04070153 CITY O CCUPERTINO �
BUILDING DIVISION PERMIT r CON AX& R IFU M TAN g
BUILDING ADDRESS: BRIAN STROM PERMIT Ncb4070153
7744 ROBINDELL WY
OWNER'S NAME: PERMITL6UEDALE
BRIAN STROM
49 NE:
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
s�oo LICENSED CONTRACTOR'S DECLARATION I Job Description
ii 1 hereby affirm Nn I am re main under pronh i ms;of Chapter 9(commencing p
n with Seeman 7M)of DIAidon 3 of me Busioesa and Profession Com.and my hear.is
mmefam ridermt, REVISION--ARBOR HEIGHT
Z — DDin, Lia.
nnmor NO NEW PERMIT ISSUED ORIG. #04060157
e ARCHITECTS DECLARATION
l 1 understand my plana shell W used as public records
J U
;'G Licensed Pmfeaimnal
OWNER-BUILDER DECLARATION
P,f I hereby affirm shot 1 am exempt from the Contractor's License Law for the
F.O o following an .(Samoa 7031.3,Businea and Professions Code:Any city of county
Which foquira•Permit m moreover.eller,impmvG,demolish,or @pair any structure
NNpoor to its issuance.also requires no applicant forsuch Permit to rile a signed statement
dian he is licensed pursiant in the poroOkoul Of(he Contractor's Lmorm Law(Chapter 9 Sq.Ft. Floor Area Valuation 0
_ (commencing wish Section 7000)of Division 3 ofthe Business and Promarsioa Code)or
$ dod W u eaemps rhfofmm and die bail for the alleged exemption.Any violation of
Seetlon 903 1.3 by airy applicant for apench subjects meapplicanl to a Civil penally of APN Number Occupancy�T�
pe
not more Nan five hundred dollars(55001. P y `7
01.as owner of Omproperty,or my Gmploysa with Wages as their arm compensation, 36223011 . 00
will do the work.and destructors to nminmrdedoro@rW forsale(Som.7044.Bua;xu Required Inspections
and Professlon Code:The Conuacmrs License law daa oat apply w e ose an owner of q p
property who builds or Impmvea Ihemon,and who dauah work himself or through his
ownemployccs.provided Nasuch imp..artams...I intendedmrmRe@d forsale.IL
however.the building of improvement is sold within one year of mmpli mon.the owner ,y
builder will has the When of proving that W did not build or Improve for purpose of [� \
sale \ \\\\\
co I,a owner of she property,am adaiveld cafessi n8 with:)Th ed cenuamars t.
construct La she esojut (See.704q Business and property
Who
Cade:)The Cenhe mr'a Lt.
who Law docs nos apply I.ts owner of progeny who Wilda or improves soros.and,
who contacts La..mf aI1CI1 projects WIN B CanllaLmr(a)IIIXIIYd pursuant m till'CoalO[IOrt �
Llttnse Law.
❑lam eaemq under See. ,Bk PCfar thin mason ,
((77 \ /��
Owner(�92Atn.�iT'TA1-ee_� Dat
OMPENSATION DECfARAT10N
1 hereby aflmr under penalty of perjury one of she following declensions:
have and will maintain a Certificate of Come,m self-houfo for Workers Compere
on,as provided for by Section 3700 of the Labor Code.for IW peffia mance of the
work for which this permit is issued.
L]1 haw:and will maintain Workers Compensation Insurance,a required by Section
3700 of the Latin,Coca.for Ne performance of the Work for which mis pemrit is issued.
My Warkers Compensation Insurance carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Trach soodon need not becomplemd iflhe permit It formic hundred dollars(SIM)
or less)
1 certify that in be performance of me work for which this permit is Issued.I shall not
employ any person in anymen,e�Zde�lo hecpme subjecuo he Workers'Compensatlon
Laws a Cal Wmn. Ir��l4J•t
Applicant OAPPLI.
NOTICE PLICA .IL eller making this Gisions of W Exemption,you shoos '
become subject m the Workers Compensation provisions of she meedLabor CnJe,you must
.,O foMwim comply With such provisions or mis permit Nell Wdcemcd revoked.
y"" CONSTRUCTION LENDING AGENCY
F 4 1 hominy affl.mar sham is a construction lending agency for the performance of
C�: me work for which this permit b issued(Sec.3097,Civ.C.)
QLenders Name
J z Lender's Address
U Q 1 cenify that 1 ham food this application and sum that the shove information is
F coma I agree in comply with all city and county aldinareas and sum laws mining r0
QU Wilding construction.and hereby aushodm rep@semathom of this city to enter upon the
�,v List above-mentivad properly for inspection purposes.
(We)agres to ass,indemnify and kap harmless the City of Cupertino against
py liabilities,judgments,eau and esperues which may in any Way.erne signal said City
U in consequence of the grunting of ibis permit.
�-^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dat
5 URCERE ATION .
Re-roofs
alure OfApplicardlyConaractior I am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupanutore or handle haalloa material
a de0nnd by me Cupenlno Municipal Code.Chapter 9.12,and 1W Health and Safety
Cade,Section 23532(e)1
❑Yrs !WN. All roofs shall be inspected prior to any roofing ma/iialeing installed.
Will she applicantor future Wilding execution,uta equipment or devices which If a roof is installed without first obtaining an inspe ,I agree to remove
li vardous air conmmmanu as defined by the Bay Arca Air Quality Management all new materials for inspection.
❑Yes Nu
I have mast the hanMum materials mquifomenm under Chapter 6.95 of me Califen
nu Hcalm&SamlyCodc,5a6oa 23305.25377 and 23374.1 unJcrsmnd thmif the Wilding
Jas nen0y bas a mnana N it u my msponihilily m notify rM acupar of me
mqu nswhichmu mel ' r issuance Ora ccrtiOcammfOccu Ly. Signature ofApplicant Date
o res mdree,gem Dim All roof coverings to be Class "B" or better
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The
CL NOT,S7e'f1Adp$ Permit ar to be ar
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l FENCE
APPROVAL
CITY Of
CUPF1�TlNO
Community Development Department 10300 �rre_LAvenuec—T7(Cu, r in , CA 95014 (408) 777.3.1(
JUN 0 03
MAr 3id'�Zoo3
(DATE)
I am an adjoining property owner of I,.,1 �� YtW-) p4cso�
�`fd2
('NAME)
whose property is located at Wqg Rpt;i1bcl,.k
(ADDRESS)
I approve (as per Ordinance No. 686, Section 16.28H
04Ct
the
� �
• Municipal Code) the allowance of a hi fence facing
(8 FT. MAXIMUM)
my property.
SIGNED: NAME: UAA14E •� T�Q�I f��(j i�0/�
ADDRESS: 7894, �n && U NAY
CUPneT/hl� A q.Se/,t f .
FENCE APPROVAL
CITY OF
CUPEkTINO
Community DevelopmentDepnrtment 10300 Torre Avenue CupertinaCA 95014 (4118) 777-3311
[ FI4VE5
U 2 0 03
ad C
(DATE)
I am an adjoining property owner of
` ('NAME)
whose property is located atq
(ADDRESS)
I approve (as per Ordinance No. 686, Section 16.28.040 of the Cupertino
Municipal Code) the allowance of a S" foot high fence
( 8 FT. MAXIMUM),r KU
°
my properly.
r" V
SIGNED: NAME:
ADDRESS: `lO