06030078 ------------
CITY OF CUPERTINO ' ` '"� �" "i` 4'
BUILDING DIVISION PERMIT ¢CONCRACQRI-NFOR�IVIATIElN.;
BUILDING ADDRESS: PERMITNO.0 6 0 3 0 0 7 8
19991 LA MAR DR
ER'S NAME: PERMIT ISSUE DAM
TAMAR & SHAI ERLICH 05/17/2006
PRONE: SANITARY NO. CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BO EO PLUMB MEOCH
jam LICENSED CONTRACTOR'S DECLARATION Job Description
m 1 acreby affirm that I am licensed Mader provlaiam of CMP-9(commencing
t
with Section 7010)of Dlvidoa 3af the Business and Professions Code.and MY license u
+�N
in full force ADD 20 ' TO GUEST ROOM/MODIFY FRONT PORCH/REMOTE
jH2 License Ores Lk.R
Dta110 ' REMOVE BEARING WALL ® MASTER BEDRM/RELOCAT
f Dam Contractor
As mallb =i DECLARATION MASTER BATH/3 NEW WINDOWS/UPGRADE SERVICE PANEL
1 undennnJ my plus dull M used as public menet.
and Lleenud Prepositional
OWNER-BUILDER OEC Contractors
I hereby atnr that i 1.camel from tun ConuamCo Licuss Law for the
p o fallowing mama.(Sacco 71531 ,Budnes.and Rofmiam Cade:Any city at county
3$
which requires a permit ra ennalrvc4 eller,Imprmx,demolish.m repair any summre
pdarmit iasuanec.also trqulres the eppllunl forauch permitm Oleaalgnad eumment
R8 Ihalhculicenudpumenuodupmviaiasa(Ne ConmcMf3Liccmclaw(Chapmr9 Sq.Ft. Floor Area Valuation
2 $ (cmmemingwith Semion7000)of Division3ofthe Budnmuod Professions Cade)or $50000
e — that he Is w pr'thmfrom and the basis fn the alleged esmpdon.Any violation or
Secdm 7031.5 by any appoessl for a perlt subjects the applicant m a civil pehully of APN Number Occupancy Type
act come than five hundred dollus($500).
❑Las owner of ft property.or my mployees with wagesas desk role mmpemadm,
will do the work and tashumme6 mtintended mattered forsde(Sao.7044,Budgets Required Inspections
and Pnomdom Cade The Contmmr's Liam Law does Out apply m an owner of q P
property who bulldsarimproves shorten,andwh doessmh work himselfortluoutb his
own employees,provided that such Improvements are not intended"offered forsde.if,
however,the buildotor Improvement is mid within ane year of completion,the owner-
builder will haw O s burden of proving that he did not build or improve for purpose or
sale.).
awrc,of the property,me eselusswi,Mucasaing with Ileensed conuaemn to
mlmm the pm)ect(Sec.7044,Business and Profeulau Cade)The ConUwWe3 U.
mine Taw tom not apply he an owner of iamperty who WHOM or Improves shaman.and,
whacontamaforauehpalwaswithacanummo Ilcenssdpmsuanlmdm Conuame.
License Law.
❑I m esempl undo See .B6:PCImmisic n
r Dam
WORK PEN DECLARATION
Iberebyaflirmuderpe lye perJuryoner, fol lowing declarWonr.
❑1 have and will maintain aCerdOmm of Commmuo alf-unum forWorker's Compm-
sWon,as provided for by Smllon 3700 of the labor Code,for the Performance of the
work for which this pump la issued
❑1 have and will.,law.Worace.Compemallon Imuran¢,as required by Section
37mof the Labor Cade,for the performance of use units for which dus peril is Issued.
My Worker's Compemulon Insurahh¢carrier and Policy number am:
Carder. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This seadm mad mtbccompleed If the peril is forone hundred ddlan($101)
or less)
I certify that in the performance of the work fm which this permit is blued,l"I ms
employ atyperson in my mannerrymay�p! emject m the eti CmnPensdim
Taws of CalifimiL Dam lel/
Applicant
NOnCETOAPPLICANT If Re ma lot this Con' mot Exemption,you should
become subject m the Waheh C.;Or M con pmol ons of tit Tabor Cade,you most
Oforthwith comply with such provisions or this peat ahail h deemed rewind.
CONSTRUCTION LENDING AGENCY
y
t-h I hmby afOr tins Nem is a mnstrOctinn lending agency for me periumance of
lY> the wart(arm which th4 permit is ishan(sce 3097.civ.C.)
94 Landers Name
Z Lander.Address
U Q I certify that 1 have mad this application and mm Nu the above Inform Wan is
U. contact.I ag,ce to comply with all city and county oralnanms and atm lava rtlaling m
0 V building construction,and hereby aulhmire mprmentalves or this city to curer upon Ne
n3 shove-menuunedproperly for i espouser
puryous
y (We)agree IM wave,indemnify and kap harmlm she City of Cupertino against
UZ incoidequarom ftheemu and eapms Fermi. many wayammagdml wait City
L)'j A consequence of the amongUNDERSTANDS
alibis peril.
.. APPLICANT UNDERSTANDS AND WILL MPLY WITH ALL NONIN7 Issued by: Date
SOURCE REGULATIONS.
�7 06 Re-roofs
Signature otApplicamunContrasi Dam
HAZA OUS MATERIALS DISCLOSURE Type of Roof
Wo the applicant an future building Occupant sore in handle hazardous material
as depted by she Cupertino Municipal Cade.Chapter 9.13-and the Health and SAMY
.
Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes e1Na
Will the applicant or future building occupant um equlpcoam or devices which If a roof IS Installed without first obtaining an inspection,I agree to remove
emit h4?Ardnus air conumb uts u depend by the Bay Area Air Quality Management all new materials for inspection.
District? J
QYea 01N.
I have mad the hvardau materials requirement order Chmnar 6.93 ofdheCalifor-
ntlmalthkSdctyCode,Saiunderstand.35 5.25533 and 25534.1understand dui lithe building
er
donot currently have a annual, m
u my responsibility court'to occupant of the
requimmenu '
which must be mel rmessumceefaccnihamaf Occury Signature of Applicant Date
S 7 o All roof coverings to be Class"B"or better
Owner or ewharixd gens Dam