07090187 CTTY OF CUPERTINO ' : ` .
BUILDING DIViSION PERMIT �������� ���������* '
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BUILD NG D ESS: PERMIT NO.
�2��� WALLACE DR MICHELL:a & RICHARD 07090187
JER'S NAME: - PERMTT 15SUE DATE
MICHELLE & RICHARD MATKOVICH 22129 W.�LLACE DR � 11/06/2007
PHONE: SANITARY NO. CONTROL NO.
ARCHI7ECTBNGiNEER: BUILDING PERMIT IWFO
BLDC ELECT PLUMB MECH
� 0 0 �
� O p LICENSED COfJlRACTOR'S DEC[.ARA7'ION
� I hercby aflirm that I sm liccnsed undcr provisions of CAaptcr 9(commcncing Job Description
��� wiih Section 7o(w) o( Division 3 of ihc Busincss and Profcssions Codc, and my liccnsc is ADD I T I Ol J 4 8 0' BDRM , BATH .
�� y in full foree and e[fec�
,� ? Licenx Class Lic. N
�'^� E ;, � Da�c Conlrac�or
ARCHITECI'S DECLARATION
y � � U 1 undcrstanJ my plans shsll bc uscd u public rccorda
a
L O y Licenscd Rufcssional
� y � OWNER-BUILDER DECLARATION
+� <� I hcrcby alTirm that 1 am cxcmp� Crom �hc Conlractor's Liccnsc Law for Uic
0 o following icason. (Sxtion 7U31.5, Busincss and Prafccsions Calc: Any city or county
e Pi which rcquires s pcm�it w construc4 altcr, improvc, dcmolich, or repair any swcWre
� Z� prior w ils issuancc, also rcquires thc applicant for such permit to filc a signcd su�emcnt
x < that hc is licenud pursuant to thc provisions of ihc Conuactor's Liccnsc Law (CAaptcr 9 : i Ft. Floor Area Valuation
� i- �(commencing wi�h Secdon 7000) of Division 3 of ihc Busincss md Profcssions Cadc) or $ 4 8 3 6 0
y�., that he is exempt theeetrom and We basis for We silcgcd exempdon. Any violauon of
Section 703t.3 by arry applicant for a pem�it subjecu the applicant to a civil penalty of e� Number Oecupaney Type
not more �han five hundmd dollars (5500). 3 2 6 0 2 0 4 ��: Y1 �
❑ I. u owner of tNe property. or my employces with wages u ihe'v solc compensadon.
will do �de work, and ihe swctwe is not intended or oRemd for salc (Sec. 7044, Business Re uired Ins ections
and P�ofessions Code: The Conuactor's License Law doet not apply �o an owner of 9 P
property who builda a improves thercon, and who does such work �imself ar Nrough his
own employccs, provided that such improvements ue not imm�ded or of[ered for sale. I[,
however, the building or improvement ia sold withia one year of complcuon, ihe owner-
builder will have the burden of proving Wat he did not build or improvc far purpose of
ukJ.
� 1, u awna o[ the property, am exclusively conuuting wiih licenaed rnnuactors to
wnswc� che pcojea (Sec. 7044, Business and ProCessions Code:) 71ie Conuxtnr's Li-
cenx Iaw docs not apply to an owner of propeny who builds or improves theceon, and ,
who conuac�s Cor such pmje ith a conuactor(s) Iicenxd pursuant to �he Convacror's
License Law.
� I am aempi und c. , B� P C for this rcason
,iet Date ���`—
W R 'S S TION DECLARATION
I de by � under penalty of perjury one af �tm fallowing dalsndons:
❑ I hsve and will maintain a Certificam of Consent to ulf-inswe fw Worker's Compen-
sation, as provided for by Secdon 3700 of the Labor Code, for ihe pedormanm of thc
work far which this pumit is issucd.
❑ I have and will mantain Worker's Compen�suon Insurance, as required by Scction
3700 0! thc Labar Codc, fa thc pcdormantt of �he work for w6ich �his permi� is iswed. '
My Worker's Compensation Insunnce carticr and Policy number arc:
Cartier. Poliry No.:
CER7'IFICA7'E OF EXEMPTION FROM WORKERS'
COMPENSATION 1NSURANCE .
(I'his scction necd irot bc completed if the permit is fw anc hundred dallus (S I00)
or Icss.) .
I artify �hnt in thc performanc thc w rk e w ich ihis pertnit is iuucd, [ shall not
employ any person in any ncr w as com s j t w the Workc s' Compcnsation
Laws of Califomis. Da�c
Applicant �'
N017CE TO APPLI : if, �cr maki g �his ertilica�c of E�ccmpGon, you should
bxome subject W� c Wo s Compenssuon pmvisions of ihc Labor Codc, you muu
, O foMwi�h comply rvi�h h provisions or this permil shall bc dcemcd ccvoked.
z"'� C NSTRUCI70N LENDING AGENCY
(-r ► I herchy affirm t there is a consuvcdon Iending agency for the perfurtnance af
pi � ihe work fur which ihis permit is iuued (Sce. 3097, Civ. C.) '
� Q L.endcr's Namc ,
� z Lender's Address
V 0 1 certiCY �hat 1 have read this application and siatc ihu thc abovc informadun is
w�"" coercn. I ayx W comply wi�h alt city and counry oNinances and sute Iaws relaang w
� U building consuuction, and hereby autAori�e representaGvcs of this ciiy w cntcr upon ihc �
� W above-mcntioned p�opcny for inspcc�ion purposes
a (Wc) agrte to save, indcmnify and keep harmless ihe Ci�y of Cupertino agsinst
�� liabilitiu, judgmcnts, cos�t and expc which may in any way accruc against said City �
V z in consequencc oC Uic g Gng i permi
�"� APPLICANT UNDER T S D 1L 0 WITH ALL NON-POINT Issued by: Date �r �
SOURCE RECULATI . � ' } 'V �
�� Re-roofs
Signatum of AppHcan on tor Da�c
f OUS MATERIALS D[SCLOSURE Type of Ro �f
Will tpE appli t or Cuturc building accupant storc or handlc ha•rardous matcrial
�lefincd by lhc C rtino Municipal Codc. Chaptcr 9.12, and thc Hcal�h and Safcty
�. Scction 2553 (a)? All roofs st�all be inspected prior to any roofing material being installed.
❑ Ycs ! o
Will thc a�licant or future building acupant usc cquipmcnt or deviccs which If a roof is ,nstalled without first obtaining an inspection, I agree to remove
emi� ha air contaminan�s at defincd by lhe Bay Arca Air Quslily Managemen� all new ma� erials for inspection.
Disuict? /
�y� ��p/
1 havc rcacl ihe ha�ardous ma�crials requiremen�t umicr Chapicr 6.95 of �c Cali(or-
nia Hcal�h & Safciy Codc. Scciians 25505, 25533 am125534. I undcrst�nd that i(�hc building
docs nol curtcnuy havc a an4 �hat il is my rcsponsibiliry w notiCy ilu occupant of �hc
rcyuircmcnts which ' r issuancc of a Ceni ate 9f Occ . Signature o.' Applicant Date
ow�cr or in ' agcn o„� All roof coverings to be Class "B" or better �
i
� �_ .