06010056 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ;C®NTRACTQ,R�INFORMA'�-ION
BUILDING ADDRESS: BYER MARIAN AND ALLAN G PERMIT NO 06010056
670 STEVENS CRK
OWNER'S NAME: PERMIT ISSUE DATE
BYER MARIAN AND ALLAN G 01/17/2006
E: - SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
u00 LICENSED CONTRACTOR'S DECLARATION O O O O
4 U P I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
n�c with sections 70 dof Division 3 of the Business sib Profession Cade.and mylice�u
H in full form andeffcts. T. I . DOORS/WALLS/BATHROOM/SHOWER/LIGHTS
> ? License ClamLre.p
=moo Dam coatramor HVAC-NATURAL BEAUTY & SLIM CENTER
^£Y� ARCHITECTS DECLAALREADY PAID THE FEES 1/10/06
D K 1 undersand my plans sMll he used u publiccreemo records
l-
"0 h Licenced Professional
I OWNER-BUILDER DECLARATION
.� 2 1 hereby affirm that I am exempt from the Conl4ecmh License Law for the
O O following mason.(Section 7031.5,Business and Professions Code:Any city or county
m which md.im a permit to cmutruct.alter,improve,demolish,or repair any amostu.
primin ies notonce.aiw requires theapplieam fofsueh rkmitto fileasigned statement
EZOthat he is licensed pursuant to the previsions of the Contractorsl3mtt
nLaw(Chapter9 Sq. Ft. Floor Area Valuation
til-$
(comm e.ingwish Scction7000)ofDivision 3ofdmBusiness;and ProfessionsCod,)tar $177655
y - mat he u exempt therefrom and due basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant fon Permit subjects One applicant o a civil penalty of APN Number Occupancy Type
not more Nan live hundred dallins(SS L P y YP
0 1,as owner of the property,or my employees with wages u their sole compensation,
will do the work.and me twmum is not intanded or offered for We(Sec.7(44,Business
and Professions Code:no Commissaries License Law does not apply to in owner of Required Inspections
property who buildsor improves thereon,and who does soehwmk himself or through his
ownhowever.
the n,p building
or i that r vemuch impm old wit in:not year fcomplRe¢d ficurthe o e.r- ��Q�a ����®
builims me buildingorimprovementitsoldwithinnae year of completion,me owner- t�T�`�VE�
builder will now the burden o!proving mat he did nm build or improve for purpott of
sale.).
f1.as owner of the property,am exclusively contacting with licensed con maws to
cnstroct she project(Sec.7044,Business and Professions Code:)The Contractor's Li. I. A t] 2006
come Law dors not apply to in owner of propeny.who builds or improm thereon,and '`IAR
who contracts for such projects with a eomeaemr(s)licensed putomann to the Canmetors
License Law.
❑lam exempt under
?Sec>. B&PCfor his nourn
ner Da
//�/ ;B� [Y
// —f5 / m O B IFtl,J
ORKER'S COM"SATIOMDECILARATION
1 hereby affirm under penalty of perjury one of me following declarations:
1 have and will maintain a Cerufnte are...,to self-insure for Workers Compen-
uri.,as provided for by Section 3700 of me Labpr Code.far the performance of the
work for which this permit is issued.
0 1 haw and will maintain Workers Compcnution Insurance.as required by Section
37W of me Labor Code,for the perform ince of the work for which this permit is issued.
My Worker's Compensation Inunntt carrier and Policy number art:
Calmar. Policy No.:.—
CERTIFICATE
o.: _CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This accun.ed not W completed if she permit is for ane hundred dollars(SIM)
or less.)
1 cenify that in One performance of the work for which this Permit is issued.I shall not
emPloY ony person in any manna.u m become subject oc M�arkrr Compensation
Laws of California.Data
Applicant I.7)/'/J(✓
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker'x Compensation previsions of me Labor Cade,you mot
.J 0 forthwith comply with such pmvisiam of this Permit shall W deemed revoked. -
Z CONSTRUCTION LENDING AGENCY
[-�E2 I hereby 4Rirm mat there is a contraction lending agency for One performance,of
!$7 me work for which this permit is issued(Sec.3W7,Civ,C.)
WM n Lender's Name
a2 Leader's Address
U O 1 certify that 1 have mad this application and sure shat use above information u
LL F connect.I agree to comply with all city and county ordinances and sum laws relating to
V building consmucaion.and hereby iumoriam mpresenutim of this city 10 enter upon the
�a above-mentioned property for inspection purpmea
(We)agree to saw,indemnify and keep harmless the City of Cupenino against
r fq liabilities,judgments.cosuand exact..which may in any wayaceme against aid City
UZ in consequence of the granting of this permit.
'-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 60 Date
SOURCE REGULATIONS.
s-,-11,/, 6 Re-roofs
Signature of Applican nm
oe<mr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof -
Will me applicant ar fuwrt building(coupon stow or handle havardaus memrial
az de0ncd by me Cupertino Municipal Code,Chapter 9.13,and the Health and Safety
ode.Sccuon 25513(x)? ���aas
❑Yes IDN. All roofs shall be inspected prior to any roofing material being installed.
Will me applicant or future Wilding,mupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
7niad=
t hazardous air contaminants as defined hY the Bay Area Air Quality Management all new materials for inspection.
rier?
Oyes 14 No
I have read mo hvardms materials requirements under Mlic,6.95 of me Califor-
Health 6 SafctyCadc,Section 25505,25533 and 35534.1 understand that if ren:building
'
not currently haw a mount,met it is my msponihility,to notify ft m<umm,of the
immcns which mow be.1 poor to iasuanee of.C,nirmam of Occupancy. Signature of Applicant Date
i � -6
act m iurhoriemd agen Dam All roof coverings to be Class "B"or better v