07120080 CITY OF CUPERTINO
BUILDING DIVISION PERMIT rSCONTRA MRINI<ORMATION "
BUILDING ADDRESS: PERMIT NO.
7677 PEACH BLOSSOM DR TBD - TO BE DETERMINED 07120080
OWNER'S NAME: PERMIT ISSUE DATE
ANTHONY & MARGARET VIERRA 03/20/2008
ONE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG EIPCf PLUMB MEC"
0 0 0 0
3 o p LICENSED CONTRACTORS DECLARATION LOS Description
�+ 1 hereby warm Nm I em limned mode,Friend..of Chapter 9(commencinIg p
with Sad.n70M)ef DivW..3.fthe Bu r.ane Professions Code.and mylketvau DEMO FOR REMODEL
in full force and effect.
Limned Clean; Uc.M
Debt Contractor
9W ARCHITECTS DECLARATION
S U I undersand my plaus enol be used at public=end.
6
b oo Licensed Professional
OWNER-BUILDER DECLARATION
EMO
1 hereby a(Sect Nat I em tempt from the Comtwctoo Ueense Law far Ne
E p o which to rete..readers co str Business and ere,demolish,dery Code:My city or manly
which mquim a Feast re air euu0.alter,Improve, emittor a asig any statement
_x ci pilar m itsissuance,also mqulm the inion o far ouch permit m c e a Law sammem
s< that me licensed pSection
esuant to the of Division
of the Comnmets Ucevelaw(Chapter Sq.Ft.Floor Area Valuation
F� 'hat he is
(commencing with Sec from and the
basis
3 of al eged sue and professions Code)of $3000
Nat k V exempt timrtfrom and Ne baa fm Ne alleged eaempdoo.Any violation of
Section7MM by any applicant for a permit subjects the applicant to a civil penalty ofNumber Occupancy Type
net more Nan fiva hundred damn(SSW). 36611148 .W
p y yp
❑I,u owner of Ne property,army wploycw with wager u Ne'vsude eampewtion,
will do Ne work and Ne tuucone is not Intended"arrived rattle(Sec.7044,Business
and Professions Cade:The Comracmis License Law dew net apply m an owner of Required Inspections
Properly who Wi IM M improves thereon,and who does such work himac If or through his
awn employwa,provldod Nal such improvements suenot intended oroRereA for sale If.
however,me building or improvement U sold within ons year of mmpledon,the a.,.
builder will ban the burden of proving the he did out build or improve for purpose of
tie.).
1,
as owner of the property,em=elusively contracting with licensed contractors to-
vwct the project(Sec.7044,Bwdrm and Rafessiav Code:)The Contractor's U.
cove Law don act apply in an owner of propeny who builds or improm Iherean.and
who concocts for such project,with a eantracmr(s)licensed pursuant to the Conmw/s
License lavvyy,,
❑lam fempt under Se ,B6:PC wNi ton
DwIal Da
WORKER'S PENSATION DECLARATIO
11...by to irm under I1,of perjury one of the fallowing declarations:
I barsand will main lain a wdriame"Mournmetf-InsumfmWortrr'aCompen-
an,as provided for by S=tian 3700 of Ne Lobar Code,far the of the
wart for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
37W of the Labor Code,for the performance of the work far which this permit Is issued
My Workers Compensation Wurtce artier and Policy number am:
Cartier. Policy Na.:
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(nualsce;m need net becamplemd ifthe permit Is for aro hundred di lus(SIW)
or Nu)
1 certify Not er the perfo ace oI IM k foewh' Ahi u b luyed,l ah n
employ anyt in the nan f p a
laws of Califomia.
APIIIam
NOTICE TO APPLICANT.If.after making em Cenificam of Excmptia ,you ahuuld
become subject to the Worker's Compensation previsions of Ne labor Cade,you must
.JO
Eforthwith comply wit such provisions or this permit shall M deemed mocked.
Z 1 CONSIRUC ION LENDING AGENCY
[r I herehyefure Wt Nem iso construction lending agency for the PudernMnee of
E
lho work for which this permit 1,issued(Sec.3097,Civ.C.)
Q Undoes Name
.:. z larshres Address
U O 1 certify Net 1 have read this application and .in Nn the above information a
ri correct.1 agree to comply wit all city and county aNinane=and east taws reladng to
0 building construction,and hereby authariee representatives of this city to enter upon the
W above-mentioned property fm Inspection purposes.
G (We)agree to save,indemnify and keep harmless the City of Cupertino against
i.n CA liabiRdes.judgmenls,costs and expenses which may in any way&come against mid City
)z ineonsegounce of the gnndn{of this permit. is _ ��
s-" A ANT UND STANDS A D WIL OMPLY WITH ALL ON-P INT Issued by: Date Com/
U REGU
5 ° Re-roofs
i{atom of ApplicamICantr r ac
US MATERIALS DISCLOSURE Type of Roof
Win the applicmtm cure building oecuptterore orhandlehuudaw material
u defined by the Cupertino Municipal Cade.Chapter 9.13,and the HcaW and Safety
Code,Section 25732(a)?
[3 Yes .sss/// All roofs shall be inspected prior to any roofing material being installed.
WE]the applicamt or future building acupan,acre equipment or dcvicea which If a roof is installed without first obtaining an inspection,I agree to remove
It hwardous air mnumivma a de0ned by the Bay Area Air Quality Management all new materials for inspection.
sukt? Y
❑Y= 1 wy
1haveread thehsardcusmawdaismq immenuunder Chapmrd.95of Ne Glifan
nu &Safety Coda.Sc6cm25505.25533wd25534.lundcmand NuifNcbuilding
net mrcmtly have a n4 Nat It u my on nnbilit notify Nc oaup of Ne
nine ichon met ri Ik,marOc` Signature of Applicant Date
!/ 6
ncranurivice ascg
All f coverings to be Class,.B„or better
wtham nm' ' rooco