08080093CITY OFCUPERTINO
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PFAMIT NO.
10120 N DE ANZA BLVD
ANTHONY HODDER CONST
08080093
NER'S NAME:
PERM17 ISSUE DATE
JOSEPH CHURCH
7504 BOLLINGER RD
08/13/2008
ONE:
SANITARY NO. CONTROL NO.
AR CHOECT/ENGINEER:
BUILDING PERMIT INFO
TEMP PERMIT ADD DTCHD PATIO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby himat wt 1 me licensed uMe, pmvW.. of Chapter 9 (commencing
wit Section7000) of Divlsan3ofw Business aM Profc Cude.andmylicensela
;n full Tome and efr"g
Ince pass Lie. g s'(' �C�TCC J 7
Dat — CanDECLA
RCNITECT'S DECLIRATION
1 understand my plans shall le used ss public records
"
Lk.d Professional
OWNER-BUILDER DECLARATION
1 hereby affirm tat I am exempt from to Conuagues License Law for the
fallowing mason. (section 7031.5, Business and Pmfemons Coda: Any city or county
which mquima a permit to cenamcn, a1kr. improve, dcmulkt. to mpair my structure
Prior In its issuance. also mquima to applicant for such permit to file a signed etakment
ulkeved mw of de Contractor's Uncom U.(CWp. 9
Sq. Ft. Floor Area
Valuation
thath puraunt proviake
(commencing with Section 7000) of Division J of the Business and Professions Code) or
that he la eumpt temfmm and to buss for w alleged exemption. Any violation of
APN Number
Occupancy Type
Y YP
Section 7031.5 by any applicun for a Permit subjects w applicant a • Civil pemlty of
Cog mom Ven Rol hundred dollars ISMP
L u solar of w ptvp.ty, m my wploym wit wgu u de'v sok chinpcuatian,
Required Inspections
will dotewart and the a4, Hoer
g, apply to of
and bu Code: The Cantrecmr's Uceue Law does rot apply lf an roles of
he Comla,mts Lk Law
propertywho Wiprovidmpmvuchimprve wW
property who ch trough his
sograt inwarkhroffeedmselfor
holoemployee,progded that such improvements taenot earadmolkred f.
IL
a w owrcr-
to building imPm la halt within arc year ofi m the
builder Front
Wildm w10 base w burden of proving that lex did not bulk m improv fm purpose or
u improve f.
sale.).
❑ 1, as owner of the property, am acluively contracting w;t licensed mntranon m
coatron the mojat (See. 7014. Busiks lad Professions Code,) The Contrhamrs U.
.
Come law dans not apply t an owe of property who Adlds or improve deteon. and.
who Conuuta for such projects with a contractor(s) licensed pursuant t the Contractor's
License Law.
'
❑ 1 un exempt under See . B & P C for this mum
Dau
kner WORKERS COMPENSATION DECIARATION
I hereby afnrm under penalty of perjury arc of the following declarations:
1 haw roti will maintain • Cutifiuu of Covera m se1R Wham for Wortrr'a Cempen.
sedan, as, provided for by Section 3]110 of the Lab. Code, for the puferne. of the
whit for whim tie permit is issued.
❑ 1 have and will maintain Wurter's Compensation Insammax, as required by Section
37W of to LaWr Code, for to performance of to wort for which to permit is Issued.
My Wor Ipnce pwvra'ca m and Policy n jr�art'
Carder. 11 Polley No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
('fhb sxdm recd wtbecmnpleted If t e permit Isfmane hundred dollam (SIM)
or lest)
I ceniry than in to performance of the wmla for which this permit is issued. I shall We
employ any person in any manner an u m become subject in to Workeri Compeankn
Laws of California. Dam
Applicant
NOnCE TO APPLICANT: IL safer making this CcdiBue of Exemption, you should
become subject to w Wedges CompceNon previsions of the Labor Code, you mesa
forthwith comply wit such provisions or this permit shall Is, dcemrd,evoked_
CONSTRUCTION LENDING AGENCY
I hereby stairs that cert is a construction lending agency for the performmon of
w wars for which Uta permit is lasmd (Sm. 3097. civ. C)
Urder's Name
Wdces Address
1 certify tat I hale mad tis application and sou to de above information Is
ConCaL 1 agree It comply wit all city and county ordinances and sou laws relating in
'an,adhmbylutmimmprueaudvenftladiymenwupnnw
ed ropertyf.impecvmpury.es
g la saw, indemnify ad lamp harmless to Ily of Cupenino !glial
ros, u gindmgms which may in any yacnue g!1 (said City
/*,J.dg.
p(w grandn 9r' is pnmlL
UNDE AND WILL CO PLY WITH A N-POINT
Issued by: Date
U N
Re-roofs
oma A,IicuuC.nttrsew, Da
HAZARDOUS MA AIS DISCLOSURE
Type of Roof
Will the applicant m(utum Wilding Pact Mm or handle hanNous ma.ial
as dcft,rd by the Cupertino Municipal Cade. Chapter 9.11, and w Holt and Safety
Section 23531(x)?
❑Yu ❑No
All roofs shall be inspected prior to any roofing material being installed.
Will the a neat or future Wilding occupant rha
pp g p equipment at devices which
If a roof is installed without first obtainingan inspection, I agree to remove
P
'emdna air conumieanuudcfimtl by the Bay Area Air Quality Managemem
all new materials for inspection.
District? U dcR
❑Yu C] No
I have mad w ha umbag; matcOgi, mquimmenu under Chape, 6.95afte Calif.-
Wilding
ing
nuHeal oa(my Cade,smd.crmu01537 .y
oild
tau ndy Mm itis myWr'a
0brory
newhichmortissunfoe
Signature of Applicant Datevim
All roof coverings to be Class 'W' or better
kfw
nor em