04080126 C TY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS: PERMIT NO.
ALPINE RESIDENTIAL CONSTRUCTIO 04080126
4171 NTMTP.J41:lER T)R
NER'S NAME: ISSUE DATE
N I GURCAN F, qITMRTT APAT, A 14(')DW I R- 1)R_ p p_L�i /1 2��Ol,NO.
E: SANITARY IY&
(4os) gr;R-4ygr
ARCHITECTIENGINEER: B UILDING PERMIT INFO
PLUMB MECH
ff
�00 LICENSED CONTRACTOR'S DECLARATION
M I hereby riffirds that I and fiverwall a&,innavi-irms of Chapter 9 fearprouni-I Job Description
�4� wn"
2��Oi m`-'R'* ADD 294 SQ. FT. (LIVING RQQ
02jE "s
Do.
CONTRACTOR: ALPINE CONST
darmand my plans shall no used as pubt��c REVISION--404090213 T
4ALED
Licensed Professional OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from Los Conerawor's License Law for the NOV :�V 2004
E:00 folkoving....(Seedr.7031.5.Bouirmismid Prefcadmas Cook:Any city or county
which wWom.permit a.,.iihm,nations.dremlialb.or.,.I,any Idowltme R mno
prior W its issuance,Also requires use applicant forsuch permit 10 file a signed identical oft
(commencing with Section 7001h ofDivision 3 ofthe Busimasmul Professions Cash)or U I LLJ I!M2
�at�isliccnwdpunuantio�epmvisions.f�C.�ti.e�Li�,..Uw(Ch�pt.,9 Sq.Ft. Floor Area
turn M is addempt dissaftound and the basis for the alleged exemplar,Any violation of
Section 7031.5 by any applicant for apernaltsubjects;the applicant to a civil penalty of APN Number Occupancy Type
am...dr.five hundred dollars($500).
0 1,asonancrufflic property,ormyemployces with wagagas quifistikicampensodmi,
wiltdo theok.andosestromiumisinnimentiodorafforted foriddesec.7044.13mitricts :3 6 2 15 OT,770
and Proftnands Cudc:no Contractors Licenow Low does an,apply to In owner of U Required Inspections
property who builds orimproves thermon,and whodoessuch work himsinfortlarrugh his,
own employmes,provided that such Improvements am not intended oroffered far ads.If.
however,Line building or improovement is mid within one year odcomplation.the owner.
build.'.111 have th.burden Uproot,that M did at Wild or improve for pummem of
side.).
[1 1,33 owner of the propmE,am exclusively contracting with licensed uncommon;to
contract the project(Sac.7W.Business,and Professional CMdk:)The,Contractia's Li.
cence,Law does not apply to an owner of property who builds or Improves dower,and
who contracts for such projects;with a contedurr(s)licensed PUMUant to the CKALICULa
License Law.
0 1 Lon mouttift unda,See B&P C for this...a
get Date
WORKER'S COMPENSATION DECLARATION
I barely afilind order pumity,of perjury one afth,(allowing declargifirmic
salkin,wa provided to,th,Section 37W of the Ube,Code,far be parfroodidend of he
work for which his permit I.ismand.
0 1 haw and will maintain Workers Compensation Insurance,as required by Section
3700 of me Labor Code.for the performance of the work for which this pconhis issued.
My Warket's Compensation Insurance carrier and Policy number mr;
Carrier: Policy No.:
CERTIFICATE OF EXEM PTION FROM WORKERS'
COMPENSATION INSURANCE
(This smaddho=it act giecomplued ifibe Permit is for encountered dollars($100)
or Less)
wf,that I.to pimirminstric.of the work far which this permit I.issued.I h.11 a.,
C1PIy any Penn y Mann corubjeet to the Worked Compensation
TO APPLICANM�f,after making this artificau,or Exemption.you should
Zcome subject to the Worker's Compensation previsions of the Labor Cock,you mot
forchwift comply with such provisions or this permit shall the decrated nooked.
z 2 CONSTR CTION LENDING AGENCY
I hereby affirm that done,U a construction lending agency or ft performance of
be work far which big permit is'Wharf(Sac.3097,Ch,C.)
VA Landim's Name
a LandirsAddreas
z
U 0 1 etinify that I haw read this application and&him on,the above information is
concert.I agree to comply with all city and county Mellowness and swe laws mating to
0 building construction,and hereby aufficatim reforademanivcs of this city to cnuardpom the
above-mentioned property for inspection purposes.
(We)agree 1.sure.indemnify add kicr,hicardless;the City of Cupertino!&,cwE
c4 liabilitin.judgments,costat and expenses which may in anyway accow against said try
Z in conwqmncc of the Standing of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON�POINT Issued by: Date
SOURCE REGULATIONS.
- ===,:e�L� "L� Re-roofs (�;7
re OfAriplicarifCommuctr Date I I
HAZARDOUS MATERIALS DISCLOSURE Type.of Roof
Will the applicant or future building ourcupard,stow or hanalk,havornious;madurnal
as defirund by the Cartoon.Municipal Code.Charter 9.12. ad 0.Health ad Safety
de ,
do Sixth.25532(.)? All roofs shall be inspected prior to any roofing material being installed.
El Y. KN. If.a roof is installed without first obtaining an inspection,I agree to remove
Will thm applicaut or future building occupant use equipment or devices which
d a
a.,it hazwolous air contaminants as turned by ft Bay Area Air Quality Management all new materials for inspection.
ow,
D.hic"
0 yas
I have road!the limandoundualeflaism,fulements,uncerChapharii.95 ofthe Califor.
his Health&SafRtyC.&.SceIners25505,25533 and M34,Ituradneword thatifft Wilding
does not currently ban a unnim.that it is;my responsibility in entry th,occupant of the
requirements which must he Met prior to issuance of a Certificate of Occupancy Signature ofApplicant Date
On,t;�thmrind agent Dow I All roof coverings to be Class"B"or better
IE
CITY OF CUPESION .00NTR&CT0R M.OR I TiId 7 -
suamnG DIVISION PERMIT- .
