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04030176 CITY OF CUPERTINO " ' ?'- _7717"'T, °x BUILDING DIVISION PERMIT CONTRACTOR INF_OORRMAT,ION : BUILDING ADDRESS: PERMIT"04030176 20633 CHERYL DR OWNER'S NAME: PERMIT LSSUE DATE PRESLEY ROSS C AND CHRISTINA E: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 ,4i00 LICENSED CONTRACTOR'S DECLARATION til CC I hcmby affirm that 1 am limned under provisions of Chapter 9(commencing Job Description iW with Sation 9glU)rf DiviaionJof NCBuv and Profccsiuns Co dory liecnscis 11faumreca fee /�L yQf�'j ADD 483 SQ. FT. Sq Lie nae clask e. zF Contractor CONTRACTOR: SALGADO CONSTRUCTION .ARCHITECT'S DECgr.QgTION iz< 1 undcrsund my plans shell he tired as murk cords 7toU 3 u.t; Licensed Professional i0s OWNER-BUILDER DECLARATION to 4 I hemlry from shed 1 am exempt from the Committees License law for the p0 folimvmg¢ason.(Seetion](1JLS,Business and Rafcssions Code:Any city Of county K 2 2 which requir a permit m cnnmruc,eller,improve,demolish,in repair any structure w-v, prior in its issuance.also requires the applicant for such Permit to file a signed mother, 1 ex - that he is licensedpumanuoOnprovisionsoftWContractor'sLimnslaw(Chaper9 Sq. Ft. Floor Area Val Da�t 000 I'm (commencing with Section 7")of Division J or the Business and Professions Code)or to .. that he is exempt Nemlrom and the basis for the alleged Monfu on.Any violation of Section 9031.5 by any applicant for a permit subjects the applicarl to a civil penalty of APN Number Occupancy Type not mere than me hundred dela s(55W). 35915036 . 00 C]1,as owner of the property,m my cmploycrs with wages as Juin it comnsatio pen, will do the work,end the slsuche:isnot intended or offered f etude(See.7W.Business and Professions Code:The Comsacmfs License law does not apply m in owner of Required Inspections property who builds or improves thereon,and who docs such work himself or through his own employ=,provided Wet such improvements art not intended Oro@¢d transit.It, however,the building or improvement is sold within one year of completion,Ne owner- build,,will have tW burden of moving that he did net Wild or improve for propose of sale.). ❑1,as owner of WeSee. propertyam exclusively contractingBashng with licensed contractors i. mese La it project ISec.o an mer of and Proo,who Code:)The Common's Li c law does not apply jo an owner of popery wce selids or imposes Contra,and who contracts for such pojccts with a convacot(s)licensed punwm of the Contucmh License law. I am exempt under Sec. .B&P C for this mason 41haveand er Data WORKER'S COMPENSATION DECLARATION VY// I hereby affirm under penalty of perjury one of du following declarations: will mmnuln a Cmificau of Censant m sslf-imum for Warkcrs Compen- nation,az provided for by Section 3900 of Ne IaWr Cod,for the performance of the work for which this permit is issued. ❑1 have and will maintain Workers Compensation humanCe,as required by Section 3900 of the Lather CaM,for the performance of the work for which this permit is named. My Worker's Compensation Insumnm carier and Policy n m,am PokeSSy CERTIFlGTE OF FXEMPTI OM ERS' COMPENSATION INUU NCE (Tuascedon need not he completed if the Permit is for one hundred dollars(SIM) or less.) I 1 Certify that in Ne performs ee of the work for which this Non is issued.I shall not mploysnyperaonI c/light �R ds' jet bwlYprkers'Compcnsadon Laws ofCabina D c //// App] "1 1 11 11�_4___� NOTItCEP ICAN :If'after eking Nu Certificate of Exemption.you should liw3meg X.to the Worker's Compcnsnlon provisions of the labor Code.you must �p forthwith comply with such provisions or this Permit shall