07070028 CITY OF CUPERTINO
BUILDING DIVISION PERIVIIT COpITI2A. -TOR4N 0�'iVIA.TI01V
BUILDING ADDRESS: PERMFI'NO.
18770 LOREE AVE TBD - TO BE DETERMINED 07070028
07/11/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECTrENGINEER: BUILDING PERMIT INFO
SFDWL 2, 18V GARAGE 436 ' BLDG ELECT PLUMB MECH
moo LICENSED CONTRACTOR'S DECLARATION IbDesGrl uDn
1 hereby alr,-INt 1 am i =d under pmv Mom of Cnapmr 9(commencing —••——--------- Op
i
I.ilreell I.sando roCC
License Class f D
ivision Jof dse Buinmatd Proressmu Gude,tied my IIICM1mu
Lie.R
Dam Codnnor
y� ARCHITECTS DECLARATION
1 understand my plans shall he used as public ro=ods
JyU
g Licensed Pmfessimnsl -
5 OWNER-BUILDER DECLARATION
E I bomb;s1Erm that 1 am exempt from the CmnmacmYa Litman law for IM
C no following mason.(Salon?831.5.Busmu and Professions;Code:My city or=my
S 31 which requires u permit to ccrNnee ghee imp...demolish,or mpoll any stmnum
_ito prior b its issuance,aim res therequic applicanm Bk
t forsuch permit a signed statement
E G thuneI,liaacdpumu^tmeeprovisasorOn,Comracm/.Lce.Law(CMpm9 Sq.Ft.Floor Area Valuation
X�n (commencing with Section 70DO)of Divuim 3ofthe Business and Pmfecsinns Code)or
that.M Is exempt therefrom and the Mair for the alleged wh mpuon.Any violation of
Section 7031.5 by any appllunt for a permit subjects dw applicant In a civil penalty of APN Number Occas Type
Ice,mare than five hundred dollars(5300). Occupancy YP
1,mow^aortMpropcny.mmymploymwithwgnudcGml=cmmp m.
will do Network and the he Como meal Lidnsm sew do fsran a(Sec.m an,Masuas
and who
rens Cade:The Conmactuls Lse=u=Law dm rot apply tu an owns of Required Inspections
propertyempoye WilNorimprov at such un Laedwho dmarch amkhimselfmr lbaugb his
boacm,mebuiprovided prsuchimpmmmentsarcnot ear adissel ofcaolfued nor camlf.
however,Ne building serden Of pmcnl ahold within one year of completion,the proem Of
Wilda NO nave IM hastier a!proving Nor M tlid Out btib a impmw fa purpose 9f
tile.}
K.—ter owner M the property.am eacluiv=ly communing with licensed convenors is
construct the Inmjen(Sec theca.Business tied Profusions Code:)The Contractors U.
rM =law dm not apply N an owner of property who builds or improves demon,and.
who contracts forsah projects with a rontractogs)licensed Instrument as the Contrcloh
License law.
W
DECLARATION
I hereby affirm under peaky of perjury one of the following declaration:
❑1 hs=and will maintain•Cetifinmof Consent m self-insure forWork=Ys Compen-
sation,u provided for by Section 3700 of the Labor Code,for the performance of One
work for which this permit is issued
❑1 hon and will maintain WorkeYs Compensation Insurance,an required by Section
3700 of NC Labor Code,for Ne perfor ance.f d=work for which this permit is issue
My Wmkses Cmmpemaubm hlsurmax carrier and Polis,numbs sire:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ttu e,chon need rot Mcmnplee,d little permit is future hundred dollars(5100)
or bas)
I=wiry Not i^the pelformwue of the work for which thin permit u Wood,I shall rat
cmpt9yanypnsgn in ymammrmu N become subjatm lh Wmrten'Compewtion
Laws
of cabr & a
Applicant
NOTICE TO ¢r m�7ng Nu Ccdrtam of Eumptio^,you Nwld
become subject m the WOmmel ComPens nden provisions of Ne Labor Code,you most
.J O forthwith comply with such internment or this permit shall be deemed rewkcd.
z CONSTRUCTION LENDING AGENCY
Thereby affirm f'there is a cmamuninn lendingfor Nc formanm"f
!Yi N=work for which Nis . .) per
permit u untied(Sec.M.Civ.C.)
Ip1 Q
Lender's Name
�z 1<ndcr's Add.
U O 1 COMFY Nat 1 Mvc rad this application and all this the above information is
(y r' cmmce 1 ague In comply with all city and county mlin actsand sue,laws mlau^g to
rV^ Wilding construction,and hereby auNosm mprucnbuvu ofthu city N cuter upon N=
yaluve-mentioned papery for l ox,ru on Purwhich may
(We)agree to rive,indemnify and kap harmlm the City of Cupertino ugan,
z li consequent Of the oaand upnsce which may in any way aarvc agunslsaid Gty
U,Z A consequence Of the granting Of this permit
ti APP CA JUNDERS ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU ULATIONS.
���(f�n Re-roofs
Sr�pplianmConuacto ae,m '
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appllant m ram=Wilding—Pant from m handle havrtlou mamris
food by de Cupertino Municipal Code.Chapter 9.13.and de Health and Safety
Section.oY.25332(a)? slf-�' All roofs shall be inspected prior to any roofing material being installed.
Will the a licadt or future building ate ant use e ui If a roof is installed without first obtaining an inspection,I agree to remove
PP g v q pnwt rot Mann which g P
emh wadnns air tmbmirants as menned by thm Bay AreaAir Quality Management all new materials for inspection.
District!
❑Yea u
I Moe read the Incautious mancerhast mquimmenes under Chapter 6.95 of Ne Ciliror.
^ins Health&Sato Cade,s=cups 25585.25533 and 25534.1 understand that if the building
dao not current] Mw a aunt Nm It u my responsibility N notify the occupant of the
rogmre�b wn nmust be met priarNissuance ser,Ccnirmam ser On maIn ell met pnarNi:snaree ser,emnirmamara Signature of Applicant Date
`7�1�c
Dw^ao�ri.clsgtnt Dam All roof coverings to be Class'n"or better