08060035 CITY OF CUPERTINOts.x€TEw e{' 'fit'
BUILDING DIVISION PERMIT C()NTRA.CTUR�'INF®RMA'TTgN'
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BUILDING ADDRESS: PERMTr NO.
.1.0474 RAMPART AVE TBD — TO BE DETERMINED 08060035
NER'S NAME: PERMrr ISSUE DATE
CArM.HINE SUN 08/13/2008
GNEI SANITARY NO. CONTROL NO.
FARCHITECT/iINGINEER: BUILDING PERMIT INFO
' BLDG ELECT' PLUMB MECH '
0 0 0
�op LICENSED CONTRACTOR'S DECLARATION Ib Description
ra I hereby aflNo Met I an licensed under provisions orCNOBaCiIP
plcr 9(commencing
r� with Sectich7M).fDrymon3ofdeBusiness walProfcadmuCost-mad mylimvcu ADD(784SQ) KITCHEN,NOOK, FAMILYRM, PORCH. REMODEL
N full farce end eBKL
oeneClass L�tractor 150 ' 0 ADD WALKIN CLOSET, LAUNDRY
! ARCHRECTSDECLARATION CLOSET, BATHRM.REROOF 17SQS. CORRECTED FEES—ADDED
I undersand my plant that W used a public records
i U
ytad Licensed Professional
OWNER-BUTLOER DECLARATION
gm 1 hereby air,.the,I em exempt from the Ckuacters License law for the
O O following mason.(Section 7031.5,Business and Professions Code:Any city or county
q which ra d.a pemdt m cnnmeM alcor.improve,donut W,m repair any structure
�^ prior to is issuance,also requires feeapplicam for such permit to file a signed swcencnl
�FE< uwlxulicensed puromotwmeprovisions ofthe comxxmr'sUccrum Law(Chapter 9 Sq.Ft. Floor Area Valuation
zg (commercial wife Section]BBB)of Division 3 of the Business and Professions Cole)or $100000 -
Met he is exempt tnemfrom and the bah for the alleged exemption.Any Acted.of
Section 7031.5 by any appnortfaapermit subjects the appiicanlmacivil Penalty of —
NNumber Occupancy Type
rot mart dun live hundred della&(SM 3 6925011 .
❑Leawas of the property.R my employees with wage u theiretc aamRroadon,
will do Newarka ddue a==h nm�d
otimed thermal for sale(Sec.R)/s,Business
ad Professions Code:Tho Contemner I loess law docs ant apply to a mater of Required Inspections
property who Wilds or impmr"demon,and wM does such work Mm mit or tiwugb his
awn employees,provided dist such improvemats as nm intended arallemd foreek.It,
havew,Ne Wilding or mprowmmt is sold within ore yea of completion,fee owas- -
Wilda will have de hinder of proving this be did an Wild or improve fa purpose of
sak.).
O 1.ss war of the property,am exclusively comruUng with licensed conurnore in
mmtmn tie project(Sec,]OH,Business and Professions Code)The Coalrec mra U.
cerise Law does not apply m a owner of property who Wilds or improves thereon.and.
who conaacls for such projects with a contractor(s)licensed pursuant he Me,Con Tactors
License Law.
❑I an caempt under See .B d P Cfefee this maw
her � G' Dao 0 0 O
WORKER'S COMPENSATION DECLARATION
1 Wreby aDinn under penalty of perjury one or the following dalmansne
1 naw and will for by a o.37M ofCamemm e16Wure far erfame Compete
work, r providedhthis
far by Smron d. of fee tabic Code.for do Rrfermmce of de
wok(a which this permh is issued.
❑1 Mw ad will maintain Workers Compensation Iwnnm,u required by Section
2700 of de Labor Cade,for the perfarmence of dm work for which this pewoit is laced.
My wmi cea compenredon I..ca rm,art Policy number sm:
Carrier. Policy No.:
CER-nFi ATEOFPXEMMON FROM WORKERS
COMPENSATION INSURANCE
(7hh sire had rot be compleed Irene permit h far.huasreM Mona,(slam
or less)
1 certify that In the performance of the was for which this permit Is issued.I Nall not
mw
employ any person in icy mrm u e been C25 icy fepy5'ortuY Compensative
Law of California,Dam
A9pllcam
NC TICE TO APPUCANM If,aMr making this catinceta of Eeemption,you should
baome subject m fee Workers Compeaadme provisions of the labor Code,you mus
.J O forthwith comply with such provinces a this p rmit"I W dcarsd reeked.
EM CONSTRUCTION LENDING AGENCY
I thereby affirm d,Nem is a construction lending F r . Rra7 for do performance:of
W ^ the Lassoes awmmhthis Rrouhmuce(se.w9],c .c)
W�E Landers Nana .
Z IanderaAddrea
UOc.. 1 amity Mut I lave read this application eras state its do show Womution h
LL,V carmct.I agree to simply With all city and county adlllmOad arale lora{relating to '
C Wilding convection,and hereby authorize repraenutiws of this city to enter upon de
[27 Glave-Madond property for inspection puryeses
6r (We)agree 0 nun,indemnify and keep harmless the City of Cupertino so=
M Ilabilidea,judgments.cuts ad"passes which may in my ray ecaue&gait,said City
U in cenregwwe of the grating of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY-WITH ALL NON-POINT Issued by:9 Date
SOURCE RiCC S L 2�C
Re-roofs �—
Slgnuure err App&licaDete
HAZARDOUS MATERIADISCLOSURE
Type of Roof
Will feeppecantorrful.tWldni ecouptmeuomahndlehaaado,ma,il
u deMd by de CuRruo Municipal Case,Chapter 9.12.and the Health ad Safely
de, 0coortY.23l32(s)1 QT u All roofs shall be inspected prior to any roofing material being installed.
❑Y.
Will the applicator future Wilding occupant use equipment ardevices which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha"do,air contaminate u defraud by the Bay Ams Air Quality Management all new materials for inspection.
Dhuicri
❑y" VN.
I hew and the ba,dws materials requirements under Chapter 6.95 ofde Califor.
me Hal"Safety Cade.Smiau 25305.25577 ad 25534.1 undersand fes Rthe Wilding
does rot'unady have a amort,the,II h my responsibility 0 notify the ueup le,of de
mquimmenuwhicnml,bcmet pilar in issuarc or a CerdOnm of q� Signature of Applicant Date
yti--v �_ o�/'z pg All roof coverings to be Class'%W`or better
Owner R mthar'uad Agent Dam