00110036CITY'OF CUPERTINO7
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CION TRACTORINEORMATI ON:
BUILDING DIVISION - ., PERMIT _ t
BUILDING ADDRESS: .^
PERMIT
ami i.@Z36
7497 f101_LINGER RD
-OWNER'S NAME: ' •
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APPLICATI"T
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PAI_I*IR THOMAS V AND JEANNI.
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SANITARY NO •' CONTROL NO.
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ARCHITF D;IF." i1176C(%
BUILDING PERMIT INFO
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BLDG 'F._ T PLUMB MUCH
LICENSED CONTRACTOR'S DECLARATION
+ • JOb Deserttion
1 hemhy fi lon th he, 1 levi and p .
J ns of Chapter orm nvnc ng
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I wall Section 7000) of revisit I ftheBn and P ficoun,Coonandm,FeensO
full force e ffe
- TEMP—POWER
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icense Class ea Lie. .33' 7sE'
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Date Cntnraetor 7TwA7W7
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' ARCHI I ECT'S DECLARATION' �'1/•`
- I understand my plans shall be trod as fair records
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Licensed Pared„nal
OWNER-BUILDER DECLARATION-
' I hereby iffrm that I am exempt from the Contractors Luccause Law formefollowing reason. sertion 70315, Business and Professions Craft, Any coffer county
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which belaires a pemtit to consnvct, alter, improve, denullsh, re,repuif any structure
prior to its issuance, also requires the applicant for such penton to file a signed statement
Sq. FL.FloorArea
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that lie is licensed monal to the I i.- : nl c ina,mrs, Licion L (ChTta9
(commencing w all Section 70ad) of D '. 3 of th Business d I'mossions, ado)
orthat h Tt beneficial adthe basis ]or the alleged conamption. Any violation
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(I Section 703L5by any app] can for op 't hJ Lthet civil Penalty
(If In For, hnndeddaers(a5om. -
APNNumb1�er�ItT�y
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.. Occupancy Type
a.y.JV,I L.f'v"t%J
°1„r nwnerorthe properly, ormy cnplei with wags untacirsole compression,
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will do Ille,work,cal-the stimclum is not intended or offerad for I (See. ]Irm
13 far,, and P I Code, The Courtrai L I ( r apply r
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'- r Required Inspections
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fp penyen n Id. r T th' l n d - n- k6 .If
or
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304,:—ROUGH ECF_CTU,SCRC - ^
lh gl h' npl re p 1 lth t 'h p 1, , t ded or
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uttered Far salf, If, h he harildinig or improvement is sold wifljo one year of
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completion, the owner bt'Idewill have the burden ofprm ng that Inv did not build of
.".pmvefar ramosenfside.)..
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°Lan owner of the property, nm exclusively contracting with licensed contractors to
the pr ject (Sec. 70TL Business and Professions Code:) The Calibration's
Linstruct
i cense Law dace not apply t f owner Ptrycoo huW 'tpnre, Bareu
td who coutioets for h projects witl'_a comerelon"s) license(] Iinarsuare to the
C.monfor's License Law.
°I non exempt under Sec. ,B& P C for this reason
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Owner_ Oma-
WORKER'SCOMPENSATIONDECLARATION
1� I hereby affirm under penalty of p Jury one orrhe follnwing deoaunions:a
° 1 have and will maintain it Ceirtifwle or Consan to self-insure for Worker's
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Confirmation. as provided fnr'hy Section 3700 of the Labor Code, for If,,
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Performance of life work for which this permit is Issued.
I Il nam W k 'Carol 'r nl:u nc 1 ui hY Se ton
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J700 f tl End f lh item n e f lh 6 f I' I ll ' p itis
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iceu J A k I Pnl' y t ober arc!
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Car,
CERTIFICATION OF EXEMPTION FROM WORKERS' -
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• COMPENSAI'IONINSURANCE'=
(This section need not beatuTlmed if the permit is for onchuWred dollars
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IS 100) or lose) • .
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A n "
1 nefrly,hm in the polo rsna of rhe wmk for which this Tomtit Is ward, 1
sM1u11•not employ coy Tetsuo in al, manner sa as to become subject m the Wnrkcry
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Date
Applicant Applicant.
N OTICH TO APPI.ICA N I If, 'fteranakin, III, Coril r iExemptionY should
it
become whject to l heWorker's Unpensat on provisions s of the Labor Code. you until
mfdnwen ranrply with such pravisianr ornis verrnit abml be deetnad revoked.
CONSTRUCTION LENDING AGENCY
Ilioneby affirm Nat there is a consvuction leading agency for the perfrnunco
a
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or the work far ismch this onau II, issued (See 3097, civ. C)
Leola,', Name �
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' I,endcr'a Address N,-
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]certify chat i have red thisn"Ieriar End- state that theahaveInf Fmmlon is
.coma. 1 agree m comply with all city and ooumy onlirm,cs and etitle Imvs relating
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to building construction, and hefebymnhonze reprvsenwrives of rhiseitym care (upon
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rheabove-mentioned prnpony Ru I nNseetun purptoes.
Wo) agree to save. indemnify and keep h mess the City atCler ag'rn0
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liabilities, judg n es, costs and expenses which may in any way,+cc ne against said
Ciry in amsoyuenee of the gaoling of this permit..
UNDERSTANDSANDWILUCOMPLYWITH .LNON-POINT
APPLICANTJ1
ISSlledb E- r� Date'"
SOURGF. RF. .ATIO tS
'Sigma.- PP v malar I Dar
Re-roofs '
., HA2fARDOt15 MATERIALS DISCLOSUREjudl
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Will handle h:vnnbnel material
mart Mnal
Type Of Roof
byliepCaperinn
Caro Chnlsmmor
as deemed nY lith Cupertino Mnnieipal cone, Chvpmf 9.12, and the fleahh mud Surety-
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COJg Sectfun 25532(u)? �,t,
Ed Yet
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All roofs shall' be inspected prior to any roofing material being installed.
w a n 1phea t n r l n Bdink p t sacqu'p t t i-1 which
If a "roof is installed without first obtaining an inspection, I agree to remove. '
collInterests., an,Timmerman,adefined hy, B'yAmuA- O I lyManagement
District
all new for inspection. Applicant with
tot
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materials understands and will comply
all non-point-sourc& regulations.`
I have read the h d finale' I, o,airepreas under Fibulae, (95 of he
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Call is 11.111I &S,fid, C1 Sections 25505.2553d 25.534. 1 arreamannidrift
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iflnumildia,doo,oree carytboventreart,thraitkolymsp allyl i[y the
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off, car officials which b t n orto McaofaCen careof
/ulat
Occ
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Signature of Apolican-t Date'
- All roofcoverings,toheClass':B"or•,better
anatmedagent D
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OFFICE'