W deemed evoked. Z ^ CONSTRUCTION LENDING AGENCY [-�� Ihereby oRiam Nat there is a construction lending agency for lW perfurmane,of DS 7 the work for which this permit is issued(Sec.3099,Civ.C.) IIJ a Lendcra Name 0. Z Lenders Address U 0 1 certify Net I have read this application and sus:Nat the aWvb mromem un is IL, F, Correa 1 agree to comply with all city and county ordinances and sum laws relating to 0U building ConsWction,and hereby authorim Mpreunlalivea Of this city m cn¢f upon the r Kl ahove-mentionrA property fm inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against F"h liabilities,judgments.costs and expenses which may in any way acerae against said city U Z in cmmmut.ce of the grumin,of this permit / ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date l SOURg0tMULATIONS. �+ �,•�lA? aj ( � Re-roofs edu4c of Applican✓ Bactor Dale HAZARDOUS MATERIALS DISCL E Type of Roof Will the applicant or future building occupantstore or handle meamous material az dcGned by We Cupertino Municipal Cuda.Chapter 9.1x.end the Health and Safety ede.Semen xss" ? Latp,xla �j/0 All roofs shall be inspected prior to any roofing material being installed. 7 ❑res Y ' j� Will the applicant or future building occupant use cycipmcnt car dcvico which If a roof is installed without first obtaining an inspection,I agree to remove i h mMots in,maturinanuA}dafned by the Bay Area Air Quality Managcmem all new materials for inspection. Wic" �/ /off// ❑Yes Nu I have read Ne hammous materials requirements under Chap rn 6.95 of the Califor- .mHcalthS,SatetyCode.Smtims 25505,x5533 and 255Jd.lundeaund Nat Lithe Wilding s note Jy hoc a mnane that it is my responsibility to nobly the omupant of Nc �irr emawhiehmr��metp��arIrsotreamofOcculley. Signature of Applicant Date Owner or agent !--' )Dare All roof coverings to be Class "B" or better CITY OF CUPERTINO " ' ?'- _7717"'T, °x BUILDING DIVISION PERMIT CONTRACTOR INF_OORRMAT,ION : BUILDING ADDRESS: PERMIT"04030176 20633 CHERYL DR OWNER'S NAME: PERMIT LSSUE DATE PRESLEY ROSS C AND CHRISTINA E: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 ,4i00 LICENSED CONTRACTOR'S DECLARATION til CC I hcmby affirm that 1 am limned under provisions of Chapter 9(commencing Job Description iW with Sation 9glU)rf DiviaionJof NCBuv and Profccsiuns Co dory liecnscis 11faumreca fee /�L yQf�'j ADD 483 SQ. FT. Sq Lie nae clask e. zF Contractor CONTRACTOR: SALGADO CONSTRUCTION .ARCHITECT'S DECgr.QgTION iz< 1 undcrsund my plans shell he tired as murk cords 7toU 3 u.t; Licensed Professional i0s OWNER-BUILDER DECLARATION to 4 I hemlry from shed 1 am exempt from the Committees License law for the p0 folimvmg¢ason.(Seetion](1JLS,Business and Rafcssions Code:Any city Of county K 2 2 which requir a permit m cnnmruc,eller,improve,demolish,in repair any structure w-v, prior in its issuance.also requires the applicant for such Permit to file a signed mother, 1 ex - that he is licensedpumanuoOnprovisionsoftWContractor'sLimnslaw(Chaper9 Sq. Ft. Floor Area Val Da�t 000 I'm (commencing with Section 7")of Division J or the Business and Professions Code)or to .. that he is exempt Nemlrom and the basis for the alleged Monfu on.Any violation of Section 9031.5 by any applicant for a permit subjects the applicarl to a civil penalty of APN Number Occupancy Type not mere than me hundred dela s(55W). 35915036 . 