08030045 CITY OF CUPERTINO
BUILDING D1vIs1oN PERMIT CakVTtACT �iR�I1�1T QTATION"
PERMIT NO.
Bu1Lplr�e,ApDjeFssB.ARRANCA DR BRIAN LUCAS 08030045
i NNALM4E: PEILW'TI$UEDATE
3RWS IAN LUCAS 10924 BARRANCA DR 04/09/2008
PHONE: SANITARY NO. CONTROL NO,
ARCHIECTfENGINEER: BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
I� 0 I�
trop LICENSED CONTRACTOR'S DECLARATION ',i Job DOSCTipI100
lb I hereby,Rem that I am licensed under provisions of Chapter 9(commencing
x withSocllonTOM)ofDivision 3ofNeBusiness andProfessionCada,and mylicevcis NEW WORKSHOP W/ELECTRCL & LIGHTING
^< in full fore.are.rias.
Lkem Class L'e.1
Data Can-no r
ARCHITECTS DECLARATION
Q I..demand my plans shall M used v public mean&
n
g a Licenced Professional
sct OWNER-exempt RDECLARATION
I horthy of0w than 11. exempt from Na Convenor. :Any c Law for the
O O following mean.(Section 8131.3,Business and P e,dere li Calle:Any city m aunty
v'$ which require,•permit to cr.amL Lice hnpmw,demulW,ri e a sig ed structuro
Sit„^ does he its pueso issuance. )an requires the tiro isiosMf for smhpemr's LIcea.Lncdaamment
< Nalhalalkemaa puissant 10the provision of the eBusinwra Liuxnmlaw(,Code) 9 Sq.Ft. Floor Area Valuation
�$
but
6 a gwhhgectlon]and ft basis for
of theeged .Md Profen violation or 10000
that io e exempt 0ererrom and the aper far the alleged eamptioa Any l penman of
gallon 7031.5 by urn hundred
ran raPermit abjau Ne appirattoarivil penalty of Number Occupancy Type
ml more the five huntlrtd tlallan(5300). 32602002 !�l�
❑1,a owner of the property,or my eroploycea with wages as their into compnation,
will do the work and rhe structure is not intended or offered for sale(Sec.7044.Busions
and Pmfeaion Cade The Camuscmra License Law dna rot apply m an awns of Required Inspections
property who builds on impam s Nueonesti who doesnchwork hianutfor Wougb hr
awe employe.,provided dot swh Improvements pee not intended oroffered forvle.If,
however,the building or Improvement rseld within am you of completion.the owner.
builder will low the Wodn of proving that he did not build or improve fm purpose of
In .
1.was awner aides Property,.m exclusively eommaing with ResonantResonantcontractors m -
et the project(Sac.7Wd,Business and Profession Code:)The Conuacar'a Li-
c rte law don ret apply to an ower of property who Wilds or Improve,Nermn,and.
who contracts reattach projecu MN a convecvr(s)licensed Formant the the Contraction
License Law.
❑tom exempt uE(Ifj SayA�Data fm to Om
•r {y-{,1„
WORKER'S
Data
WORKER' COMPENSATION DECLARATION
1 hereby affirm under penally of perjury nn often following declarations:
❑Ihawand willmainaM.Canifrmaof C.ae.twul6Wumfor Worker.C.Peo- ,
ation,as provided far by Sado.3700 of the Inbar Code.for 0m performance of the
won fm which this permit is Wood.
❑1 have and will maintain Workers Compensation insurance,a required by Section
37M of the labor Code.far the poll mace of the wank fm which the pc.I,is ivmA
My Wmkera Crmpaatim humans carie sad Policy number art:
Canter: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
true secom nasi an,W cereplemd Htie pa ou is fm me,hundred dollars(5100)
or tea)
1 codly that in the performance or the work for which this Permit a Wud,l Nal not
.employ anypermn in M maarcao up Water.aat'xI a the Wmken'crmpevatian
law.of Caifomia.n 1 oe is
App icvl
NOTICE TO APPLI ANT.If,afar making this Certificate of Exemption,you should
secure subject in the Wm1an'3 Compensation provision of the labor Code•you mus
.J O forthwith comply with Such,provision w
or this pewit sinal)W deemrA mated.
zCONSTRUCTION LENDING AGENCY
[r I hereby affirm NU Nem is a convection kindles agency for the performance of
a > Qm work for which this pewit is island(Sect.3097,Civ.C) '
W 0 Lenders Name
7 z Landers Address;
()0 1 anify that 1 haw road this applicaim and sum Nu the aWw inremadu t r
W corrin.I agme m comply with alt city and county Stalemates Md sum rho ranting to
.�
Wilding construction.and hereby autbortm represnutives of this city to cmn uprn the
W alnove-mentioned pmpeny for Inspection purposes.
gL (We)Agra to Saw.indemnify ad keep harmlea has City of Cupertino agsiat
C4 liabilities,judgments.casts and expenses which may in My my amuc aaml aid City
V Z in coarquMce of the granting of Ne permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH///kkk111...1,��sjjjOOON-POINTIssued by: Date
SOURCER
Re-roofs
HAZARDOUS
'
Sigwum of ApplicecOr
HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof
Wil lythe Cupertinnt or o
futurebuildingode.Cpataareor handle Health amamria
tlefnd io the Cupertino Municipal Code.Chapter 9.13,and the Health and Sacty
Beebe zs532(a)7
[3y. All roofs shall be inspected prior to any roofing material being installed.
o
` WIII the applicant or future Wilding occupant ane equipment or
device which If a roof is installed without first obtaining an inspection,I agree to remove
`
..it W ardoa air contamiana a defend by N.Bay Ana Air Quaby MMaemenl a ,n w m enals for in pec tion.
District? �J ' ass
❑lb 7U o
Ihave mad the haSectios 21%5'2 mgviremmtsunder CYupmr6.93 aide Glifm-
rte scabhave-kmrd Sit as m 77 ad233W.I tonnunde Tran of the
don rot cWrt have a uutMt It a my .Feasibility m notify the aper of the '
reulreacn m Wmel aCcmfica r Signature of Applicant Date
q pr All roof coverings to be Class'W'or better
Owner or auNodmd agent Dam"