06010164 CITY OF CUPERTINO
BUILDING DIVISION PERMIT WONTRx CTOIt;INFORMA. IO.
BUILDING ADDRESS: THOMAS E HARRINGTON PERMIT NO.06010164
22350 HOMESTEAD RD
ER'S NAME: PERMIT ISSUE DATE
THOMAS E HARRINGTON 105 FREMONT AVENUE 2006
PM3NE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG EIPLT PLUMB MECH
trop LICENSED CONTRACTOR'SOECIARATION MJob Description
t� 1 hereby of irm that de
I am licensed under provialmu of Chapter 9(commencing
with Section 7M)of Division 3 of the Business and Professions Coca,and my license is
M
in mllto=andefect. REVISION-FOUNDATION.
,04 Lmense Clue Lk.N
nP Dale r \
ARCHITECTS
DECLARATION
Q I undemund my plans shall be used as public records S,w
4 Licensed Professional V
J U
O OWNER-BUILDER DECLARATION
E 1 herehy Won that I em emmpt from tie Conlmcrors Lima.Law for the
O O following reason.(Secaun 7031.5,Business and Professions Code:Any city or county
$tai which requires a permit to commuct alter.Wpmw,demolish,or repair my strmlu e Q
prior to its issuance.alau requires the applicant Mr,mh Permit to file a signed sutement
g�< that he is licensed removal to$a provisions of Ne Contractor's Uceve law(Chaprer9 Sq.Ft. Floor Area Valuation
99 $ (commencing with Sation 7000)of Division 3 of Ne Businessand Professions CoM)or
that an is aaampt therefrom and Ne bash fm the alleged assumption.Any violation of
Section 7031.5 by any applicant fora permit subjects,Ne applicant in a civil penally of rU U Occupancy Type
nut more than Rve hundred dollen(S500).
OX,u Owner or Ne property,ar my emplayen with wages as their sole eampewtion.
will do the work and Neauuctuse is at intended or afraid for safe(Sec.7041,Business Required Inspections
and Proressiou Code:The Contractors Ucenm es law donot apply to an owner of q P
property who Wilds in impmvuthemon.and whodoesauch worklumself mNrough his _
ownemploym,provided that such improvements art ret invaded monered ferah.U.
hmrew,Ne Wilding or rmprevemem la sold within one year of completion,the mance,
Wilder will haw Re burden or proving dust he did nm Wild or improve fm purpose of
sale.).
t]1.u owner of tix property,am exclusively canuanin,with licensed commucaus to
construct the project(Sec.7044,Business and professions Code:)TTe Cmlranar't U-
catue Law does not apply in an Owner,of propertywho W its or minnows Ihimme.and.
wed marmas msuch projects with a contractor(!)Ilcensedpurshan,lithe Continence,
L rue Law.
lam=pt B&P C for this wan
.casner l Dau /L7t^
IFS COMPENSATION DECLARATION
1 hereby dr maker penury of perjury dm of the following deelarmans:
❑Ihaw move ntsin a ranlilcam afCanunuo self-mium for Worker.Cwnpeo-
action•in provided for by Section 3'100 of Ne Labor Code.for the perfammnm of Ne
work for which this permit is issued.
p 1 haw and will maintain Workeei Compensation Insurance,as required by Scotian
37W of the Labor Code,for due performance of the work:for which this permit is issued.
My Workeeg Campenindon luum an seamier and Policy number ae:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section beeak not W cmnpleed lithe permit isforom hundred dollars(SIM)
or leu.)
1 certify that In the performance of the work for which this permit is issued.l shall not
employanypermn myoncr u become subject to the Workers'Canpensadon
Uwe of Califon am
Appltond
NCMCET1ZQV,W
,super making this Cenificam of Escondido.you should
bCCOrlle NbryR e N orker's Compensation provisions of IW labor Code,you a=
OO (aMwiNcemPlY wi such provisions or this Permit shall.lad domed Minded.
Z� CONSTRUCTION LENDING AGENCY
[r I hereby affirm duan then iso comOuNen lending agency for the performance of
�i 7 the work for which this permit is issued(See.3097.Civ.C.)
Q Lender's Name ,
z Lenders Addw
U O I mnify that 1 haw mad this application and sum Nat the above information is
ly F contract 1 agents in comply with all city and county ordinance,and sum laws relating to
OU building construction,and hereby authorim mpmunutiws of this city de ester upon tie
W shove-mentioned property for impecdan purlexs.
(We)agree to tow•Indcmniry and keep harmless the City of Cupcniea against
n„raja
liabilities,judgments.costs and expenses which may In any way accrue against aid City
U 7 in conuqueme of the granting of this permit.
F1 APPLICA UND R NOS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date G"dam C
SOURC GUL S.
Re-roofs
Sign o A ican anuaaor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will appllcatorfuture building mcupmt none or handle huardou,material
as defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
soca°"355320)? All roofs shall be inspected prior to any roofing material being installed.
❑Yea pyo
Will the applicant or rutoe Wilding Occupant ase equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit huardOu, it conuminanu so de net by the Bay Area Air Quality Mamagemem all new materials for inspection.
District?
pYes Nu
I haw mad the hesardmu marcnaluequiroments under Chaper&95 of ted Califor.
.is FleaI"Salely Sati=25505.25533and25534.1un w.WNatifNe Wilding
does net by Mint dust It is MY responslMllty m maty Oe mcupent of de
require soh er prior W Wumce of a Comfit or Signature Of Applicant Date
_ o (,
0%64 rte r dagent Dae t All roof coverings to be Class"B"or better