06070076 CITY OF CUPERTINO �sl�,�� +��I�i�!g�rsa♦* /,"' *"�*�Y��^ '� "' �T'"'"' '
BUILDING DIVISION PERMIT L�,CQy,^;1lt�C�aVR111 O s^,10. �. :
.a�.i
BUILDING ADDRESS: x ROS ELL HOMES INC PERMIT N0.06070076
10684 STEVENS CYN
.R'S NAME: PERMTI L95UEDATE
STEVEN CANYON VILLAS LLC 1202 MERIDIAN AVE 6
PHONE:
SANITARY NO. CONTROL N0.
(408) 267-9400
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
y�2221110 0 0 0
mpp
LICENSED under
DECLARATION Job De$Crl pysV�
Sia
Ej 1 ion 7 allure Nu I am of
under and
Profss of Chapter 9(commencing y■q�— NA gJbp,
with Section)OTD)of effect
3 of tM Business and Profcssom Code,and my license u {®�f,a/�fl
t in full forteanticffcci tdg DEMO RESIDENTIAL BLDGS
i Liceenc ass Is.N
j F Da¢--H—Contractor 7
A Hf1ECfS OECt.ARATION
i < 1 undersand my plans shall he used as public rtrnrth V✓t '� I)j.6
itL
u.t; Licensed Professional
'ro g 0. 1 am BUILDER DECLARATION
I S 1 M¢hy a1Erm Nat 11. tempt from tM Caavct Col,Any c law for the
.p0 followingmen. 9117 L5,Business and Profcssinen Cale:An cit or
Y Y
�m�
which tcquima a permit m constroct.alar.Improve,dcmoltsh.or repair any swclum BUI� � l U'U U�Q
,Z< pin.rbits i....C..]so requims fliumplicanl fil Wch ImmSit to file aaignedslalemenl
Nat he is licensed pursuant to the provisions of the Continent's Umnde Law(Chapter 9 Sq. Ft. Floor Area Valuation
IFC (commencing with Section]000)of Division J of tM Business and Professions Code)or
Nat he in eumpl tbom(rom and the basis for Ne alleged exemption.Any violation of
Sudden 7071.5 by airy applicant for a permit subjects the applicant In a civil part of r Occupancy Type
nor,mom Nan firs hundred dollars($500).
❑I.asownerofthepmpmty,nrmycmploymwiNwagesudteuxlccanpeenadon,
will do Newark.ind themrucumisnotintcndddoroffered fortale(See.9044,1business
and Pmfeulent,Code:The Contracmh fume Law does rot appy 0 an owner,of Required Inspections
property who builds or impost themed,and who does such work himself or through his
own employees,Provided that such improvements are nothre,rded or offered persalt If,
however.Ne Wilding or improvement is sold within one year of completion.the rwae
builder will have the besides of proving that M did not Wild or improve for purpose of
mak.).
I,as owner of the prepeny,am exclusively conducting with Betted contractors to
conswct din prolies(Sec.9s1t4,Btinm std Pmf loom ns Cotler)TM Cnotraner's Li-
client,law doer not apply in an owner of property who Wilds or improven themon,and.
who contacts for such projects with acomrachi licensed pursuant w he Conductor's
License law.
❑ Iamtempsunder See ,B&PCforthisreon
Das
ale
WORKER'S COMPENSATION DECLARATION
I hereby afBron under penalty of perjury one of the following declad dions:
1 him and will maintain a Cerdfeate of Conant to self-insum far Worker's Compcm
sation.as provided for by Section 390O of the IaWr Code,for the petfomnrtm of the
work for which his permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
of the labor Code,for be performance of the work for which Nis p.i,is issued.
My Worker's Compensation Insured¢carrier and Policy number art:
Cartier.-Vu&
as n Policy No.:
CER IFICATEOF EXEMPTION FROM WO KERS'
COMPENSATION INSURANCE
rlhisuddern add not Mcompleted done pcnnn is fore.WMrtd dollen(SIMM
or less)
I certify Nat in the Performance of the work for which his permit is issued.I shall not
employ any person in any manner in an to become subject to the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this CeniOcatc of Exemption,you should
become subjm m be Worker's Compensation provisions of Be labor Code,you muss
.J O Nadi comply with such lum,minru or this permilaWll M deemed revoked.
Z in CONSTRUCTION LENDING AGENCY
't•+ I hereby aRred that them is a construction lending agency for the Performance of
fYi > to work for which this Permit Is timed(Sec.3091 Civ.C.)
QLcndcr's Named
z Lender's Address
fJ O 1 sonify that 1 have lead this application and mute that the about information is
U.I-^ correct.l agree to comply with all city and county ordinances and mute laws relating to
�O building c0nadi and hereby authored repreaenntives of this city to enter upon the
move mentioned properly for inspection purposes.
Ha (Wt,)agree to save,indemnily and keep hamdess the City of Cupertino again
In Iiabilides udgmcrid.costs and tallest which may in any way accrued against said City
the
C.7? in APPLICA etc U DERrsnI DS Aof tND WILL COMP WITH ALL Issued by: Date �7"G
SOURCE R G A
( Re-roofs
Signedure of Applicare on ter Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fume Wilding occupantamm or Mndk han doua material
/ fined by the Cupertino Municipal Code,Chapter 9.12.and tM Health and Safety
f c:5ation]5512(a)?
f Ely. aaNn All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingn inspection,I a o remove
Will 0m applicant or forum Wilding occupant use equipment or devices which aagree t
P g '
crit handout;air conuminants as defined by the Bay Amt Air Quality Management all new materials for inspection.
DIWICI?
❑Yes No
I have mall the hvardWS materials n:quimmcn s under Chapter 6.95 of the Giifor
nit Hthh yC tioen25W5,255JJantl255J4.lundersundthmifthc Wilding
edition utmm dant,that it u my mento 'lily 0 notify the decvpant of the
myvim lin uxMmet ialsom ICenlOtteofOccupency. Signature of Applicant Date
i Wil/
Owner of authrrirttl agentpartAll roof coverings to be Class"B"or better
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