05110035 CITY OF CUPERTINOaxayas..A:�.�a � * :
BUILDING DIVISION PER ' CONNfRA; QR,ANFOWMATIO ,
BUILDING ADDRESS: AMERICAN BRANDS CONSTRUCT OWIT NO'05110035
22035 MC CLELLAN RD
OWNER'S NAME: PERMIT ISSUE DATE
GERD SCHLITT 1145 HAWKS HILL ROAD 12/14/2005
--INE: SANITARY NO. CONTROL NO.
(408) 210-4945
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELF.C7 PLUMB MECH
o LICENSED CONTRACTORS derpDECLARATION Jobb
1 hro 7O affirm that I am fft B under provWam of Chapter 9(Commencing L
w(th Section 701111)o(plvisl 7ofthc Businem sM Prouuinm ode.and my license is
O
n� imm�foreeandefraa PATIO COVER (135 ' )
ED
o:�°CT DI MAY 9- �J QQ
0
ARCHITECT'S D ON 1DOU
I undc,tand my plain shall W uud as public race
G
Licensed Pneby art l B�1+L�
h OWNER-BUILDER DECLARATION
1 hereby amain that 1 am exempt from Ute Contractor's License law for the
0 o following moon.(Section 7101.5,Business and Profeviom Cade:Any city m county
S g� which requires a permit to comuucL alter,improv.demolish,or repair any structure 2 8 9 3 9
prior m N Issuance.aim requires the applicant for such permit lO Ills a signed statement
< thaLW is licensed pursuant to the provisions of the Contractor's LiceneLaw(Chapter 9 Sq.Ft.Floor Area Valuation
rF (commencing with Salton 7")of Division 7 of Ne Business and Professiam Code)Or
S del W is exempt Therefrom and the bub for the alleged esemption.Any violation of
Section 70713 by any applicant for a permit subjects the applicant to a civil penalty of M Mbbr u U Occupancy Type
not more than flv hundred doll.,($500).
❑L u owner of the property,re Is employees wish rages r Ihetr sok7044,B s hum,
will do thework.and the of cture Ormncones Intended or Law ffered
not sale
70 M,Business Required Inspections
and Prouahiobu Cade:The Canuxton,Liaise law does not apply lr an own"is q P
oumproertywW .provirlmprowahImprwments andwho amnouchwork Mmselror ffered hrough his
ownemployes,ping or improvement
vemlmprovemmtaamnot year
ofAmoRemd fm sab.lf.
builder Me building orimpmwmenlis Bald did aneWildofmmpk,forthe owner-
builder will Mve the burden of proving that W did not Wild or improv far purpose of
ukJ.
❑1,as Owner of the property,am exclusively contracting with licensed contraction;to
camlruct the project(Sec.70W,Business and Pnefesdons Cade:)The Conmactors U.
come law Most not apply to an owner of property who Wilda or ImMnws tiemon,and,
who mnuscns for such pmjccu with a co tuacer(s)Iicened Forward th the ContractaM1
License Law.
❑I am exempt under See ,B&PC for this moon
Own" Dau
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ore of the following declarations:
arc and will maintain.Ceniflesu of Consent to elf-insom for Worker's Compeer.
u provided for by Section 7700 of be labor Code,for the performance of the
for which this permit is issad.
❑1 haw and will maintain Worker's Compensation Insurance,u required by Section
7700 of the LaWrCedo,for the performance of the weak for which this permit is leaned,
My Workers Compemadon I seance Barri"and Polity num
Canier. 0,�•'.(^�Policy No: .
CERTIFICATECOMPEN ATION I0N FRAM ORKERS
COMPENSATION INSURANCE
(Thin section need not W completed line permit mferme hundred doll.n($100)
M las..)
1 certify that in the performance of the work for which this permit is issued,l shall not
employ any person In any manner an as m become object In the WorkersCompensation
Laws of California.Data
APPliesnl
NOTICE TG APPLICANT:If.afar making this CenlOcae of Exemption,you should
become Subic"be the Workers Compensation provision of the labor Code,you mint
.�JQ forthwith comply with such provisions or this permit shall W deemed rked.
r► CONSTRUCTION LENDING AGENCY
[—i 1Weby.M.that them iia mneuuctine lending agency for the performance of
CL the work for which this permit Is Issued(Sec.7097,Civ.C.)
1 Q Landes Nanta ,
Z)z Leader'aAddmn
U0 I centify that I have read this application and sum that the&bow Infmma iun Is
Iy F correct.1 agree 0 comply with all city and county ordinances and s e laws relating 10
OU building construction.and hereby author=mpreentsaws of this city to enter upon the
r S above-menlionod property for inspecdon pu0eses.
(We)agree to save.Indemnify and keep harmless the City of Cupertino against
ti liabilities,judgments,saw and expenses which may In any way acmue agalmt said City
t,)7 in mmmmenev of the graining of this per t. - �f
ran APPLICANT UNDERSTANDS AND L COMPLY WITH ALL NON-POINT Issued by: Date Z (�J q,--
f Re-roofs
re 0 pp.—c WMIJmtwo0r Data
HAZARDOUS blIALSDISCLOSURE Type of Roof
Will the applicant at future Wilding occupenl am or handle hnardom material
as denned by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Cw.,Samnnz5s7x(a)7 `"� All roofs shall be inspected prior to any roofing material being installed.
[--]YaNd5
Will the applicant or[.lure building occupant iso equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
harardnm air conumimnu u def d by the Bay Area Air Quality Management all new materials for inspection.
n7
❑Yes u
I haw mad the bmaNnusmwrialsmquimments under Chapter B.95ofthe Califon
nla Hcahh&SofctyCode,SMiom75107, 77 ond75330.1mulkmasiNnifthe Wilding
does int curten0y haw a tenant Nat h i y rupomihilily to nudfy the occupant of Ne
mgairementar auKcanceNnesearOccapanry. Signature of Applicant Date -
Owner or authoriod agent pain All roof coverings to be Class"B"or better