06040043 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ;CUNTRACT012IN 'U,,R�Te1;T4, 1 �:
BUILDING ADDRESS: SCOTT HUGHES PE2M"No.06040043
7752 HUNTRIDGE LA
OWNER'S NAME: PERM"ISSUE DAM
SCOTT HUGHES 05/04/2006
E: SAN"ARY NO. CONTROL NO.
ARCHITEC(ENGINEER: "BUILDING PERMINFO MECH
BLDG EO PLO O
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LICENSED CONTRACTORS DECLARATION Job Description
I bantn N
by sal" ei 1 am licensed under provisions of Chapmm
r 9(comramng
with Section 70M)of Division 3 of me Business and Pmfasslour Code,and my license is
+� ifall faaeanderrau. ADDITION; 334 SQ FT-LIVING RM/GAME RM/BATHROOM
j License Lime Lica
Dam Contractor
ARCHITECTS DECLARATION
I understand my plats shall he used as public recarda
.oda Licensed Pmfcsond
3 OWNER.BUILDER DECLARATION
1 hereby aalnn Nat 1 em essmpt rim.Ne Contranars License law for the
p an 7(313,Bud.and Pmfesdun,Cada:Any city at county
$f which requires a permit to mrutrOct alw,winnow.dammtsh,m tepair any suumme $130000
_Z'n prior to its issuanm.&I.requires meapplipm far each lermi(m file aslowd suumem Valuation
<
that be is licensed pursuant to Ne prevision,of Ne Connector's Limmc law(Cheptm 9 Sq.Ft.Floor Area
{5�9 (can mewing with Section 7000)of Division 3 afore Business and Pmfmdam Cow)or
L that he Is attempt timrefrom and the basis fm the alleged esempdan.Any violation of
Section 7031.3 by arty Applicant fm a permit subjects the applicant m A civil Penalty of 3M Mbhr U v Occupancy Type
not more than aw hundred dollars(SM.
1�]1.uownerofthepmpmy.mmyemploymwithwa{eau NeUselem Pmwtion,
will do me work.and NeaWCIYm 4 rmthnended of OBCRA forsam(Sm.7044.Bushels aired Inspections
and Profession,Cade:The Cantraam's License Law owner Of sot apply m an onof Ll p
property who builds m improwa Neswn,and who does such work himself or through hu
own employees,provided ths,such impro•.emmu are natim dmI martered feassle.a, '//
however.me holding m improwmmt s said within m s year of anmpledoe.am awmr-
builder NO bow tits burden of proving that he did m,atim m improv(or pugase of
tole, u�
ISI.u new,of the progeny w aselasiwly contracting LINcesu
IleEv
muactara m
tauvum the project(Sac 7044.Businm ad Professiam Code:)The Caoasemrs Li-
me Law dna not apply m an awns of property was seats or improws Nemo",and,
who contracts for seats projects whh amnnacm is)licensed pressures m the Concurrences
License Law.
❑lam .96,under Sea Be PC for,Nu
I
reaeoIe
u3/ L/L Dam 5/4 06
WORKER' PIENSATION DECLARATION
I hereby aaim un@r penury of perjury not of the following declared.
❑1 haw and will maintain aCettlOeam ofComentta self-insure for Workers Compen-
sadon,as provided fm by Section 3700 of the Labor Cade.for me performance of the
we&for which Ws parent,is issued.
❑1 haw and will maintain Workers Compensation Imuranm•as required by Session
37W of the Labor Code.far the performance of Ne work for which this Permit is blued.
My Workers Compensation Insurance carrier ad Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EKEMFRON FROM WORKERS
COMPENSATION INSURANCE
r
(Ibis section need set beeompmmd if the permit u forms hundred dallars($100)
or less)
I certify the,in the peafarmama of the wart fm which this perml,Is issued.)shall m,
employ any Perron in ymanmrsamm bmomombjm,mme Wahen'CwcPcmwm
Laws of GlifomlA. •" �H U
Applicant
NOTICE TO APPLICAITT'.If,after anaft NU Cmdacate of Esemp,lon,you Nauss
haeme subject as the Workers Compcn,atian lem isiam of the labor Cade,you muse
.J 0 foMwim comply with Inch provisions or this permit shall be dcemedresulted.z 51CONSTRUCTION LENDING AGENCY
f+ I hereby affirm dor there s a eomtmcdon lending agency for to Performance of
fYr use work for which this permit Is issued(Sm.3097.CN.C.)
aQ lcndara Num
D z I<ndeM1 Addle.. - .
U0 I certify,that I haw read this appilmadrn and ease mu the above Wormatiun Is
V.r correct I ogre to comply with all city and county abin,ncxs and sum laws missing m
O V Wildin{ronwuction.orb hcntbY auNori><mpresenmives of Nis city to enserupnn Nc
r lId almw-mendund property for in,Pecuo t purposes.
F 6. (We)agree to saw.indemnify and keep hermkss the City of Cupertino against
v.res liabilities,jdgments.costs and expenses which may in any any accrue sgaln,t said City L
V z in consequence of the{ranting of this Permit
APPLI ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:S4&0 Date
SOU RIA71 � /
,i i Ati .S-�4,/ Re-roofs
SileattwofApplicarrUClamifids, Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or Intent building Occupant stare or handle haasdow maters]
as deand by On Cupertino Municipal Cade.Chapter 9.12.and the Heanb and Safety,
-a de.sued.3s332(a)7 All roofs shall be inspected prior to any roofing material being installed.
Yes V.
will the applicant ar future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air conuminanu a actions by the Bay Am Nr Quality Management all new materials for inspection.
Disuict7
❑Yes 1114
I haw rad mehaasNousmameiais sequirtmenssunder Clap ct6.95oftie Califon
ma HoalmAt Saluy Code.Smims 23505.25533im125534.I understand muffine building
dors n,1 my low•=Wk dm it a my rtapon hility m mdry Ne omvpmt of de
require nuw hh/m/�/p me atmamm
anaracerdaeamorarmp.my Signature of Applicant Date
'f-srr'I.A— J/a/ 706
caner ar aatnarizeaa Dam All roof coverings to be Class"B"or better