06070145 CITY OF CUPERTINO
BUILDIeNG DIVISION PERMIT CLI v-;,, TGI NFORMA.TIO.Nn
9..P.n.`s 1l°..rt_.el
BUILDING ADDRESS: a CATHERINE & STEVE HOCH PERMrN°'06070145
22420 ST ANDREWS AV
7 OWNER'S NAME: PERMIT ISSUE DATE
CATHERINE & STEVE HOCH 06
E: SANITARY NO. CONTROL NO.
ARCHITECTYENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
toLICENSED CONTRACTOR'S DECLARATION IOb DCSCTI hOn
`FSOFu� I hemby affirm that 1 am li¢nsod under provisions of Chapter 9(mmmmncing P
'may in fullora andAffm'vwonJofNeBusinassandPro@ssM
imuCade.amylicenseis REMOVE AND REPLACE 9 WINDOWS LIKE FOR LIKE
i License Clan Ls.Y
r Dam Contractor
££ ARCHITECTS DECLARATION
k i I understand my plans shall W used AS public records
taU
C LiccrwJ Pmfcssioul
5 OWNER-BUILDER DECLARATION
QC I hereby stTim that I I. exempt from the Consomfemonaor's :Any c law for sW
m following reason. atent,t ]03L3.Business And ve d exons Calc:Anycity or county
which¢quire a peumit ro mnwucL alar,impmw,dcmmlisM1,car¢pair any swnum $4713
prior wits issuance.also requires tW applicant for such permit to file a signed Summr,
?sip That he is licensed pursuant tomeprovisions ofSheCmancmr'sLicenseLaw(Chapter 9 Sq. Ft. Floor Area Valuation
21- (commencing with Section 7M)of Division 3 of the Business and Professions Cods)or
`<$ than he IS exempt Nenfrom and the buts far the alleged rxMpd .Any violation of
Section 7031.5 by any appltant for a permit subjects the applicant to a civil penalty of er Occupancy Type
not mom dun five hundred dallus
❑1,u awstr of the pmpmy.m my empbym with wage u the'v sek campensadon,
will do the wank,andth
nd a Code:The Commerce,mLiMLicensede orLaw Sams.1 Apply.m]OAn oewunei,of
Required Inspectionsections
property he buildvi improes theeon,and who chwmrk hamluoughu
wnemployees,provided Such improvements
am riotmndedarorteandfmsala.lf.
however.
scam Wilding or imprrovementuoldwitthinam e
ildofmproefortheownr-
builder will have the burden of proving that k did trot build w improve for puryau of )(� p�/�(y���pp pryp®�.,�gp��u�®ging
uky HNALEU
IT�s'
I,u owner of de property,am exclusively contracting with licensed conhacrors to
construct tau es project(Sec.7014,Owner
and Pr,who u Code:)Thum doesor'a n
cased Taw dose notch apply jean owner of nmpcny who builds m improves thereon,and
who contracts for such projects;wiNacontranor(s)fccnudptvmunttotk Conuacwfs `^ •� �`
Lkeue law. Vc/ iq: �nnr]
❑lam11Pit undr See .B&PC for Nis
Owntr 11/�as A,pt n( Data
0.1 wa
L b WORKERS CO S or,car DECUBATION ����jQ�
1 hereby allirm uMer Artistry o(pujury one of the following dalarationc [gj����/�
1 M1aw and will maintain ACanifau of Consent m self-tuum far Wormca Compm-
sniam,u provided for by Srtion 3700 of Ne Labor Code,for the peAornance,of tW
work for which this permit is issued.
❑1 haw and will maintain Worimrs Compensation Insurance,AS required by Section
37W of the labor Codc,for Ne Polecat of the work(Of which No permit is ssuN.
My Worker's Compensation lam rarem artier and Policy number am:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
OTs section need not he completed if the permit is forum,hundred dollars(SIM)
or kssJ
I certify then in the performance of the work for which Shia permit is issued,1 shall not
amployamypcno many mAe..ASso Came subject to the Workeri Compensstlan
IA wn of Califo aa{pane G.•
Applicant / )I'Oy;a I"'2 O
NOTICE TOTAPPOCANT:If.after making this Cenifcam of Exemption,You should
become subject an the Womear's Compensation provisions of use Lehr Code you most
.,O forthwith comply with such provisions or this permit Nall W droned rooked.
z CONSTRUCTION LENDING AGENCY
[-
•tm 1 hereby affirthat Nen u a construction lending army for the perftumasuce of
ce> the wmk far which Um pemrit s issued(Sec.3031.Civ.C.)
0 Lender's Name
ISZ Lender's AM.
U0 1 certify that 1 haw mad Nis application and sou that o,above infotmuiu t is
f" correct.1 agree ro comply with all city and county mumanm and sou taws relating to
�U building convection.and hereby auncrin representatives of this city to enter upon lac
aided-mentioned pmpeny for inase
pecuon furlongs.
F y (we)agree to saw,mdcmm(y and keep harmless the City of Cupenimo against
fn Iiabilid[aJudgments,casts and expenses which may in any way accfuc against said City
C)Z in coucqumme of the granunt of this permit.
APP ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SR REGULATIONS. Issued by: Date 2 L —U
Re-roofs
ignuure of AppliamuCanuazmr Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant ar future building excupantsron or handle humahms maurial
as defined by the Cupertino Municipal Code.Channel 9.12 and the Health and Safety
Code.Section 25532(s)?
pYa All roofs shall be inspected prior to any roofing material being installed.
`will the applicant or future Wilding occupant sec equipment or dicAm which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants AS def sed by the Bay Area Air Quality Management all new materials for inspection.
District? r
❑Ya �[u
thaw tad tau hvardmumllamrials nquirtmcnuunekr Chapmr6.95 of Nc Calif.,
ma Health&Safety Cade,Seen=25505.25533 and 25534.1 understandNrt ifthe Wilding
Jou c nJy haw a teem.that it is my nspouihilitY m notify the acmpamt of the
n mm,u hehmtmWmaNio,"myss)yxmm faCcnifseaneofOcapan SignatureofApplicant Date
Q'l�ocQ— �-/17 0
O�,ncr or auNarimd Arm Dau All roof coverings to be Class "B"or better
'