8070102 CITY OF CUPERTINO
BUILDING DIVISION PER -ON'T"CTORimORMATION
BUILDING ADDRESS: PERMITNO.
10441 PHAR LAP DR GARDNER CONSTRUCTION CO 08070102
OWNER'S NAME: PERMIT ISSUE DATE
ARTHUR AND MARIA LECLAIRE 750 LOCUST ST 07/24/2008
ONE: SANITARY NO. CONTROL NO.
(408) 615-8010
ARCHTTECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT FLUME MECH
X00 LICENSED CONTRACTOR'S DECLARATION O O O O
1 M1wby.loan Nat I w li¢nad aMcr pmvianns of Clumpter 9(commmcmt Job Description
w)N Sad.nl").f Divism.3ofthelbruwasmd Professiam COM,aMmy[I...I. REVISION—REMODEL NEW HEADER REPLACEMENT/FOOTING@
°pm nMirome mdeffec
��z ueen W�ue.tssasr ✓�Z FAMILY RM SECTIONS
T'Sr DECLARATION RQN`�G t]LrsT /p
Q ARCHf1EC15ublicm ORIG#08040232
a� 1 undewnJ my plans Nall he umtl u public rerords
JyU
yLLa Licensed Pmfessi.nal
5 OWNER-BUILDER m Ce CommaON
coo hereby afsw that 1 em xempt from the C.nI..ors L ten a law for the
coo O following mason(section
aavasr susintas and Pm.loom Cade:My rily s county
which requims•permit re ewswtt.Iter,impmw,h pamh t a repoir any ammum
_Zy prisms accun¢,arurequiw theapplicantfor sucCommute Lics.Jib!A Law sutwem
E�G thuheulieenmd Secdntm Nepma,kv rfdc Comramra d itrlaw(Cb )., Sq.Ft. Floor Area Valuation
$ (cwmeis mum
t therefrom n d)the basis f r of the Buanwand on.Anyou Caee)or $2500
.. Net he is ue5Pl therefrom sntl the aper for bj ds�ho asuman to Any l pawn of
Section.1.. than fins
but applrcmt for a permit mbjau thte Applicant m a coil putalty of Number Occupancy Type
notm.mNanrlwhaMmdaoll,n(S50pk 32635042 . p �' YP
❑I.uowser of Ne pmlamsY,amy wploym with wagnuthteir mk ewpevadon,
will dodmsions Ca Ne Too
Casouts Liamm Law
a.k(sec.In an Basions
W aty who
Cale:The Crnc.cmfs nd whe law data oat apply m rt roux.offis _ Required Inspections
pwpem who builds orImpmvu b imp,end whodoesmem wank M1 rmforarNmum his
own wPloycpe.proNded Natsahimprowmmain ant earofmrroRwtl the ale IL
bultdo,.Neavoth twimpmtemung Oat mdidnmu)ear of cmtpkdonr polum of .
builder HR love We buNan of proving Nat M1e did not Wild a impsme for purpose of
sale.).
❑I.u causer or the properly w reclusively conuactint with 0seued ranbamn W
c.mtm t the Mjcm(Sec.TOm.Business and Pmfasiou Co kc)The Crntm mrs W-
mnm raw does rot apply in.n.wnes of Impact who build,.,rmpmws thereon,and
who contracts for such Micas with a contractor(s)focused pursuant on Ne C.ntramors
Lice.law.
O l um exempt anchor See .B&P C for this repeon
se Can
WORKER'S COMPENSATION DECLARATION
1 hcmby.T.under pewt'of perjury ane of ex frlmwas dala o mm:
❑I law aM will for by
•CmuficW.f Copecm r Cods.for n, Woa...f On
wilt,u provided for by Ssis u dToO rf Ik labor Cove,for Ne perfowan¢rf thu
wart(a whiem this prank r issued.
❑1 have and will maintain Warterr Compcnsati.n Imurance,as rugmral by Secv.n .
37W.f the labor Code.for On performanre of Ne work for which Nr permit is issued.
