -inure far Warlues Cout
.tion, .provided for by Suction 3700 of the Labor Code, for the performance of the
work for which this permit is wood
1 have and will commain Workers L'ompeput InOMLe, a Rgailed by Second
3700 of de labor Cade. fa Nc perform.ce Of lW work for which dorm permit is issued.
My Workers Compensation durance mrrim end Policy number art:
Cartier Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
.
(ITumNut need ret W Completed if the Permit u farone hundred doBLs (5100)
or I=)
1 cmifv that in the Pulomauce Of the work for which Nis permit u Usual. l shall not
employ any pawn in my manarw.m w too lheworken'Campensation
taws of California. Dam
Applicant
NOTICE TO AP L (CANT: IL ear making this CedifilSaw of Eamptian, you should
become subject to Ne Wohcrs Compensation proHsion of On Lane Code, you atm
forthwith comply with such provisim n or this Permit shall W darond mated.
CONMUC71ON LENDING AGENCY
'
1 hereby affum Nu the. ire a ronuuction lending agency for IW me fumaae of
the oat for which this permit a iuucd (Sec. 3099, Civ. C.)
-
Lendc'sNamc
Lenders Address
I Codify that I aro rad this application .d soup that the above infomatiun is
comcL 1 agree m comply with all city and counly adinuuts.drum laws elating to
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Wilding e011y(eCljOn, Ltd hereby au homore re eaeu num Of this city. enter upon NC
.hove -mentioned progeny for inspection purposes
(We) agree to an. hodcmnify ad keep hamle. the City of Cupertino agent
Iimilhica judgmcnu.cnu ad espouser which may in my way ¢oon cagainst aid Ctry
in consequence of the granting Cl this permil,
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCEREGULATIONS.
Issued p
by: Date
�/
< ` / 2
eof
Re -roofs
Signature On
pphaa9�tatmor ,
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or fu,une Wilding occupant start or hondlc hasardan maenal
fined by f Contuse- Monidpal Cade, Chapter 9.12, ad the Health and Safety
. Scotian 25532(+)+ , I
❑Yes fR Na
All roofs shall be inspected prior to any roofing material being installed.
Will the splicer, or future building u. of which
fT g
If a roof is installed without first obtainingan inspection, I agree to remove
P g
by ft Ba
cab hanrdnes air caumianu u dcfiad by Ion Bay Ama Air Quality ManaScmcnt
. Air Qu Man
all new materials for inspection.
"auric'?
kIT
'�Nu
❑Yrs
1 have mad the mnrdeus maeriils mquiemcnu umkr Cha ter6.95 oflhe Califon
MAHCOM& SafctyCade, Section 25505.25533 and 25534.1 uedcnand NLif t e Wilding
dos -1 'Wendy ham • ansa. Nu it u my reasonability to ati(y de 16Yp.1 of de
mgdm nor Which atm W mel pd., W i.u. of a Cndfcaa Of L .pi�nrCy.
Mn ,
Signature of Applicant Date
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All roof coverings to be Class ')T' or better
ownerm.thar>oot D,a