06070187 CITY OF CUPERTINO •�+w�t• *+"`
BUILDING DIVISION PERMIT e,0R
BUILDING ADDRESS: v LINDA YOUNG PERMITNO.06070187
19651 MERRImm nn
OWNER'S NAME: PERMIT ISSUE DATE
LINDA YOUNG 07/27/2006
E: SANITARY NO. CONTROL NO.
ARCNnECrIENGiNEER: BUILDING PERMIT INFO
ZZ BLDG ELECTO PLUMB MECHO
p LICENSED CONTRACTOR'S DECLARATION Ib Description
1 hereby unfits,Ww t 1 IkonseE under provisions of Chapter 9(coO
mm maing P
.IN Smdon 70IM0 of Divialon 3.r am Bummas and Prefemons Code,and my[fee=ls
I.full fr...ad g [t({ �((1(e MODIFY EXISTING DINING ROOM WALL, EXTERIOR ONLY
,pz LleenmClsss�Lk.« ELECTRICAL INCLUDES OUTLETS AND SERVICE. ADD
i Dam Contractor
ty As shall CTS DECLARATION LIGHTS TO KITCHEN/HALLWAY
i of I understand my plane shall be used u probit Drecords ECLARATION
i myU
LLp
Licensed Prolrssionsl
OWNER-BUILDER DECLARATION
i I hereby.(Rte Nal 11. eusinl s an the Cssiond o e:enseMy c taw for Oe
:00 whip re moon.permit
i 7031.3.Business and vefesiom Cale:Any ally of county
:2E! which require a permit o cansuuet,alcor.Improve,dcmul's4 Or repair my sbucbre
7iy^ priw b.Ilemoce.alore in rho provisions
lar Commamdo lose,Lnedwmment
< Net he k liunhill with Se not o Ne provivisns 3 1 the nuool,.4 Pro Law(CMp e 9 Sq. F[. Floor Area Valuation
f�9 (cat he is exempt Seclfan70ndthasIdiafrmfNeegedromdan.AnynsCode)m $20000
•�.. Nat he ts exempt Nmefrom and Ne bole far de alleged exemption Any violNun of
Section 7031.3 by ary applicant for a permit objects the appikol to a civil penalty Of APN Number Occupancy Type
of mart No five hmMrtd do1Wa(5500).
0 1,as owner of the property,or my employee with wages ss their auk comp aAdon,
will do the wan.and to structure is of Intended or offmcd for sok(Sec.7044,BusinessRaired Inspections
and Aofewom Code The contractors tors LicenseLaw does of apply m o ower C of q P
property who builds m izepmves thseen,and who does such amts himself or nrough his
Mum employes,povided Nu such improvemuts se of handed moOeteJ fm sale.if.
haw ner,the building or improvement U old within ane you of compleum.the aoer-
builder win have the burden of proving that he did tet Mid m improve for purpose of
sskY ��IJ VI/ Ds� ne!e'°
0 I.u owner of the prepny,am uclusively contracting win liunsed cmnuuon b
Ll-
cause
Lt d mnkn(Set n an Bwkos aim property
who
CodeI Them thamen,and
whoa Law doe not apply je anwith
Owner of proper(who builds m improvm Coreran,and
who contracts for eurA pojecu wIN a contexelal(s)Iiunsd pursuant an the Conuomf.
Lice.Law. �",I /Ly p
❑Lam uemDt undo Sea ,BBPC(or Nis rtasoo � e7V— T�l'7
s
Owner Date ww/�sswwy..,
WORKER'SCOMPENdurym DECLARATION
1 hertby aPrtm under pemhy of prjmy ate o(dte following dedwions )Iry`'till Jlllyll IIA\\\VI/II I\1\V'r�.
aveandwillmainudaCe fl.wof Consentmself-insure("W9rke/iCemPen-
u provided(a,by Rection 3700 of the labor Code.fm Ne Performance,of the
wort for which this Permit is issued.
0 1 have and will maintain woraces Compensation Insurance,as mquired by Section
37W of the labor Code,for the performance of Ne work for which Nis permit la Issued.
MyWorime.Comppmoton Insurou a
d Politym rare
monu '
G.rriu: fr'WVIT policy
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This ucdm need tet W coaplewl if the Permfl is fmanehum ed dollars(3100)
lir less.)
1 cmdfy Nal in rte pr(orro nee of Use wart for which Nis prmh is fumed.1 man me
employ any Peron in any mono an as in become object to Use Wmrkera'Compemadon
Law.of Calffomia.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ceniacate of Exemption,you should
become objet to the WortseYs Comp etloa previsions of Ne labor Coda,you mut
Oforthwith comply with such provisions at his Permit shall ho decoed revoked.
Z tiCONSTRUCTION LENDING AGENCY
[•+ I thereby M.Nat Vert Is a commchm lending agency fm the Fri..of
a 7
the work(m which des Permit is issued(Sec 3097.Civ.C.)
aQ Iattle/f Name
M Z Landers Address
U O 1 curtly that I love read We applicom and sum Nat Ne above information is
H ca a 1 agrte to comply with all city and county oNlmnm and sus laws resting to
l�U building cormction,and hereby authorize repmonutives of this city to enter upon the
W ahmvc-mcntioncd property for inspection purposes
6. (We)all=to save.indemnify adtecp ber aless the City of Cupenino against
save
CA Il.hilitiea Judgmcns,cons and expenses which may in coy way accrue against rid City
t.)7 In consequence of the granting of this prmh. 27�d•�
r7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RECU ONS ., / -
7M44)to Re-roofs
Signature of im UaFWr
.ARDOUS MATERIALS DISCLOSURE Type of Roof
WIII Ne applicant or future building Compact sore or handle loom mm material
as darned by the Cupertino Mumcl ode.Chmmr 9.11.and the Health and Safety .
C .Section 25331(a)? �/p)kC All roofs shall be inspected prior to any roofing material being installed.
❑Yes 17 Ne
Will the applicant or future Wi g occupant me etimpmmt m ICA=which If a roof is installed without first obtaining an inspection,I agree to remove
McRrdmm air conumem.nra. red by the Bay Area Air Quallly Mmagemeo all new materials for inspection.
m?
0Yes Nu
I ham read the hvardom materials requirements under Chpmr6.95ofNe Califm>
niasmalih J:Sa(ayCode.Samimu15503,25533sm125534.1undcomd Nuifde building
Joey tet currently have a abot.Nat It is my responsibility to Codify the occupol of the
requirements which mss lar met prior as isoance of a Certificate of ompuncy. Signature of Applicant Date
Owner or authorized agent Dam All roof coverings to be Class"B"or better