04060234O 2
r V
{pLi'
UC
U FC,
OF
U2
r.
CITY OF CUPERTINO.;
CO iT1ZA.CTOR iNFUitMAT16N
- '_ .._ ......- .
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
JAMES GUIDOTTI
PERMTTN004060234
2264 _...
OWNER'S NAME:
PERMIT ISSUE DAM
JAMES GUIDOTTI
E:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:BUILDING
PERMIT INFO
"
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
l Job Description
P
1 hereby affirm that 1 am licensed under previsions of Chapter 9 (commencing
with Section 7W0) of Division 3 of the Business and Professions Code. and my license is
in mllto=andcrrtet.
REVISION --IN HOUSE USE ONLY
License Class u,. ar
Dale Contractor
NO NEW PERMIT ISSUED ORIG. #04030014
ARCHITECTS DECLARATION
E DECLARATION
CHANGE SIZE FR: 520 SQ.FT. TO 486 SQ.FT.
1 understand my plena shell used a public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from On Contractors License Law for the
fallowing mann. (Section 103 1.5, Business and Professions Cade: Any city or county
which requires a permit to convect, alter, Improve, demolish, or repair any structure
prior to its issuance, also requires the applicant forsuch permit to file a signed statement
Sq. Ft. Floor Area
-
Valuation
Oatheislicensedpu mem. In the provisions of NCConlncloesLicense Law (Chapter 9
(commencing with Section 70M) of Division 3 of the Business and Pot essionsCode) or
$55733
that he is exempt th,mfram and the basis for the alloged exemption. Any viDlafian of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the apPlicanuo a civil penalty of
not more Nan five hundred dollar (5500).
I,nownu ofthe prop,ny,umy employe"with wagesn Ncir axle campenption,
Required Inspections
will do the work and theswctum is not intended or offered for+ale (Sec. 7044, Business
and Prof.,eVuns Cade: The Contrattor'a License Law does nut apply N an owner or
prapenywho buildamimpmws thereon, and who douauch worlehimselfor through his
awn employ,.,, provided shedouch improvements am not intended oraffefed forsak. If,
however, the building or improvement is sold within one year of oompletian, the owner.
builder will have the burden of proving Nat he did not build or improve for purpose of
of n
I. u ling owner of the property, am "elusively conics with licensed contractors to
C]tr
construct Business and Profusions Codei The
coct Ne project (See. 70 aemon,
es n
cone law tlau not apply m an owner of Property who Wilda of improve thereon, end,
n
who contracts for such projects with a cantaazmr(U licensed pursuant On the Cantnctar's
apse Law.
21 xempt undo See. ,B&PC fu Nis moron
Yv\
6
Ow
WORKER'S COMPENSATION DECLARATION
rcby aRrtn under penalty of perjury one of the following declarations:
I have and will maintain a Card Ocate of Consent o as]Nasum for Workers ComPe a-
sadon, as provided for by Section 3700 of the Labor Cade, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance, as inquired by Section
3700 of the labor Code, for Nc pertormanee of the work forwhich this permit is issued.
s
My Workers Compensation Insurance carrier and Policy number am:
Cartier: Policy NO.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
CThu section need not W completed if tW Permit is for one hundred doll+n (SIM)
or less.)
1 certify Nat in Ne per mmance of Ne work for which this Permit is issued. l shall not
employanypen i yore nen an as to boo a subject to the Workcra'Compensadon
Laws off: * rnl9, atC ^
Ap 1i t
PLICANT: If, after making Nis Certificate of Exemption, you ahu id
bac e s 'c to the Worker's Compensation provisions of the Labor Code, you must
IMK with comply with such provisions or this permit shall W dccm,d revnk,d.
CONSTRUCTION LENDING AGENCY
1 hereby affirm Nat Nero is aconswctian lending agency for the Performance of
N, work for which this permit Is issued (Sec. 3097, Civ. C.)
Landers Name
Lender's Address
I cattily Nat I have read this application and sate that the above informadun is
'
correct I agree to comply with all city and county ordinances and state laws mlating to
-
building convection. and hereby authorize repicsenutives of this city to enter upon On
above-mandoned Pmpefty for inapectiOn palfusEL
m
(we)agree to save, indemnify and keep hadeu the City of Cupertino against
�OK
liabilities, judgments, costs and expenses which may in anyway accrue against said City
in consequence of the granting of this Permit.
LICANT UNDERSil S AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
S EREGULATIONS,
Re -roofs
Type of Roof
'
HADOUS MATERIALS DISCLOSURE ase
ignam ofApplk ZAR
ill On applicant or future building Occupant store or handle havamous material
dned by the Cupertino Municipal Code, Chapter 9.13, and the Health and Safety
ode, Ye25532(a)?
All roofs shall be inspected prior to any roofing material being Installed.
0s
If a roof is installed without first obtaining an inspection, I agree to remove
Will the apPlicanl or future building Occupant use equipment at devices which
mit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
Distinct?
❑tics
[love mad the hazamous materials requirements under Chapter 6.95 of the Califon
riaHulth&Saf,tyCode, Section 35505,25533 and 25534.1 understand that if the Wilding
dors not cumendy hew a tenant A., itis my responsibility to notify the occupant of the
nui.k,lientswMoh most W to h(jasa c,n a cemn,at,Or""O'ey.
Signature of Applicant Date
Z
All roof coverings to be Class "B" or better
ow
er of othorizcJ ager Oa