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06050061 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTnR INFORMATION BUILDING ADDRESS: MARTIN SHEILA D AND ROBER "T""ND'06050061 10382 ORANGE AV OWNER'S NAME: PERMIT ISSUE DATE MARTIN SHEILA D AND ROBERT T 06/21/2006 NE: SANITARY NO. CONTROL NO. ARCHITECITENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH moo LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm Oat T am licensed under previsions of Chapter 9(=mmcncing P nullfoorm ndeffecDivisian3afthcBusinaaandPro@ssionsCode,andmylicenuis t. KITCHEN ADDITION/REMODEL - MINOR STRUCTURAL 171 7 z Liceruc Class Lic.0 Date Contractor ARCHITECTS DECLARATION T understand my pi... s shall o used u public mcard, JyU k Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm Om I am exempt from Oe ConuactoYs Leftist,Law for On :MC fallowing memo.(Section 703 1.5,Business and Professions Code:Any city or county m which requises a permit to construct,ober.improve,demolish,or repair my su ent. $85000 I< pnor to its issuance.also mquims Oce applicant for such parent to file a signed sammnt Out he is licensed pumsnt to The previsions of the Contractors Licence Law(Chapter 9 Sq.Ft. Floor Area Valuation y (commencing with Sceuon 7000)of Division 3 of the Business and Profeuinns Codc)or y 5$ Oat he is exempt themrrom and the basis for dw alleged exemption.Any violation of Section 7031.5 by any applicant fora permit subjemt the applicnuo a civil penalty of Occupancy Type oat mart dun firs hundred dollars(1500} ❑I.uownes of Ore propeny,nmY employees with waguse Ness salt nmpcvatian. will do the wart and the swcture is not intended voffered rot ale(Sec.7W.Business and Professions Code:The Contractor's License Law don oat apply to an owner of Required Inspections properly,who Wildsmimprares Owfnn,ndwho doessuch wart himee forthrough his awn employers,provided Out such improvements am not intended ofssRered fertile.IL however,the Wilding or improvement is sold within one year ofcompletion.site owner. build.,will ban the Widen of proving Oat Na did Tref Wild ar improve far purpose of tib.). 0 1.as owner of tlh,property am exclusively cnuacting with Remand conuacmm to contract the project(Sec.7044,Business and Profession Cade:)The Conuacmts Lt. manlaw does not apply in an owner of property who Wilda or improves demon,and, who contracts for such projctts with.emuacmr(s)licensed pursuant m da Contractor's License Taw. I am ampi under Spcc ^/ B&P C for this memo OwnerrfiL�Date0LA(e WORK ER'SC MPFNSATION DECLARATTON 1 baseby aRsm under penally,of perjury one of the fallowing deGarauons 1 have and will maintain a Cartirina,of Covent to self-insure for WorkcYseompcn. sad.n,as provided for by Secuan 3700 of site Labor Code,for On peAormanc:of the work for which this permit u named. Q 1 have and will maintain Wor s Compensation Imuran=,az sectored by Section 37W of the Labor Code,for Oe peRarmnee.[On work for which this permit u issued. ' My Workers Compensation]=ran=earner and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE This.sectmn need not W completed if the permit Is We.hundreddnBan(1100) or less.) I cmlfv than in Oc pefformarce of the wart for which this Permit is issued,I shall not employ anyperson in anymnncrsou come bjmmOC Workcn Compensation Laws of Colifomia.paq Applicant {g i f(46w 14w NOTICE TO AAP t:CANT.If,aMr making this Certificate of E`emption.you should become subject m me Worm's Compensation Provisions of the tabor Coda you must .JO foMwith comply with such provisions or this permit shall W deemed revoked. zy CONSTRUCTION LENDING AGENCY (-a l omby affirm Out tom is.constvcumt lending agency for the perrorman=af IY 9 the work fur which this permit is issued(Sec.3041,Civ.C.) W�Q LeadcYs Name Lender's Address U0 I certify Oat I hale road this application and sum Oaf the move information is ly P came,.I agree to comply with all city and county ordinances and slow laws relating in 0 Wilding connuunion,and hereby authorize mpresntatins or Ois city to ntcrupnn the abovomcntioncd ino rfy for insri Purryus F ped, (We)agree to eve,indemnify and Incept harmless Or City of Cupertino against t;A liabilities,jtdgromis osm d..p..which may in my ways=nuc against mid City U Z in consequence of Oe granting of this Permit. '--' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. �iay' a e�r//1/; Re-roofs Stgnuurt ofApplinnaATERIALS DISCLOSURE.TAT HAZARDOUS Type of Roof Will the applicant or future Wilding occupntaam or handle haaaNnus mammal - az defined by the Cupertino Municipal Code.Chapter 9.12.cad the Health and Safely Crude.Section 25532(a)7 (]Tes W140Allroofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtainingan inspection,I agree to remove Will the air cone t or future Wilding by ft S use Area Ail Qu or devices which P g Omit hnaNnus air conumirtans as defined by me Bay Arta Air Qualify Managcmcm all new materials for inspection. District? / ❑Yes AN. 1 have mad wary the Idn��CCm lmo srcquium ens.oder@aper 6.95 of Ow Calif., nfa HealO&SafctyCede.Sttuov 25505,25533 and 25x34.I udcmand Otmirdc Wilding duns not curmmly Wac a wont that it u my mspers bility m noufy the oceupnt of Oe myvi WhiehmuSlbemetpiorwiuusccofaCcNficzwolo, apncy. Signature of Applicant Date �a ��"a /. All roof coverings to be Class"B"or better OWner or aamonmd agcm w