Nl
.""DING ADDRESS: ALPINE RESIDENTIAL CONSTRU TT"bNGU4O8O126
OWNER'S NAME: PERMIT LSSUEDATE
GURCAN & S
E:
SANITARYNO. CONTROLNO.
(408) 858-4S46
ARCHITECTiENGINEER
08 858-
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT' PLUMB MECH
0 0 0 0
"96
LICENSED CONTRACT'OR'S DECLARATION
b 1 hereby of ion that I am licensed under provisions of Chapter 9(commencing Job Description
n�
with llto=afd DivisionWestr30f the Business and Profesaiom Code,and mylicense is r ■ �®
�y mmumrc and West. �j' I ADD 294 SQ. FT. (LIVING R L
j!d Z License clue Lie,# IRC
'R Dam Cemaca, CONTRACTOR: ALPINE CONSTE, I
e RCHITECTSDECLARATI N
y I undersand my plana shall W used as public records NOV ��
G Licensed Prosai
fconal
y 2004
OWNER-BUILDER DECLARATION
I I masa .(firm Nal 11. exempt from the Cnnlnctm's License Law for the
atO4 which re uireon. (anion 7031.5.Business and Professions Coot:Any city or county
$ whichrequiresa..nisi.uscous the eller,improv,h permit.or...h,anystructure ,
Fly that hnisiensedprsus.nquimstWvisions of for such permit to I.Ntise Law(Chapter
hmmcm BUILDING_
4�o that he inset,wis pursuant to N)of Division
of line Contractor's Prof Law(C Code)or Sq.Ft.Floor Area alu�gt 033
y $ (commencing with station 7")of Division]of the Business and Professions Cnde)m
.. Nat he Is exempt therefrom and Ne basis for the alleged c u mp Ion.Any violation of
Section 7031.5 by airy applicant fin a Permit ubjects she applicant to a civil penalty of APN Number Occupancy Type
not mom than Ow hundred dollars(SSW).
P yT�Y
❑I,mownerofthepmpay,mmyemployceswithwagesasheirmlecomwnadon, 36215002 . 00
willdo the work,end the ruumum iaoot intended or offered fomite(Sec.7014,Business
and Professions Cade:The Contractors License Law dean not apply to an owner of Required Inspections
property who builds or improves shemon,and who doesauch work himself or Orough his
own employees,provided that such improvement,are not Intended oronemd for We.It,
however,Ne building or improvement Is sold within one year of completion.Ne owner.
builder will hove the burden of proving that he did not Wild or Improve for purpose of
ale.).
❑1,as owner of one property,am exclusively contracting with licensed contractors to
construct the pmject(Sea 7004,Beat..and Professions Cade:)The Comrcrers L(-
cove law dose not apply to en owner of property who Wilda or improves thence and
who contracts for such projects with a eonuactor(s)licensed pursuant o she Contractors
License Law.
09l am exempt a er Sec. B&P C for this mason
Owner ooh 3
WORKER'S COMPENSATION DECL.ARATION
I hereby afllrm under Penalty of perjury one of the following declarations:
have and will maintain a Crimiiate of Consent to self-insure fm Worker's Comp oi.
tion,as provided for by Section 3700 of the Lubar Code,for the performance of the
work for which this Permit is issued.
❑1 have and will maintain Workers Compensa0on Insurance,as requited by Section
3700 of the Labor Code,for the performance of the work for which this Permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Cartier. Policy No,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This auction wed not W completed if,he Permit is foronc hundred dollar(SIM)
or less.)
1 certify that in the performance of the work for which this permit is issued.I shall not
employ any Peron in any mwnerao as m ncenme subject to lW Workeri Compensation
Lam of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Centicate of Exemption,you should
become subject to the Workers Compensation provisions of the Libor Code,you must
.JO forthwith comply wife such provisions or this Permit hall he deemed invoked.
„'�55 CONSTRUCTION LENDING AGENCY
vfA+ I hereby affirm Nm Nen is it construction lending agency for she performance of
the work for which this permit is instead(Sec.3097.Civ.C.)
D]Q
Leaders Name
z Lender's Address
U Q 1 certify thi l 1 low read this application and sate that the above information is
(~ correct I agree to comply wish all city and county incomes and state law,.].ting to
�O building construction,and hereby auction=mmusemhtims of this city to enter upon the
W above-mentioned property for inspection purposes.
y (We)agree to ave,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
t.) in consequence of Ne granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:91te� Date
SOURCE EG CATIONS. �/31 /O Re-roofs
Sigvinrc of pplicamsConuector Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will she applicant or future building Occupant atom or handle havaNOu,material
as dented by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
to
e Section as3z(.)] nn .. All roofs shall be inspected prior to any roofing material being installed.
❑Yes future
NO
Will the applicant or future building aceupam sea cyvipmenl or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I Ocardous air conaminanu as defined by leo Bay Area Air Quality Managemcm .all new materials for inspection.
umlT
❑Yes �No
I have mad the harardsms materials requirements under Chapner6.95of the Califor-
Hc.1"SafelyCedc,Scch..25505,8533 anJ25530.1unicrhnd feotif Nc Wilding
l not currently how a heart,Nat it is my responsibility in notify the Occupant of the
ircmcnis which mus,W mel prior to issuance of a Certificate O( apanar. Signature of Applicant Date
M14 3 O - All roof coverings to be Class "B"or better
Owner or autheria spent ate