05010063 CITY OF CUPERTINO T� sr"eaA+. id. �+swro/�r�y&� g,�`
BUILDING DIVISION PERMIT04\' VT,I� R IN�VR�lYIATIwN ''
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IWIND ADDRESS: LARRY SQUARCIA PERMIT NO05010063
NEWS NAME: PERMIT ISSUE DATE
LARRY SOUARCTA
ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
300 LICENSED CONTRACTOR'S DECLARATION Job Description
i I baby affirm that I em licensed under provisions or Chapter 9(rnmmendng P
a< with Section 70M)of Division 3 of the Bust.end Profculum Cade.end my lianau
s LiceneClassfirma deRttv PATIO COVER
'n a Data Clare ARCH TIEf.TS DECLARATION
DUI understand my plain shall he used As public rtemds
=o
Licensed Prof,sionelZ-- tl,ap,
a
OWNER-BUILDER DECLARATION ffLf�� lilt'
F I hereby affirm that 1 am exempt from the Conuaaoes L'cenw Lew for the It
p0 following maon.(section'RDI.5,Business nd Professions Code:Any city or county �, 1 ❑ry
$ which requires a permit to maumeL alter.Improve.roundish,or repair any structure �:�!EI II I/Il f!": it Cs f /"`x
y prior in itsissuance,also requires the applicant for such permit o file a signed statement
2 a that he is licensed pursuant to the provisions or the Contractor's License Law(Chapter 9 Sq.Ft. Floor AreaJ�t�f if r�j JIB I� f`J Valuation
2 a (commencing with Section 1000)of Division 3 of the Business and professions Code)an Ij u
$
at he is exempt therefrom and the bests for the alleged exemption.Any violation of
Semon 10313 by any applicant fur A permit subjects the applicant to.civil penalty of 3 9&NP ulfi&cr0 0 Occupancy Type
not more than S.hundred dollen(5500). P Y YP
❑1.a owner of the property,or my employe"with wag,As their sok compensation,
will do the work and Neaumm.is at inanaed m offexul f..efe(S,.TIN/,Business Required Inspections
end Professions Code:The Common's License Law data not apply to an owner of q P
property Asha bulldaafimprows thereon,end whe dmasuch..,it himsalf m through his
awn amplayms,provided that such improvements art not intended morrartd for Asia.IL
however,the building or improvement is sold within one year of wmplction.the owner-
Wlidu will haw the burden of proving that he did not build or improve for puryose of
.1.1.
❑1.a owner of Ne property,am exclusively contracting with licanxd contractors to
construct the pm*t(Sec.7014,Business and Profession Cade:)The Conu.emes Li.
;[3
Law does not apply to a owner of property who builds or improv,there.....d
o.uacw for such prejuts with a conaacsIds)licensed ruminant to tk Corsa aces
a Lawf
ex/qfn/pt.under Sec. ,BAPCf Nbmeson
I hereby arm under penalty of perjury ane of the fallowing declarations:
am and will maintain&CeNOamofCoacntWself-inumfmlVorteesCompere,a provided for bySection 3700 of Nc Ubor Code.for the performamx of the(or which this permit is Issued.
haw said will maintain Wmkees Compensmon Insurance,an required by Section
3700.(the Ube,Code,for Ne performance of the work for which this permit la issued.
My Wmkees Campensrd..lasers."niu and Policy number Am:
Cartier: Policy No.; -
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(lTisactim need nothecanpla n!if ft fcrmlt is for ane hundred dollars(SIM)
or less.) _.
1 certify that in the perromiam of Ne work for which thi rmit u laved,l shell not
employeny Fctsen enymarcrm�,Cu�geeo NC Worken'Campensellan
Laws of Celiforniy}^Dem Y
Applicant
NTOA !n:—ir—..�nfgCcnrfFaof6ofa Ex rIpm/_yo
u should
become subject t'o'
the!WrkerCmpensp siom2fiNeUhorCo .]yomuMOI7CE /-
.,z forthwith comply with such Provisions an this permit shall k deemed mwted.
17 CONSTRUCTION LENDING AGENCY
1 berthy.frim Nat Vert its construction landing.gency,for the performance of
Y, the work for which this permit Is issued(Sec.3091.Civ.C.)
YQ Lender's Name
=z Latices Address
J Q 1 certify that I haw read this application and some Nn the.bow mifmrnatiun Is
y cmrca.I agree m comply with all city and county on inanms and state Jews minting in
7 V building convection,and hereby AULWOIM representatives ser this city to enter upon the /
G show-ma boned Property for Inspection Purposes.
ti (We agree to new,indemnify ad keep harmers the City of Cupertina.gaimt
(n llabilitle ailments,Costs and eaperyce which may in any way same against aid City .`
of ft
..3 APP CANT UN ERSTgrand, S AND WILL COMPLY WITH ALL NON-POINT ed by: Date U
SO CE E CATION r _
L'�/ Re-roofs
Signature ofAppli VComcact r Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building acupam stare or handle hanrduus matonal
fined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
edc.smtien 255324)T
Yen All roofs shall be inspected prior to any roofing material being installed.
.65
Will the applicant or(muse uilding occupant use equipment ser devices which If a roof is installed without first obtaining an inspection,I agree to remove
tit hasardnus Air conaminuiu As defined by the Bay Area Air Quality Management all new materials for inspe tion.
Irtrictl
❑Yen (9�0
f ,a
Thaw mad the haaNtms materials requirements under Chapin 6.95"(the Califar-
dies, -@Safety Code.sacdua35YJ5.35533ad25534.lundenmdNMirft building
does t cunsoly hawaanon fumy r,poaihllitppanotify the asvpat of rax
req ' mcntswhichmuR IpdormiseuanmoraCcrdficnmofOc pansy Signature df Applicant Date
Owner ser.mn aa.g 'Data All roof coverings to be Class"B"or better