06070008 CITY OF CUPERTINO p vw•7 ,saw ` I. '
BUILDING DIVISION PERMIT ` CdNTIU0()R INFORMATION.
BUILDING ADDRESS: a ABCO CONST PERMIT NO.06070008
10620 S TANTAU AVE
Ov'vER'S NAME: PERMIT ISSUE DATE
ROGER WINTLE 14880 LLAGAS AVE 2006
p E: SANITARY NO. CONTROL NO.
(408) 779-7577
ARCHITEC IENGINEERt BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
wid,
ad LICENSED CONTRACTOR'S DECLARATION IObD0SCT1 UOn
w 1 bertby affirm Nisi
at l am licensed under provons of Chapter 9(commencing P
ad section 7")of0ivla'an 3 ofthe Business and P,ofevsiolu Code,and my license is
in fall I..a ad dree,. HOUSE DEMO
lnv License Class Lic.g
Hp Dow Continuator
ARCHITECTS DECLARATION
)wI urndeBand my piens shall W it as publi..cards
U
y
I,t; Licensed Professional
S OWNER�BUILDER DECLARATION
iI 1 W reby alum that 1 am exempt from dm Contractors License Law for the
I
O o following mason.(Section 7151.5,Business and Profedom Cade:Any city or county
m which.,.I.a permit to construct,elle,improve,d.mo0.sh,or repair any structure $10000
prior at its issuance.also imparts the applicant forsuch permil to file a signed summcm
that W is licensed purvsant to the provisions of she Centimeter's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing wish Suwon 7000)of Division 3 of she Busines,and Professions Crude)or
that he is exempt thancrom and the baso for the aleged exemption.Any violation of
Section 7031.5 by any applicant fm a permit subjects Ne applicant W a civil penalty of tU Uf lyd,�o'f Oc 9nC Type
nos mart Nan fere hundred dollars(SSW). Y . na y yp
❑1,as owner of the prepary,m my employees with wages as their mk Compensation, Y
will do the wad, ad Ne stmetme is not intended or offered Formic(Sad.7014,Business r' p
and Pmfeadom Cade:The Conmcmrs License Taw dinner Inst apply W in owner of Required InspeZtiens
property who huildsteimpova Nertan.andwhe docasuch wank himselfur through his ltd 1
howam empbyrs,ping or i prvemesuch ntp;mid within amnot
far sales- fa fg".+//
however,the ow,thetrrimpmpourin usaldwiiin oro year of improve
Ne owner-
builder will have the burden Of proving that he did rot Wild Or improve far purpose of qqq
sold.). !/
❑1.as owner of ct property,am=elusively dd Prolcontractingfume wish licensedTheCcentramm i. 4H
Com l.a d prones(Sec.o an owner
of ark Py,who m Code:)The Contramon.Lid
cense law does not apply c m owner of prapeny,who Wilds m improve Nemon.and yyy����III
who ns Lacufar such projects wish acanranor(s)licensedpmwambNe Convasnrr
License mlaw.
❑Tom czcmpl undo See- .B&P C far this mason
r /v v Dale1261
WORKERS COMPENSATION DECLARATION
hereby affirm under penalty of Perjury one of she following declarations:
❑ I have and will mountain aCertiBele of Commis to self-insumfwWorkcrsCompcn-
sadon,as provideA far by section 37W of the labor Code,far Nc performance of the
wart for which this permit is issued.
❑1 have and will maintain Workers Compensation Wuomed.as required by S.ction
37W of did labor Code.for Ne performance of Ne wort for which this permit u issued '
My Workers Compensation Inmrance carrier anal Poli,number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This it.reed act W completed if Ne permit Is fora..hundred dnllan(SI W)
or less.)
I certify Net in the performance of NC wad for which this Permit u issued.I shall act
employ any laccen many matter as as u,WCalne subject in the Workers!Compensation
Laws of Califom' . m
ApPliCo..
NOTICE TO ANT:IL OMr making this Ccrtifiwle of Exempsion,you should
bccmne m dile Wartcra Compensation provisions of the Labor Cade,you mus
.J z lard, comply with mels provisions or this pcnniuhal)W domed nrvakcd.
z CONSTRUCTION LENDING AGENCY
r
[-+ Thereby affirm WI Vert is a ed(See,30 leading.Cagency for de perfunna�of
E
Nc wort for which Nu permit is issued(Sec.7W7.Civ,C.)
1 A Lenders Name
7 z LcMers Add.
U O 1 cutify that I haus read this application and rude that ft above information is .
U. f' correct.1 agme to comply with all city anal county ordinances and ruse laws relating to
pU building eonswclion,and hereby authoom apracmatives of this city m cmcr uPnn the
FLS7 abovomenuon.dpmpcny far dexNeoon VwrFewhich s.
gy (We)agree to...Indemnify and keep harmless IW City of Cuperu.0 agunsl
Z in
of the cuts and of this
may inany vnyacme against inial City
U z A eanmgvNT of the granting of Nis Permit. r
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date t�" � tel/
SOURCE REG2 OfiS. ,
�� ��� Re-roofs /�-
5m1n2ppluWWConracmr Ease
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will she"Isom or forum Wilding comport am Whandle Wrmdons material
as tleBced by IW Calamine Municipal Cade,Chapter 9.13,and the Health and Safety
.
Section 25532(a)T
❑Ye El No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding Oecupam um equipment or deviav which If a roof is installed without first obtaining an inspection,I agree to remove
' emit hovardnus air csnmminams as derined by the Bay Arca Air Quality Management all new materials for inspection.
Diss mT
❑Yes 0N -
I beer,real de hvardaus materials requirements under Chaper6.95 of Ne Califon
Ria Health&Safely Ced.,Sections 25505,35533 andM34.I undersand thatifshe Witding
doe not'imera y have a enant that in u my ropes olity m Iwury Nc occupant of the
requimmcn It msa W.1 Our in issuance ora cerlifem Ocapamy. Signature Of Applicant Date
Gw uthrived agent D,le - All roof coverings to be Class "B"or better