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CITY OF CUPERTINOyyyy/�gyn�A?5,-
BUILDINGDIVISION PERMITWA,/.gua,�,.%1f�.0
RESS:
BUI 1M5
PERMIT NO.
VAI AVE
EARTH BOUND HOMES
07050121
R'S NAME:
PERMIT ISSUE DATE
DAVID & STEPHANIA KANEDA
990 RICHARD AVE STE 104
02/08/2008
PHONE:
SANITARY NO, CONTROL NO.
(408) 244-5392
ARCHITECffENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
seeder provisions of Choler 9 (commencing
1 thereby affirm Nal I am licensedof
p
MeBa
with Section7ag3)afDi"n7o(Ne Business roti Professions Code, and my license is
in full tome
HOUSE DEMO
and effect. f
tion a tie.• �P
6/9/08 PETE MOFFAT CONSTRUCTION NOT CONTRACTOR
Date ntr enaf
ARCHITECTS DECLARATION
ANYMORE. EARTH BOUND HOMES PD FOR BL 6/10/08.
I undemand my plana shall W used as public menrds
THEY
-
Licensed Pierson nal
OW NER-BUILDER DECLARATION
I hemhy alarm that 1 am exempt from the Contrectara License Law for the
following mason. (Section 703 LS, Business and Proteesios, Calc: Any city or county
which mcquims a penult to consiuc4 star. improve, demolish, or mpoir any mature
prior to its issuance, also requires Ne applicant for such remelt to file a signed staement
that he is licensed to Be of Ne Courecmr's Liana Law (Charon 9
Sq. Ft. Floor Area Valuation
pursuant provisions
(commencing with Section 70D0) of Division 3 of Ne Business and Professions Code) or
$15000
that he is eaempt therefrom and the basis for Ne alleged emmption Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant In a civil penalty of
Number
Occupancy
not mom Nan five hundred dollars (5500).
36205029.E71�Pe
0 1, u owner of de pmpwy, army wploycea with wages u the'vmk rompewdan,
will do the work. and the structure is nmmtendcd or offered formic (Sec. IDN, Business,
and Professions Cede: The CanuacmYs License Law dor not apply a an owner of
ns
Required Inspections
q p
property who builds or improvesNeuron, and who does each work himself or through his
awn employcat, provided thotsueh improvements art not Intended oroRered for sale If.
however, to building or improvement is mad within oro Par of amptetion, the man".
builder will have Ne burden of pmHng that W did an, Wild or improve for Purpose of
sal..).
0 I. as awn. of the property, am exclusively cmuatrting with licensed aumeton to
contract the pmje. (Sec 7044, Business and Professions Cade:) The Conrracters U.
cense Law dean net apply in an owner of property who Wilds or improves thamon, and
who contracts for such pmjecu with acentra.oKs) licensed pursuant m the Conaslors
Le.ue Law.
R"' "am See ,B&PCfarthismMon
R"
Data
WORKER'S COMPENSATION DECLARATION
I thereby aRbm under penalty of perjury oro of the following &,].do=
❑ I have and will malnuin a Cardfiae of Consent in self-insum for Workers Camper.
Milan, an provided for by Section 3700 of the IJWr Code, for the performance of the
work for which this Parrott is issued.
0 I have and will mains Workers Compensation huunnce. ss required by Section
3700 of the labor Coce. far the performance of the work for which Nis permit is Wood.
'
My Work Co pen on ltmsu ce cam. and Policy numbe�r3am- ^ ^
Carrier.. Yl�� Policy No.:At a' R y V oat —mss
7
CERTIFICATE OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu seedmm tread nut be completed If the permit is forme hundred dollen (SIM)
or leas.)
I anify, that in Ne performance of the work far which this rerndt Is issued, I shall not
employ any person in my mamcrm as e become subject In the Workers'Compensation
Laws of Cataluna.. Data
Appl cml
NOTICE TO APPLICANT: IL afler making this Certificate of Exemption, you should
become subject to the Workers Compensation previsions of the IAhor Cade, you must
foMwire comply with such provisions or this permit shall W domed revoked.
CONmmL;cr10N LENDING AGENCY
I hereby nlrvm Nat Nem its construction lending agency for Ne performance of
Ne work for which this permit Is issued (Sec. 3097, Civ. C.)
