04030199 CITY OF CUPERTINO dM 's.�uf�' E " b a ,"7s
BUILDING DIVISION PERMITWCONTRACTORINFORMATION
BUILDING ADDRESS: JOHN BESSELING CONSTRUCTIO TERMITND04030199
21901 OAKNOLL CT
OWNER'S NAME: PERMIT ISSUE DATE
WES & EVE CASTLES 1336 PEGGY CT. 06/01/2004
E: SANITARY N0. CONTROL NO.
(408) 379-4853
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u00 LICENSED CONTRACTDWS DECLARATION Job Description
_W F I Wrcby affirm that 1 am licensed under provisions rOf mChador 9(commencing p
=W with Section nde)ocDivision]oflW Budneuatb Professions Code,and myliceueix
in fon force and effect. ADD 605 SQ. FT. /REMODEL
o�J z License Class Lk.M
tin
Dale CmaracWr
ARCHITECTS DECLARATION
i I understand my plans shall M used As public records
JyU
3 0� Licensed Professional
<7 S OWNER-BUILDER DECLARATION �'���®
1 hereby alarm ft 1 am exempt from Comn.ofa License Law for the
❑O following season.(Smdun Rs]1.5,Business and Professions Code:Any city m county
5$ which mquiru a pemtit construct, ter,W alimprove.demolieh.m repair MY Ami 8190000
-zi prior W its issuance.alw require tW applicant for such Permit to file a signed suament
E�$ that he is licensed pursuant o lie pmvisinns of the Contractor's Liccna Law(Chapter 9 Sq.Ft. Floor Area -1,;? r Valuation
s (commencing with Section 7")of Division J of NC Business and Professions Cmke)or
slut he u exempt sberdfrom reit the basis for Ne alleged eaception Any violation of
Section 7031.5 by any applicam fora pmmh subjects the applicant to a civil penalty of ser Occupancy
nut more fun five hundred dollars($500). P Y Type
❑1,u owma of fu progeny,m my emplOym wish wage u Neu sole compew0en,
will&O work,and 0testrumure is oat intended or offered forsake(Sec.7044,Business R1 III n1hin
and Profusions Code:The Conuacmrt License law dos nm apply At in Owner of ID
props.,who builds or improv themon,end who daa ouch work hie alf or through his
own employees.provided Omatich improvements are not intended or offered forsale.If,
hmwnve.Ne building or improvement is sold within one year of cr,mpleuun,Ne owner-
builder will Nve the borders of Moving Tut he did am Wild or improve for impose of
ale.).
u Owner of fu proMir,,am exclusively contracting wish licensed cenuacors to
nswct one project(Sec.7044.Business and Profusions Code:)The Conuecor's U.
cense law docs not apply Wan owner Of property,who Wilds or improv thereon,and
.
whocomrams for such projects with a contractm(s)licensed pursuant to the Contractoes
Lcense Law.
❑1 am exeemmpy:u h Sec .B k P/C this reason
Owxr /f ///1XT�Cv— Dau t�
WORKER'S COMPENSATION DECLARATION
affirm under
1 hereby am Penalty of perjury one Of fu fO;Rog declerstions:
Saw and will maintain a Cenifiene ofConsent W self-insure for Worker's Compcn- `
satin.,As provided!for by Section 3700 of Ne LAW,Code,for 1W Md...of the
work for which this permit is issued.
0 1 have and will maintain Wei Compmosmon Insurance,As required by Section
3700 of Ne labor Code,for f performance of Ne work for which this remit,is issued. . .
My Workers Compensafon Insurance carrier and Policy number see:
Cartier. Poliry NO.:
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(lhusection reed not becompleWd Hshe rami,is formic hundred dollars(SIM)
nr lass.)
I mmty Na,in the performance of she work for which this Permit As issued,l shall not
employ any Peron in any manner o w W become subject o she Workers'Compensation
Laws of California Date
Applicant
NOTICE TO APPLICANT:If.after making Nis Cenifieate of Exemption,you should
become subject in the Worker's Compensation previsions of dq tabor Cadc,you must
.J z fmMwiN comply with such provisions in this permit shall be decmce revoked.
Z O CONSTRUCTION LENDING AGENCY
r
I-+ Iberebydnthi thin ft.iss issued(Sec.
ding agcmy(Or ft of
a Nc murk for which this permit is iuucd(Sec.J097,Civ.C.)
fit z Lender's Namc
4 Lender's Address
5z
U O I certify Net 1 have mad this application and Bute Nn 1 d sum im mutiun is
0 U Wilding
1 agree W comply with ill ally and county nNinanRf Nd city
t lawn r upon
ne
O shrive gconsned construction,and hereby euNonp representatives,Of our city manor upon Ne
�C. abovrmce)Agre to..Nrty for inspection Ime,es
ha
(We)i Agree m ave.indemnify and heap harmless tk City of Against s against
F"h Iiaconsequence r tom granting expenasmit. may in anywyacrncageinn said City
(„)Z in consequence of Nc gaming of this Permit.
APPLICAUNDERSTANOS AND WILL COMPLY WITH ALL NON-POINT Issued by: p
SOU CE ULATIONS I ( k�
(� U Re-roofs
natio of Applican✓Conuacmr m
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant store mhandle buaMoso material
As defined by Nc Conciliar,Municipal Colo,Chapter 9.12,and the Heald and Safety
ode.Scchon 25532(a)?
Eyes 11P All roofs shall be inspected prior to any roofing material being installed.
Will Ne applicant or future Wilding occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
havardou air contaminants as defined by the Bay Area Air Quality Maugemem all new materials for inspection.
tsuim? Q�'�
❑Yes T"
1 haw real Ne harmhorsmaWnabrequimmenu under Chapmr6.95 of the Califon
ma Health&Safely Code,Sections 255)5,25533 and 25534.1 understand shaifNe Wilding
dons nos cwonil h e tenmq Nat it b my suponsihiliq W rosily 1W ocucu(ypmt of Ne
rcyviremc hie .W. poor W (t c of a Cutifuam tufo apa9'd 0 r
/G'/v IlfnJ IlY Signature of Applicant Date
w (,(f, r
Owne rauNmnr<dagent rDT- All roof coverings to be Class"B"or better