04030007 (2) CITY OF CU
PERTINO
BUILDING DIVISION PERMIT ORM
CONTRACTORINFATION j
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BUILDING ADDRESS: MATS & MARIA OBERG "°04030007
202
OWNER'S NAME: PERMIT ISSUE DATE
MATS 6c MARIA OBERG E; SANITARY NO. CONTROL NO.
IF
ARCHITECnENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
o LICENSEOCONTRd under
SDECons of CON
m❑ I hereby affirm that 1 em licensed under And
Pnif ss of Chapter 9(commencing Job Description
;;Z with Scction]IXNp of Division Sof the Business and Professions Code,and my license is
^`m„ in full fora and effect. ADD 798 SQ. FT. (DETACHED GUEST HOUSE)
7g? License Class Lic.0
Dow C.M.Ow
ARCHITECTS DECLARATION
I uMcntend my plans shell W tired a public records
at
;o)n Licensed Pmfcaioml
$ 3 OWNER-BUILDER DECLARATION
d a E I herebyafr m'hot I am exempt from Ne Conwerm/s License Law,for the
00 fallowing rearm.(Seed.7131.5,Business and Professions Cade:Any City in county
ym which acquires a Permit to construct.alar,improv,demolish,or repair any structure
t-¢a prior to its issuance.also requires the applicant far such Permit to file a signed statement
< thethcI,licensed imotmnuotbcpmvisionsoftheContmmor,U...Law(Chaptm9 Sq. Ft. Floor Area Valuation
ceetz-$ (commencing with Section 7")of Division 3 of the Business and Professions Crue)or
.. the be"is exempt therefrom end the bats for the alleged emmpton.Any viotwiOn of 0 485529
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more then five hundred dollars(S500). APN Number J, U tpe
❑1,as owner of the Property,or my employees with wages As their sole compensation,
will do the work end Neswctum is not inmiMed oroRemd forselc(Sec.]Ods,Baixa39935010 . 00 ---
and Professions Cade:The Contractor's License Lew does not apply m an owner of RequODS 1 Ls
property who buildsmimpmves rhemon,and whodoesauchweek himmlforthmugh his - {7
own employees,p Wilding
or ded
Nat suchen)is improvements we not intended oroffemplauced fairsthe O e.r..
however.the building or den of patent is old within ane year of compv fo.the owner
builder will have the burden of proving Net he did not Wild or improve for purpose of
11101
0 1.
❑1,u owner or the property,.B exclusively contracting with licensed contamurs t.
construct the project(Sec.o in Business end Professions Codeor Them daemon.Lid
who Law docsnotapply jean Owner ofproperty who Wilds orimpmms Comon,and
whocontracts
W. for such pretecta with acanuacror(s)Iianud pursuant athe Convacmr's
License W.
❑1 smmic,criptunder/ u +/%' .B&PC,ththis }:�
Owneyy / em Qy/(/ '0�/n
j WORKER'SCOMi ON DECfA�ON
1 hereby affirm under penalty of perjury one Of the following declentlons:
1 have and will maintain a Certificate of Consent 10 self-insure for Wmlice,Compen-
setion,As provided for by Section 3700 of the Leber Code,for the perrmmance of the
work for which this permit is issued.
thaw
have and will mention Worker's Compensation Immuno,u requimd by section
3700 of the Labor Code.for the performantt of the work for which this permit is issued. ,
My Worker's Compensation Insurance canis and Policy number aa:
Cartier. Policy No.:
CERTIFICATE OF EKEMMON FROM WORKERS'
COMPENSATION INSURANCE
M isxerian and not W completed if the Permit is for one hundred dollars(5100)
or Ices.)
1 tartly that in the Performance of the work for which this permit is issued.I shell not
employ any parson in any manner so as to become subject to the Warkcrs'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making Nu Certificate of Eacmption,you should
biome subject to the Workers Conformation previsions of the Labor Code,you must
.J O forthwith comply with such previsions or this Permit shop W accrued revoked.
Z CONSTRUC`nON LENDING AGENCY
F .�.. I hereby ARrm that then is a construction lending agency for the perfurmartee or
6i the work for which this permit is issued(See 3097.Civ.C.)
Ig1 Q cancels Name
6. Landet's Address
C.3 Q 1 ccnify test I hoe mad this application and sum the the maw inforreeton is
0 correct.)agree m comply with all city and county ordinances aivesof and cute laws¢Irving to
p U euva-geotiorml o,and hem by authonmreisrs of Nu city mcnru upon the
[k1 ahove-mentionm Property for inspection purposes.
i
a (We)agree m ave,indemnify and keep hNnleas the City of Cupertino against /
fA Iiacormarteracc fthellsu expcnseswhich may in anyway ettmc against said City /
C.) z APPLICANTcofthcgra this permit.
" APPLICANT UNDER DS D WILL -Y WITH ALL NqN-POINT Issued by: Dat
CE REGU �1 y
LC /{v, Re-roofs
cofAWkwo/Contravor /1 A is CDem
DOUS MATER! DISCLOSURE
HA Type of Roof
Will the applicant or fu um building occupanutom or handle haardous material
as defined by the Cupertino Municipal Cook.Chapter 9.12,and the Health and Sefmy
Code,Section 25512(e)7
0y. 011a All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
rt Wrardous air contaminants As dc0ned by the Bay Arad Air Quality Management all new materials for inspection.
Dictriee]
El YEA R14.
I have mad the hvardooss momrieS requimmcros under Chapter6.95 of em Califon
as Health&Safety Capppppe,$$$ddf``car. 5M5.25533and8534.IundcrsmnddtetiflW Wilding
does not cuwmly hyk,(ien Nat it u my�spevihility m notify race occupant of the
mquimmenuwhic priorwisATgsa raceNfiamof Signature of Applicant Date
owns rria<d.gent D,m All roof coverings to be Class"B" or better