05110138 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INF,ORMATIO;N
BUILDING ADDRESS: JM CONSTRUCTION PEµMITNo.05110138
10446 PRUNE TREE LN —
`-"tER'S NAME: PERMIT ISSUE DATE
DUANE STEVENSON 562 DIVISION ST 11 /2R/200S
P E:
SANITARY NO. CONTROL NO.
(408) 379-9852
ARCHITECT/ENGINEER: ..le BUILDING PERMIT INFO
L'DG ELECT PLUMB MECH
r B O
;op LICENSED CONTRACTOR'S DECLARATION
of CON Job Description
xV L7 �j
1 C eon 7 a)Rfm Nn 1 am IismN mulct pmsiofess of Code. 9(rommcnci is I) `((O
szb�s with Section 7")of Division 3ofNe Busircv arW Professions C^de.aM myl¢cnx is VVV
< in Tall rem m ffm / _t, p56 ADD WINDOW/UPGRADE �j��
y�? License CI s L'c.g
Dam
ECCanlrxmr
ARCHITECTS DLARATION tt/V//YJ��
f
An 1 undumanJ my Pia„shall W used As public records
set 0 1
s G Licensed Professional
3 OWNER-BUILDER DECLARATION
rC O O I hereby.M.(Sct Nu 1 am exempt from the C stoma o I:Any c taw for dm
O O following nxmn.(Scotian Icon I.S.BUslter, Nd we.de am Code:Any mar county was
<m which requires a permit m cnnstnms Alter,improve,demolish.m repair any structure
11 S O O O
ui< prioremus„uermeumanequirnpmvisilmofm xchperwes Ucnsc La (Chapter
thathc i,B¢reed punuanua Ne provision of Nc CanummisLcemc law(Chaptu9 Sq.Ft. Floor Area Valuation
Y F O that he sero ompt t Smuon 70n d the
basis f r di NC Alleged
casand on.An,
kCthm or
y��
that k u exempt therefrom and de buil for the alleged eumpuam Any violation of
Section 7031.5 by any applicant for a permit sebjccu Bic applicant to a civil pcnaity of -'AP14fNiSbe-rUU Occupancy Type
trot more Nan five hundred dollars(3500).
❑1,u oo.,of tie pmpuay,or is not wmmndcdwithwagesaz Nci( Ac.m .Busmen,
will dotWwork.and Ne he Contracue'nLicense awdoiffered forsalepply 7060,Business Required Inspections
and eny.hiarts Code:The Contmemr's ml wall law don ml apply N ar owner of q p
pmpenywW Wipd &dp at tbimn,anmmu nsmhwork himseercedf sad his
awnem,doe Wiprodded Nat svch impmsemncs are rat inmMed maRuW fm gale.U.
however the Wildingorimprovementusold withinm year of mprowfrNe owe of
builder will have the burden of proving that he did rot Wild m improve fu purpose of
sale.).
El 1,As name,of the Property am exclusively contraeting with licensed cmuanon to
contmcl the project(Sec.7064.Business and Professions Cade:)The Commences U. _
cense Law does Am apply An an awn.of propenywW Wilds ar impro n thereon,and
who..lues fm such projects with a canesanar(s)icamand pumuam An Use Courtrai '
I.ice^x Law.
❑I am exempt undu Sec ,B&P C for this mazon
Dam
Or WORKERS COMPENSATION DECLARATION
1 hemby affum under penalty of perjury one of the following dmlarauons:
❑Iham and will mainwn•Cemvfinm of Comemroxlf-insertfaWandsCompcn-
sauon,as provided for by Section 3700 of Ne Labor Code,fel One performance of the
wart for which Nis pmnit is issued.
❑1 have and will maintain Wo(ker's Campei,adan Insurance,As required by Suction
3700.(me Labe Code,for am ped..c.of the work for which Nu permit is issued.
My Wankel,Compensation N room amu red Polity numW are:
Cartier. 7-7.A
f01 JlSSOr Policy No.:� �- "-
CE IFl TEOFEKEMPION FROM WORK S'
COMPENSATION INSURANCE .
(Thu aectim Aced nm W complemd if the permit is Toon,hundred dollars(5100) '
u less.)
I comity that in dm Performance of the work for which this Permit is issued.1 shall not
employ any person in any mannerso as m become subject N the Workers'Comperamon
Laws of Califomis.Dame
Applicant
NOTICE TO APPLICANT:If.after making this Cenificate of Exemption,you should
become subject N the Worker's Compensation provision W tW label Cad,you am
.J z faMwitb comply with such Provisions or this permit shall be(kX=d mmkad.
z O CONSTRUCTION LENDING AGENCY
IWrtby AM.that Here iso mostmetimn lendingagem for the purfmno.Of
CY > the wart for which Nis Permit Or issued(Sce.3097.Civ.C.)
(] Undue,Name
=z Undef Addreas
t.3 Q 1 coldly But I have read Ws application aM sum Nat the anbw udonnatiun is
ly t” torten.I agree to comply wide all city and county aNinames and sum laws rotating N -
pU building construction,and hereby authorim mprncnuu.es of this city m cnmr upon Ne
W .hove-menummd propeny far inspection purpmes
(We)agree to coca AndcmNfy and hep hay 1.An the City of Against s id City
Fy
liabilities.
(WO
judgmeto cos,indemnify
er ad Ich may wayaceof Against id City
of the
C.)z LIMCAPPLCA UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date //-2- 81- 4,r—
SOURCjjEGVjrON,%M
a, 01 k1919S Re-roofs
Si, fAPplinndCon rot Dam
xAZA OU ATERIALS DISCLOSURE Type of Roof
W I theapplicertm fill ding occupant Rose orhandk hsardan mawmd
az defmncd by the Cupenfvo Mu ip Code.Chapmr 9.12,and the Health and Safety
.Section 25532(a)?
❑Yes GdNa All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant tic equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havandous air mnuminants as&feed by the Bay Area Air Quality Management all new materials for inspection.
District? /
❑Yn on
1 ham read the hvamichiss materials requirements and rChapmr6.95 of de Califor-
nia Hcalth&Safety Code.Sccu.25505,25533 and 25530.1 umkrnand Nxtifilic Wilding
dee,out nit base a ren Wl it u my re,pamihility m mufy the ocoupanl of the
recd which k priartoissuanmaracmifcamof _11am�mmy. Signature of Applicant Date
Low., ha .dapent I DateAll roof coverings to be Class"B"or better