01070011 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS PERMIT NO.
10282 PARLETT PL 010yy70ss0yy11
8IF�sN DATE IWAN H AND ESTELLA C TR S A07G/05/2001
PHONE: SANITARY NO. CONTROL NO.
n c z ARCHITECl/ENGINEER: BUILDING PERMIT INFO
O
w- BDG ELECT PLUMB M[CH
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i P LICENSED CON DECLARATION - lob Description
O i❑O I hercpy affirm aha 1 em u
licend under provisions of Chap¢r 9 m
(comencing RER00 F.
is in fail lone ad effect. onJaf the 0usiness and Professions Cole.unJ my license
_„sem iammnromeartaercet.
z z a Lice ,Class ( - r39 Co. r'75_2EG7
O y U Doc SSS/o/ Corac or
ad,u O t• ARCHITECT'S DECLARATION —V
F } unylerstand mm�y[�lpany�hall bs'ua us public recuNs
w rc p O L�cn ed/Profersm—conal
OWNER-BUILDER DECLARATION
u = i hereby affirm that I am exempt from lcroG the CoatnLicense Law liar the
I_z as following rca..r.(section 7031.5.Basincss sad Profession.Code:Any city or county $9500
Exp which requires a permh to construct,alter,improve,demolish,or repair any structure
n 3_ -Poo t ¢ arrt<.alio req the pplieam for such pemuuofka 'erred slaumens ._._....._ .
(hot he it sed radomed,noth pran.adeoftheCommctm'. I L (Chatter9 ,3 f®4F6CF�K.4[ a.,. ,-n i h ! Valuation
(co ,with Selo lt") f Division 3 onhe Buame adrasions Code) Lt,�,i',f s.,:.._ _ ,s..•S't6 lJ},
It,that tie is ckempt therefrom and the basis for the alleged exemption.Any violation
-of Seems.7031..5 by any applicant for a permit e.bjcc.the applicant to a civil Penalty
ofnotm..than five hundred dollars(550o). 3 0 5APN PRIFIME j Occupancy Type
❑1,asownerofthepropert,ormyemployeeswithwagesastheirsakcompemation. 307 — INSULATION !
will do the wars.and the structure is not intended or offercaTorsale(Sec.701q, 601 - ROOF TEI l 'fFI05 CCtiODS' •rn-1,
...
Boiiness aid Professions Cade:The Convector's License Law does no,apply m an Q p
owner of property Who build.,or improves Ihcrem,and who does.such work himself 602 — ROOF PLYWOOD NAIL
or through his awn employees.provided t1da such improvements are not intended or _ _
:afTered for sale If,However,the building or iinpinvement is sold within one year of 603 - ROOF BATTENS- - --- - -- -- ----
completifnn,the ownerfbuiiderwill have theWiden ofprovingthathedidnot buildor 604 — ROOF IN—PROGRESS
improve purpose n
am exclusively
x L ive. o
_ -
01'
1,as w•nerrof the n . . .... ..... .... ... -
grape y,um exclusively d Proctin'with licensed convectors m
_ onswct the - a lace
. to a owner o and Profession.Ctde:)The Contractor'sn. t f
Licence Ww docs not apply no an owner ih progeny who builds A,improves thereon,
anti who conlrucns fur.e' projects with a commnndsLlittnssd..pucmant to the - - - -- - -----
Cmmnoe diva cWw. 1
❑I am exempt under See' t '.<S,&P C far this mason 1
Owner •. s - Date - -
WORKER'S COMPENSATION DECLARATION
ercby affirm under penally of perjury one of,the following ticdarations:
1 have'end will maintain a Ccrtilicatc of Consent to self-insure for Worker'S /
_ Compensation, a.,provided for by Section 37W of the Labor Code, for the
- _ performance of the work for which this conn,is issued.
