04030014 CITY OFCUPERTINO ' � ;� "`� �' -
BUILDING DIVISION PERMIT °CONTR` `Q OR INF()RMA ipN.�'
BUILDB+G ADDRESS: JAMES GUIDOTTI IFRM11NO04030014
640 RTC.ARnn RD
R'S NAME: PERMIT ISSUE DATE
JAMES GUIDOTTI
ONE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� 0
�Oo LICENSED CONTRACTOR'S DECLARATION Job Description
(y i hammy affirm that 1 Am Banned under provinces of Chapter 9(rommencht
p1 with Section 7000)of Division].(the Business and Profusiom Code.and my license is
I.fall fame and affect. ADD WORK SHOP (520 SQ. FT. )
�R
3 Licensc CIm IJe.N
2 Date-C.n DECLARATION D
ARCHITECTS DECLARA770N
1 understand my plans"I W end As public records
tg Licensed Pmfusional
OWNER-BUILDER DECLARATION
9 I hereby affirm that I am exempt from the Committee License Law rot the
10 following mason.(Section 7031.3.s,Ww. and ve.demos Code:Any city or county
which mqulres A permit re quires tha piste,h.prove,demolish.m mash any comment
F pat be itaissumce,akureyoires provisions for Co Vomit NeaeLaw(Ca¢menl
< (commencingis mdpunuanttothe 00)ofDiaision3 ftheBuacmr and
sw(Chapwr9 Sq. Ft. Floor Area / Valuation
$ (commencing with Sodlon 7000)b(Divkion Sof the Business and Profossinos Cmk)of
BBB
Out he k exempt t emfrom and Ile India for the alleged exemption.Any vlolNnn of
Seeslm 7031.5 by any applicant for a permit'subjecu the applium but a civil penalty of 3 9&51fi" 0 0 'U _ Occupancy Type
not mom dun five hundred dollars(5500).
❑I.u owner of the property,m my employes with"Sea u their able compensation, V
will do ties work,and to sbumwe knot Intended ofoRered f...I.(Se..704e,Busimss Required Inspections
and Feature on Code:The Communes Liceme Lew does not apply to an owner of q P
property who bundsbrimpmws themes,mdwho doessuch wmkhimtt for Wough his
own employees,provided that such improvements Are nttim, moffefedfmsaleif.
huwever,the building or improvement is cold within one year of completion.the owner.
Wilde'
will he.the burden of proving Nat he did not build or Improve for purpose of
file.).
❑1.as owner of to property,am exeluaively contracting with licensed mnuacton to
ceutsect she proves(Sec.7044,Business and Professions Code:)The Contractors U.
came law done twt apply to m omms o(propeny who builds.r improve Ihemon.ad,
who coronets fm such pmjecu with n conuecto(s)licensed pmunt w de Comm es
ante Law.
I empunder5m ,B k P C for this reason
Dote 3^2-ci
WORKERS COMPENSATION DECLAR
1 by elErrtt under penalty of perjury aro of the following declandoos:
1-o-rk�for
have and will mdnuin ACeNOnte ofConsam to self-imum for WorkehCompen-
n,u provldW fo by Section 3`110 of the Labor Code.for the performance of the
which this permit is issued.
have And will maintain W.rlaces Compensation Interslice,u required by Section
oftha LAbor Code,for Ne pedosmance of the work forwhlch Nis permitis knued.
Worker's Compensation
Insurance curio and Policy number w:
Carder. Policy No.;
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(I1Tk soNon need nothecompleted If On permit Is fmonchundmd dollars($101)
or leu.)
I unify Net We pc formance of We work for which this permit u issued.I shsil not
cmpley w y mAKsBAs'm be ewbjmiw NeWsk CompmsAdm
V o Cebu e.DHc�G ZJ���_
A Ica
N ICANTIf,arra n tis niOGe of Exemption,you ahnuw
bee hJm w Ne W.rktt'A Compensation provisions of N.Ichor Code,you ours
,,O fort ith co ly with such provision or Nis pmmit shsil bu seamed rewtrd.
Ell CONSTRUCTION LENDING AGENCY I
[w Ihar which thi Nat Nen isaod(Sm.3M,Cing Apency(or Ne perrurmance of
ai to murk for which Nu penult Is iuuetl(Sec.309'i,Civ.C.)
W� Q Lenders Nem.
�z Lenders Address
U O I certify that 1 have reed this application and tete Nn Alm Above information is
(y!". mrma 1 gree to comply with sit city and county ordinances and sues Incas telating to
0 kSJ^ building construction,and hereby auhodre representatives of this city to enter upon the
W .hove-co nti.vcd property for Inspection purposes
(We)agree to an,indemnify and keep humlesa the City of Cupertino Against
ry liabillfies,judgmenu,emu and expenses which may in my way amus against said City
U tnPPLnICANT UNDERSTi�goS ANf this D WILL COMPLY WITH ALL NON-POINT Issued by: Date
rmofMplim
GULAIIO
1-2;0`4 Re-roofs
"',H onRDOHAZARDOUS MATgoccup DISCLOSURE Type of Roof
he Applicant w forum building eceupant r9.1 redie Cupenlno Munirilul Code.Chapter 9.13,and tbu Health and Sawty
.zss3z(.)` All roofs shall be inspected prior to any roofing material being installed.
s �Noe applicant of future budding mupant tea.wuipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
os air contaminants u defined by Ne Bay Ana Air Quality Mansgcment all new materials for inspection.
y
❑Yes iy Nu
ve
1 hamW the hasardous\materials mttimm ms under Chapter 6,95 of ft Cafirm.
nu HcaIO&Saf:tyCode.Sa9 505.23533 slid 7533e.l understand Nml(Ne building
of carom" haw a tenor t it u my msponsihility w notify the mupant of the
mqui menu whichmustbu or emmc.w.rOccuputcy. Signature of Applicant Date
S,2,-o4 All roof coverings to be Class"B"or better V
2t!rLauffintrized agent Date