06050046 CITY OF CUPERTINO a
BUILDING DIVISION PERNIIT eWOIVTRA�TORII�T.FOILII'IAxQl� ^
,.tff,0!.
BUILDING ADDRESS: JALSON MILLER Itun ' ND06050046
10620 S TANTAU AVE
iIts NAME: PERMIT ISSUE DALE
JASON MILLER 08/07/2006
PHONE: SANITARY NO. CONTROL NO.
ABUILDING PERMIT INFO
ARCHITECT/ENGINEER!
B� EO PLUMB ME�CH
ip0 LICENSED CONTRACTORS DECLARATION Job Description
i ba 1 hucby affirm that 1 am licensed uakr Provisions of Chapter 9(commencing
with Section 70001 ofDivinon 3 of the Business and Pufn,sm toCode,and my Ikcnec is
Z„ in fullforoeandtfral. SFDWL NEW: LIVING 1971 ' , GARAGE 427 '
to Dow clot Lle.g SANITARY IS SUNNYVALE ' S JURISDICTION
F Dem Camr
ARCHITECTS DECLARATION
I� I understand my plans shall he used at public ranrds
2yU
G Licensed Pmfcntonal
OWNER-BUILDER DECLARATION
I hrcesu .(Sect Net I am attempt from Ne Cortins Co License Law for the
As o following rtamn.(Sadao 7e3 Lt,Butlm'u and Rofcnton Code:Any airy of county
S$ which its i tn,o a.tmin m ctrou the alms improve,dersonfith parmitt or mash any innocent.ant
-Zi
prior toiuiensedpasuantWrathetpPllcan,for theCoharmrtofileasigned Law( ham,9 Valuation
e < Nommencingsedpursuant7011ofDiviomNNeCanuacmhl!¢nselaw((Capttt9 Sq.Ft.Floor Area
`ad 3
(commencing ve!h Section7011n d ofDivisionr of the BusinessCoal d PMy vi ladonCoda)of $446597
t,`s Net he e,exempt Nertfrom and the bait for the alleged the unmpdan Any l penalty
of
Seton for ApNNumber Occupancy Type
not mart Nan Ow hundred dollars(5500).
❑L u owner of the Property,or my employee with wages n thek mleeampen.dtn,
will do thework.and thettrucmrtif rmlldtended mastered Wide(Sec.70u,Busixn Required Ins actions
and PmraLION Code:The Contractor's Lic nle Law don,set apply m an OW no,of 9 P
property who builds err Improves thereon,and who doss such work himsel f or trough his
awn employees.provided that such improvements tee eat Intended araReend for silo If.
however,the building or Improvement Is cold within am year of wmpledoe.dea owmr-
build)er will Mw tic huNm of proving Ilut be did Our build or improve for purpose of
I,u awuer of the Property am eaeluvvely conuacting with licensed Cenocort in
wnwct Ne Pmice,IS..706x.Bueinm old proposal.Cuda:)The Combacm/s U.
case Law does out apply in an tamer of Property who builds or imp..Nerean.and
who contracts for such projects with a eantrnmKs)licensed Foramina an the Ctntnc,oft
License Law.
❑Ism cion tunder Sec. .B&PCrm ' a
Dau b
WORKER'S COMPENSATION DECLARATION
1 Mby affirm under penalty of pmjWY one of the fallowing dalarad u:
❑1 have and will maintain a Catfiam or Cament an self-luum for Worhels Campcm
.don,u provi@d for by Salon 3700 or Ne Labe Code,fm de performance of Ne
wort for which this permit is aimed.
❑I haw and will maintain Worheft Comp mndon Ineurana,as required by Section
3700 of dm Labor Code,for the performance of the work for which all perm!,is issued.
My Workee,Compensation Insurance carrier and Policy number sm:
Cater. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(The,section wed nothecomphund lithe permit Is form hundreddollast(5100)
M lea].)
1 certify,Net In the perfmmance of Ne work for which this Permit is Issued,l"1.1
employ anypersun in any ma �sstohecemesu ' Ne Worten'Compevauon
Laws of Ctlifomia.Dau
Applicant
NOTICE TO APPLICA .If,After cutting the,Certificate of Exemption.you Would
become mbja,to tiro ofteej ComPermdtn provisions of Ne labor Code,you mon
wJ O forthwith comply with such pmvi iom or Nu Permit Mill he deemed revoked.
„zi ti CONMUCTION LENDING AGENCY
f" 1batch,affcm Na Vert It a construction lending ageaY for the performance of
g1!7 the work for which that permit I,issued(Ser.3097,Civ.C.)
W Q Landers Name '
7 z Landers Address
U Q 1 canify that 1 haw read this application and sou Nu the above information is
lL F coned.I agree m comply with
all city and eowq oNinemo and tum lam mleain{m
V buildln(We)agee 1.save.
ereby indeauNa d luepmsnuaiwte Nis Naymcnmro ago the
W ahove-mcntiuned propcny far impcton purposes.
0. (We)agree to cave,and expea and hap harmless the y 1c m Cupertino nd against
„y y liebilidu.judgmcnu.cotu eM expeun,which may In any myacc,ue apimit rid Cary (W
C.)sZin conuanc+ APPLICANTeUNDERSTANDS AIND WILL COMPLY WITH ALL NO 11111. -POINT Issued by: Date C
SOURCE R ULATIONS. ' 91
Re-roofs �—
Signatu ApplianUCon rector Date
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
11 the cep dmaum or future building aaup.t more mhmdin hazardous mamdal
defined by the Cupertino Municipal Cade.Chapter 9.13,and the Hea1N and Safety
.Seton 35533(x)? All roofs shall be inspected prior to any roofing material being installed.
❑yn,
Will the applicant or future building occupant use equipmen,or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cml,hvudnut air conuminans a defined by the Bay Area Air Quality Management all new materials for inspection.
District?
Fyn, Qnu
I have mad the hnardnusmiedals requirements under Chiper6.95ofthe Califor-
nia Heal"Safety Code,Saoau35505.35533 and 27534.1 undcttmnd thallfde building
docs Out curendy haw a tenant,that it 6 my..Possibility at notify Ne,Top-'of the
nol.i ts hwhmmibcmipfiorwWuwaof,Ccrfifwawa(Ocnpar. Signature of Applicant Date
All roof coverings to be Class"B"or better
to ter m xutharoca again e