05120125CITY OF CUPERTINO5r�v's
BUILDING DIVISION PERMIT
CONTRAC QR'ANFOIiMATIQN `
BUILDINGADDRFM:
10366 AVENIDA LA
CALIFORNIA SKYLIGHTS
PEkM`PNo05120125
NAME:
PERNm ISSUE DATE
WRS
MYRNA EHRLICH
18637 BUCKNAU
12/21/2005
PHONE:
SANTIARY NO. CONTROL NO.
(408)866-6759
A0.CHr1ECf/ENGINEER:
BUILDING PERMrf INFO
BLDG ELECT PLUMB MECH
0 0
LICENSED CONTRACTOR'S DECLARATION
lob Description
I betcby.fOrm that m I .limosed Under pony':,,,,. of Chapter 9 (commencing
.
wtb Section 7") ofE lvisan 3 of the Busmen and Rafc000ns Code,.d my license Is
inmllferteudeDm - g �'
REPLACE 6 EXISTING SKYLIGHTS
Lieertsi'
r' econlr�; .
Coo
ARCHI'IEC"rs DECLARATIONN
1 advuaod my phis shall he usd u pblk research
Licctued PrtY®olid
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 w exempt from the Canv.clor', lieeue Law for the
following reason (Section 70515, Business ad Ptafeaiuu Code: Any city or county
which requires . Penh w rnnaruct, .ler, hnpmK, demolish, nor mpir my structure
$9100
pd. w its is.. slatunquire the.pplesam fmsuch permit W file. slgrad uue.M
Sq. Ft. Floor Area
Valuation
hal he is licensed pu.t to the pmvisioru of the Coeuetnri litcrose Lsw(Chapter9
(commencing with Section 70D0) of DWhian 5 or the Btoo. as! Ptafeniotu Code) or
Nu he U exempt thertfrem ad the bmh fm the a1 ftd exemption. Any riolad.. of
r U U
Occupancy Type
Section 7031.5 by my.pplionl fur. permit subjx the applies to. civil prnWy of
aces mese Nvl EK hmdrtd ddha 155004
.
❑ Luarmcr of the pvpny.amy mvplyvru with wrpesulhe4rok eompnatimn,
Required Inspections
will do the work. ad the stratum is not lnteodrd orarfered fmsale(S .7044, Business
,ad Ptoreuioru Code The Conactors License Law does tet apply it an owner of
q P
Property aro builds or tmfames thmmn, and who does nsAw himu3r or though hu
t»m empoyas, p mided thou mch ImptoKtoenu.rt not inratle! or offered fm ale. If.
how .du building or im,mKment haid wlNvlone Year ormmplNon.themarc+-
budder will baw Ne btuden of ponying that he did nes WW R improve for purpose of
ale.).
n
❑ 1. a afar of the propn4 . ely with licensed i-
onetanors
ca the (Sec. B sonetg prolescoomatingless Code) The Cemmcwr's Lin
rty whalmu
case lar noes r so apply on as ower of pmpeny aro bcd P m Impmtn Comosa. and,
La es not n as aoser of Property
rro..Lace lm card pojecU W N lcaluceds) IYcerued ptmwnt w the Gay.norl
❑I.m eumpumdc See .Bol PCfm thhrram
Date-
atWORKERS
WORKERSCOMPENSATION DECLARATION
I bcxchy syrionts Ludes Penalty of prim,, arc a the fmlowitq,wt.,.rt,.�
-
ruftcue Waiters Cempuo
❑IhaK.dwcclfor
Section 5'/W of t4 I.bor Cole. for de pufamuraz of the
sedan, ySce 0 do Labor
pds idor for
wmY for ahleh tbu permit Is Tested
r mi
❑ 1 Wroc"rill maimain Wortrfs Compeesadco Insurance. as required by Secdon
3700 d the Labor Code, for the perfermace crone rerk fon which this permR Is Usved.
.
Mywuhds Compew0 Insman wrier d Pdiry oumbar are:
b�
Grim:PdN
OMWO?2
FRO WORKERS
CERTIFICATE FCOMPENSATION
IEXEMPTION
COMPENSATION INSURANCE
Clhb canon aha tat he compleud if the I +mtk h fm ve hmlthd de ala (SIOg
m kss)
I certify tbu N the amfotma me of the rork for which this Perrot, U honed. I mail not
TpWy lily N. In my mNar,a at a beepae Alb}YI to NC W.ra Coreop onadw
IM of Califomh. Due,
APpLnru
NOTICETO APPLICANT: If. ares making this Ccniftatc of Euet0cm. you should
become wbjeml W the Worker, ComPewlbn p Woo d the UW Code, you must
fonhwN comply, with such Prmisimu or this pmrroi shall he deemed rooted.
I
j CONSTRUCTION LENDING AGENCY
1 ber by.rtbm that Here is a cownctim lerldin, avoc, fm Ne pmfmmmce or
' tro wont for whkb Nh Moor It Issued (Sec. 3097, Co, C)
Lender, Name
Leder's Add'.
j l certify that l NK rtW Nis apPlicWon and sae that do above inf.a. h
x cotton. I .gra w comply wN JI city std camty ordinuce, ad sale has relulnS w
-
building eotuuunion,.d hereby.uthorire rtprnaalives or thh city to calm upon the
.ro-mmttioted property for inspection purpoac
(We) .gra w uK, indemnify well ISW harmless tho City of Cuprnlnu agsans
j IUbilldes.jdgmcoa, coedad capuucs which may u any ray a¢ruc.g.lnx said City
in consoce tee of the Scanting d this Permit.
APPLICAtiT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POIT
Issued by: Date
SOUR
e -roots
Si(n.tore ofAPIkffVContram,or Dale
HAZARDOUS MATERIALS DISCLOSURE
Type. of Roof
Will Ne.pplionl or rtntoe building taupeart some or b.rdk b.ardtws m.teral
as deOmN by the CUpeNro Mtmld* Code. Chaper 9.12.4 the Ninth W S.fay
. Sermon 255320)?
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes
If a roof is installed without first obtaining an inspection, I agree to remove
will ase'*iou on lot. buiWNt .,son, equipment as duiac rh¢h
emit b.rardntu air conumirr ns as defnrod by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes
1 have read Inc hanrdnu tn.crUh ray'vmron, undorChaptem 6.95 of the CaFfm-
ni. Heard, dS.fmy Code, Smoimn 2505.25533 and 25534. Itudctnud thatifthe Wilding
does rot,tort ve e I It h lcspauihility W notify the aavpal a the
nctr01R111C h aw aar.cairmesion, of
Signature of Applicant Date
I l:of
All roof coverings to be Class "B" or better
Ow�it rm.uNmrs=d m me