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