My Work-a s C2wWramx ompedoo ucarer and Policy ntumbbeerr/am:
r
Caer 56 '7, %A!. Poliry Na.�3 1 &���
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tau mmwar reed not becwpleud If the permitis(mom hundmddollan(tido)
or less)
1«rdfy Net ld Ibe performaae of the wort far which Its permit u Issued,l shall nm
employ any perm.in my manse,an as to become subject to Ne Workri Cwpcuadon
Laws of California Dam
Applicant
NOTICE TO APPLICANT:IL after maid,this CeniBeam of Exemption,you should
become subject on Ne Worker's Compensation pmvraru of the labor Code,you mute
.J O fo thwid,comply with such provisions or Nu pmmit shall is,dsemed revoked.
'Z
CONSTRUCTION LENDING AGENCY
F+r 1 hereby afDrm that cure u a mwration lemilr a for do
t 6^n' pmfuwutm of
Ci Le work far which ads pewit is issseseC)
d(S .709T,Civ.
Ia
�W nticName .
.7 z !.coders es Mmss
e
U O 1 m'rfY Nat I have read Nis.pplkaumr and arm d u am mum iNmm.don r
^, rnwa 1 agree m comply with aea all city and county andinsand sum laws relating m
O il'J buildingamorn,cdon.and hemby mthouim mprnnulws of Nu city N enkrupon Oc
W .hove-mat mad plapeny for impec4M purp mae
a (Wc) C.Ir mw,indemnify and keep hawlns dx City of Cupernr ag.imt
h liabilities,judgments,torts and espertsca which may in any way arra gent mid City
U Z AcPLICANT of the UNDERSTANDS AND
pewit /1 is ••y _
^
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SO Date
YR REGULAT�pS.
Re-roofs
Sigwum py ppli aConuaiur . Dau
HAZARDOUS'MATERIALS DISCLOSURE Type of Roof
Will thx applinnt m forum Wildint aavpantmcc m NnEle hrurdou maurY
ss ceased m 25 32(.)? Munici WI Cotle,mapper 9.12 and ex HNN antl Safety
cade.s«d.nsssn:r,)+
❑Yes ON. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant m futum Wilding oavp on pea equipment a eruts which If a roof is,installed without first obtaining an inspection,I agree to remove
arkh�gnu air contaminants u dalncd by the Bay A.Air Quality Mwagcmcm all new materials for inspection.
DistricDYn pNu
I haw read Ne hasndoua nommods requirements under Chapter 6.95 of thx c lif n-
nuHeslth&Safety Code,Sccaope 25505,25533 av125534.1 undcmvW tha ifthc buildint
dura ,cuwndy how.¢nam,that It r my rupownwhy m wary On ocvamm,or the
�yI nuwhkhMUSL ro ppt,i�oorwisss�cooraccrtificauoloccPpY
/° ` 0 � /zy/O q Signature of Applicant Date
-7C
Owne aramboriagent Tran All roof coverings to be Class';.a'or better
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10441 PHAR LAP DR
CONTRACTOR: GARDNER PERMIT NO: 08070102
CONSTRUCTION CO
OWNER'S NAME: ARTHUR AND MARIA LECLAIRE
750 LOCUST ST DATE ISSUED: 07/24/2008
OWNER'S PHONE: 4087392098
SANTA CLARA, CA 95050 PHONE NO: (408) 615-8010
❑ LICENSED CONTRACTOR'S DECLARATION
i 7
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lia 4
MECII RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: REVISION -REMODEL NEW HEADER
(commencing with Section 7000) of Division 3 of the Business & Professions
REPLACEMENT/FOOTING@
FAMILY RM SECTIONS
Code and that my license is in full force and effect.
ORIG#08040232
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
Sq. Ft Floor Area:
Valuation: $2500
performance of the work for which this permit is issued.
l 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.
APN Number: 32635042.00
Occupancy Type:
APPLICANT CF. RTI FI CATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
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
Issued by: Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9 18.
RF, -ROOFS:
Signature Date
All roofs shall be inspected prior to any roofing material being installed. 11'a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date.
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District 1
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date:
permit is issued.
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 Worker's
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9 18.
Signature Date