08060244 CITY OF CUPERTINO at = �s�s!nge.•stir.«�ssip ��- R*�,gT`( ':>
BUILDING DIVISION PERIVIIT "�0s\I11\(?C� 4j tt, Q, Y-glV'!
BUI I,G D RFSB: PERMIT NO.
57.� TI. KENDLE ST TBD — TO BE DETERMINED 08060244
NER'S NAME: - PERMIT ISSUE DATE
FRAU 1.,.1.0 07/22/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHIT tENGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMBm
MECH
l� l� 0
o p LICENSED CONTRACTORS DECLARATION
7d u 1 hereby affirm Net I w Ibcnsed umbr pmvivena of Chapter 9(commencing Job Description
^z1 with section 7")of Division 3ofNeBusocautand! mf siren Code,and myEamcu REMODEL EXISTING POOL ADD DECK, ADD SPA
in con lame and
j _ Licenu One, Lic.g >t
Dau ontredar
nk- RCH CTS DECLARATIO
ee 2-e 1 uncle red my plans shall bo used u public records
JyU
yDin U,.d Professional
3 OWNER-BUILDER DECLARATION
F I boreb, M.Nu I an eumpt from the Con ateme,License law far the
O o following minion.(Section 70I LS,Busine; Nd PmfC4tiom Civic:Any city of county
$ which requites a pmmit u mount after,Improve,dme.l ah.or repair any stmetuu
mforto ire issuance.all mquima the applicant for such pmmit In rile a signed"=an,
that the isbcenudpumuamtothe pmvisloncofNeCammelm'sue<meLaw(Chaper9 Sq.Ft.Floor Area Valuation
(commencing wide Sztian7000)of Division 3 of the Brei.tied Pmfutiou Code)w 56 00
$
Chat be is exrmpt Ncacfrom and the basin for Ibo alleged.0—Any H=1 of
Section 7031.5 by any applicant for a permit subjects the applicant a civil penalty of
anra NNumber t moan five hundred dation(g5BD3 3 2 61310 5 Occupancy.� P y T*
❑I.u ower of the prvpmly.a mY wplaym wide wage u Heir tele compewdon,
will do the wart and Neawem.u am brooded aofrarod for sale(see.7044,Butte..•
and Pmfma om Caen:The Comrumfs L)mua law data not apply N an owner of Required Inspections
prop ertywhohubIds irepmvv Nmcon,andwhodimsamM1wah M1imulfm Nroogh his
own employees,provided dere stehimismid ntsare.at intended aoBeudtressle U.
however.Ne building u Mpmwment is sold a did orc yw ofimproe for tlm owmr-
builder will low Ik burden,of proving Nu he did eat build or improve far purpose of
tib.).
❑I.u outer of the property am reclusively convecting wide licensed..=am N
couuuct the project(Sec.7044.Business and Profetiam Cade:)Too Commem's W-
ceme Law dao nes apply to an o mer of property who builds or improves Herm t.and
who contracts for such projects wide a eanuamems)licenced pursuant in Ibo Carromme3
Licame,Law.
I am uempt undo See B h P C fe,this manes
40 nm Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under potWty of perjury one of dee following MrJumimts
❑IMwoM will mainuina Cenifuwoof Canunuo telt-imam fa Warkefa Compere
aeon,u provided for by Section 3700 of the Labor Cade,In,the Rrfam in¢of the
west for which this porm(t is banned.
1 have and will munum Wertces Compamation lam rang,u required by Sa.7ian
37m of the Labs Code,foe the perfo m..fNe u mt for whim this permit is ire .
My WorkeY tin o e carver and Policy n m f
Grtier: Polley No.:
CERGTE PEXEMPIION FROM Off ER '
COMPENSATION INSURANCE
i'llus umm road ambecompkind time permit is faone hundred dellan($100)
nr less)
1 atify that in the perform, of the work for which Nis permit is issued.I shall am
employ any penin in my manner an as to became subject m dee Workeri Compenadun
Laws of Cniforoia.Dau -
AppEmnt
NOTICE TO APPLICANT:If.after madding this Certificate of Exemption,you ahould
became subject W the Woheh Corpcnssuon pmvimmin a the Labe Code,you mute
.J,z foMrith comply with such pmvism.or Nis permit atoll he darted uwkcd.
OCONSTRUCTION LENDING AGENCY
1 hereby of irm WI Nem I..concmmthm lending agenry far du performance of
IY the worst for whim that,parent,4 issad(see.3097,CN.C.)
W Q Lender's Name
z L<ndefa Add.
U O 1 cueify that I have rand Inds appliestian W mm Nu de above Information I, .
LL CmreeL I agree u comply wide W city W county onlinamxa and sum law relating m
O boiddingconsvation,and hemby aothorm upoemontim of Nu city mentor upon Ne
above-Cann maedi property for inspection purpmeg
(We)ague to eve,indemnify and keep hamlets the City of Cupertino again
Nen liabilitiu,judgments,ante W expenses which may in any my accrue Union,mid City
U,Z in comeaquence of Ne granting of this peri.
" APPLICANT UND STANDS AND ILL COMPLY WITH ALL NO OINT Issued by: Date / 22.
SOURCE REGULA Ns. d9 --
f�I Oofs
Crimean,Sig Apel' onor p u
Us MATERIALS DISCLOSURE Type of Roof
Will Oe apt tofutuu loading aaupantstaeCor Nndlehvallou material
as defined by Ne Cupertino Municipal Cade,Clupmr 9.12 and an.Hudde and Safety
Section 3443x(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Will On applicant or future building occupant ore equipment or&,I.which If a roof is installed without first obtaining an inspection,I agree to remove
emit huaadnu air conumimnu u defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yen u
Lha Ne haaudouti and earpiiumenatuWerChaji rGb 93ofdeeGli(or-
maHmlNk ctyC 5.3$533 W2533d.iundcmmnd Nulfde building
does note Y 'umy nornmirlitY in notify do asupect ofNe
regmual arm isr..faeeruliateofOcc'umancy Signature of Applicant Date
mina <d agent Damt All roof coverings to be Class's"or better