04110147 CITY OF CUPERTINO - R,•. h `x^�r" -a" > r"I -
BUILDING DIVISION PERMIT . CONTRACTOR INFORMATION -
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BUILDINGADDRESS: H T CONSTRUCTION PERMIT Nfb4110147
10981 BARRANCA DR
WSNAME: PERMIT fS5l1E DATE
CECILIA MAROSI 1554 47TH AVE
PHONE: SANITARY NO. CONTROL NO.
(415) 566-5502
ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I,__1
0 0 0
uOp LICENSED CONTRACTOR'S DECLARATION "'
1 hereby affirm that I em)io"uJ�r provLdonJob DDSC!'I1100s of Chapter 9(commencing P
with Sefon 70)B)of Division 3.fft BueUeas tab cwuu Code.And my license is
^ore nfailf doff L ✓ �j7 o�o9 REVISION--IN HOUSE USE ONLY
5 q b Licenu s Lk.R
z—o Dam ctntami NO NEW PERMIT ISSUED/ ORIG. #04070065
iH ARCHITECTS DECLARATION
Cun�cr Oa d plvu shall be uuA As public..'a
DyU
Licensedcssionel
OWNER-BUILDER DECLARATION
.� 0 I hcrtby,.Sce Net 1 ore esempt from Ne Canvas Co Licenu law for the
K—p o following reason.(Section 7f13 LS Business and ere,de ons h,or:Any city n s county
$ which requires issuance.Permit re cnnsweL alma impmsu demolish,rare pair any mrumum
Pdmmiucosedalumto the the
ovisio of for such teou's odea,signedstatement
rcne Nat me cingwitpursuant7")ofDiviomofNeConuxws; LI¢nsclaw(Chapter e)or Sq.F[. Floor Area _ Valuation _$p
�� Our W is(commencing t Seton Rand the bull
far the
N alleged Business;And on.Anynvi Cade)or -'
Our Section
r exempt tang apps and the aper fm the alleged exemption.to Any violation of _
....Our five
mryreddollafor,s(m)permit subjecu the epplicmnoacivil penally of APN Number Occupancy
mm mme Nan RK namrte aan.rA(s5oo). P Y Type
❑loAowrca of Bre pm pony,mmyemploym wiNwaguuNe'v sole 044,Business uuon, 32601006 . 00
will Pr Ncwons and Neswdure iactorimtonded orofferedturseLwdo isnot aply or inwneof >. - -- - - -
and property
who
Code:The mttracmr'.Licema Law does not appy m an owner of - Required Inspections -
moncap whoauildsorimpraau Nereonand wlmaoesauchwork hinue3for through his
owneer.the building
Natvuchimpm aid within
ne year ofc or oRaredforests.eown r.
however,Neauil thebrden of provingsuld didnot ild of completion,Nt owncn
builder will have Ne burden of proving Nat he aid nm Wila or improve for pugmc of (\'�
uleJ.
❑I.u owncr of the property am uclea vely contracting with licensed cumracems to (p
construct Nc es not apply
(SecoBaa,Business and Prolusions Code:)The Contractor'shereon. n
come law docs not apply to is owner a(property who builds M improve and.
who canuacu for such pmjuu with acontracmr(s)licensed pursue¢m Be,Co...,',Can \ser\
' law.
0 1 Ion am evempt under Stt. .B&P C for Nis..,.on
Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury one of the following decorations:
CI I have and will maintain a Certifcaa of Consent to self-insure for Worear'sCompen-
xtion,As provided for by Saction 3700 of the Tabor Code.for the Performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurence,u required by Section -
37W of the tabor Cade.for the performance of the work for which this permit is issued
My Workch Compensation Insurance carrier and Policy number wo:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thr action need not he complowd ifthe Permit is Intone hundreddollars(SIaO) F
or less.)
1 certify th in the performance of the work for which this Permit r issued.l¢lull not .
employ any�uncr �subiactAO NSRWkers'ComPcn
laws of Calif mid.
AP0.1'ant - ..
CE TO APPLICANT: ( making IISu Ccnificam f EacmPti�n,you should
me subjet m Ne Worker's Compeuation previsions of the Labor Cade,you mum
.,C) forthwith--IiY with such Provisions art Nis permitshall be deemed revoked.
'Z CONSTRUCTION LENDING AGENCY
Fw I herby Affirm that dare is a eonsuucdnm lending agency for the Performance of
!Y Ne work for which this;permit is issued(See.3097,Co.C.)
A Lendch Hamm
.7 Z Lender's Address
TJ Q T certify that I have read Nil application and Auto that Ne above information is
!L Fcorrect.1 agree w comply with alt city and county ordinances and sum laws relating on
pU building construction.And hereby auborim representatives of Nis city to enter upon the
alavefiesjuoned property for imPeNon whicous.
F 0. (We)agree to save,indemnify and keep harmlw the City of Cupc!tum against
H tieconseq judgmenheStarting expenses;which may in any way decree vgainstsaitl City -
(„)z A APPLICANT
of the granting of this Permit.
'—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N N-POINT Issued by: Date
SOURCE REGULATIONS. � y y o
Re-roofs
Si uofApic ¢mete Dam
AZARDOUS MATERIALS DISCLOSURE Type of Roof
Wtll the applicant or fou.building occupanumre ar handle huaratu material
as acfincd by Bre Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
.Sccbon 25532(.)1
❑Yes rNt -All roofs shall be inspected prior to any roofing material being installed.
u
Will thc Applicant or future building occupant taequipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit h..dnua air cmnwninams u defined by the Bay Area Air Quality Management all new materials for inspection.
IDiabictl /
❑Yes �fu
G
Ihavemadtheb,a c6o 25M5r5533adcnuunder CbaPmd6 wofthe Wi)dmg
Ria
es allmHh&antly Ced a rearam, 25505.25533 and 25bility ndersund thm if the huorffic
Jacs not curenJY ham a tonanL Nat it r my tuponsihilitY m rattily ted ecuPant of the
iremcnu which mum be met primrm issuance of a certificate of OccoloO , Signature of Applicant Date
Owner or arch cJ agent D„ -All roof coverings to be Class"B"or better