_ C 1 have and will maintain Worker's Cnmry:nwiiun Insurance,us required by Section
3700 of the Wbur Cade,for the performance of the wad:for which this permit is
issued,My WorkersC pc .-i Insurance carver and Policy u are
Ca M Polcy Nn C1OVAG0.2�37 t'. '` r ist. '�: i +, i i s t.'• : )'JLC: 1, d
_;"CCRTIPICAT0 OFEXENPTION FROMORS KERS " s.. ks•s 1 +""'1. 1 +
COMPENSATION INSURANCE _.._..__._...._--_Less_-.._..._____—____._.___. - ___..._ _ _--.____
' I'"mik".0ion need not be completed ifthe permit is for one hundred dollars }C'alh";':. s l ('•
IS IWI or less.) . ,
..t 'I citify that in m pc f non¢ins,,s at a fm wh' h bbj'vd 1.the awed,
Coopoat nnploy day persomof
in anyate er w as io become.wbjcn to the\Vork<ri
A I¢ant . _California.
Grmpensltmn Lads of Collfoma
-. _g _. . . ..... .... .. . .. ... _. ...Less - ._.__..
NOTICETO APPLICANT.If.afe,trakm Ihis Certified.of Exemption,you should
Z ben 63 nt me Wo leaf:C means f p ons of ih WMr Cale you oust
0forth ith comply tilt ch provisionso ,hi pc lxhall be do Wresoked
� _ .. ._.
Z liG n'';!CONSTRUCTION LENDING AGENCY- t "'
�'� i herepy urian Nm .bit
issued
(See
IenJing hgency for thi Mrrtirnianm - '
Wthe work for which this pennil is issued(Sec.J0a7,Civ.C.)
[� Wer','Nnal _. . _ ... ... _ ..
�' Mcr's Addr<zJ
V 0 I certify Mol 1 have read Ihis application noxi neem than that above information A t
lz..F correct.I agree to comply wiffi all city and county,ordinances and stat,laws mlaing
OU to building construction:and hereby audinnicerepre.emanives of this city to enter upon
the above-mentioned property for inspection purposes.
'i"'.0. (We)agreenn.ave:Indemnify and keepmarobs.,the City ofCaadmaoagainst
t 7-m liabilities,ludgri costs and expenses which may in any yway drams,against said
Z City in mrx„ a,rc of the gra ti ng of this punct ll.
_
APPLICANT VNDERSfANt�ANDWILL COMPLYWFINALLNON-POINT Issued b ': Date
S01-19 UEGUIa1f1fYn, ./ �''. -` ZZ
/ )
4791
Signaarc of ApobarYCrniraetor:� �. •Date' Re-roofs
„ - HAIG\RDOUS MATERIALS DISCLOSURE
. -
Will the applicant Or f bre re (ding neemicant store or handl mou
lta ,beasnal Type of Roof a
as
definod by Ore C.panim,Mtiaicipaak Chapter 9.12,and the Health and Salary
CJ S i n2553-(al s tt i.. - r` 1 r Ji f
oY, CCC3TSNn' k':: I _.All.roofs shall be inspected.prlor-to any roofing.material being installed. .__-_.__
wIttheapphr t - f t build s t twetl 'p t devices- wmch If a root is installed without first obtaining an inspection I'agreelto remove
conch dais air cat t. .d,Ca ynM1 ByArcaA (R Its Mamgarram
District? - oN all new materials for inspection..Applicant understands and-will comply with-
Yes
all non-point Sour re natio _
1 have read the h saN u..oaten I q t under 4 1 un bst of Ne
California Health&S I,ty ar J S t .25505 5533 d once;
C P understand that
iffleb dd 'does note ort tl)h cdiamond.- that t my pct 'bliryt unity the Dp
occupant of the requ vox.which mus.be met prim w iswance of a Certificate of ` A
ci pccupan y.,
,y ✓S Signature of Applicant_, .... Date
�,�as(I 7 Gy All roof coverings to be Class "B” or better'
_ Owwncred,gem Date
OFFICE ._