08010130L3
CITY OF CUPERTINO
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BUILDING DIVISION PERT
COQ RACyT1OR' INFOI.tMATIN.
BmLQlric,3pgtkFsN DE ANZA BLVD
1:R'S
ANTHONY HODDER CONST
PERMITNO.
08010130
NAME:
PMtMIT MUE DATE
ST. JOSEPH CHURCH
7504 BOLLINGER RD
09/23/2008
PHONE:
SANITARY NO. CONTROL NO.
(408) 257-4317
ARCHITECTrENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Chapter 9
Job Description
P
I Wmby affirm Nat 1 am I'wsmxcd .akr provision of (commencing
withseedan7alB)ofDivision3offtBusiness and Pro(eldumsCode,IMmyuanlcu
RMV EXSTNG RF COVR AREA & UPDATE ENTRY AREA, INCL
in full forte and
License Class s 7 te.♦
ELECTCL
Data Conlracbr
RCHRECCS DECLARATION
I Mers and my plans shall banned u public record,
Licensed Professional
OWNER -BUILDER DECLARATION
I bcmby alE m that1 am exempt from the Contractor's License Law for the
following moon. (Section 1031.5, Business and Profcssfou Calc: Any city or County
which recuur" a Permit m contract. a]a , improve, demolish. fir mpoir any sanctum
oar" its issuance. alum requires the applicant forsuch Permit to rile a signed statement
Nal be is licensed m Ne of dm Conumlork Uceve law(Chapter 9
Sq. Ft. Floor Area
Valuation
pursuant provisions
(commencing with Section 7000) of Division 3ofthe Business and ProrossiamCode)err
$5000
Nat he u except therefrom and the basis for the alleged esempdon. My violation of
Section 70313 by try applicant f. a permit mbjccu the applicanuo a civil Penalty of
11626093.E Number
Occupancy Type
P Y YP
Out roam Nan five hundred dollars ($5M.
0 L as owner of the property, a my employe" with wages" thc'vsolc compe^sation,
will da the wart. and Ihesaactum is notinmhded or offered for sale (Sec. 7W, Business
and Pmfessiom Code: The Commuter License Law dors not apply m an awmr of
Required Inspections
Property who Wildaaireproves Merton, and whodocssuchw k himselforthrough his
we employe", provided Net such improvement are not intended oroRered for Pale. If.
however. the Wilding. improvement H said which arc yet of completion. the ow.s-
W ilder will have the Wmden of proring Nat W did act Wild or improve fa purpose of
ukJ.
1, u wncr of de property, am "elusively contracting with decades mnwaom to
consumer dne project (Sec. 7040, Business and Professions Cade:) The Coamsoces U.
.
cease law does oat apply u an owner of property who Wilds err improves theme, and,
who Contracts fa auch im*cs with a ... dacorfs) licensed pursuant w the Condamine.
License law.
lamexcmptander See ,BAPCf.tairs.
Date
WORKERS COMPENSATION DECLARATION
I hereby Mr. under penalty of perjury mm of the following declarations:
Q Ilu.eandwiflrmdm ..Cenifi"uof C...ti self-insumfaWteser'sCumpen-
Milan, as provided f. by Section 37M of de labor Code, for the performance of the
work for which then permit is issued.
❑ 1 have and will maintain Worker's Campemtien Imo .. as required by socio.
3700 of the fabar Code. far Nc performencc arms work fawhich Nu permit i. issued.
My Workd CVenus earth. and Policy nom
Cartiv. Policy
CERTI EDATS OF EXEMPTION FROM W RKFRS'
COMPENSATION INSURANCE
(nen aced. need .t W canpkwd if the permit is faonc humbe ldollam (2100)
or kss)
1 ardfy that in the performmax of the work far which this permit u bound, l Nell .t
employ any person in any atan.rso u n become subject m the Workeri Compevssm.
Lawa of Celif rnim. Data
Applicant
NOTICE TO APPLICANT: If, after making Nu Cenifica c of Exemption, you should
become subject w the Wmida's Compctuation provisions of the Inbar Cade you mut
comply with such provisions; or this permit Nall W saturated rooked.
CONSTRUCTION LENDING AGENCY
1 W mby.M. Nu Nem Us Comsumctian tending agenry, f. the pW..s of
Ne work (ar which this pemlit is issued (See. 3097, Civ, C.)
Undoes Name
Undoes Adders
I certify that I have read this application W sum Nu the above information is
correct. l agree us Comply with all city old county ordinaries me sou Ire relating to
Wilding conanuction, and bemby.uthorixc rcprtse.aives of this city to emoupnn the
(We) to... imi
above-mentioned pmDcrly f..,
agree ..lfy end keep harmless the City of Capoom against
gmeml.,. perwas which may
perwas h may In any Way.CL.0 agYo1{ iNd Glly
. .
1. Co.
in. eafd ERSIrA OS Nu permit.
.
APP CA UNDERSf NDS AND WILL C MPLY WITH ALL NON -POINT
�yr�-
Issued by: C/y
S RCE UL
Date
Re -roofs Cl—
Gi
Signal or ApplinnVConuamlor Data
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Willy or future handle
Co e.
do,applicant
•Osed Municipal Chaptsum.
Cupertino Municipal Cadc. Chapter 9.13. and the H"IN enJ safely
Health and
section 25
...don 7ss33(.)7
❑Yu No
All roofs shall be inspected prior to any roofing material being installed.
Will the. militant or future Wilding Occupant tete
Ire p equipment or device Mich
If a roof is installed without first obtainingan inspection, I agree to remove
P
d
emit ha"Nnus m c.uminans u dcfi.d by the Bay Area Air Quality Managcm.t
all new materials for inspection.
Disdia7
❑Y"
10611 mol Ne hascadnus materials require==underClupterd.95oftheCalif.-
ifia NO & Ialety Got 505, 75533 and 2553/ lhetifdte Wilding
dna of cu ntly he - at it ts my capowp n u dry th pant of the
req 'arm
furs whichmatn isumtesar.0 r'teer Y
d
Signature of Applicant Date
All roof coverings to be Class ';W' or better
ora., cn,.d.gmdDo te I