04050033 (3) CITY OF CUPERTINO '�"/�. n*� /'�-a� /� }a'�"" -"
BUILDING DIVISION PERMITCob`I l.' CTVII_ VR�AY1 VO
BUILDING ADDRESS: VANNI BROTHERS CONSTRUCTIO 11ITND04050033
1503 POPPY WY
OWNER'S NAME: PERMITISSUEDATE
161, RONALD BERNARD 914 RYDR. AWE,
E: SANITARY NO. CONTROL NO.
(408) 253-7028
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELER PLUME MECH
u O'z LICENSED CONTRACTOR'S DECLARATION
V F 1 hcrcny emrm tont 1 am Ilantttl under provisions of cock',9(rn lk.a i. lob Description
n� with Section 1")of Division 3 alum Basin Profeainna Cade,and myliwnm is
�„ i.mfm�agqtltleffeeLd r �g 2 HALL BATH REMODEL �1
t,kix Llcenae Clot{
am C- G-:0 C.nOacmr
ARCHITECTS TION �I!�
I undersund my plans shall h umd menrda "� f
G�S Lkeved Professional
/ l
3 Oat I am eU exempt
from
mDECLARATION C,
I I as .(Seto the 11. exempt from Ne Contnmoo License Lew for me J
p O following meson.(Sectiontt7(amora Business and Pnt,thn oli Cod,:Any city.,,.Only
$ff which its •permit to tut.1 1,alar,i 1Imw,lb .it,fi mpairmy atrumum
FZ< Paolaitsiensedp pursuant
ntto Rim meapplisof the Con rotor's o TticaaLaw(aleesmcm
(comate cingwitpSewamtothepmvieioruofowCowafinar9Littnmlaw(Chapmr9 Sq.Ft.Floor Area Valuation
that M Is exerewith Section and)of Division r of sM aged cxav pt P,Ofn y vi COM)or
$
that io b numpl therefrom and the bur far the subjects
find cscmant 0.Any violation of
Section I=f by any applicant for a permit anbjecm the applicant to a civil penalty of 3 Cr�N3'QI[bZer0 0 Occupancy e
not mom Nan fw hundred dollen(5500} P Y EYP
❑1,u owner of the property,er my employees with wages a their sale c.mpenalion,
will do dm soul,end shoo untrm beat inmnded or offered for saes(Sec.7044.Buaiaa Required Inspections
and Professimu Code The Contractors Lt.Law doss not apply m an Owner of q p
property,who builds.,improwa them..,and who dwa aueh wok himself or though his
own employees,provided that such improvements are notimnded or a@red foraaie.If.
however,the building or improwment is sold within one year Of completion,the Owner.
Wilder will haw the burden of proving that M did not build or improw fa purpose of
sub.).
❑I.u owner of the property,am acluavely contracting with licensed conuacmrs to
construct the project(Sec.7014,Business and Profusions Code:)The Contractor's Lt.
taus,Law does not apply to an Owner of property who Wilds or improve themon,ad
who contracts for such projects with a contractor(s)licensed pursuant to um Comram.rs
License law.
*lamexemptunderSec, .B&PCforthramon
Came, Dau
WORKER'S COMPENSATION DECLARATION
I hereby effbm under Penalty of perjury am of the following declanuou:
I haw and will maintain a Cminwto ofC.mOL to scif.h.um for Workats,Camped.
action,a provided for by Section 37W of the labor Code,for the Performance of the
wok for which this permit is inuatl.
❑I haw and will maintain Workers Compensation Insurance,a required by Section
37M of due labor Code.for Ne pertamtance of the wart for which this Permit is issued.
My Workers Compeuaau.n laurance time,end Policy number am:
No.:
CERTIFN ATEOFEX' ONFROMWORKERS'
COMPENSA ON INSURANCE
M6 section need not becomplemC if the permit is foronc hundred dollars ISHII)
Or ran)
1 certify Not In the performance of Ihn work for which this permit r Issued,I shall nut
employanypermn in ym..�w.; ecRr�eanbjectioiMWorken''Compemauon
L
of Califom(E �I•�� 4. //
ApPlica Iso .,`._._
NOT APPLICANT:If afmr making thb Ccrtifcaes of&emPtion,you thould
bcame lett to the Workeh Compensation Provinces Or me labor Code.you must
Q (pMwrh comply with such prnviaiorm or this permit shall M deemed mo4acd.
EZ CONSTRUCTION LENDING AGENCY
[-� I hereby abet that Nero is a construction lending agency for Performance of
ame work fur which this Permit is issued(Sec.3097.Civ,C.)
W Q Under's Name
z Lenders,Addmm
V 0 1 certify chat I have need this application and sum pan me W.infom rid.is
t[.!' mann.I agree to comply with all city and county an it ances and sues lam echung to
C)SU Wilding conswcuon,and hereby aumanae reprmenuuwa of this city to enter upon the
W abavcmenuom:d property for impecaan purposes.
py (Wc)agrtt m mw.indemnify and keep harmless the City Of Cupenino agaicat
IA Ilabilltiesjudgments,tofu and expenses which may in any my accrue against mid City
V Z in conmgance of the gnating Of this permit.
�-` APPLICANT UNDERSTANDS WILL COMPLY WITH ALL NOWPOINT Issued by: Date
SOURCE RE ULATIONS.
Re-roofs
sun of ApplicanVContnctor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or futon Wilding occupant slam or handle handous material
a defend by me Cupertino Municipal Code.Chapter 9.12.and the Health and S@ty
We.,.Section 25533(e)i All roofs shall be inspected prior to any roofing material being installed.
❑Yes �No
Will the applic
nriant s future building Occupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
rdous air cm mminants a kr,.td by the Bay Ama Air Quality Management all new materials for inspection.
n7 hna
❑Yes g'iVu
I Mw mad on haardeas materials randomness under Chapter&95 of the Califor.
nia Health&Sa,tyCode,Secuom 35505,35533 and 75534.1 undersmnd that if the Wilding
does not cumntly haw a tenant ton it b my rap.mibility mjmli an,occupant Of me
mgvimmcnts h a"it mWinqtulamance of aCmiem,ofOccupancy. Signature of Applicant Date
6-�
own nn.dIagent Dam All roof coverings to be Class"B" or better