00 C]1,as owner of the property,m my cmploycrs with wages as Juin it comnsatio pen, will do the work,end the slsuche:isnot intended or offered f etude(See.7W.Business and Professions Code:The Comsacmfs License law does not apply m in owner of Required Inspections property who builds or improves thereon,and who docs such work himself or through his own employ=,provided Wet such improvements art not intended Oro@¢d transit.It, however,the building or improvement is sold within one year of completion,Ne owner- build,,will have tW burden of moving that he did net Wild or improve for propose of sale.). ❑1,as owner of WeSee. propertyam exclusively contractingBashng with licensed contractors i. mese La it project ISec.o an mer of and Proo,who Code:)The Common's Li c law does not apply jo an owner of popery wce selids or imposes Contra,and who contracts for such pojccts with a convacot(s)licensed punwm of the Contucmh License law. I am exempt under Sec. .B&P C for this mason 41haveand er Data WORKER'S COMPENSATION DECLARATION VY// I hereby affirm under penalty of perjury one of du following declarations: will mmnuln a Cmificau of Censant m sslf-imum for Warkcrs Compen- nation,az provided for by Section 3900 of Ne IaWr Cod,for the performance of the work for which this permit is issued. ❑1 have and will maintain Workers Compensation humanCe,as required by Section 3900 of the Lather CaM,for the performance of the work for which this permit is named. My Worker's Compensation Insumnm carier and Policy n m,am PokeSSy CERTIFlGTE OF FXEMPTI OM ERS' COMPENSATION INUU NCE (Tuascedon need not he completed if the Permit is for one hundred dollars(SIM) or less.) I 1 Certify that in Ne performs ee of the work for which this Non is issued.I shall not mploysnyperaonI c/light �R ds' jet bwlYprkers'Compcnsadon Laws ofCabina D c //// App] "1 1 11 11�_4___� NOTItCEP ICAN :If'after eking Nu Certificate of Exemption.you should liw3meg X.to the Worker's Compcnsnlon provisions of the labor Code.you must �p forthwith comply with such provisions or this Permit shall W deemed evoked. Z ^ CONSTRUCTION LENDING AGENCY [-�� Ihereby oRiam Nat there is a construction lending agency for lW perfurmane,of DS 7 the work for which this permit is issued(Sec.3099,Civ.C.) IIJ a Lendcra Name 0. Z Lenders Address U 0 1 certify Net I have read this application and sus:Nat the aWvb mromem un is IL, F, Correa 1 agree to comply with all city and county ordinances and sum laws relating to 0U building ConsWction,and hereby authorim Mpreunlalivea Of this city m cn¢f upon the r Kl ahove-mentionrA property fm inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against F"h liabilities,judgments.costs and expenses which may in any way acerae against said city U Z in cmmmut.ce of the grumin,of this permit / ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date l SOURg0tMULATIONS. �+ �,•�lA? aj ( � Re-roofs edu4c of Applican✓ Bactor Dale HAZARDOUS MATERIALS DISCL E Type of Roof Will the applicant or future building occupantstore or handle meamous material az dcGned by We Cupertino Municipal Cuda.Chapter 9.1x.end the Health and Safety ede.Semen xss" ? Latp,xla �j/0 All roofs shall be inspected prior to any roofing material being installed. 7 ❑res Y ' j� Will the applicant or future building occupant use cycipmcnt car dcvico which If a roof is installed without first obtaining an inspection,I agree to remove i h mMots in,maturinanuA}dafned by the Bay Area Air Quality Managcmem all new materials for inspection. Wic" �/ /off// ❑Yes Nu I have read Ne hammous materials requirements under Chap rn 6.95 of the Califor- .mHcalthS,SatetyCode.Smtims 25505,x5533 and 255Jd.lundeaund Nat Lithe Wilding s note Jy hoc a mnane that it is my responsibility to nobly the omupant of Nc �irr emawhiehmr��metp��arIrsotreamofOcculley. Signature of Applicant Date Owner or agent !--' )Dare All roof coverings to be Class "B" or better