08080186BUILDING DIVISION PERMIT
SQ
EWS NAME:
FRESCURA BERT L
YO`p LICENSED CONSRAUMIUh UELIANAI IUN
fm 1 hereby arm that 1 am licensed under provisions of Chapter 9 (commencing
E with Section 70M) of Division 3 of the Businear end Professions Cade. eW my limmm is
" in full fora and ercxt.
j �? License Clara Lts. 0
Dale Canawmr
ARCHTIECIS DECLARATION
NU I understand my plans Mall W used an public records
s a In Licensed Profcaioul
5 3 OWNER -BUILDER DECLARATION
I Wreby M. that I am exempt from the Contract&. License Law for lie
r O OO fallowing mown. (Section 703 1.5, Business and Profusions Code: Any city or county
which requites a permit to conioneM alter. impmwu. dcmalLM, Or repair any fouctum
zi< priorm is issuance.alw, mauimstheapplicamforsuch permit mBleasigned statement
(Who is licensed pursoantto the provisionsof Ne Conhacmr's License Law (Chapter 9
9 (commemingwidh Sccdon7000) of Divsion3oftW Businesseed ProRssioa Cade)or
that be is exempt Eemfrom and lie basis for the alleged eaernption. Any violation of
Section 7031.5 by any applicant for a permit mlbjcc; dm applicant o a civil penalty of
ms mom dee five hundred dollars (5500).
fl 1. u awrcr order momxa. a my wvlovees with waees u Nelr vele comanudon.
and prole tions Cblc: The ConVYlOff Licesse Law done net
property who Wildsorimprovea Neneon,and whodoessuch Werk
builder MB haw one Wrdm of Proving that k did not Wild or improve for purpose of
a6.).
®1 as owner of the property, am exclusively contras ing with licensed contractors On
coatmet Ne pmjcm (Sec. 7044. Burin and Prosssioes Cedo) The Conoamars LL
cense law docs not apply to an owner of property, who Wilds err improves thereon, and
who contracts for such projects with a contractor(s) licensed purwant to the Commutes
Licarve law.
am ezmn}p ,unavS5� . B B: P C for this reawn
FRESCURA BERT L
10100 PHAR
PERMIT ISSUE DATE
08/25/2008
cull INUL nu.
vmwmo resmu
REMODEL MASTER BATH, HALL 'BLDG ELECT PL
Ft. Floor Area
1 hereby affirm under penalty of perjury one of the following dalarstioos
❑ I him and will maintain a Cerufialeof Consent to selGuum for Workers Compen-
ation. u providW for by Section 370E of the Labor Code. for the performance of f
wort for which this permit is issad.
❑ 1 baa and will maintain Workers Compensation Insurance, as required by Section
I70(lof the labor Cade, for the pMarmalree of the work for which this permit is issued.
My Workers Compensation lessens artier and Polity number art:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thiswction need not becompleted iflW permit'; foroa hundred dollars (SIM)
or leu)
1 certify, Nu in the pmfoonaae of the wart for which this permit is Wood. I Mall owl
employ any .on in mY maorrwambecam wbjalmthe Worken'Compensadon
mi
La o(Cali(aas
Applicant
NOTICE TO APPLICANT. . alher making this Certificate of Exemphion, you Mould
haome sabjan or the Worker's Compensstion provisions of the labor Cade, you most
.JO forthwith comply with such provisions or this permit shall W deemed nevekcd.
'z y CONSTRUCTION LENDING AGENCY
[-s IWreby affirm that Nem is a construction lending agency for the performance of
ani Ne work for which thin permit s saved (Sec 3097, Civ, C.)
QLanders Name
z Itndcra Add.
U O 1 certify that 1 haw mad this application arts slate the the mcm infmmmon is
tg, ^ cortat. l agree m comply with all city and county ordinances and slam laws mleGng W
C) SV^ Wilding construction. tatsd! hereby wNorim rtprtxnutivu of Ns city wrnlvupnn 0e l
aWse-meetioned property for inspection purposes t/\
F G (We) agree to ave, indemnify and keep hannlw the City of Cap,"rtino IBainsl
('A IiabilitiesjudBmem.comandexperom which may in anywaymeme iBYnsl mid Cry
U;Z in conamaae ardwS sting of Ns prnnil.
^ APPLICANT UNDERSTANDSAND WILL COMPLY WITH ALL NON -POINT Issued by:
SOIIDGF RFfaO JTLWS �/
Will Neapplicantorfuture Wilding occupantsmmmbndlebara wmw material
fined by the Cupertino Municipal Code. Chapter 9.12. and the "wild, and Safely
Section 25532(a)T
❑Yu VC
Will lie appli=( or future Wilding acupant use equipment or devices which
haardna all contaminants as defined by the Bay Ara Air Quality Management
im7
❑Yon �9u
sardea matelot mattirmus under Chapter 6.95 o f da Cather.
:, Sessions 25505.25533 and 25534.1 undersand that ifNc Wilding
a !mann thm its my resporn ellity to mdfy, On, oeupon or the
Re -roofs
Type of Roof
Job Description
Required Inspections
Date
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class'W' or better