06050016 CITY OF CUPERTINO
BUILDING DIVISION PERMIT RCON'CRACTbR INFO,RM�1.'TIQN` '<
Y2 '
BUILDING ADDRESS: PERMIT NO.0 6 0 5 O O 16
10715 PENINSULAR AV
Ell S NAME: PERMIT ISSUE DATE
JOHN HERRIT 06
ONE: SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
iaaC LICENSED CONTRACTOR'S DECLARATION IOW Description
!O U with Section 7000 of Div lioat I n 3 of utBootless uar�undernd licensed and Profession Provisions Of Code r _i p
and my license e se
is
is infullfomean fejk
Lic
I REMODEL-KITCHEN, DINING RM, ELECTRICAL THROUGHOU
LfullClass h - �-
ARCHITECTS DECLARATION
I < 1 undersand my plain shall he used ss public record
JyU
�o� Licensed Professional
3OWNER-BUILDER DECLARATION
iZ 1 hereby affirm Not 1 am exempt from the Canuactor's License Law for the
p o following reason.(Section 7W 1.5,Business and Pmfetioos Cade:Any city or County
<m�+ which inquires a Permit to Coruwch cher,impmw.demolIM,or repair any structure 7 5 O O 0
°i< prior In its issuance.also inquires the applicant for such Permit to file a signed stathmcnt
that he is licensed pursuant tothe pmvisiom of the Conuscler's Let=law(Chapt:r 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7(013)of Division 3 of the Busineu and Prof.ions Code)or
that he is exempt therefrom and Me basis for ore alleged exemption.Any violation of
Section 7031.5 by airy applicant for a permit wbjew the applicant m a civil penalty Of r Occupancy Type
nut more Nan five hundred dollars(1500).
❑I,sso-wmr of Mc propoty,rcmy wployeca with wagussMe'v vele Compensation,
will do thewoh,and the he Com is not intended or a-(In foetal-(Sec.7044,w-I Of
and do Me moors code:The Gonmemrs Uiesusse uw tum nod apply m 44 owner ar _ Required Inspections
property who builds ar i.prow theecon.and who does such work himxl f cwthrough his
awn employees,provided thatsuch improvemenu art notioerWed orolfmed for sale U.
however.Ne building or improvement is sold within one year of completion.the Owner.
Wild.,will have the burden of proving donne did not build Or improve for purpose of �i��/� //
whoc / l/i/5 {a
0 1,as owner f Ne property,am exclusively contracting with Bayed c dracmrs N
convect Ne project(Sec.70,14,Business and Professions Cade:)M Contractor's Li-
ceme raw dons not apply he an owner of Property who builds or impmvcs themrn,and, �/e17
//� /�� I J
Lic..Laeu for such projects,withaeonu-u:tar(s)Iieensd pvrswntb Ne Canvagoh (`/- (///
C]I.Law.
❑1 ore exempt under Set ,B k P C for Nia maven Q�
W
WORKER'S COMPENSATION DECLARATION N
1 hereby affirm under ponaldy of perjury Cote of Ne following&x eauom:
❑1 have aM will msnuin a CeniRCote of Content roself-invert for WorkersCompen-
radion,m provided for by Saturn 3700 of du labor Code,for the performance of Ne
work for which Nis permit is issued.
1 have and will maintain Wortces compensation i...as required by Section
3700 of Mm Labor Codc,fw Nc performance rNe work for which Nis permituissued. '
My Workers CmL�emahe.Insurance ca and Polity moderate:
Cartier. +` Ce s.�— Polity No.:
CERTIFICATEOF EMPIION FROM WORKERS'
COMPENSATION INSURANCE
(rhicwmlm mcd mdtee,completed if the Permit is Arcane hundred do0ars(5100)
or Nis)
I coney Nat in the performance or Ne work for which Nis Permit is issued.l shall not
cmployany'p cam.inan anmrs as me rt,L5the Wmken'Canpemauon
Law s of California Dar _ (O
97
App lfcenl -
NOTICE TO APPLICANT:If,oftt{C`+r raking Nis CeniBnte or Exemption,you should
become subject to the Wrhers TOy reunion provisions of the labor Code,you mea
.J Q forthwith Comply with smA prod .rc Nis permit dull be licensed rewked.
z es CONSTRUCTION LENDING AGENCY
)-. 1 bereby,Amin Nat urea is It o..unn Iendi.g.,ne,Cor the pertomuna rr
C > the work for which dus pemN is Wood(see.3897.CW.C.)
VA
0 Lenders Namc
0. 0 fenders Address
V O 1 Certify Mut I have sad this application and curt Nat dee above information is
(y f^ COMM 1 agree ro comply with all city and county ordinances and Mae laws misting In
OU building Convection,and hereby authorize representatives Or Nis city to enter upon thc
Move property for ins nedon purposes.
F (We)agree to save.Indemnify and kCp heard.Ne City Or CVpel4no against
h liabilities.judgments.Casa and expo.which may in any way acme against said City
U Z in consequence of be gmnung of this Permit.
^ APPLICANT jNDqSTANDS AtieWILL COMPLY WITH ALL NON-POINT Issued by: M6� Date S2
SOURC5,VGU Ns.
- -4�a Re-roofs
Signou of Appllcan naanmr Dam
x USMATERIALSDISCLOSURE Type of Roof
Will the fp it or rune Wilding mcupmlgomurh Ichua usmawda
az dc0ned by N enino Municipal Code.Chapter 9.12,and Ne Health and Safety
Section 255320)9 All roofs shall be inspected prior to any roofing material being installed.
0y. 115Wo
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
-raft ho laolnm air Cone dram"as de0md by Ne Bay Area All Quality Management all new materials for inspection.
District?
0Ym fAHo
lit
rcaJ the hvardsmsmarerials inquiremcw under Chaprcr 495 of Mte Caliror-
nuk loaSectyC ,Smuwu25505.2533and25534.1�dutifMe Wilding
does not eurmn0 have
",ram,that it u my responsibility to rmOfy the occupant of the
mquim stbcat miss..aafaccru0mo:oroccupncY. Signature of Applicant Date
1All roof coverings to be Class "B"or better
Owner atauthoriyed gent Datc' g