04040127 CITY OF CUPERTINO rp,?r mss.%vviceeaaeo-eyr.Nt r7r� c" ' �X'f§�=- :
BUILDING DIVISION PERMIT CONTYtA.CT>QX2 TNFUA�'TON' "''
BUILEINGADDRESS: YARON & NANETTE VIDAN-PELE ERMIT N%4 04 0 12 7
10288 RICHWOOD DR
0 NER'SNAME: PERMIT ISSUE DATE
YARON & NANETTE VIDAN-PELE
E; SANITARY NO. CONTROL NO.
ARCHTIECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
]
SIG 0O LICENSED CONTACTORS DECLARATION
Ci i hereby affl m that 1 am licensed under provisions of Chapter 9(commencing lob Description
with Scctlon7=)).fDivislan3aflhcB i still Pro(culons Code,and myliccnse is
'a� lomuml aorrm ADD 810 SQ.FT.
Z�z Dme t
E 11 Dau ARCHITECTSalbe, e D ter ATION
My �nunJ my plus Nall he used u ubOc mcnrda
Lxcnsed Profranonal A, �®
OWNER-BUILDER DECLARATION O
I harchy.(Sect Bin 11. exempt from the fission o e:enseAny c Law for the /Ie /
O O following mason.(Section 71131.3,Business and un,de oli Cole:Any city m county
$ which its isca n permit re eom;the wet Improve,demolish.m repair say amateur A/z000
prior miu issuance.aUu requires;Nc appliuntfwsucl,Permit ufilc aslelud wument
gg <
don heI.licensed pursuant mthe provisiovid'ftContractor.U...Law(Chapear9 Sq.Ft.FlooryWValuation
$ 3 (commencing with Section 7000)of Division 3 of the Business no Profesiona Code)or
Out he is attempt therefrom and 0e basis for the alleged nsemption.Any violation of
Section 7031.5 by ul applimi fm a permit objects dse applicant to-civil penally Of -i�6�610 0 Occupancy Type
not more Nan Etta hundred dollars(5500).
b u miner of the property.or my employee with wages u their ols compenaatlon,
will do Newark and Neatmom.is Out lnundedororferm!formic(Sm.70M,Business Required Inspections
and Pmfessions Cade:The ComranoYs Licuue Law doe Out apply lo an owner of q P
popeny who builds or im prove Narcan,and who does such work himself or through his
own employers,provided that.ch improvements are not Intended oraRered(orale.IC
however,the building or improvement is sold within ons year of eompledon.the ownct-
builder will hose the burden of posing Wt he did wt build or Improve for purpose of
sale.).
1,ace anon.of the property,am"elusively contracting with licansed wntracton m
carm uct Ne project(Sec.7044.Business ted Perfedans Cade:)The CanbacuYs W,
course law doe not apply u an owner of property who build,or Improves thereon,and,
who contracts for such pajeca with a convaclor(0 licensed pursuanl in the Contractor's
41,haw
se Law. '
am n to " Sea .B& Cf rthls mue
. � W RKERS COMPENSI hereby affirm under penalty of perjury ane Or the following declarations:
and will maintain a CeNfiau ofCauent to self-lucre for workersCumpen-
u too.u provided for by Section 3700 of the labor Code,fear than Performance of the
work for which this permit is issued.
❑1 haw Md will maintain Worker's Compensation Insurance.u required by Section
3700 of the labor Code,fa the perfoonmee of the walk for which this permit is Issued. -
My Worker's Compensation luumut ante and Policy number are:
Carrier, Policy No.: '
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
enm auction need not be eompteted i f the permit H fw one hundred doll an(S 100)
or less.)
1 mousy Net In the perfoonawc of the work for which this permit is issued,I wail not I
employ any161 ronin ymenwrso alsmbes�rl cmbjecitathe Worteri Compcmgw
Laws at Califo ^ ,.
App c t \ t/�
NN TO PP CANT.If,after skin this Certificate of Exemption.You should
e object u the WOr S Compenssdon Provi6Ons M Ne tabu Cada you must
,z `forMwid,comply with such previsions or this turned,&hall be deemed rooked.
.zi 0 y0.j CONSTRUCTION LENDING AGENCY
F' 1 l hereby affirm Nn Nero is a construction lending agency for that perfunneno of
C> the walk for whim this permit Is issued(Sea.3097,Civ.C.)
W�Q Leaders Name
r7. z Landers Address
fJ 0 I sonify that 1 Mm read W,application all suis Nat Ne,hove infonnwon is
Dr comm 1 ague to comply with all city and county ordinances and ensu laws relating lo
0 building commutation,and herebyauthOdm representatives of this City tO enter upon No
W above-mentioned properly for inspection purposes.(we)agme to ave,indemnify and keep harmless ftCity of Caprt(no against
^'V] Iiabilidea.judgmcnu.caw andcapeuu which may In say soy acerm.gainstsald City
V t`+ APPL IncoCseNf UA
f DE STANDS tND WILL COMPr WITH LL1.NON-POINT Issued by: Date
OURC R G T NS. 2� t7"I
-I Re-roofs
ignuu ofA lien ontrutor Dau
HAZARDOUS MATERIALS DIS OS Type of Roof
Will the applicant or forum building Occupant store or handle huallou material
u defined by the Cupertino Municipal Cade.Chapter 9.11,and the Health and Safety
Cade,Suetian 155310)7 All roofs shall be inspected prior to any roofing material being InstIled.
❑Ye (�Nu
will the applicant or future building occupant nae equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It haeuau air conumi"nts u Jelled by Ne Bay Arta Air Quality Management all new materials for inspection.
Diurict?
El Y., No
ItuunlwsmaurlalsmquimmenuuvkrChapur6.93ofNcCalifor-
niaH11,10
,sxdm255115.25533W25534.1udenwbthuifthebuilding
J •unmt Nat It is my mapnsihility m p01'y tie oceupant of Nc
hetMmetpriorIn auuccofaCefB at qs q ,O�v. Signature of Applicant Date
r or authorrred agent )/lY L Date All roof coverings to be Class"B"or better