04060101 CIBUILD
BUILDING
PERMIT YCON''1'$4CTC)R NF(JO TA" lf)N
BUILDING ADDRESS: SIERRA LUMBER & FENCE PEKMITNO04060101
21952 LINDY LN
OWNER'S NAME: PERMITIS9UEDATE
CANDAN TAYSI 1711 SEN
E: SANiTARYNO. CONTROL NO.
(408) 286-7071
ARCHITECTAINGINEER: BUILDING PERMIT INFO
BLOC ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION Job Description
1 h.mby afOrm Nat 1 am licensed send.,provtaio u of Chapter 9(commencing -
with Sation70(kOofDivinion Softhc Busman and P.fcuin.Code,and my lice..is /J1A (� p��
mmnf.roeandefr«t. REPLACE (E) DECK Q ,fidg�LS
5—M License Cless Conn
nip Dem Cun DELL
42< ARCHITECTS DECLARATION JUN 17 2004
<� i understand my plans shell be used as public records
Di•s
C t; Licensed Pmfeasi...I u Is e1�
3 OWNER-BUILDER DECLARATION BUILDING
UIL ®IpA G
+� 1 hcrehy affirm on 1 1. exempt from tc Cantns C's License Law for the {(a vva
zoo following e.nn.(Sado.8onstr B,ma.and w,demolish,
h,or:Any city or county
$ which mqus u n asmit re construct,alcor.improv,be ermit t,nr a pair any structure
prior msllanae),also requires the for tachpicessignedstatement
that he is licensed pursuant 70th)previsions of the Contractorsusincend LicenseLaw(ChapterCode)
Sq.Ft. Floor Area Valuation
y $ (commencing wit confroon 91n0)ofdth Dasicfon rn(the Bped weempt Professions Any vi Code)or 3500
� .. dot he is escmpt thme(rom and she bas for the Jlcged.esemptlon.Any violation of
Section 7031.5 by any applicant for a permit subjects to applicant to a civil penalty of APN Number Occupancy Type
not mole than five hundred della.($500k
❑1,u owner of the property,w my employems,wit wages as their sole compensation,
will do the work and the moseture isnminteadcd mortared forest.(Sm.7044.Business Required IHS eCt10DS
and Profs..Code:The Contractor's Licensee Law does not apply to an Owner of q P
propertywhobuilda orimproves theme ,and whodassuchwork himselfor trough his
own employers,provided thatsuch Improvementsam notimmnded oroffeed forsale.If.
however,On building or improvement is sold within can year of completion.the owner.
builder will have the burden of proving that he did not Wild or improve for purpose Of .
sale).
L as owner of Onproperty.am combatively connecting with licensed contractors to
en truct the project(Sec.71144.Boston.and Professions Code)The Cmummr'a Li-
cense Law does not apply to an owner of property who Wilds or improves themon,and
who contracts for such projects with a conlracmr(s)lianxd pursuant to On Contactors
License Law.
❑1 wor fc—m— under Sea .B&P C for this...a
ncr a me
WORKWORKE S COMPENSATIO TION L ff �oY
I hereby drion under peaty of perjury On ft1h,RR''ffo/allowing declaretimee
have and will maintain aCmulate of Consent to relf-insure for Worker'sCompen-
tion,.provided for by Section 37M of the ISWr Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,.required by Section
37M of the Leber Code,for the performanoe of the work for which this permit is issued.
My Workers Compensation Insurance tamer and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
fDskuction need not be completed time permit is reran)hundred dollars($HO)
or less.)
1 certify tat in the Performance of Inc work for which this permit is issued.l shall not
employ any person in any manner u as m become subject o the Workeri Comp oc ation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If.after making this CcrEDCae of Exemption,you should
become subject in the Wmker's COmpenatom provisions Of the Labor Cade,you..at
QZ forthwith comply with such previsions Or this pmmisahall Wdcemol ewism.
.Zi O CONSTRUCTION LENDING AGENCY
[�. 1 hereby affirm no,there is a construction lending agency far the perfurmamc)of „
�i> the work for which this permit Is issued(Sec.3097,Civ.C.)
IT3 Q Lenders Name
z Lenders Address
U Q I ceNfy tat I have road this application and sum tat the above information is
F correct.I agree to comply with all city and county ordinances and state laws minting to
OU building construction,and hereby authorise representatives of this city to enter upon the
W above-m)nduned property for inspection purposes.
gy (We)agree to use,indemnify and keep harmless the City of Cupertino against
t..,y liabilities,judgments,costs and earcrom which may in any way acerae against sold City
U in consequence of to granting of this permit.
Tran APP /V
UNDERSTAN AND WILL COMPLY WITH ALL NON-POINT Issued by: Da
SOU CER ULATIONS.
gj Ms. -ll•G Re-roofs
nature of ApplicanUCOponctor sok Ir
HAZARDOUS MATERIALS CLOSURE Type of Roof
Will tc applicant Or future building oecupu m or handle haardova material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cod..Section 25532(.)7 �(' All roofs shall be inspected prior to any roofing material being installed.
Y.
Will the applicant Or taloa building Occupant arc equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
tit bevardous air contaminants as dermal by the Bay Area Air Quality Management all new materials for inspection.
islrict7
❑Ycs D<Nu
1 have mad the haaardtms materials mquirmunts under Chapter 6.95 or the Caliror-
niaH ctyCodc,Sections 25%5,25533 and 25534.1 understand Out iftW Wilding
f
cure sly how a mean, t it u my responsibility to notify 7W meupant of t.
ems hichmustWmctprio uanceor.cmincateofOccup ry SignatureofApplicant Date
YAll roof coverings to be Class"B"or better
r mhummd agent Dam