08060133 BUILDING DIVISION PERT o;�ELRA 'T,QR52� 00
PERMIT NO.
eDlLD9.'Y5RTDMESTEAD RD BARBERA ROBERT J AND LINDA 08060133
ORS NAME: PER.Mrr ISSUE DATE
BARBERA ROBERT J AND LINDA C 22120 HOMESTEAD RD 06/19/2008
PHONE: SANITARY NO. CONTROL NO.
ARCH1=11INGINEER: BUILDING PERMIT INPO
BLDGELECT PLUMB MECH
I� 0 0
too LICENSED CONSRACTOR'SDECLARATION - IObDe$CfIlpn
w 1 hereby affirm Nru
al l am li¢ cd under proviu timof Chapter 9(comDescription
P
' with Section 7000)ol'Division 3 of Ne Budoess and ftretiom Cade,and my liccomu ADD(66SQ)RMDLE BTHRM (50SQ)
in full fora and enca
j i License Clms Lk.a
Da¢ Contractor
ARCHRECTS DECLARATION
1 understand my plans shall M med an Public records
Ule
leo Licensed Professional
OWNER-BUIIAER DECLARATION
I I hereby oRrm Nal I ern exempt from on Convectors License Law for the
p o following moon.(Section 9031.5,Bmineu and Prefessiom Cade:Any city or county
which requiresa p riled m cmuudm,alley,impmw•dcmeluh.m.Palo any stmctme
_Z< prim to its issmnce,tout requires the applicant forsuch permit to rile a signed setement
that he'a Hamed pmsuantm the pmvidomor Jx CantracNr'a4eemc law(ChapW9 Sq.FL Floor Area 2 Valuation
y1--� (commencing with Section 7000)of Division 3 afthe Butimemand Prefetsiom Codc)or 0000
y $ out he Is caempt Nerefmm and the bait for the a11bgW exemptitm My violation of
Sccom 1031.5 by airy applicant for.permit tcbjecu the applicant N a civil penalty of Number Occupancy
Out more than firm hundred dollars ane s(SM 32601005 .E P Y Type
Lo the wornluie pmperty,o my with wgmualen sole .Butsunh,
will Pr tewons addCram:
Ne suumumunotintendedn,owrdesed not a(See.7014,Owner o.
and en, h bis Code:The.therm rt.came Law atm not apply N an owner or Required Inspections
man emywho buildsviimPmwut ch impr add who deexouch work himselforthrough on
ow ewer. yos,DmMord pnown impsm id within am
not intended completion.eeaxi mesale.lrhow .
Witecr Neave ng ed.o Freft is,chat edict am yea of W .fr the owner- ..
builder toad have the burden of proving Nat he did tet build m improv rte purpme of ,
saeJ.
❑1.a owner of the Property am eacluuvelY communing with IiremW centracem in
comuuct on project(Sec 71%4.B.O.and Prete smon Code:)Toe Onalcmers Li-
cent Law doer am appy to an owner of propeny who builds or imprewu 0ereem.and
who mmu mus fm such projects with.rontramer(a)lionsed pursuant N the Contractors
Len.Law.
I am esempa a Sec .B b.PC far out watchP
neI. O Date ems/mJ0
WORKER'S COMPENSATION DECLARATION
1 Mreby affirm under penalty of perjury one or the following declarauom:
❑I have and will malnuin a Certificate of Consent he self-imurt fm WorkersCompen-
radon,as provided for by Section 3700 of the labra Code.for the Performance of the
work for which this permit is ismu d.
❑I have and will maintain Wtaftea Compemation Insurance,an,required by Soctinh ,
3?IXl of the labra Code,fm on,perfro mmen of the wok for which this permit is Wend.
My Workcrs Compemxtitn Introduce artier and Policy number arc:
Cartier. Policy No.:
CERTIFICATE OF EKEMPr10N FROM WORKERS'
COMPENSATION INSURANCE
(nor...need Out he completed ir0e permit is foronc hundred dollar($I00)
or ICL.)
1 cenify that in the performance of the work for which this Permit is casted,I Nall not
employ anypmtcn in any mannersoR m bb��pme sub'Iot to the Workers'Compemation
laws of California.Date G Y s�'a—
Applicant
� , - -yi
NOTICE TO APP If,a1mr making this Ocr o m e of Exemption,you should
become Subject m the Wokcrs Compcm noon proviuom of Nc lobo Code,you must
.,Q m forthwith comply with such prov(door Nu permit shall he domed revoked.
'E r CONSrgucnoN LENDING AGENCY
vim-, I hereby affirm that Nem u a com necom loading a
f" Y gam for the pcuurmance of
Cli tie work fur which this permit is issued(See.709'1,Civ.C.)
z Lenders Name
n
� z l<nders Add. ,
U Q 1 codify that 1 have red thin application and use that Ne above infmmatiun is
Iy F Context.I agree a comply with all city and county ordinances and state laws miming e
building construction•and hereby authodm mpmrnmWiM of Nis city a enter upon the
pro
N a
tome-mentioned ma.crtY for inspection pugwseb /FYI
(We)agree to un.indemnify and lop hermmus the City of Cupertino agalmt
rad incoiucs,Judg of the mond expemmmit. may in anywyamuc agalmiand City
U z in conscgoxeo(Ne Eranun6 of this permit.
v-. APPLICANT UNDERSTANDS AND WILLffOMPLY WITH ALL NON-POINT Issued by: Date
SOURCER l�'j. p�� G/
Re-roofs
Signature or ApplimHAZARDOU -T puce
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicantorfuture Wilding eoupantstore m handleard oanmaterial
Oby on CupertinoH
Municipal Cade.LTapter 9.12,and the calN and SafetySce
vc,Section 25532(a)?
❑Yu '4P No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cm(t hauardnm air conuminanu as alincd by the Bay Area Air Quality Managcmcm all new materials for inspection.
District?
❑Yes fiitNo
I have mad the hma materials requircmcnu under CupW6.95ofthe Califur-
nit,Health A,SarctyCudo.Somicw25305.25533 and 25534.1 and rmand this irme building
Jou not co endy low a Want.that It is my rmpomibility a notify the occupant of the
mgtiremcnu bleb tete met a�yln hauana oft certificate of Occupancy. Signature of Applicant Date
�de$Z_ia0 All roof coverings to e ass'/{
Owner n bClor better or authonvcd agent Date ng ••
gE _ �