04120131 CITY OF CUPERTINO
BUILDING DIVISION PERMIT a.� Ql\Itl' Q-" RINFURl�!'ATIQN .'
BUILDING ADDRESS: THOMAS HARRINGTON PERMIT No.05120131
OWNER'S NAME: PERMIT ISSUE DATE
THOMAS HARRINGTON 105 FREMONT AVE01/09/2006
E: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BO EO PLQ MECH
O
300 LICENSED CONTRACTOR'S DECLARATION Job Description
tl
x I hereby affum TNI I am licensed under provisions of Chapter 9(commencing on
n< with Section 70M)of Division 3mf the Business and Professions Code,and my liceruc is
Ll noratceadeHat r� _Il}pt{Sgp REVISION TO STERN WALL-FOUNDATION
Z License CI s Lu.I
IIII---- Dam ��� Canincltsr
;e ARCHITECTS DECLARATION
y 1 understand my plans shall W used as Public records
yo Licensed Professional
OWNER-BUILDER DECLARATION
y T Nrahy,(Rene on 1 am exempt sane the Cantns Co License Law for the
>D O following moan.(Section 703 cots Business and w,demolish.
Cade:My city or county
$ which requires;a permit re construct,he plot Improve,demolish,ore a sir any swdun $v Q
z�^ Pliasmits slissuance,also
nt to the the applicant for such panni'mcaaaLnedaatemem
ve°
Man
ommcncingwd Scxdcm70th)ofDiviomofthe (Chapter 9 Cole)or Sq.Ft.Floor Area Valuation
$ dust he 3 aceraim Smalmon and
dth basis for
of Me alleged
esaandon.Any viCnde)m
.. Net io r 31.5 b mcmfrom and the aper far the Waged eampdm.Any violation of
Section Man by Yry red dolla for•permit subjects dm applicant m a dull pemlly of
net mon Nan five hundred dollars(5300). (7CCUpanCy Type
❑1,as owner of the property,or my employees with wages as their sole eumpenadon,
will tits IN wart and Me aWcmm 4 aa'Intended IXaRtmd for 444(Sm.7044,Real.
and Pro(adam Code:The Conusemis License Law docs not apply in in owner of Required Inspections
property who Mid&or i mproecs ulercon.and who does such work himself or lluough his
own emplayca,provided that men Improwmenu tie notinundetl oro@red fmsau.If.
lumcm,Ne building or improwmem is sold within am year of completion,Ne owner- \
builder will haw Ne burden of proving mal N did net Wild or Improve for purpose of an
sae.). V
❑1,as owner of me property,am eaclutiwly contracting with licensed cenascun te
convect the project(Sec.7090,Business and Professions Code:)The ConNcteri U.
cepa Law does at apply m an owner of property.who Wilds or improves thereon,and, `\ \
who contracts for such projects with a eantrsemr(s)licensed pursuant m the Coammuses v
License Law.
❑lomexemptunder See ,Bal PCforthisranan
ner Data
WORKERS COMPENSATION DECLARATION
1 busby&Klan under penalty of perjury one of the following dedan0om:
I Nus eM will mpinuin•Candftcate of Consent in self-Warm far WorkersCamper.
sation,as provided for by Section 3700 of me Labor Code.far use performance of dte
work for which this Permit r Wood.Wood.rmit d.
❑1 haw and will maintain Worker's Compensation less
mance.n required by Section
3700 of the labor Code,for the performance of the work for which mis permit is issued
My Workers Compensation Inaunnce carrier and Policy number Ye:
Carrier: Policy No.: 1'7U- (4
CERITFl EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thr section ncetl net W completed if IW permit 4 foram hundred dolWs($1+0)
or Icac)
1 certify,that In the performance of tine work for which this permit is issued.l Asti not
employ any Perron in any manner an at to become subject to the Workers'Compenallan
Laws of California.Data
Applinnt
NOTICE TO APPLICANT:If,after making this Cenifinu of Exemption.you should
become tunnel b the Wmlmf'a Compemation provisions of me Labur Code,you mute
.J O fortlwim comply with such provisions or this permit shall W deemed ranked.
'Z'" CONSTRUCTION LENDING AGENCY
ti
(-+ work
whdBthi W'tinrt I..connotation leading agenry,lbrmo performan¢of
!Yi the work for which ner permit is issued(Sec.7097.Civ.CJ
W�0 Lender's Name
�z Lender&Mama
U O 1 cenify thm 1 haw mad this application and sum mat the AW w information is
FcmracL 1 At=to comply with all city and county ordinances and sate 4ws miming to
OU building consuic'ion,and herebyauthodm repreanutims of this city to enter upon the
W abow-mentiancd property for inspection,purposes
W
Ly, (We)agree m ave,indemnify and keep harmless the City of Cupertino against
[yW Imbllltinjudgmenu,coN aap
dcxpcwhich maylnaywyacrne agalnntaid City
U,'� inconse of me ting of this permit.
"" APPLICgmnce UN ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU OUL
Re-roofs
Sign tic I/Contrsetar Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will applicant ar future Wilding occupntsrore or Nndlc havardms material
a defined by the Cupertino Municipal Cade,CNpmr 9.12,and the Health and Safety
Code.Section xss7x(e)7
❑Yes All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building assistant ax If a roof is installed without first obtainingan inspection,I agree to remove
5equipment or deviw which P g
iI havadous air conuminmts n d Iced by the Bay Area Air Quality Management all new materials for inspection.
uftict7
Q Ycs u
I haw mal the hvadoammcrmisnyuimmcn4 unierCNpler6.9softhe Califor.
nip Healm&SLfctyC .Safi=25505,25533Ld25534.lunderstsMmmiff Wilding
dna not rmmly umnl,mat it 4 my responsibility m notify me oceupat of the
gal tswn' mWmet prior missuance anCertificate araapa¢. Signature of Applicant Date
Owner rad agent ate
All roof coverings to be Class"B"or better