05080217 CITY OF CUPERTINO x
BUILDING DIVISION PERMIT rRR011�1.VTQ �il,l "OITI�', -
BUILDING ADDRESS: TECHCON PERMIT NO.O 5 0 8 0 217
10526 MANZANITA CT
OWNER'S NAME: FERIV TISSUE DATE
CARLO PANACCIONE 17450 MONTEREY 05
E; SANITARY NO. CONTROL NO.
(408) 778-1350
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
'BLDG ELECT PLUMB MECH
loo LICENSED CONTRACTORS DECLARATION Job DescrI tion
I hereby Kinn that 1 am licensed under pmWlau of Cluper 9(cemmencing p
with Section 7")ofDivldon 3afthe Business and Profmmm Code,aM my Ikam ts
£�
- flit ADD ARBOR ATTACHED TO HOUSE
j�Z Lleenm crag Lle.» SrZ'13 3
Dam 1- Contractor xGc '•M/ ser
ARCHITECTS DECLARATION (w.vtl! ,fyv
1 undersand my pins Nall be used As public recnNs
y U
s t� LkcwO Pmfcadonel
OWNER-BUnDERDECLARATION
DSS I hereby man.(Rrm thus 1 1. exempt from the Canlons Co Licence Law for the
6 following mama.permit
(Section 7 ons Business nth w.4-mus Cork:Any city err county
$ which requires n pormit re emuwet.aler.hnpave,domW W,a epoig any aronuro $15000
E�^ pnofmits icreadp arm requires the Pro applicant for sthpermitmcessignedsatament
<
that(commencing
witpawanlmtheofDiviauoftheeBummr'alkemclAwrCMpmr9 Sq.Ft.Floor Area Valuation
(cremes esemith Section?ODD)of pivialonr Oof ur al Business anion.Anyvil4donon,Cade)of
Y��
that k V exwpt therthorm and We buil fm Tho alleged reception.MY viOlaim of "
Section 7031.5 by ary applicant for a permit subjects the app0eant An a civil penalty Of r Occupancy Type
set mart than Trw hundred dolWa($500L
❑I.uownerofthepmpmy.amyeroploymwithw psutheirmlecampmwm,
will do the work and theswnure h mtleeultul offered forces(Sec.7044,Business; Required Inspections
and Pmu feasiaCade:The Commerce,Lienee law dm set apply m an owner of q p
property who builds or I meow thereon,and who dao ouch wall himwlf a through bit
own employees,provided that such improvemnm art not landed maffered fa se,if.
however.the building or improvemant W mid within oro year of completion.the awm-
buildu will haw the burden of proving dust he did set build a improve for purpose of
ces I.
❑1.u t the project of the progeny,an sinus velyW conations,wild;)The centctor's - —
cent L dn (Seo 7044,Business and Predations,Wi Cade:)The Cmdmmea U-
cent law mf as apply m ts oma nt pmP tp(s)for Wilds or unpmw thereon,sed.
whence La ts for web Pmkns with a rnnutmr(q Ileansed puruunr m Ibe ConuxIDM1
License Law.
❑lam eaempt unM See .B&PCfa this reams '
w Daa
WORKERS COMPENSA71ON DECLARATION
I hemby a01rm under penalty of perjury am of that fallowing declarations:
❑1 ham sed will mainuin•CeNficasaaf Consam m sel(•imurt(a Warkees Campen-
radon.As provided for by Section 3700 of be labor Cade,fns the pedatsance of Ile
work fa which this permit is issued.
1 have and will maintain Wofkees Compensation lormance,u required by Semon
3700af the Labor Code.fa the performance of tbe cork ftrwhkh this permit is issumi
My Worker',Compensation Insurance carder and Policy numberam: '
Carrier. CUa"r. IdAwv Pi a 'd%_Ilay No,: 01KCO 23 U 95 .
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(lhuseNm ted not be completed If Ile permit is foranc hundred dollars($100)
m leas)
1 certify dist In the pafomate of the work for which this permit is issued.I shall set
employ any person In my mumrm As in hesemo subject cede Workers'Compensation
Laws of Califamin.Dao
Applicant
NOTICE TO APPLICANT:IL after making this Campeau:of Eacmplion,you should
became subject to the Worker's Compatsadon provWoru Of the labor Cork,you min
.J O forthwith comply with such provisions or this petit shill be deemed revoked.
-z CONSTRUCTION LENDING AGENCY
(ti Ibereby affirm thus dartW amuanmOnm lending agency far thc rastf. ace of
CL the work for which this petit is Wood(Sm.3097.Civ.C.)
aQ Lender's Namc ,
.7 lendeh Address
U 0 I certify that 1 haw mad this applicuion And New this the above infomadw Is
M coma 1 agree to comply with all city and county ordinances ad wile laws relating m '
0 building cmuuocdon,and hereby ambo ee representatives of this city m enter upon the
t27 ahow,mcauuned property for inspection purposes.
(We)ago to saw,indemnify and kap homeless the City of Cupcndm against
ti rn Ilabiliuu,judgmems.cops and etpeetws which may N Any way accrue against said City
in
of the
at
U APPLICANT UNDERSTANDS S AIND WILL COMPLY WITH ALL NON-POINT Issued by: Date y f'-G d—
SOURCE_UXditA1'1ONS.
r'Z9'aC- Re-roofs
wumof HAZARD ATERIALSDISCLOSURE Data Type of Roof
Will No applicant or forum Wilding Occupant rare or handle hazardous manual
As dcmed by Ne Cupendno Municipal Cade.Chapter 9.12,and the Health Are Safety
.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
40 ❑Yu KN.
Will the applim,or forum Wilding Occupant use,equipment or&-4m which If a roof is installed without first obtaining an inspection,I agree to remove
cmlt hasamnus air contaminants u denied by the Bay Amo Nr Quality Management all new materials for inspection.
Disuin?
❑Peau
1 have mad the husNrm marries requhc ncnaundcrooper A95afdte Califa-
niaHwllh&Safety Cads,Scum 25505,23533 and 25534.1 understand thuiflle building
data set currently have•ewer,that it is my maponsihil4y m mdfy the amPant of the
requirements which most W tpdan
or Ora eeruncae orawpancy. Signature of Applicant Date
^z °� All roof coverings to be Class"B"or better
Owns u a t Data