08120140BUILDING DIVISION PERMIT
BUILDING ADDRESS:
10535 F
OWNER's NAME:
MAT�PTT� RW QOMM
PHONE:
ARCHITECT/ENGINEER:
u OC p p LICENSED CONTRACTOR'S DECLARATION
U C 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
Z m with Section 7000) of Division 3 of the Business and Professions Code. and my license is
e = y in full fore and effect
v� Z License Class Lie. 8
C —,z Dam Contractor
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
�yV
g W y Licensed Professional
C < OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
a O following reason. (Section 7031.5, Business and Professions Code: Any city or county
e m Pi which requires a permit to constrac4 alter, improve, demolish, or repair any structure
o rn prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
$ (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
y that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (1500).
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If.
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
Cas owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li-
cense law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
exempt under Sec . B & P C for this mason
/ 'lwner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
] 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
tation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Cod� for the performance of the work for which this permit is issued.
My Worker's C art ads n acotatrier and Policy number am:
Policy No.:
FICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section treed not be completed if the permit is formic hundred dollars (1100)
or Icss.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
4%vi ol-Califomia. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you mast
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that them is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Address
I certify that 1 have read this application and state that the above information is
correct I agree to comply with all city and county ordinances and state laws relating to
building construction. and hereby authorise representatives of this city to enter upon the
above-mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANQS AND WILL COMPLY WITH ALL PAINT
SOURCE REGULATIO i
Signature of ApplicanlIC66inctor Dale
HAZARDOUS MATERIALS DISCLOSUR
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Mun_icjpal Code. Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑ Yes Q No
Will the applicant or future ng occupant use equipment or devices which
emit hazardous air contaminan defined by the Bay Area Air Quality Management
District?
❑ Yes ❑ Nu
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building
docs not curendy have a Icrafit, [bat it isresponsibility m notify the_ t of the
requirements which !Dat r to�ti scarce of a Ccrtifrcate of ancy.
Owner or
Job Description
ADDITIO\T 499 SQ FT. TO.MASTER BATH AND,.EXTENDING
2
BEDRMS, MOVE 2 EXISTING BATHRMS, REMODEL FLOOR
PLAN IN KITCHEN, RE—ROOF 23 SQ.
Sq. Ft. Floor Area
35918011.00
Issued b;
Re -roofs
Type of hoof
lzi
Required Inspections
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new r iaterials for inspection.
Signature: of Applicant Date
All roof coverings to be Class';" or better
PERMIT NO.
PERMIT ISSUE DATE
A
CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT
PLUMB
Job Description
ADDITIO\T 499 SQ FT. TO.MASTER BATH AND,.EXTENDING
2
BEDRMS, MOVE 2 EXISTING BATHRMS, REMODEL FLOOR
PLAN IN KITCHEN, RE—ROOF 23 SQ.
Sq. Ft. Floor Area
35918011.00
Issued b;
Re -roofs
Type of hoof
lzi
Required Inspections
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new r iaterials for inspection.
Signature: of Applicant Date
All roof coverings to be Class';" or better
I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10535 FELTON WAY
OWNER'S NAME: MATTHEW SOMMER
OWNER'S PHONE: 4087302204
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor
Date
1 hereby affirm that 1 am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
1 have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I certify that in the performance of the work for which this permit is issued, 1 shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, 1
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9. t 8. 1i
Signature
Date V/J 6
CONTRACTOR: MATTHEW SOMMER
10535 FELTON WAY
CUPERTINO, CA 95014-4305
PERMIT NO: 08120140
DATE ISSUED: 04/09/2009
PHONE NO:
BUILDING PERMIT INFO: BLDG r ELECT F_ PLUMB F_
MECH r RESIDENTIAL COMMERCIAL f—
JOB DESCRIPTION: ADDITION 499 SQ FT. TO MASTER BATH AND
EXTENDING 2
BEDRMS, MOVE 2 EXISTING BATHRMS, REMODEL FLOOR
PLAN IN KITCHEN, RE -ROOF 23 SQ.
Sq. Ft Floor
APN Number: 35918011.00
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. if a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
or au norrzea a nr:
�
s,Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional