06010176 CITY O4CUPERTINO .fr ^BUILDNPERMIT CO1VTlt`ACTQR�INFOBUILDING APERMITNO.06010176
105 2OWNERSNAPERMIT ISSUE DATE
03/03/2006
B; SANITARY NO. CONTROL NO.
ARCHmiCr/ENGINEER: BUILDING PERMITINFO
( BLDG ELECT PLUMB MECH
1=top Q
LICENSED JbDescri tion
�t+� 1 herem N
by efRret 1 em licensed under Provisions of Chapter 9(commeoP
ncing
e with Sadon 7(trp)ofDivWon 3 of the Business W Purcuiou Code.and my liecrueu
IefwlfonendaIf -f �� DEMO EXISTING HOUSE
7 N
I Lkeo Cl Lic.•
�' Data a Commence-' 1/31/06 SHEPHERD CONST PD FOR BUS LIC
ARCHITECTS DECLARA ION
I undersand my plassmall be,used as public records
ir pre
C Licensed Pmfeuionel
Oat I am exempt
U apt from
DECLARATION
< I hereby.(firm that 11. eu sin faro the Contnaec's Liease Law for the
D o which moon.(Section 7031.5.Business and n,demolish.
Code:Any sty ler cowry
S$ whichitsbrequires•permit re cores ft picot unpnw,demalwh,nr repair any auu Ont
tprior has he is
its issuurcFsion'to
thurbilounl for achperselttue mOlea Laedwument
< (c me licensed Saon7w )ofDiv on3of ft0wiwr'mdu elaw(Chapur9 Sq.Ft.Floor Area Valua[' Ty500
(comm cmingwiNSccvon 70nd of but.frsh al Bwino and PnfAny vi Code)of
$ Nat h u cumpt thrt(mm and the buss for du alleged eumpdon.My violation or
Section 71131.5 by any applium for a permit subjects the applicant In a civil Penalty of APN Number Occupa cy pe
not mare than nw hundred dollars(5500). 37528030 . 00
0 1,a owner of du property,army aoployceswith wages u their ole compensation,
will do the work and Neawaure ianotintended oroffaed fu to(Sm.7044,Business Required Inspections
red Pmfeuioos Cade:The Contractor's License dare neot apply to an owner of q P
prop'"who u"w"Or imprmes thereon,and who dean s ech work'hen.1 f a through hu
ova employ=,provided that match Improvement me not lntandel m offered for sale if.
owewithin
O /
hwt,we building or improvement is aW
id hin ore year of completion.thas
e owr.
builder will law the burden of pmvin8 Nh atdid not build or improv fn purpose of
esu.). ®�
❑h u tweet of ct property,,Basin=and contracting with licensed m eubrs i.
cause a the project(Sec.7044,weerof sed property
who builds
Cade:) pro Conuaton.LI-
w
cause Law coca not apply in at owner of trrapeny.who bullas or improves thereon.red
who contracts for such pmkcu with a eonvenor(q licensed purwem to the CarmaM1
License
beaLaw.
❑lam uempt undo See .Bk PC for Nu wan
41 Owecr Data
WORKERS COMPENSATION DECLARATION
1 hereby Man under penalty of perjury oro of the fallowing declar ma u:
0 1 ban and will maintain a Cardinale of Consent N self-Insure fat Warkers Curawn.
salon,u provided far by Section 37M of the labor Code,for the performance of the
work for which this Permit Is issued.
0 1 Mw ad will maintain Workees Compensation Insurance,as required by States,
37M of the labs Cede.far the performance of the work fawhich this permit is issued.
My Workefa C9�PrrPeu�a�d�anlnurnnn cava and Policy number
Caller. e�T-C V Policy No.:
CERTIFICATE OF EXEMPI70N FROM WORKERS
COMPENSATION INSURANCE
(Thu section need not incompliant if tie permit is fortune hundred dtllara($100)
or less)
1 sentry that In the performance of the work for which this permit is issued.I shill not
employ any person in my mmrcr ais/o?b rge abject to t�Wmkeri Compenutia
Laws of Cvifomi&.Data 7.4/ //nz='=
NOTIAppliCEt
NOTICE TO APPI! G a(u m pr Ce finale of Exemption,ya u most
.J Qbecomeh comps ithWohere Co codon MILmai of the Labor Code,you must
forthwith comply with ash provisions or this permit Mtll bu deemed revoked. '
'y CONSTRUCTION LENDING AGENCY
(r
4 I hreby eRrm Na there as construction lending spray for din porronnase or
i5S> the work farwhich this ec Permit is issued(S3097,Civ.C.) '
4.
lenders Name
=2 Lender's Addmn
L)Q 1 carry that 1 lave reed this application a d sun that the&bow infanadit Is
Iy ;•". cones 1 agree in comply with all city ad county ordinances nd sure laws relating In
C)rV^ building construction,and herebymoNmin hepreunutiws of this ity in enlet upon Ne
[Tt almw-mentioned property for inspection purposes.
(We)agree to an,indemnify and keep hamlets the City of Cupertino against
H Ilabilidu.jedgmonu,cure and expenses which may in my way tau against said City
ATIO
U F4 In comaxwence of we grating of Nu permit. %Z
SOURCANT UNDERSTANDS ANLyWILL COMPLY WITH 3(1(1 INT Issued by: Date (J
APPLICg/EREGUNDERST DSAN`(DI IL /V,
Re-roofs
Sl�jr iSf ion auumr .—'0m
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or town building Occupant More or handle hauutlous mawvd
as donned by the Cupertino Municipal Code.Clapwr 9.12.and the Health and Safety
Coca.section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
C]Y. ran
Will the applicant or future building Occupant We equipment or devises which If a roof is installed without first obtaining an inspection,I agree to remove
t barudous air coauminenu in defined by the Bay Area Air Quality Management all new materials for inspection.
District? --//
0 ye, HNu
I have mad we I naMms materials requirements under Chapur 6.95 or the Celiror.
nia Health&S.fctyCode,Sadmu 25305.25533 aml25534.1 understand that ifthe hiiarig
data not cuncrul,have a wont that It' my mapouiMlby w atify the Occupmt of ftrequire ntswhichma h prior IssuanccorsGentneawor aP . Signature of Applicant Date
Ow aatb ed at Win All roof coverings to be Class"B"or better