Lenders Name
.
(tenders Address
I certify Nat I have read this application and sum Nat the above information Is
crteca I agree in comply with all city and county ordinances and sum laws misting e
building convection, and hereby auNorim reprexnutives of this city in enter upon the
shove -mentioned rropertY Ior inspection proposes.
(Wc) agree Ir Mve, Indemnity and keep harmless Jur City or Cupertino against
lhdo itia,judgmcnu, casts and expenses which may in my way same against mid City
in consequence of Ne Starling of this permit.
APP ICA UNDERSTAI4DS Atte WIp,L COMPLY WITH LL ON -POINT
S9OU C GULATIONg"ji -I'
Issued by: Date
` t'o.4f `�`� t' 6T
Re -roofs
Type of Roof
Si um fAppaicmVContrmlor Dam
HAZARDOUS MATERIALS DISCLOSURE
Will tie applicant w too= building occur anumm or haMlc hawdans material
rad by Ne Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
'
oYle; 25532(a)7
All roofs shall be inspected to any roofing being installed.
Na
prior material
If a roof is installed without first obtaining an inspection, I agree to remove
Will the a,P,i,., o rd u1u.e building rsupant use equipment or devices which
emit ha'rardous air cmtsminsnm M defmol by the Bay Area Air Quality Management
all new materials for inspection.
District?
Oyu
-
Iheve read the hraNausmnerialsrequimntenu under CM Ite6.95afthe Califor.
a /n� �p
nieHUIN&Safety Cade,Secdoa25505,25533a n534.1undentsndthatlfNe Wilding
�a'�Af�
does not currently haw a tenmt. Nat it is my responsibility m notify the upant of
re ma blah muss W m brm iuvammeepr. Car irtm rfuucu may.
ign ture of Applicant Date
�`
A11 roof coverings to be Class 'A!' or better
or D,e;
uNarimd agent
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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
GiIITRECT+C�R IQR'IA7 Z01
BUIL ,pI qA r�KESS:
PERMIT NO.
G�S54U VAI AVE
EARTH BOUND HOMES
07050121
OWNER'S NAME:
PERhM ISSUE DATE
DAVID & STEPHANIA KANEDA
990 RICHARD AVE STE 104
02/08/2008
PHONE:
_
SANITARY NO• CONTROL NO.
(408) 244-5392
ARC HITECT/ENGI NIEER:
BUILDING PERMITiNFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Di ' n 3 of thc Business and Professions Code, and my license is
HOUSE DEMO
in
Licen force and effect. Lic
6/9/08 PETE MOFFAT CONSTRUCTION NOT CONTRACTOR
Date Contractor EArff, f6dki o+'4a1
ARCHITECTS DECLARATION
ANYMORE. EARTH BOUND HOMES PD FOR BL 6/10/08.
1 understand my plans shall be used as public records
THEY
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following mason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, altar, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
he is licensed to the of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that pursuant provisions
$15000
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
36205029 Number
_
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom than five hundred dollars (S500).
❑ 1, as owner of the property, or my employers with wages as their sole compensation,
Required Inspections
fl
will do the work, and the structure isnot intended orofferedfor sale (Sec.7044.Business
and Professions Code: The Contractor's License Law dors not apply to an owner of
P
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li-
cense Law dors not apply to an owner of property who builds or improves thereon, and.
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
❑ I am exempt under Sec , B & P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self-insum for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued
'
My Work Co pens •on Insurance carrier and Policy numb�e�r arpe:
Carrier. T i Policy No.: C�a oC f�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S 100)
or less.)
I cenifv that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lenders Address
1 certify that 1 have mad this application and state that the above information is
COMM I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities,judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this Permit.
APPLICAPIT, UNDERSTANDS��ANJN WILL COMPLY WITHfLL NON -POINT
Issued by: Date
SOU GULATIONnL�^a-l)'
Re -roofs
Y
more
Sig f Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
All roofs shall be inspected to any roofing material being installed.
❑ Yes No
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant o• future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District? �
❑ Ycs )R Nb
I have read the hazardous materials requirements undcrChapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534. I understand that if the building
dors not currently have a tenant, that it is my responsibility to notify the cupant of the
req • me hickmus tbem . toissnancc faCe"i;Fate frkca
§ign Lure of Applicant Date
l �� w w
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