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CITY OF CUPERTINO
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13UILDING DIVISION PE MIT
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Bu1LDIL+Q,bppR MINE CT LOT4
TBD - TO BE DETERMINED
PERMIT NO.
07060116
W NEWS NAME'
PERFfff MUE DALE
'
06/11/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECDENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
P
1 batch,affirm Nal 1 me licemad under Provisions, of Chapter 9 (cammmtcing
with Section 711M) ofDivision 3 ofthe Business and Prorcasiuu Code.and an, license is
SFDWL-2 STORY 1, 749' , PATIO 219' , GARAGE 436' .REV
iLnse class ett seg
#07110130
Dau tractor
ARCHITECTS DECLARATION
PERMIT APPLICATION EXPIRED 12/14/07 -EXTENSION
1 understand my plane shall W used as public meords
Licensed Professional
OWNER -BUILDER DECLARATION
I Wmhy M. that I am exempt from the Contractor's License law far the
following moon. (Section 7031.5. Business and Professions Cade: Any city or county
which nupe es a permit to cormumes, al er. improv:. demolish, or mpmr my structure
prior to its issuance. also rupture, the applicant for such permit o file a signed auumcm
he is licensed plc of the ConuuNrY Lk-... Law (Cn.pm,9
Sq. Ft. Floor Area
Valuation
that pursuant provisions
(commencing with Section 7000) of Division l of Ne Basin. and Rofeuiou Cade) or
$180000
Nal he is exempt therefrom and the bane for the alleged exemption. Any violation of
316 4 7 017.
Occupancy T
P Y YPe
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of
trotNumber
mart Nan five hundred dollam (VIMI
1, u owner of the propmry. or my employees with wage as their ante compensation,
Required Inspections
will do Ne work, and the swcturt u not inumded or offered for sale (Sec. 70M, Busia•..
and Proressm. code: The contractors Lica se law doer act apply m an awes, of
property who milds or improves thereon, and who does such work himself or duougb his
own employees, provided that such improvemrnu an, not imended aronesW for We. U.
havever. me building or improvement ismid within aK year of compleuan, the owner.
builder will have ft harden of proving War he did rot Wild or improve for purpose of
vlc.).
0 1. as owner of the property am exclusively contracting with licensed coronations in
construct the project (Sec 7044, Baines and Professors Code:) The Coovacuu's Li-
.
cotie law does am apply N an owns of property who Wilds or improves f... and,
who contracts for such projects with a conuanol(s) licensed pursuant to Ne Conuactoes
License law.
O l am exempt under See ,B d P C for this
ma
RATION
1 Wmby &M m under penalty of perjury ane of du folbwing declusuou:
I hsve and will maintains Cuvificau afComc Imaelf-inurefor Worker Compen-
ation, as provided for by Section 3700 of Ne Labor Code. for the Performance of IW
work for which this permit is issued.
❑ I have and will maintain Workers Compensation Inevrarue, u nyuired by Section
3700 of dtc Ledo Code, far Ne palfiarmance of the work for which this permit is Issued.
'
My Worker's Compenauoa immanence mover and Policy number am:
,
Carrier. Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ihisseclinn need not W complc¢d ifthe permit is forono hundred 011. (SIM)
or has.)
I terrify that in the performance of the work for which this permit is Wood. [she) not
employ any person in anymonster. as to become subject to Ne Cordon
Laws of California,
Applicant/ LAS
NOTICE TO APPIICAf�v' : If, after making Nu Ccnifiuu of mption, you should
berome subject to the Workers Cmnperution provisions of the labor Code, you mune
forthwith comply with such provisions or this Permit shall W downed naked.
CONSTRUCTION LENDING AGENCY
1 Wroby.M. that Nen, I.. caosuuctinn lending agency (or the performance of
the work for which Thu permit It issued (Sec. 3097, Civ. C)
Undoes Name
Lenders Add.
1 artily that 1 have read We applicause aed sum Nu Ne salve irdarmatiun I,
correct I agree N comply with all city and county ordinances and suis laws miming to
Wilding construction, and hereby sultanas mpcmnmol s of this city to anus, upon plc
c for
shove-manudgm
an pmrpxawhich
(We) agree to save, indemnify and leap harmless the City of Cupertino against
exIm
dgments. costs may
juand expenses which may in anyway accuse against said City
in tilisammme of
in PLIC NT of IW RSTAgoserfing of Nu permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCEREGULATIONS
��/ ��
Issued Date (/t�—
!
Re -roofs
/
Signature of AppliarDOr Dau
HAZARDOUS
HAZARDOUS MAng
Type of Roof
WIII the occo ent11.DISCLOSURE
future Wildinge. handle
JN
Cupumas,
Chaptamrtas,
u defined by the Cupertino Municipal Code. Chapter 9.13. arw the HaIN and $area
Health and
. Section 25533(a)7
❑Yes �e
All roofs shall be inspected prior to any roofing material being installed.
Will plc. lic m, or Wilding anti and nm t as, which
np e p ea
If a roof is installed without first obtaining an inspection, I agree to remove
g P
emit air contaminants u defined by Ne Bay Area Air Quality Management
Air Q Mann
all new materials for inspection.
ict?
DisuictT JJ
❑Yes GIN.
In 11Nehutafdousm&uHalsm uimmenuundcr. Chapmr6.95afthe Califor.
nu HealthatSeclycodc,S d=25505,ss533. 25534.1undnwd Nuudc Wilding
.
does not currently hast a Rnan4 that it u my responsibility, a, notify plc occupant of the
reyuirernaa!
All roof coverings to be Class'J?" or better
Owner o a
r d agent Dau